Nursing

Assignment: Covalent Bonding
Assignment: Covalent Bonding
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MATCHING SECTION #1
MATCHING SECTION INSTRUCTIONS: Read all instructions carefully. Please answer all questions. Each question is worth 1 point. This Matching section is worth 10 points.
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**Do not enter your answers here.** Type in the letter you select from the right column as the best answer on the Answer Sheet provided by your instructor.
Term or Concept
1. Water molecule
2. Carbon
3. Homeostasis
4. Ionic Bonding
5. Covalent Bonding
6. Carbohydrate
7. Enzyme
8. Acid
9. Base
10. Lipid
Definition/Association
A. energy source
B. two atoms sharing electrons
C. electron donated/received
D. hydrophobic
E. element found in all living organisms
F. catalyst
G. OH-> H+
H. polar
I. characteristic of all living organisms
J. H+ > OH-
MATCHING SECTION #2
MATCHING SECTION INSTRUCTIONS: Read all instructions carefully. Please answer all questions. Each question is worth 1 point. This Matching section is worth 10 points.
Term or Concept
1. Ribosome
2. Mitochondria
3. Nucleus
4. Golgi apparatus
5. Smooth Endoplasmic Reticulum
6. Membrane
7. Cell Wall
8. Lysosome
9. Chloroplast
10. Cilia
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Definition or Association
A. packaging and transport
B. digestion
C. genetic material storage
D. protein assembly
E. structural support
F. lipid production
G. glucose breakdown
H. movement
I. oxygen production
J. contain transport proteins and receptors
SHORT ANSWER SECTION
ANSWER TWO QUESTIONS (OUT OF 4) FROM THIS SECTION. Each question is worth 10 points. Total points for this section is 20 points.
Each answer should be roughly half a page long. Answers will be graded for accuracy and completeness, as well as spelling and grammar.
**Do not enter your answers here** Type your answers into the Answer Sheet provided by your instructor.
1. At the beginning of the spring, Dr. Allan notices that there is an equal distribution of yellow and blue butterflies in the vacant lot across the street from his house as well as in his own backyard. Several of the shrubs and flowers in the area are also yellow. By the end of the summer he notes that there are mostly yellow butterflies around with very few blue ones. These observations are examples of what biological principle? Develop a hypothesis to explain Dr. Allan’s observations.
2. You are analyzing the ingredients in a new hot dog that is going to be put on the market soon. A) Explain the biological function of these natural chemicals that you might find in a hot dog: protein, fat, carbohydrate, vitamins.
B) Would it be healthier to eat a hot dog that contains mainly saturated fat, or one that contains mainly unsaturated fat? Explain your answer
3. Explain the difference between, and give an example of: mutualism, parasitism and competition
4. Explain the differences and similarities between a prokaryotic and eukaryotic cell.
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ESSAY SECTION
Complete 2 out of 5 questions in this Essay Section
INSTRUCTIONS: Each question is worth 20 points. Total points for this section is 40 points.
**Do not enter your answers here.** Type your answers into the Answer Sheet provided by your instructor.
1. Give a specific example of how humans are damaging the environment. Explain how this environmental damage could be reduced or eliminated.
2. Humans share 98% of their genes with chimpanzees, 90% with mice, 50% with fruit flies, and 37% with celery. Please explain the evolutionary significance of these data. Why do you think that many studies of the possible toxicity of new drugs are done on mice?
3. The habitat of one species of tropical fish is red coral reefs. The large majority of the fish in this population are red. A few individual fish carry a mutation that prevents the production of the red pigment; as a result these individual fish are white. The temperature of the ocean where these fish live gets warmer and warmer over a 10 year period, and as a result the coral is bleached and turns white. Use what you have learned about natural selection to explain how this bleaching event may have affected the evolution this fish population (not including possible direct effects of warmer temperatures on the fish). Include the following terms in your explanation: differential reproduction, beneficial trait, allele frequency, selection pressure, evolution.
4. Use what you have learned about energy transfer in food chains and the second law of thermodynamics to explain why it is an environmentally good choice to eat a plant based diet. Include the following terms in your answer: producer, herbivore, omnivore, trophic level, resources and energy.
5. If researchers establish that Myrothecium verrucaria is an effective biological control agent against kudzu, they must then demonstrate that the pathogen will not harm desirable species such as soybeans (a close relative to kudzu). Describe an experiment that could fulfill this purpose, including all steps of the scientific method. Identify control(s), dependent and independent variables

Assignment: Biological Macromolecules
Assignment: Biological Macromolecules
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This experiment requires your lab kit.
You will explore the basic properties of the chemistry that underlies biology. You will determine the presence of biological macromolecules such as proteins and carbohydrates using reagents that change color in their presence.
Additional Materials needed for the labs (not included in lab kit)
Experiment 1: egg white, potato, onion, hot water, fork, knife, hot water bath, tap water
Photos of the results of all the tests in this experiment are required. Please include within the pictures an index card with your name and date.
We discussed last week that the properties of living organisms are determined by the properties of their building blocks. These building blocks interact through chemical bonding, and then form even larger entities. The elements most frequently found in biological molecules include carbon, hydrogen, oxygen, nitrogen, phosphorus, sulfur, and a few others in smaller amounts. The chemistry of the element carbon is particularly important for the formation of “organic molecules” that form the basic structure of biological molecules.
Biological molecules can be very large in comparison to atoms or subatomic molecules and are referred to as biological macromolecules (macro means “big”). Learning about macromolecules is important to understanding living organisms. All living organisms are characterized by the presence of four major classes of macromolecules: proteins, carbohydrates, lipids, and nucleic acids. These macromolecules are often called the molecules of life.
Biological macromolecules such as proteins are able to carry out specific functions in living organisms. For example, certain proteins such as enzymes act as catalysts—substances that increase the rate of a chemical reaction between other molecules but do not change chemically themselves. These enzymes activate reactions occurring within living organisms.
However, enzymes and other biological molecules made of matter do not possess the properties of life. Only after we combine these molecular building blocks to form a cell can we finally see the emergent property of life. At this point we have the smallest units of structure and function in biology: cells are then living entities.
Types of cells differ considerably in their structure, size, shape, and function. Scientists usually categorize cells based on their structural features. You will learn these classifications and understand how those different features affect the cell’s purpose and abilities. Some living organisms, including humans, are composed of many different cell types among trillions of cells. Other living organisms, such as bacteria, are composed of just one single cell.
In this section, we will discuss cell theory and the various organelles of a cell. We will then learn about a cell structure called the plasma membrane and see how materials move in and out of this membrane.
You will participate in a class discussion related to topics in biology.
You will also complete a laboratory experiment related to biological macromolecules.
And you will demonstrate your knowledge of course concepts with a quiz.
Week 2 Outcomes
By the end of this week, you should be able to
describe the structure and function of biological molecules;
explain cell theory, the role of cells, and methods of studying cell structure;
compare and contrast eukaryotic and prokaryotic cells;
compare and contrast animal and plant cells;
describe the structure and functions of the major cell organelles, as well as the cytoskeleton and extracellular matrix;
explain the fluid mosaic model of membranes and the processes of cellular transport in eukaryotic cells;
determine the presence of proteins, glucose, starch (carbohydrate) using indicator solutions;
manipulate test tubes and measure liquids;
measure pH (acidity) using pH strips; and
apply concepts and/or argue a position related to a scientific topic.

Assignment: Inhibition Of Pain To Patient
Assignment: Inhibition Of Pain To Patient
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QUESTION 25
A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient?
A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.”
QUESTION 26
A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient?
Venlafaxine (Effexor)
Duloxetine (Cymbalta)
Clozapine (Clozaril)
Phenytoin (Dilantin)
QUESTION 27
The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work?
A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain.
QUESTION 28
Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above
QUESTION 29
The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?
A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin
QUESTION 30
The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select?
A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera)
QUESTION 31
A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe?
A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C
QUESTION 32
The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient?
A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above
QUESTION 33
The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP?
A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.”
QUESTION 34
A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe?
A. Antipsychotics B. Lithium C. SSRI D. Naltrexone
QUESTION 35
Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options?
A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.”

Discuss: Objective Personality Assesment
Discuss: Objective Personality Assesment
Prior to beginning work on this assignment, review Chapters 8 and 9 in your textbook.
In this assignment, you will compare projective and objective methods of personality assessment. Research a minimum of three peer-reviewed articles in the Ashford University Library that were published within the last 15 years on these techniques. In your paper, you will provide an evaluation of these techniques organized according to the outline provided below. Use information from your researched peer-reviewed articles and required sources to support your work in each section.
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Discuss: Objective Personality Assesment
Define the term objective in objective methods of personality assessment.
Summarize the features of objective methods of personality assessment, and provide at least three examples of these types of measures.
Explain the assumptions on which objective methods are based, and provide an analysis of empirical research testing the validity of the assumptions you identified.
Appraise the research exploring the technical adequacy (i.e., reliability and validity) of objective tests.
Describe the impact of social and culture variability on the administration and interpretation of objective tests.
Section 2: Projective Personality Assesment
Define the term projective in projective methods of personality assessment.
Summarize the features of projective methods of personality assessment, and provide at least three examples of these types of measures.
Explain the assumptions on which projective methods are based, and provide an analysis of empirical research testing the validity of the assumptions you identified.
Appraise the research exploring the technical adequacy (i.e., reliability and validity) of projective tests.
Describe the impact of social and culture variability on the administration and interpretation of projective tests.
Section 3: Synthesis, Conclusions, and Recommendations
Write a brief one-paragraph scenario for a fictitious client. Include the following information: presenting concerns (reason for referral), age, gender, ethnicity, language(s), and any other significant information (e.g., military status, health issues, marital status, sexual orientation, etc.).
Debate the arguments supporting and opposing the use of projective and objective personality assessments with your identified client.
Select a minimum of one objective and one projective measure to use with your client. Compare the use of the selected projective and objective personality measures with your identified client.

Assignment: History Of Fracture,
Assignment: History Of Fracture,
1.Question
What demographic variables were measured at the nominal level of measurement in the Oh et al.(2014)study?
Answer:The demographic variabless measured at the nominal level include non-smoker,non-drinker,history of fracture,regular exercise and are considered nominal because can be describe by precentages, and mode.
2.Question
What statistic were calculated to describe body mass index(MBI) in this study?Were these appropiate?
Answer:Mean and standard deviation were the statistic used to calculated BMI.Because BMI is an interval-ratio variable,mean and stadard deviation are appropiate.
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3.Question
Were the distributions of scores for BMI similar for the intervention and control groups?
Answer:The distribution of scores for BMI was similar for intervention and control groups because the mean and standard deviation were very similar.
4.Question
Was there a significant difference in BMI between the intervention and control groups?
Answer:There was not a significant difference in BMI between the intervention group and the control group.
5.Question
Bssed on the sample size of N=41,what frequency and percentage of the sample smoked?What frequency and percentage of the sample were non-drinkers(alcohol)?Show your calculations and round to the nearest whole percent.
Answer:
Frequency of participants who smoked=0+0=0
Percentage of participants who smoked=0%
Frequency of participants who were non-drinkers=20+20=40
6.Question
What measurement method was used to measure the bone mineral density(BMD) for the study participants?Discuss the quality of this measurement method and document your response.
Answer:The bone mineral density (BMD) was measurement by ratio/interval level.The mean and standard deviation equal central location and dispersion gives us the shape of the graph.
7.Question
What statics was calculated to determine differences between the intervention and control groups for the lumbar and femur neck BMDs?Were the groups significantly different for BMDs?
Answer:The statistic used to to determined the difference between the intervention and control groups for the lumbar and femur neck BMDs was the mean.The value between lumbar and femur neck does not show us a significant difference.
8.Question
The researchers stated that there were no significant differences in the baseline characteristics of the intervention and control groups(see Table 2).Are these groups heterogeneous or homogeneous at the beginning of the study?Why is this important in testing the effectiveness of the therapeutic lifestyle modification(TLM)program?
Answer: These groups are homogeneous,homogeneous scores are similar,and heterogeneous scores are diferent having a wide variation.This was a key factor because if the groups were heterogeneous the the data results would have been broader and more detailed.I feel as if if we compared the groups with similarities in the beggining, then this allows the results to be more profound when all is concluded.
9.Question
Oh ET AL.(2014,P.296)stared that adherence rate to the TLM program was 99.6%.Discuss the importance of intervention adherence,and document your response.
Answer:The adherence rate was almost at 100% during the 2 week time period.If the adherence rate would have ben less then the significance and importance of the results would have declined significantlly.I would not put in question the data results as they 99.6% for adherence and the group showed increase.I believe the TLM program is effective.
10.Question
Was the sample for this study adequately described?
Answer:Yes, the sample was adequate, the group showed that the program worked, the program consisted of a mix of individuals and even though it functioned well, I believe if the study was done with more individuals and done at longer intervals, then it would indicate and show more accurate results.

Assignment: Genetics To Treat Disease
Assignment: Genetics To Treat Disease
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* This case study presents a fictitious scenario, but one that is based upon clinical observations.
† Background information on Acute Lymphocytic (Lymphoblastic) Leukemia modified from Satake, N., Acute Lymphoblastic Leukemia, http://www.emedicine.com/ped/topic2587.htm. Last accessed: 07/08/09.
“Pharmacogenetics” by Jeanne Ting Chowning Page 1
by
Jeanne Ting Chowning Department of Education, Northwest Association for Biomedical Research
Part I – Acute Lymphocytic (Lymphoblastic) Leukemia It’s called the children’s ward. For two teenagers who have been recently diagnosed with leukemia, it seems insulting to have their lives hijacked by doctors and nurses with stuffed animals clipped to their stethoscopes.
Laura is a forward on her school soccer team and leads the league in scoring. For the last four months, she has been really tired, but nothing seemed really wrong until her legs became covered with bruises. Just pressing her fingers on her skin was practically enough to make a bruise. It didn’t seem real when her doctor, Jane Ryder, diagnosed her with Acute Lymphocytic (or Lymphoblastic) Leukemia (ALL), or when she told her that ALL is the most common malignant (spreading) cancer found in children. She’s 14 years old; she’s not a child!
Beth is 13 and looks remarkably like Laura. Both have straight dark hair, large brown eyes, and tall slender builds. Beth has never been that athletic; she prefers reading and theater. She’s hoping to be part of the drama team next year when she goes to high school, even though she’ll only be a freshman. But she’s been missing a lot of school because of one virus after another, lots of fevers and night sweats, then that rash in the fall. Now she’s in a hospital, and it seems like the only people she sees are her parents, Dr. Ryder, and the nurses.
Laura and Beth both have ALL, which arises from the uncontrolled growth of immature lymphocytes (a type of white blood cell, or leukocyte). These cells, which are “stuck” in an early stage of development, become so numerous that they crowd out normal blood cells. Each year about 30 cases occur per million people, and most of those cases are in children aged 2–5 years. The cause of ALL remains largely unknown, although a small number of cases are associated with inherited genetic syndromes.† Both girls are suffering from anemia (low blood cell levels), fevers, bleeding, and are pale and thin. Dr. Ryder has decided to treat them as in- patients, keeping them in the hospital while treating them with a “thiopurine” drug called 6-mercaptopurine (6-MP) known to be highly effective in treating leukemia. Thiopurines are very similar to the regular purine nitrogen bases such as adenine and guanine that make up DNA and RNA. The only difference is that thiopurines have an extra sulfur group attached to them. They are similar enough to a regular purine base that our cells convert them to nucleotides (with the addition of a deoxyribose sugar and phosphate). These modified thioguanine nucleotides (TGN) are then incorporated into DNA.
The TGN nucleotides interfere with DNA replication and stop rapidly growing cells like cancer cells from further growth. Unfortunately, they also block the growth of other fast growing cells needed for good health, like the cells in the bone marrow that develop into erythrocytes (red blood cells) and leukocytes. As with
Pharmacogenetics: Using Genetics to Treat Disease*
“Pharmacogenetics” by Jeanne Ting Chowning Page 2
many drugs given as chemotherapy, it is important to give a high enough dosage to prevent cancer cells from replicating, while avoiding damage to the normal tissues. Too high a drug dose can be very toxic. Dr. Ryder knows that drugs are processed in various ways in the body. They must be absorbed by the blood, distributed throughout the body’s tissues, converted or transformed into forms that are easier to eliminate, and then removed from the body. Dr. Ryder gives both girls the same dosage of the drug before leaving the hospital for the night.
While making her rounds over the next few days, Dr. Ryder sees Laura’s vital signs plummet. Her anemia has worsened; her erythrocyte count is so low that her heart function could be compromised. Her fevers are spiking, and her breathing is becoming shallow and labored. She is not eating and is being hydrated intravenously. Her condition is life-threatening. In contrast, Beth’s anemia has decreased, she is free of fever, and is actually showing signs of an appetite and boredom, good indicators of improved health. Dr. Ryder had not anticipated that the drug could act so differently in two individuals. Even as she looks at Beth’s chart, she can picture Laura’s body struggling to hold its own just two private rooms away. Dr. Ryder knows she must find out why her patients are responding so differently. But where should she start, and will she find an answer in time to help Laura?
Questions 1a. Suggest a reason why the drug might affect the two girls differently.
1b. What tests might Dr. Ryder order to determine why the two girls are reacting as they are to the drug? Provide two or three appropriate examples of tests.
“Pharmacogenetics” by Jeanne Ting Chowning Page 3
Part II – Enzyme Activity Dr. Ryder learns that the difference in patient reaction to the drug probably has something to do with how the drug is naturally metabolized in the body to be removed as waste. After searching the scientific literature, she learns that the drug 6-MP can either be converted to the active form, TGN nucleotides, or can be inactivated with the help of the TPMT enzyme (thiopurine methyltransferase). Within each patient who takes the drug, both processes are occurring and they compete with each other.
Figure 1. Flow Chart Flow chart showing activiation and inactivation paths of the drug 6-MP.
“Pharmacogenetics” by Jeanne Ting Chowning Page 4
Since the therapy aims to harm rapidly replicating cells without overly impacting normal ones, it is important that excess drug is inactivated. Dr. Ryder decides to see how levels of the TPMT enzyme activity might vary between people.
She reviews the research papers that have been published about the TPMT enzyme and finds an interesting graph. From a study of 298 randomly selected Caucasian individuals, researchers found the following levels of TPMT enzyme activity:
Figure 2. Simplified Results. Simplified bar graph showing results from a study of 298 randomly selected Caucasian patients.
Questions 2a. If Dr. Ryder had 10 Caucasian patients in the next month, how many would you predict to have each
of the TPMT enzyme activity levels, based on the graph above?
Low:
Medium:
High:
Would you expect the actual/observed number of patients to be different? Why might there be differences?
2b. Each individual inherits two copies of the gene for the enzyme, one from each parent. Dr. Ryder suspects that variation in enzyme activity level is controlled by two different versions (alleles) of that gene. Does this graph (and the number of phenotypes) suggest that enzyme activity levels are based on a dominant/recessive or a codominant pattern of inheritance? Explain your answer.
Source: Simplified graph patterned after the top panel of Figure 2 in: Weinshilboum, R.M., and S. Sladek (1980) Mercaptopurine pharmacogenetics: Monogenic inheritance of erythrocyte thiopurine methyltransferase activity. American Journal of Human Genetics 32:651–662.
“Pharmacogenetics” by Jeanne Ting Chowning Page 5
2c. Which bar (low, medium, or high) represents individuals who might be homozygous for a “low enzyme activity’” version of the gene? Which bar represents individuals who might be homozygous for a “high enzyme activity” version of the gene? Which bar represents heterozygotes?
2d. Answer the question: “How does enzyme activity level vary among the patients examined?” In your answer, be sure to include supporting data from the graph above. Explain how these data support your conclusion.
2e. Challenge question: The actual graph (below) showed much more detail. Why do you think that there is more variation between patients than shown in the simplified graph?
Figure 3. Histogram RBC TPMT frequency distribution histogram for 298 randomly selected Caucasian subjects.
Source: Histogram drawn after top panel of Figure 2 in: Weinshilboum, R.M., and S. Sladek (1980) Mercaptopurine pharmacogenetics: Monogenic inheritance of erythrocyte thiopurine methyltransferase activity. American Journal of Human Genetics 32:651–662.
“Pharmacogenetics” by Jeanne Ting Chowning Page 6
Part III – TPMT Enzyme Activity Levels Dr. Ryder tested Laura, who was very sick, and found that her TPMT enzyme activity level was extremely low.
Question 3a. Why would individuals with the lowest level of enzyme get the sickest when they take the drug?
Suggest one possible reason.
Investigating further, Dr. Ryder decides to look at drug levels in many patients who are all receiving the same standard doses of the thiopurine drug and compare them to enzyme levels. When she compares the level of thioguanine nucleotides (TGN) created by the thiopurine drug to the body’s level of TPMT enzyme in patients, this is what she finds:
Figure 4. Scatter Plot of TGN vs. Enzyme Activity Thioguanine nucleotide concentrations and TPMT enzyme activity levels in 95 Children with Acute Lymphoblastic Leukemia (ALL) who were being treated with standard doses of thiopurine drugs.
Source: Modified from Lennard L., J.S. Lilleyman, J. Van Loon, and R.M. Weinshilboum (1990) Genetic variation in response to 6-mercaptopurine for childhood acute lymphoblastic leukaemia. Lancet 336:225–229.
Question 3b. Describe the relationship between TPMT enzyme activity levels and TGN levels. Be sure to include
supporting data from the graph.
“Pharmacogenetics” by Jeanne Ting Chowning Page 7
Part IV – Putting It All Together From her research, Dr. Ryder hypothesized that patients such as Laura (who became very sick upon receiving the drug) have very high / low TPMT enzyme activity and therefore very high / low levels of TGN nucleotides at normal doses. They easily became sick from the effects of the drug, and could even die. These patients are homozygous / heterozygous for the version of the gene encoding high / low enzyme activity. A better drug dose for these patients is 1/10th the level of other patients.
Patients such as Beth with high / low TPMT enzyme activity had high / low levels of TGN nucleotides. These patients would do well with the drug, and in some cases might even need a larger-than-normal dosage for the treatment to be most effective. These patients were either homozygous for the version of the gene encoding high / low enzyme activity, or were heterozygous.
Based on the graph in Part II, about 10% of the Caucasian population is homozygous / heterozygous.
Question 4. In the paragraphs above, circle the correct answer (high or low, heterozygous or homozygous).
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Part V – SNPs and TPMT DNA techniques reveal TPMT gene is located on chromosome 6, is about 34 kilobases in length (34,000 DNA bases), and has 8 exons. An exon is a region of a gene that is present in the final functional transcript (mRNA) from that gene. The diagram below shows a representation of the TPMT gene, showing the exons as boxes. The first “wild type” is the most common version. In our case, the second version of the TPMT gene is associated with low enzyme activity (TPMT*3A) and has two single nucleotide polymorphisms (SNPs), or changes in single DNA nucleotide bases (from “G” to “A” in one case and from “A” to “G” in another) that result in different amino acids being inserted in the enzyme. This, in turn, affects the enzyme’s function. Over 20 different gene variants have been found, three of which are shown below.
Figure 5. Selected Human TPMT Alleles. The wild-type human TPMT allele (TPMT*1) and variant alleles TPMT*3A, TPMT*3B, and TPMT*3C. Rectangles represent exons, with black coding areas and white untranslated regions.
Source: Weinshilboum, R. (2001) Thiopurine pharmacogenetics: Clinical and molecular studies of Thiopurine Methyltransferase, American Society for Pharmacology and Experimental Therapeutics 29:601–605. Available online at http://dmd.aspetjournals.org/. This case is based on this article.
Questions 5a. Dr. Ryder now has the ability to conduct a SNP genetic test on her patients to determine what level
of drug they should get. A new patient on the ward, Kevin, is homozygous for TPMT 3A*. The graph shown in Part III is reproduced on the next page. Circle the area of the graph that might likely corresponds to Kevin’s TGN and enzyme activity levels. Explain why you circled that region.
“Pharmacogenetics” by Jeanne Ting Chowning Page 9
Case copyright held by the National Center for Case Study Teaching in Science, University at Buffalo, State University of New York. Originally published February 4, 2010. Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work. Title block illustration, licensed, ©Scott Maxwell | Dreamstime.com.
5b. What level of the drug (low, medium, or high) should Dr. Ryder give him? Explain your answer.
5c. In your own words, summarize how knowing someone’s TPMT DNA sequence could be used to determine what kind of medical care they should receive.
Postscript Dr. Ryder responded quickly to Laura’s drug reaction. She discontinued the drug while alternate treatment regimens were explored, and Laura’s condition began to improve.

Discuss: Safety Belonging Esteem Self-Actualization
Discuss: Safety Belonging Esteem Self-Actualization
FIGURE 8.2 Maslow’s Hierarchy of Needs. Physiological needs are most readily satisfied, and self-actualization needs are least easily satisfied. A person works to satisfy these needs in a hier- archical fashion, with the most time spent on the most potent need, which is lowest on the hierar- chy, then working up the hierarchy to the next potent need.
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satisfied less and less. Physiological needs are based on homeostasis and include food, water, and a generally balanced internal state. Maslow also includes sexual, sleep, and activity needs in this category. Once physiological needs are addressed, then safety needs begin to emerge. Safety needs refer to the absence of fear, anxiety, and chaos and the presence of security, stability, dependency, and law and order. With the satisfaction of safety needs, next on the hierarchy are the belonging needs. In order to satisfy these needs, humans seek to establish social relationships with friends, lovers, and family members. Without these relationships the individual feels rejected and lonely. Next on the hierarchy are esteem needs, which concern the respect of self and the respect of oth- ers. These needs involve achievement, adequacy, mastery, and competence plus the pres- tige, fame, and glory derived from the recognition of others. Finally, at the top of the hierarchy is the most elusive of all needs, the need for self-actualization. This refers to the need to fulfill and utilize one’s abilities and talents to the fullest in whatever area one chooses.
The Need Satisfaction Inventory (Lester, 1990) in Table 8.2 provides a possible means for testing whether needs are indeed arranged in this hierarchy. The inventory measures the degree to which a person has satisfied each need category. The inventory has face validity, which means that its items appear to measure what they are supposed to (i.e., “on the face of it”). Thus, question 36, regarding the amount of exercise, would help determine the sat- isfaction of your physiological needs, while question 10, regarding whether life has mean- ing, is valid for determining satisfaction of your self-actualization needs. If Maslow’s (1970) theory is correct, then Lester’s inventory should show a decreasing amount of need satisfaction going up the hierarchy. In other words, a person’s physiological and safety needs should be satisfied more than her esteem and self-actualization needs.
Discuss: Safety Belonging Esteem
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Motivation: Biological, Psychological, and Environmental, Third Edition, by Lambert Deckers. Published by Allyn & Bacon. Copyright © 2010 by Pearson Education, Inc.
C H A P T E R E I G H T / Drives, Needs, and Awareness 189
TABLE 8.2 Need Satisfaction Inventory
For the 50 statements listed below, use the scale to indicate the extent you agree with each statement. Read each statement carefully and answer with your first impulse.
?3 ? Strongly disagree ?2 ? Disagree ?1 ? Slightly disagree 0 ? Neither disagree nor agree
?1 ? Slightly agree ?2 ? Agree ?3 ? Strongly agree
Physiological Needs 1. I never have trouble getting to sleep at night. 6. I have an income that is adequate to satisfy my needs.
11. I get an adequate amount of rest. 16. I have a satisfactory sex life. 21. In general, my health is good. 26. In winter, I always feel too cold. (R) 31. I eat enough to satisfy my physiological needs. 36. I get an adequate amount of exercise. 41. There’s usually some part of my body that is giving me trouble. (R) 46. The summers are too hot for me ever to feel comfortable. (R)
Safety and Security 2. I think the world is a pretty safe place these days. 7. I would not walk alone in my neighborhood at night. (R)
12. My anxiety level is high. (R) 17. I feel secure about the amount of money I have and earn. 22. I feel safe and secure. 27. I am afraid to stay in my house/apartment alone at night. (R) 32. My life is orderly and well-defined. 37. I can depend on others to help me when I am in need. 42. I am often worried about my physical health. (R) 47. My life has a nice routine to it.
Belonging 3. I know my family will support me and be on my side no matter what. 8. I am involved in a significant love relationship with another.
13. I feel rootless. (R) 18. I have a group of friends with whom I do things. 23. I feel somewhat socially isolated. (R) 28. I have a few intimate friends on whom I can rely. 33. I feel close to my relatives. 38. I am interested in my ethnic roots and feel a kinship with others in my ethnic group. 43. I am religious and consider myself to be a member of a religious group. 48. I am able to confide my innermost thoughts and feelings to at least one close and intimate
friend.
Esteem 4. I feel dissatisfied with myself much of the time. (R) 9. I feel respected by my peers.
continued
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Monhybrid and Dihybrid Crosses Discussion
Monhybrid and Dihybrid Crosses Discussion
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Mendel crossed true-breeding pea plants in order to develop and understanding of how traits are inherited. True-breeding means that if a plant was crossed with itself, it always generated offspring that looked like the parent. Although Mendel didn’t know this at the time, it meant that the parent plant was homozygous or had two copies of the same allele that controlled the appearance of the trait.
Mendel noticed that when he crossed two true-breeding plants exhibiting different versions of a trait (e.g., green and yellow); the offspring (F1) always looked like only one of the parent plants. We know now that the F1 individuals looked like the parent that carried the dominant trait. But what surprised Mendel, was that when he crossed the F1 individuals with each other, the F2 offspring exhibited BOTH traits! Based on this observation, he concluded that the F1 individuals were hybrids, meaning they carried both alleles for a given trait. Only the dominant trait was expressed in the F1 individuals and the recessive trait, although present, was masked.
A monohybrid cross is when you are interested in crossing individuals that vary in only a single trait (e.g., flower color, seed color, stem length). In a dihybrid cross, we are crossing individuals that differ at two traits (e.g., flower color and seed color, flower color and stem length). Obviously, the more traits that vary, the more complex the crosses become!
By examining the distribution of the various traits obtained following different types of crosses, Mendel was able to describe the general pattern of genetic inheritance. Be sure to review the online lecture this unit on Genetics and pp 146-153 in your book before starting these first two exercises.
We will be using the following website for the first exercise. Be sure that you can access it and use it before beginning:
Glencoe-McGraw Hill. No date. Punnett Squares
You will need to complete the Tables and answer the questions in the Unit 6 Experiment Answer Sheet for Exercises 1 and 2.
Inheritance of Human Traits – Introduction
Some human traits are controlled by a single gene that has only two alternative alleles. If a characteristic is determined by the dominant allele, one or both parents express that trait and many of the children will as well. Dominant characteristics will most likely be present in every generation, since the expression of these traits requires only one of the dominant alleles in order to be expressed. If the characteristic is determined by the recessive allele, then neither parent may express the trait nor few of the children. This is because two copies of the recessive allele must be present in order for the recessive trait to be expressed. If a trait is X-linked recessive; meaning the gene for the trait is found on the X chromosome, it will be expressed primarily in males.
The application of human genotypes in medicine and genetic counseling is becoming more and more necessary as we discover more about the human genome. Despite our increasing ability to decipher the chromosomes and their genes, an accurate family history remains one of the best sources of information concerning the individual. In this exercise you will determine your genotype for certain characteristics that are controlled by a single gene with two alleles based on your phenotype. We will not be looking at any X-linked traits in this exercise.
week_6_experiment_answer_sheet_1.doc

Physician Freed Intestinal Adhesions
Physician Freed Intestinal Adhesions
Assign CPT code(s) and appropriate modifiers to each statement.
1) After performing an emergency cesarean section, the physician noticed that the appendix was distended, resulting in medical necessity for an appendectomy performed during the same operative session.
2) The physician freed intestinal adhesions.
3) The physician resected two segments of small intestine and performed an anastomosis between the remaining intestinal ends. An open approach was used for this surgery.
4) The physician repaired a defect in the mesentery with sutures.
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5) The physician performed a laparoscopic partial colectomy with end colostomy and closure of the distal segment.
6) The physician drained a pelvic abscess through the rectum.
7) The physician removed a portion of the rectum through combined abdominal and transsacral approaches.
8) The physician performed rigid proctosigmoidoscopy and obtained brushings.
9) The physician performed a flexible sigmoidoscopy and removed a polyp. The physician inserted the sigmoidoscope through the anus and advanced the scope into the sigmoid colon. The lumen of the sigmoid colon and rectum were well visualized, and the polyp was identified and removed with hot biopsy forceps. The sigmoidoscope was withdrawn upon completion of the procedure.
10) The physician inserted a colonscope through the anus and advanced the scope past the splenic flexure. Two polps were identified and removed by hot biopsy forceps.
1) Hepatotomy for open drainage of abscess or cyst, 1 stage.
2) Surgeon removed segments II, III, and IV (the whole left lobe) of the liver from a living donor.
3) The physician performed radiofrequency ablation of a liver tumor via open laparotomy.
4) The physician removed the gallbladder and performed a common bile duct exploration through the laparoscope.
5) The physician performed a cholecystostomy with removal of calculus.
6) Subsequent to previous peritoneocentesis (performed at a different operative session), the physician withdrew fluid and performed infusion and drainage of fluid from the abdominal cavity (peritoneal lavage).
7) The physician reopened a recent laparotomy incision, before the incision had fully healed, to drain a postoperative infection.
8) The physician performed laparoscopic repair of an initial inguinal hernia.
9) The physician performed a reducible ventral hernia (initial) repair and inserted mesh implantation.
10) The physician repaired an initial reducible, inguinal hernia with hydrocelectomy in a 5 month old infant.
1) Physician made an open incision and inserted multiple drain tubes to drain an infection (abscess) from the kidney.
2) The physician pulverized a kidney stone (renal calculus) by directing shock waves through a water cushion that was placed against the left side of the patient’s body at the location of the kidney stone.
3) The physician removed a kidney stone (calculus) by making an incision in the right kidney.
4) The interventional radiologist inserted a percutaneous nephrostomy catheter into the right renal pelvis for drainage. Fluoroscopic guidance was provided.
5) The physician performed a laparoscopic ablation of a solid mass from the posterior hilum of the left kidney.
6) The physician made an incision in the left ureter through the abdominal wall for examination of the ureter and insertion of a catheter for drainage.
7) The physician examined the patient’s right and left renal and ureteral structures with an endoscope, which passed through an established opening between the skin and the ureter (ureterostomy). He also inserted a catheter into the ureter.
8) The physician revised a surgical opening between the skin and the right ureter.
9) The physician injected contrast agent through an opening between the skin and the left ureter (ureterostomy) for ureterography (study of renal collecting system).
10) The physician made an incision in the left ureter (ureterotomy) to insert a catheter (stent) into the ureter.
11) The physician performed a transurethral resection of a postoperative bladder neck contracture using a resectoscope.
12) The physician inserted a special instrument through the cystourethroscope to fragment a calculus in the ureter using electrohydraulics.
13) The physician inserted a cystourethroscope through the urethra to drain an abscess on the prostate.
14) The physician made an incision through the abdominal wall into the urinary bladder and inserted a suprapubic catheter to withdraw urine.
15) The physician performed a cystourethroscopy with fulguration of the bladder neck and then removed a calculus from the ureter.
16) The physician performed a sling procedure using synthetic material to treat a male patient’s urinary incontinence.
17) The physician made an initial attempt to treat a male patient’s urethral stricture using a dilator.
18) The physician, in the first two stages to reconstruct the urethra identified the area of stricture by urethrography and marked it with ink.
19) The physician performed a transurethral destruction of the prostate using microwave therapy.
The physician excised a specimen of tis

How human species are special
How human species are special
Language Structure
What makes the human species special? There are two basic hypotheses about
why people are intellectually different from other species. In the past few chapters,
I indulged my favorite theory, which is that we have unmatched abilities to solve
problems and reason about our world, owing in large part to the enormous development
of our prefrontal cortices. However, there is another theory at least as popular in cognitive
science, which is that humans are special because they alone possess a language.
This chapter and the next will analyze in more detail what language is, how people
process language, and what makes human language so special. This chapter will focus
primarily on the nature of language in general, whereas the next chapter will contain
more detailed analyses of how language is processed. We will consider some of the
basic linguistic ideas about the structure of language and evidence for the psychological
reality of these ideas, as well as research and speculation about the relation between
language and thought. We will also look at the research on language acquisition. Much
of the evidence both for and against claims about the uniqueness of human language
comes from research on the way in which children learn the structure of language.
In this chapter, we will answer the questions: • What does the field of linguistics tell us about how language is processed? • What distinguishes human language from the communication systems of other
species? • How does language influence the nature of human thought? • How are children able to acquire a language?
•Language and the Brain
The human brain has features strongly associated with language. For almost all
of the 92% of people who are right-handed, language is strongly lateralized in
the left hemisphere. About half of the 8% of people who are left-handed still
have language left lateralized. So 96% of the population has language largely
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in the left hemisphere. Findings from studies with split-brain patients (see
Chapter 1) have indicated that the right hemisphere has only the most rudimentary
language abilities. It was once thought that the left hemisphere was
larger, particularly in areas taking part in language processing, and that this
greater size accounted for the greater linguistic abilities associated with the left
hemisphere. However, neuroimaging techniques have suggested that the differences
in size are negligible, and researchers are now looking to see whether
there are differences in neural connectivity or organization (Gazzaniga, Ivry, &
Mangun, 2002) in the left hemisphere. It remains largely a mystery what differences
between the left and the right hemispheres could account for why language
is so strongly left lateralized.
Certain regions of the left hemisphere are specialized for language, and
these are illustrated in Figure 12.1. These areas were initially identified in studies
of patients who suffered aphasias (losses of language function) as a consequence
of stroke. The first such area was discovered by Paul Broca, the French surgeon
who, in 1861, examined the brain of such a patient after the patient’s death (the
brain is still preserved in a Paris museum). This patient was basically incapable
of spoken speech, although he understood much of what was spoken to him.
He had a large region of damage in a prefrontal area that came to be known
as Broca’s area. As can be seen in Figure 12.1, it is next to the motor region that
controls the mouth. Shortly thereafter, Carl Wernicke, a German physician,
identified patients with severe deficits in understanding speech who had damage
in a region in the superior temporal cortex posterior to the primary auditory
cortex. This area came to be known as Wernicke’s area. Parietal regions
close to Wernicke’s area (the supramarginal gyrus and angular gyrus) also have
also been found to be important to language.
Two of the classic aphasias, now known as Broca’s aphasia and Wernicke’s
aphasia, are associated with damage to these two regions. Chapter 1 gave
Brain Structures
Broca’s area
Wernicke’s area
Supramarginal gyrus
Angular gyrus
Motor face area
Primary auditory area
FIGURE 12.1 A lateral view of
the left hemisphere. Some of
the brain areas implicated in
language are in boldface type.
(From Dronkers, Redfern, & Knight, 2000.)
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examples of the kinds of speech problems suffered by patients with these two
aphasias. The severity of the damage determines whether patients with Broca’s
aphasia will be unable to generate almost any speech (like Broca’s original
patient) or be capable of generating meaningful but ungrammatical speech.
Patients with Wernicke’s aphasia, in addition to having problems with comprehension,