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It won’t help this divorce purchase 10 mg prednisone visa allergy forecast fort wayne, but my counselor said exer- cise will lift my spirits buy cheap prednisone 5mg on-line allergy forecast kxan, and I’ll be healthier discount prednisone 5 mg on-line allergy medicine making me dizzy. I’m not the most attractive I can’t do a lot about my appearance other woman in the world generic prednisone 10mg on-line allergy medicine used for anxiety. I ignored our lack of When I find another relationship, I need to communication in the marriage. After completing your Rating Responsibility Exercise in Worksheet 5-18, the next step is to create an action strategy to determine how you can begin solving your problem. By identify- ing productive actions to address the problem, you’re able to move forward and stop berating yourself. Name the problem you’re blaming yourself for and write it at the top of the worksheet. In the left-hand column, list the specific contributions you’ve identified that you have some control over. In other words, record anything you did that may have led to the problem or made it worse. In the right-hand column, list any steps you can take now or in the future that may be useful in solving this problem. Worksheet 5-21 My Reflections Chapter 6 Indicting and Rehabilitating Thoughts In This Chapter Investigating and charging thoughts Putting thoughts on trial Repairing thoughts ost people simply assume that thoughts they have about themselves and the world Mare true. But thoughts don’t always reflect reality, just as funhouse mirrors don’t reflect the way you really look. In Chapter 5, we help you uncover the distortions (also known as reality scramblers) in your thoughts. We show you how to take your distorted thoughts to court and charge them with the crime of inflicting misery on yourself. If you find them guilty (and we think you will), you see how to rehabilitate those criminal thoughts so that they can contribute to your well-being. From Arraignment to Conviction: Thought Court We base our technique called Thought Court on the principles of cognitive therapy. Beck, who discovered that changing the way people think changes the way they feel. Many studies attest to the fact that cognitive therapy works very well to alleviate anxiety and depression. We give you examples of Thought Trackers in this section, but for more information, flip to Chapter 4. Thought Court is a process of indicting the accused thought (the one you pinpoint in your Thought Tracker) and then bringing it to trial. As the defense attorney, you present the evidence that supports the validity or accuracy of the thought. In other words, the defense claims that your thought is true and isn’t culpable for your anguish. On the other side, you, as the prosecutor, lay out a case demonstrating that the thought is actually guilty of distortion and therefore has caused you unnecessary emotional distress. If you find the thought guilty, we give you ways to replace or rehabilitate your thought. Most people learn better through stories and examples than through laborious explana- tions. With that in mind, we help you master the process of Thought Court by presenting a case example in the next section. Then we give you the chance to put your thoughts on trial, and in case you need more help, we follow up your practice with more case examples. Examining a sample case in Thought Court Jeremy is a good looking 23-year-old personal trainer who takes pride in his healthy lifestyle. He’s known at the gym for the colorful, long-sleeved T-shirts that he always wears. Jeremy gets more than his share of attention from women, but he never gets involved because he has a secret: He was seriously burned as a child, and his chest and arms are deeply scarred. Jeremy has never had a serious rela- tionship; he believes any woman seeing his body would recoil in disgust. Rather than face rejection and ridicule, he locks himself away in solitary confinement. His com- bination of fear and yearning motivates him to see a therapist, and he manages to tell his therapist about his lifelong secret. Jeremy’s therapist suggests that he start examining his thoughts with a Thought Tracker (see Worksheet 6-1) and then take his thoughts to Thought Court. Worksheet 6-1 Jeremy’s Thought Tracker Feelings & Sensations Corresponding Events Thoughts/Interpretations (Rated 1–100) Anxiety (85), fear Chelsea asks me out for I can’t possibly go out with her. Anxiety (75), The guys asked me to go The shame would overwhelm shame (85), bitter into the hot tub with them me. Chapter 6: Indicting and Rehabilitating Thoughts 79 Jeremy’s most malicious thoughts: 1. Next, his therapist suggests that Jeremy put the first of these thoughts on trial using a worksheet (later on, they address his other malicious thought). As you can see in Worksheet 6-2, Jeremy writes down the malicious thought first and then in one column defends the thought by listing all the reasons, logic, and evidence he can muster to support the case that the thought is true. In the other column, Jeremy attempts to prosecute the thought by demonstrating that it’s false. Worksheet 6-2 Jeremy’s Thought on Trial Worksheet Accused thought: I couldn’t stand to see the look of repulsion on her face. I’ve seen the look of shock on people’s My family seems to have gotten faces before. After one surgery, a physical therapist made a comment that my burns were permanently deforming and I’d just have to learn to live with them. So far, this case is going very well for the defense and very poorly for the prosecution. Thus, Jeremy remains quite convinced that his thought is a true reflection of reality; it’s just the way things are. The therapist tells him he’s made a good start but asks him to consider the Prosecutor’s Investigative Questions in Worksheet 6-3 and write down his reflections on those questions (see Worksheet 6-4). Do I know of friends or acquaintances who have experienced similar events but for whom this thought wouldn’t apply? Worksheet 6-4 Jeremy’s Reflections These questions are a little difficult to contemplate. Well, I guess I would really dislike seeing repulsion on her face, but I could probably “stand it. And I suppose I’ve seen attractive women who are with guys who have substantial disabilities like morbid obesity, missing limbs, and so on. I was in that burn support group, and I admit there were some people who had nice relationships after they’d been burned. And I guess the thought is doing me more harm than good because it keeps me from ever considering a relationship. After Jeremy reflects on the list of Prosecutor Investigative Questions, his therapist advises him to take another look at his Thoughts on Trial Worksheet and try to add more evidence and logic to his case (see Worksheet 6-5). Worksheet 6-5 Jeremy’s Revised Thought on Trial Worksheet Accused thought: I couldn’t stand to see the look of repulsion on her face. Actually, there are a few people I know who haven’t been shocked or repulsed by my scars. I’ve seen the look of shock on people’s My family seems to have gotten faces before. If they can, it’s certainly possible that others could do the same — especially if they cared about me. I can remember my mother crying when Just because my mother cried she saw how badly I was burned. Chapter 6: Indicting and Rehabilitating Thoughts 81 Defending the Thought Prosecuting the Thought After one surgery, a physical therapist The physical therapist was right in made a comment that my burns were that I do have to live with this. But permanently deforming and I’d just have that doesn’t mean I can’t have a to learn to live with them. Sometimes when I go for a checkup, I My burns are noticeable; it doesn’t hear people talking about me. If someone really likes and cares about me, she ought to be able to look past my scars. At this point, Jeremy carefully reviews the case presented in his Revised Thought on Trial Worksheet. He and his therapist agree to work on a replacement thought for his most malicious thought (see the sec- tion “After the Verdict: Replacing and Rehabilitating Your Thoughts” later in this chapter). After he creates the first replacement though, he continues putting his other malicious thoughts on trial and replacing them, one at a time. Putting your thoughts on trial You guessed it; it’s your turn to visit Thought Court. Don’t be concerned if you struggle in your initial attempts; this important exercise takes practice. Pay attention to your body’s signals and write them down whenever you feel some- thing unpleasant. Refer to the Daily Unpleasant Emotions Checklist in Chapter 4 for help finding the right feeling words. Rate your feeling on a scale of intensity from 1 (almost undetectable) to 100 (maximal). Ask yourself what was going on when you started noticing your emotions and your body’s signals. The corresponding event can be something happening in your world, but an event can also be in the form of a thought or image that runs through your mind.

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Implementation of an automated patient-specific medication storage and management solution cheap 10mg prednisone with amex allergy uk. Computerized clinical decision support for prescribing: provision does not guarantee uptake generic prednisone 10mg fast delivery allergy shots numbness arm. Informatics tools for the development of action-oriented triggers for outpatient adverse drug events discount prednisone 10 mg overnight delivery allergy forecast flagstaff az. Implementation of a comprehensive quality assurance program in a major cancer center prednisone 40 mg visa allergy treatment using hookworms. Implementation of a comprehensive quality assurance program in a major cancer center. Computerized antimicrobial decision support for hospitalized patients with a bloodstream infection. Database-driven computerized antibiotic decision support: novel use of expert antibiotic susceptibility rules embedded in a pathogen-antibiotic logic matrix. Computerized antimicrobial decision support: an offline evaluation of a database-driven empiric antimicrobial guidance program in hospitalized patients with a bloodstream infection. Developing and testing a system to improve the quality of heparin anticoagulation in patients with acute cardiac syndromes. Medication reconciliation at an academic medical center: Implementation of a comprehensive program from admission to discharge. Development of computerized alerts with management strategies for 25 serious drug-drug interactions. Methodology of an ongoing, randomized, controlled trial to improve drug use for elderly patients with chronic heart failure. Piloting a pharmacy-based automated adverse drug event monitoring and prevention system. Medication compliance-helping patients through technology: Modern “smart” pillboxes keep memory-short patients on their medical regimen. How to implement smart pump technology in a pediatric hospital setting: The good, the bad and the ugly. A web-based incident reporting system and multidisciplinary collaborative projects for patient safety in a Japanese hospital. Overcoming barriers to the implementation of a pharmacy bar code scanning system for medication dispensing: A case study. A semi-autonomous on-line chemotherapy prescription system Memorial University of Newfoundland (Canada)Editor. Feasibility study for identifying adverse events attributable to vaccination by record linkage. Developing a taxonomy for research in adverse drug events: potholes and signposts. Yakugaku Zasshi - Journal of the Pharmaceutical Society of Japan 2003;123(3):191-200. Detection and prevention of medication errors using real-time bedside nurse charting. Controlling clostridium difficile associated disease using a proactive pharmacy plan. Overview and update of automated dispensing technologies for inpatient and outpatient services. Computerised prescribing: assessing the impact on prescription repeats and on generic substitution of some commonly used antibiotics. Use of computer-generated alerts to identify pediatric patients at risk for nephrotoxicity. The impact of computerized provider order entry systems on inpatient clinical workflow: a literature review. Computerized provider order entry system - does it support the inter-professional medication process? Prescribing with the International Common Denomination in paediatric primary care. Pharmacy involvement in a multi-disciplinary approach to improve medication safety in a community hospital. From danger to safety: A complete redesign of a health system medication management model. Underuse of evidence-based warfarin dosing methods for atrial fibrillation patients. Improving the delivery of care and reducing healthcare costs with the digitization of information. Look before you leap - The impact on pharmacy operations of implementing multiple technologies to decrease medication errors. Computerized provider order entry and prescribing and the evidence for safe practice: update for the clinical nurse specialist. An anesthesia information system designed to provide physician-specific feedback improves timely administration of prophylactic antibiotics. The computer-assisted management programs for antibiotic therapies in connection with an application in geriatrics. Analysis of medication administration errors intercepted by a bar-code medication administration system. Analysis of the online order entry process in an integrated hospital information system. Ordering of continuous renal replacement therapy in a computerized provider order entry system. Implementation of hospital computerized physician order entry systems in a rural state: feasibility and financial impact. A checking system for injectable anticancer drugs using each patient’s own data and its evaluation. Yakugaku Zasshi - Journal of the Pharmaceutical Society of Japan 2002;122(6):389-97. Primary health-care services with a functional ambulatory care clinical pharmacy in a low-income housing project clinic. Leveraging on information technology to enhance patient care: a doctor’s perspective of implementation in a Singapore academic hospital. An analysis of the decision process in the pharmacological treatment of a patient with chronic heart failure by means of a therapy management information system: the experience of the Montescano Heart Failure Unit. External quality assessment for warfarin dosing using computerised decision support software. Characteristics of antimicrobial overrides associated with automated dispensing machines. Computer-generated physician and patient reminders: Tools to improve population adherence to selected preventive services. Improving medication use and outcomes with clinical decision support: A step-by-step guide. Implementation of a computerized system to identify patients with heart failure not receiving reninangiotensin system inhibitor therapy: supporting pharmacist role in adherence to standard of care. Design and implementation of the Indianapolis Network for Patient Care and Research. Does national regulatory mandate of provider order entry portend greater benefit than risk for health care delivery? Run-to-run control of blood glucose concentrations for people with Type 1 diabetes mellitus. Development of an interactive tailored information application to improve patient medication adherence. Opinions on the use of clinical decision support systems for paediatric prescribing in a New Zealand hospital. Implementing renal impairment and geriatric decision support in ambulatory e-prescribing. Reducing unintended consequences of e- prescribing on the path to nuanced prescriptions. Effect of a computerized alert on the management of hypokalemia in hospitalized patients. Evolution and growth of the department of pharmacy at a university teaching hospital. Impact of a prescription action profile on residents’ attitudes and perception of time management in a resident medicine clinic. Electronic prescribing in ambulatory practice: promises, pitfalls, and potential solutions. Use of a personal digital assistant in a pharmacy- directed warfarin dosing program. Exploring health information technology innovativeness and its antecedents in Canadian hospitals. Implementation of a closed-loop reporting system for critical values and clinical communication in compliance with goals of the joint commission. Implementation of RxNorm as a terminology mediation standard for exchanging pharmacy medication between federal agencies. Patient focused pharmacy services ­ Implementation of a decentralized unit-based pharmacist program. Use of carousel technology to decrease medication errors and increase efficiency in an outpatient ambulatory pharmacy in a private, not-for­ profit, university-affiliated pediatric hospital. Fifteen best practice recommendations for bar-code medication administration in the Veterans Health Administration. Automated medication dispensing system impact on drug distribution and pharmacy expenditures. Journal of Acquired Immune Deficiency Syndromes & Human Retrovirology 1997;15(5):356-62.

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Therefore best prednisone 20mg allergy associates, most systems have a limited loading capacity purchase prednisone canada allergy forecast orlando, so that often only quite potent drugs buy prednisone 5 mg lowest price allergy testing edmonds wa, such as hormones purchase prednisone overnight delivery allergy forecast nashville, may be suitable for delivery by implantable devices. If a new biomaterial is proposed to fabricate an implant, its safety and biocompatibility must be thoroughly evaluated to secure the approval of regulatory authorities. These issues can attribute to significant delay in the development, marketing and cost of a new implant. Adverse effects may be caused by: • The intact polymer: this may be due to the chemical reactivity of end or side groups in a polymer, organometallics used as polymerization initiators, or extractable polymeric fragments. In the case of a bioerodible poly(vinylpyrrolidone), the accumulation of the dissolved polymer in the liver raises a longterm toxicity issue. If the surface of an implant has an affinity towards specific chemicals, an abnormal boundary layer will develop. The subsequent intra-layer rearrangement or reactions with other species then trigger tissue reactions. The defence reactions of the host tissue often lead to encapsulation of an 77 implant by layers of fibrous tissues. Since the encapsulation frequently impedes drug release, in vitro drug release data may not permit the prediction of in vivo drug release patterns. High local drug concentrations at the site of implantation over extended periods of time can also cause severe local irritation or adverse tissue reactions. The performance and response of the host toward an implanted material is indicated in terms of biocompatibility. Major initial evaluation tests used to assess the biocompatibility of an implant are listed in Table 4. These tests include: • observation of the implant/tissue interactions at the site of implantation; Table 4. The choice of whether to select a reservoir-type, or a matrix-type, implantable system depends on a number of factors, including: • the drug’s physicochemical properties; • the desired drug release rate; • desired delivery duration; • availability of a manufacturing facility. For example, it is generally easier to fabricate a matrix-type implant than a reservoir system, so this may determine the selection of a matrix system. However, if drug release is the overriding concern, a reservoir system may be chosen in preference to a matrix system. This is because reservoir systems can provide zero- order controlled release, whereas drug release generally decreases with time if a matrix system is used. They vary in molecular weight, filler content, R and R, and1 2 1 2 the type of reactive silicone ligands for cross-linking. Variations in these parameters permit the synthesis of a wide range of material types such as fluids, foams, soft and solid elastomers (Figure 4. These copolymers have the advantages of: • Ease of fabrication: the copolymers are thermoplastic in nature, thus an implantable device is easily fabricated by extrusion, film casting or injection molding. As the ethylene domain is crystalline, an increase in the content of ethylene unit affects the crystallinity and the solubility parameter of the copolymer. Other polymeric materials commonly used as non-porous, rate-controlling membranes are given in Table 4. The penetration of a solvent, usually water, into a polymeric implant initiates drug release via a diffusion process. Diffusion of drug molecules through non-porous polymer membranes depends on the size of the drug molecules and the spaces available between the polymeric chains. Even through the space between the polymer chains may be smaller than the size of the drug molecules, drug can still diffuse through the polymer chains due to the continuous movement of polymer chains by Brownian motion. For transport through the membrane, there are three barriers to be circumvented (Figure 4. The drug molecules in the reservoir compartment initially partition into the membrane, then diffuse through it, and finally partition into the implantation site. C −C where Cr and C denote the drug concentrations in the reservoirr i i and at the site of implantation respectively. The release rate of a drug from different polymeric membranes can be compared from the corresponding P values. This is the familiar form1 of a first-order rate equation and indicates that the rate of diffusion is proportional to drug concentration. However, in this system, the drug reservoir consists of either: • solid drug particles, or • a suspension of solid drug particles in a dispersion medium so that the concentration of drug (C ) in the system always remainsr constant, so that Equation 4. Thus the release rate of a drug from this type of implantable device is constant during the entire time that the implant remains in the body. Microporous membranes can be prepared by making hydrophobic polymer membranes in the presence of water-soluble materials such as poly(ethylene glycol), which can be subsequently removed from the polymer matrix by dissolving in aqueous solution. Cellulose esters, loosely cross-linked hydrogels and other polymers given in Table 4. In microporous reservoir systems, drug molecules are released by diffusion through the micropores, which are usually filled with either water or oil (e. Solvent-loading of a porous membrane device is achieved simply by immersing the device in the solvent. When this technique presents some difficulty, the implantable device is placed inside a pressure vessel and pressure is then applied to facilitate the filling of the solvent into pores. The selection of a solvent is obviously of paramount importance, since it affects drug permeability and solubility. In this system, the pathway of drug transport is no longer straight, but tortuous. The porosity ε of the membrane and the tortuosity τ of the pathway must therefore also be considered. As for the non-porous reservoir device, in the microporous system, both: • the surface area of the membrane and • the drug concentration in the reservoir compartment remain unchanged, thus “M t” kinetics is again demonstrated and zero-order controlled release is attained (Figure 4. The capsules are surgically implanted subdermally, in a fan-like pattern, in the mid- portion of the upper arm. The implant releases levonorgestrel continuously at the rate of 30 µg/day (the same daily dose provided by the oral uptake of the progestin-only minipill) over a 5-year period. After the capsules are removed, patients are promptly returned to normal fertility. The implant is surgically placed in the vitreous cavity of the eye and delivers therapeutic levels of ganciclovir for up to 32 weeks. Matrix-type implants are fabricated by physically mixing the drug with a polymer powder and shaping the mixture into various geometries (e. The total payload of a drug determines the drug’s physical state in a polymer: • Dissolved: the drug is soluble in the polymer matrix. A dissolved matrix device (also known as a monolithic solution) appears at a low payload. When the drug content occupies more than 30% volume of the polymer matrix, the leaching of drug particles results in the formation of pores or microchannels that are interconnected. Regardless of a drug’s physical state in the polymeric matrix, the release rate of the drug decreases over time. As release continues, molecules must travel a greater distance to reach the exterior of the implant and thus increase the time required for release (Figure 4. This increased diffusion time results in a decrease in the release rate from the device with time (Figure 4. Numerous equations have been developed to describe drug release kinetics obtainable with dissolved, dispersed, and porous-type matrix implants, in different shapes, including spheres, slabs and cylinders. Suffice to say here that in all cases, the release rate initially decreases proportionally to the square root of time: (Equation 4. Thus a reservoir system can provide constant release with time (zero-order release kinetics) whereas a matrix system provides decreasing release with time (square root of time-release kinetics). A summary of the drug release properties of reservoir and matrix nondegradable devices in given in Table 4. The decreasing drug release rate with time of a matrix system can be partially offset either by: • designing a special geometry that provides increasing surface over time (this strategy is used in the Compudose implant, described in Section 4. The initial diffusion of drug molecules leaves a drug- depleted polymeric zone with a length h, which increases with time. This event leads to an increase in diffusional distance over time System Release Mechanism Release Properties Release Kinetics Matrix Diffusion through a polymeric Drug release decreases with time Square root of time release “M t1/ matrix 2” 4. This particular design, consisting of a thin layer of the drug-containing matrix and a relatively thick drug-free inert core, minimizes tailing in the drug release profile. When this implant is placed under the skin of an animal, estradiol is released and enters into systemic circulation. This stimulates the animal’s pituitary gland to produce more growth hormone and causes the animal to gain weight at a greater rate. At the end of the growing period, the implant can be easily removed to allow a withdrawal period before slaughter. The Compudose implant is available with a thick silicone rubber coating (Compudose-400) and releases estradiol over 400 days, whereas one with a thinner coating (Compudose-200) releases the drug for up to 200 days. Once implanted in the animal’s ear, the implant delivers estradiol valerate at the rate of 504 µg cm−2 day−1/2 over a period of 16 days. Such systems are designed in an attempt to improve the “M t1/2” release kinetics of a matrix system, so that release approximates the zero-order release rate of a reservoir device. The mixture is blended with a cross-linking agent, which results in the formation of millions of individually sealed microreservoirs. The mixture is then placed in a silicone polymer tube for in situ polymerization and molding. Drug molecules initially diffuse through the microreservoir membrane and then through the silicone polymer coating membrane. This implant provides zero-order release kinetics, rather than square root of time-release kinetics. The two open ends of the implant do not affect the observed zero-order release pattern because their surface area is insignificant compared to the implant’s total surface area. The drug permeation through the polymer membrane occurs at a rate that is 20 times slower than that through the polymer matrix, thus diffusion through the membrane is rate-limiting, which again improves the matrix-type square root of time-release kinetics, so that the release is like the zero-order release rate of a reservoir device.

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B Electrode noise most often results from an unstable Instrumentation/1 junction potential 10 mg prednisone with mastercard allergy symptoms coughing night. Blocked junction at the salt bridge sample buy generic prednisone 40mg on-line allergy testing za, but is kept from equilibrating via a barrier C cheap prednisone 20mg on-line allergy medicine effectiveness. Improper calibration by salt crystals proven prednisone 10 mg allergy symptoms pressure, the reference potential will be unstable, Chemistry/Identify sources of error/Electrolytes/2 resulting in fluctuation in the analyzer readout. Which of the following statements accurately of coulometric titration with amperometric detection. Te indicator electrodes generate voltage oxidation of silver wire at the generator anode. Constant current must be present across the ions react with chloride ions, forming insoluble silver generator electrodes chloride (AgCl). Silver ions are formed at the generator cathode silver ions are detected by reduction back to elemental D. Chloride concentration is inversely proportional silver, which causes an increase in current across the to titration time indicator electrodes (a pair of silver electrodes with a voltage difference of about 1. Charge or Chemistry/Define fundamental characteristics/ titration time is directly proportional to chloride Instrumentation/2 concentration as long as the rate of oxidation remains constant at the generator anode. Gelatin or Chemistry/Apply principles of special procedures/ polyvinyl alcohol is needed to prevent pitting of the Electrolytes/2 generator anode. Which of the following compounds can interfere AgCl, preventing dissociation back to Ag+. Nitrate include other halogens such as bromide, cyanide, Chemistry/Apply knowledge to identify sources of and cysteine. All of the following compounds contribute to the dissolved solute per kilogram solvent. Proteins and osmolality of plasma except: lipids are not in solution, and do not contribute to A. B Both freezing point and vapor pressure are lowered characteristics/Osmolality/2 by increasing solute concentration. Increasing solute cause all of the following except: concentration of a solution opposes a change in its A. The temperature at which a solution freezes can characteristics/Osmolality/2 be determined by measuring the resistance of the 50. Electrode calibrated variable resistor, so that no current flows Chemistry/Apply principles of special procedures/ to the readout. The resistance required to balance the Osmometry/1 meter is equal to the resistance of the thermistor. Termal conductivity bridge Chemistry/Apply principles of special procedures/ Osmometry/1 5. Which measurement principle is employed in a Answers to Questions 52–57 vapor pressure osmometer? When sample is cooled to its dew point, the Chemistry/Apply principles of special procedures/ voltage change across the thermocouple is directly Osmometry/1 proportional to osmolality. B Alcohol enters the vapor phase so rapidly that it vapor pressure osmometer in that only the freezing evaporates before the dew point of the sample is point osmometer: reached. Requires a thermoelectric module alcohol and can be used in emergency department D. Requires calibration with aqueous standards settings to estimate ethanol toxicity. Te method for measuring iron or lead by plating mercury cathode by applying a negative charge. The the metal and then oxidizing it is called: voltage of this electrode is reversed until the plated A. C An isocratic separation uses a single mobile phase of Chemistry/Apply principles of special procedures/ constant composition, pH, and polarity, and requires Instrumentation/1 a single pump. Te term isocratic is used in high-performance mobile phase to increase distance between peaks. Mobile phase is at constant temperature using a controller to change the proportions of B. Mobile phase consists of a constant solvent using a nonpolar sorbent (stationary phase) such as composition octadecylsilane (C18). Most clinical Chemistry/Apply principles of special procedures/ separations of drugs, hormones, and metabolites High-performance liquid chromatography/1 use reverse phase because aqueous mobile phases 56. Organic and the stationary phase is aqueous the mobile phase and stationary phase is most D. A stronger solvent than the stationary phase important and depends upon solvent polarity, pH, Chemistry/Apply principles of special procedures/ and ionic strength. Cation exchange Chemistry/Apply principles of special procedures/ High-performance liquid chromatography/1 184 Chapter 5 | Clinical Chemistry 58. Termal conductance from a flame is used to excite the analytes as they elute from the column. The flame is made by igniting Chemistry/Apply principles of special procedures/ a mixture of hydrogen, carrier gas, and air. Current is Gas chromatography/1 produced when an outer shell electron is ejected 59. A The order of elution is dependent upon the velocity volatiles is usually based upon the: of the analyte. The Kd is the partition Chemistry/Apply principles of special procedures/ coefficient, and is a measure of the relative affinity Biochemical/2 of solutes for the stationary phase. The pK is the the solute migrates divided by the distance the negative logarithm of K, the ionization constant, and solvent migrates is the: is a measure of ionization. More than a High-performance liquid chromatography/1 90% of the drug will be nonionized and will extract in ethyl acetate or another organic solvent. Neutral solution of ethyl acetate Chemistry/Apply principles of special procedures/ Biochemical/2 5. A Internal standards should have the same affinity as injection the analyte for the extraction reagents. To correct for background absorbance peak height (or area) of all samples (standards and C. To compensate for changes in flow rate unknowns) by the peak height (or area) of the D. To correct for coelution of solutes internal standard reduces error caused by variation in extraction recovery and injection volume. What is the confirmatory method for measuring substance has a unique and characteristic spectrum drugs of abuse? Cations can be formed by various Chemistry/Select instruments to perform test/Drugs of methods, the most common of which is electron abuse/2 bombardment (electron ionization). Cations caused by electron loss or proton a nitrogen laser causes transfer of a proton from the attachment matrix (an acid) to the protein. Chemistry/Define fundamental characteristics/ Instrumentation/1 186 Chapter 5 | Clinical Chemistry 68. Electrospray ionization uses a small-bore tube that forms a 1–4 μ nozzle at the mass Chemistry/Identify basic principle(s)/Mass spectroscopy/1 filter inlet and which is charged by several kilovolts. In mass spectroscopy, the term base peak typically The sample enters the tube along with inert drying refers to: gas. A natural isotope of the molecular ion reaches the nozzle, it becomes highly charged. Te first peak to reach the mass detector size of the droplet is decreased owing to evaporation. Chemistry/Define fundamental characteristics/ This causes the charge density to become excessive, Instrumentation/1 and the droplets break apart. These particles are drawn into the for errors of amino and organic acid metabolism? Electrospray ionization tandem-mass parent or “molecular” ion, a process called soft spectroscopy ionization. B The base peak is typically the “molecular ion” or Chemistry/Select instruments to perform test/Newborn parent ion, meaning that it is the initial fragment screening/2 made by releasing an electron. The cation thus formed has a charge of +1, and therefore, its m/z ratio is equal to its mass. It is the most abundant and most stable ion, and gives the best sensitivity for quantitative analysis. C While two-dimensional thin-layer chromatography can separate both amino and organic acids, it is not sufficiently sensitive for newborn screening. Electrospray ionization allows a small alcohol-extracted whole-blood sample to be analyzed by two mass spectrometers without prior separation by liquid or gas chromatography. Disorders of both organic and fatty acid metabolism are identified by the specific pattern of acylcarnitine ions produced. Amino acids are detected as amino species that have lost a carboxyl group during ionization, a process called neutral loss. In tandem-mass spectroscopy, the first mass filter Answers to Questions 71–73 performs the same function as: A. Te vacuum system molecular or parent ions of interest by excluding ions outside a specified size range. Therefore, it effectively Chemistry/Apply principles of special procedures/ separates the analyte(s) of interest from unwanted Instrumentation/1 compounds. Results of an Autotune test are drawn into a second mass filter where they are showed the appearance of a base peak at 16 with bombarded by argon atoms.