Reference no: EM133860975

The case study.

Understanding the determinants of individuals' assessments of their quality of life may help clarify why the scores of proxies and patients differ. There is no direct correspondence between objective functioning and an individual's quality of life nor between the perceptions of patients and healthy people, professionals, or others with similar disabilities.12,13,14 Patients may rate their quality of life highly despite obvious problems or may show significant improvement in scores that do not correlate with objective measures of disease or physical function. Clinicians may find it difficult to accept patients' ratings of quality of life. This can be an important issue when working with patients with severe disabilities or with those who are dying because clinicians may hold expectations about quality of life that are not supported by patients' assessments.

For example, it is often presumed that dying is a time of great suffering and severe problems15 and that quality-of-life scores will therefore decline as death approaches. Indeed, in a study comparing quality of life measures in patients with advanced cancer it was argued that the fact that one measure identified greater deterioration over time than another meant that it was more sensitive.

Functional status

The functional status of patients with cancer declines as death approaches and is a good prognostic indicator.17 Scores on other quality of life domains in patients with cancer are neither necessarily lower than in other people nor do they necessarily deteriorate. In one study, patients in hospice had lower scores than apparently healthy adults on two quality of life domains (psychophysiological wellbeing and functional wellbeing) but not on a third (social and spiritual wellbeing).18 The implications of this "disability paradox" for comparative measurement of quality of life, using methods such as quality adjusted life years, was discussed in the second paper in this series.

1. The __________ operon has a __________ chain of __________ acid long polypeptide. What does this entail and in what positions? Where are they uncommon?

2. _________ can operate over extremely _________ distances, occasionally, even from discrete _________ and this mechanism is recognized as _________. Where is it best studied? What does it involve? From where?

3. _________ were originally identified in SV40 virus.

4. Supplement to a TATA _________, another two _________ duplicates situated further _________. What is their significance?

5. Within which cell types are Immunoglobulin enhancers dynamic?

6. How many domains are transcriptional activators?

7. How many techniques exists for boosting transcription by the enhancer molecules?

8. Which phases for the production of RNA is not controlled by enhancers?

9. What is the role of enhancer molecules in the case of transcription regulation?

10. What does gene imprinting involve? What does it allow?

11. Identify the handiwork of siRNA. In how many trails does it transpire gene silencing? How do they operate?