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Essay Instructions: Cardiac surgery, with or without cardiopulmonary bypass [CPB], elicits a potent stress response. This stress response has two key components, activation of the inflammatory response and the release of stress hormones, including Epinephrine, norepinephrine, cortisol, and adrenocortical hormone. Nonspecific activators of the stress response include surgical trauma, blood loss and/or transfusion, and hypothermia. CPB may directly activate the inflammatory response via at least three distinct mechanisms. One mechanism involves direct 'contact activation' of the immune system following exposure of blood to the foreign surfaces of the CPB circuit. A second mechanism involves ischemia-reperfusion injury to vital organs as a result of aortic cross clamping. Restoration of perfusion on release of the aortic cross clamp is associated with activation of key indices of the inflammatory response. In addition, systemic endotoxemia, resulting from gut translocation of endotoxin across a damaged mucosal barrier compromised following splanchnic hypoperfusion, may indirectly activate the inflammatory cascade.

The inflammatory component of the stress response to cardiac surgery is increasingly well characterized. Scientific knowledge in this field is continually expanding and this area constitutes a major interface of clinical and basic scientific research. Inflammation constitutes generalized, non-specific response to tissue injury, of whatever etiology, and is a rapid, highly amplified, controlled humoral and cellular response. There are several key components of the inflammatory response to cardiac surgery. The complement cascade is activated upon contact of the blood with the foreign surfaces of extracorporeal circuit, reperfusion of ischemic tissues, and heparin neutralization with protamine. Proinflammatory cytokines such as tumor necrosis factor-a [TNFa], Interleukin-1b [IL-1b], IL-6 and IL-8 play a pivotal role in stimulating and coordinating the inflammatory process. The role of the coagulation/fibrinolytic cascades and its interaction with the inflammatory response is increasingly recognized. The cellular immune response, in particular the process of neutrophil-endothelial adhesion, may lead to widespread endothelial damage and dysfunction. The inflammatory response may result in widespread endothelial activation and diffuse endothelial injury, which is considered a key event leading widespread organ injury and dysfunction.
First, the degree of activation of the components of the complement cascade have been demonstrated to correlate with indices of pulmonary (1), renal (2), and hemostatic (2) dysfunction, and the incidence of postoperative arrhythmia (3,4) following CABG. Strategies which reduce indices of complement activation, such as improvements in CPB circuit biocompatibility (5,6), or specific anti-complement strategies (7) reduce the morbidity in patients undergoing cardiac surgery. Second, systemic spillover of pro-inflammatory cytokines, such as TNFa, IL-1b and IL-6 appear to contribute to the pathogenesis of post-CPB myocardial stunning, ischemia and dysfunction (8,9). TNFa released during CPB may contribute to the pathogenesis of postoperative hepatic (10) and renal (11) dysfunction. Strategies to remove pro-inflammatory mediators, such as mechanical removal of cytokines by hemofiltration, limit these adverse effects (12).



REFERENCES: use Journal of cardiovascular cardiothoracic surgery, Anesthesia Analgesia, British Journal of Anaesthesia, Anesthesiology, Perfusion, Critical Care Medicine.
I also am requesting that copies of the references be sent to me as well.
Also here is grading criteria:
Criteria for Grading a Scholarly Manuscript

1. Issue relevance to contemporary practice. (10%)

2. Title Page (10%)
- Title stated as pro/con (advantages/disadvantages)
- Running head and page header consistent with APA limitations
- Appropriate use of lower and upper case

3. Abstract (10%)
- Tells the reader what the report contains
- Includes purpose, methods, scope, summarized results, and conclusions
- Approximately 150 words

4. Introduction (10%)
- Title present at top of page
- Provides a brief back round of the issue with a statement of opposing viewpoints
- Contains the purpose of the paper

5. Adequacy of literature and referencing (30%)
- Pro (advantages) and con (disadvantages) arguments presented with statistical evidence supporting the researchers conclusions
- A minimum of 5 literature sources cited supporting each pro/con argument
- Citations use APA standards

6. Implications to practice (20%)
- Students position is stated based on conclusions extrapolated from readings
- Potential effect on general practice stated

7. Organization (10%)
- Paper organized into sections using APA level heading
- Paper adheres to margin guidelines

8. Reference page (10%)
- Variety of journals consulted
- APA guidelines

Essay Instructions: write a 3 page essay about cardiac surgery =the past,present and future and it's doctor's.

specifically at Mass General Hospital (boston).(what does this facility offer patients in cardiac surgery, ect)

and it's cardiac surgeon's specifically Dr. Arvind K. Agnihotri, M.D.

Wirte about His work, biography (brief)and cite 3 or more papers (minimum 3)( medical journals) on cardiac surgery that he has written.Critique the papers he has written and published and write about the importance of the topics and what it's contribution will be in healthcare.Why is this surgeon important to healthcare.would you feel comfortable having this Dr take care of you or your loved one's.

no spelling errors, grammar or citations.
Write the essay like it will be published in the harvard medical journal(professional).Be articulate, eloquent and creative.

Essay Instructions: Name of article: Estimating core temperature in infants and children after cardiac surgery: a comparison of six methods, Fiona J. C. Maxton, Linda Justin RN & Donna Gillies.
The following questions must be answered:
1. What is the research question? If it is not explicitly written, but is implicit in the article, suggest null and alternative hypotheses.
2. List the variables used in the study and identify each of them as either independent or dependent variables. Also describe the level or scale of measurement of each of them.
3. List ALL the statistical analyses performed in the study, descriptive and inferential. What is the purpose of each of the analysis you listed?
4.Describe the sample used in the study. Was the sample a good representation of the population that they were making inferences towards?
5. List the findings in the study and report on their level of significance.
6. What changes to the methodology, if any, could make this study stronger? (Support your answer)
Need to reference the article used.

Essay Instructions: I need to write a 10 pages research proposal for My graduate thesis project.The graduate thesis 150 pages need to be completed by January 2015.The proposal is due July 25 2014.I share this info because I will seek assistance from essaytown-hopefully one skilled writer in the next few months in order to complete the thesis.At this moment I'm seeking assistance for the research proposal.A little background information for the writer assigned to this order.

I work in a major hospital as a clinical coordinator for cardiac surgery.I'm currently enrolled in a masters program seeking a business degree.I wanted to write My graduate thesis in something I had knowledge,access to data and passion for.It's a long thesis it can get tiresome I'm sure. I seek the advise and support first of My boss for writing the paper and if he had any input as to what he wanted a research conducted on.My thoughts were to make a dual purpose out if this project. He was ecstatic about this project to say the least which is good in case I need an IRB submitted to conduct this research.
He is a physician so his thoughts were purely clinical.I thought the research proposal can be about building a best in class quality infrastructure,raising the standard of cardiac patient care by providing excellent quality metrics.Since this has to have a business focus (finance) should be incorporated in the research proposal.This is where I need assistance in integrating both of these areas. Since My boss and I have started to work on metrics for our program about two years ago.We came from another facility and were recruited to change the infrastructure of cardiac surgery and increase yields both which we have done in the last two years.He thought that we should showcase that to the Financial folks (Coo,CEO, hospital president).The proposal will be submitted for review and approval at work but,I also would like it to cover for My class project.

The following are quality metrics we have worked on for the last two years:
1.100% compliant beta blocker administration before coronary bypass graft surgery.
2.Administration of prophylaxis antibiotics within one hour of skin incision.
3.Evidence based practice on glucose control.
4.Evidence based practice and surgical techniques on air embolism to prevent strokes.
5.Evidence based practice on prevention of pressure ulcers stage 3 & 4.
6.blood conservation -we consume minimum blood products during bypass surgery do to better surgical techniques,MIS cases,better heparin control during bypass.this is a major finance to the hospital.
7.Patient length of stay has decreased from 7 days to 3/4 days in the SICU.
8.Quicker patient extubation which means less complications related to prolonged insulation period.
9.Less narcotics administered during bypass cases and in the unit due time changes in protocol.
10.Decreased our mortality rates.
11.Less OR time, efficiency measures developed.

All of these initiative we provided to our program,service and patients yield profits the institution.My goal is to demonstrate that by improving quality metrics,improve patient satisfaction the institution maximize in their investments.
I just need a politically correct research hypothesis. I definitely want to stay employed too.
I do have access to the STS national data registry and My boss will get any data from the hospital needed to complete this project.

The instructions are to complete a research proposal on the material(information) I listed above.It has to be a quantitative design.,10 pages, APA style,12 Roman font.
If the writer has suggestion,comments,or inquiries I am happy to share and listen to. I'm nervous about this project not so much for school but,work purposes.
I hit the resource button in case you needed more material that I might have access to for the order.
Thank you,
JA

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Customer is requesting that (writergrrl101) completes this order.