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Category Archives: Academic Writing

M6 Assignment 2 Submission

M6 Assignment 2 Submission

Instructions

Assignment 2: Analyzing and Interpreting Data

This module taught you about analyzing and interpreting data. In addition, this module taught you how to plan the data collection process and how analyzing data for qualitative research, analyzing data for quantitative research, and analyzing data for mixed methods applied research studies differ. Using your textbook, the Argosy University online library resources, and other scholarly sources, create a data collection and analysis plan. Specifically, discuss the type of applied research study you plan to conduct (qualitative, quantitative, or mixed methods) and why you selected the data analysis technique.

In the last module, you listed your plan for data collection. After restating the purpose of the study, your data collection methods should have been organized and described by research question. In this module, you will add the analysis portion to your plan following your data collection plan for each research question.

Tasks:

  • Assuming that you have collected the data identified in your plan, how will you analyze and interpret the findings?
    • Describe the analysis process that will be used for each research question. In some cases, analysis may include more than one method (e.g., descriptive and inferential statistics). Describe the full analysis process anticipated for each research question.
    • If any statistical tests are needed to analyze the data of any of your research questions, identify the appropriate test and your rationale for its selection.
    • If the data collected produces qualitative findings, describe the analysis process and how you will narrow and interpret the findings so as to answer your research questions.
  • Identify the resources and/or software that will be required to analyze your data.
  • Use at least two scholarly citations and cite the sources in the body of your work as per APA standards.
  • Prepare a reference list.

Support your rationale and analysis by using at least two resources from professional literature in your response. Professional literature may include the Argosy University online library resources; relevant textbooks; peer-reviewed journal articles; and websites created by professional organizations, agencies, or institutions (websites ending in .edu or .gov).

Submission Details:

  • By the due date assigned, save your document as M6_A2_LastName_FirstInitial.doc and submit the document to the Submissions Area.

 

 
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Posted by on August 11, 2018 in Academic Writing

 

hyroidectomy PTH in Predicting Hypocalcaemia

The Role of Post -Thyroidectomy  PTH in Predicting Hypocalcaemia

 

 

Correspondence: Dr.

 

 

 

 

Category: Case series

 

 

 

 

 

 

 

 

 

 

Running title:

 

ABSTRACT

 

 Hypocalcemia is the most common complication after total thyroidecto­my. It is also the leading cause for prolonged hospitalization after thyroidectomy. The purpose of this study is to determine the validity of PTH monitoring six and twelve hours after total thyroidectomy in predicting hypocalcaemia. Nineteen patients who underwent total thyroidectomy alone or with neck dissection were included. PTH levels and calcium levels were monitored for all patients at two major points: at 6 and 12 hours post-operatively. In all patients, corrected calcium level was calculated.

At 6 hours post-operatively, 47% of patients had calculated calcium level< 8, with normal PTH level in 5 of them. At 12 hour post-operatively 37% of patients had calculated calcium level< 8, with normal PTH level in 3 of them. The validity of low serum PTH in predicting the post-operative hypocalcaemia and of normal serum PTH in predicting the normocalcemia were calculated.

 We conculude that there is a strong correlation of postoperative PTH with post thyroidectomy hypocalcaemia. A single serum PTH level 12 hours post-operatively is an accurate predictor of normocalcaemia. Patients with normal PTH and normal calcium level 12 hours postoperatively can be considered for discharge.

 

 

Key Words: Thyroidectomy, hypocalcemia, parathyroid hormone, surgery

 

 

 

 

 

 

Running title:

 

 

INTRODUCTION

Thyroid cancer is the most common endocrine malignancy accounting for approximately 1% of all human cancers and causing approximately 0.5% of all cancer deaths. Total thyroidectomy is the treatment of choice for clinically significant thyroid cancers. Transient hypocalcaemia after total thyroidectomy is reported at 20%-30% in most studies . The search for a blood test that identifies patients who will become hypocalcaemic after total thyroidectomy versus those who will remain normocalcaemic in the early postoperative period has evolved since the late 1980s (1-5) . Transient hypocalcaemia after total thyroidectomy is reported at 20-30% in most studies (2,7). Hypocalcaemia after total thyroidectomy is multi-factorial, but parathyroid dysfunction is the main cause.The incorporation of parathyroid hormone (PTH) levels as a monitor for hypoparathyroidism leading to hypocalcaemia has been the next step in the evolution of this field of research (2). Serum PTH has a half  life of 1 to 4 minutes. Any insult to parathyroid glands with impaired PTH secretion leads to an immediate decline in PTH levels.

Serum calcium homeostasis by PTH occurs through a variety of mechanisms:

  1. It promotes distal tubule calcium re-absorption.
  2. Bone re-absorption.
  3. 1,25(OH)2D mediated intestinal calcium absorption.

The nadir of serum calcium post total thyroidectomy is 24-48h postoperatively and it may be delayed as the 4th  postoperative day (6). Thus, monitoring calcium levels postoperatively, might lead to patients being hospitalized for longer time than otherwise necessary. The risk of hemorrhage and hematoma is mostly in the early postoperative  period, and warrant 24 h in hospital observation.

Inpatient stay beyond 24 h after Total thyroidectomy, in the absence of complications, is not warranted because patients suffer minimal pain (8).

Grodski found that postoperative PTH can be used to stratify the risk of patients developing    hypocalcaemia after thyroidectomy (1). In addition, the routine use of oral calcium supplements was shown to lead to decreased incidence and severity of post-thyroidectomy hypocalcaemia (1) .

In this work we aimed to investigate the role and best timing of PTH monitoring post total thyroidectomy in predicting hypocalcaemia.

 

MATERIALS AND METHODS

In this study we included patients (men and women) that underwent different thyroidectomy procedures: total thyroidectomy  or total thyroidectomy with central neck dissection. PTH levels were monitored for all patients at two major points: at 6 and 12 hours postoperatively. Calcium levels were measured twice a day. Corrected calcium level was calculated using the next formula:

Corrected Ca. = serum calcium + 0.8 (4 – serum albumin)

We defined two different points for hypocalcaemia:

While the corrected calcium level was less than 8 mg/dl

While the PTH level was less than 1.6 Pcmoll/l (8).

 

 

RESULTS

Nineteen patients were included (13 women and 6 men). Age of patients ranged from 20 to 76, with a mean age of 45 years. Patients underwent total thyroidectomy and 4 patients underwent total thyroidectomy with central neck dissection.

Mean time of hospitalization for these patients was 5.05 days (SD 0.97). The PTH levels, and corrected calcium levels (calculated) at three measurements are shown in Table I.

At 6 hours post-operatively, 47% (9 from 19) of patients had calculated calcium level< 8, with normal PTH level in 5 of them. At 12 hours post-operatively 37% (7 from 19) of patients had calculated.

calcium level< 8, with normal PTH level in 3 of them. At 48 h post-operatively, 2 of those 3 patients, had a normal calculated calcium level and were asymptomatic without calcium supplementation.

Seven of our patients (36.8%) received intravenous calcium treatment after the operation. Six of them received also the calcium supplementation. Five from these patients were symptomatic. Furthermore, one patient who underwent thyroidectomy with central neck dissection required 5 month calcium supplementation.

We calculated the validity of  low serum PTH in predicting the post-operative hypocalcaemia and of  normal serum PTH in predicting the normocalcaemia. For low serum PTH, the sensitivity of this test was 55% at 6 hours after the operation, and 71% at 12 hours after the operation. The specificity of this test was 90% at 6 hours after the operation, and 100% at 12 hours after the operation.

The sensitivity of normal serum PTH level as a predictor of normocalcaemia was 91% at 6 hours after the operation and 100% at 12 hours after the operation. The specificity of this test was 44% at 6 hours after the operation and 75 % at 12 hours after the operation.

 

 

DISCUSSION

Hypocalcemia is the most frequent complication of total thyroidectomy. The reported incidence in the literature varies from 1-50% (1). The risk of hypoparathyroidism increases in reoperative thyroid surgery and when central neck is associated (11). Patients symptoms and serum calcium levels dictate the necessity for calcium and vitamin D supplementation. The need of monitoring hypocalcemia is the leading reason for patients’ hospitalizaion beyond 23 hours (7) . Within the last decade, numerous studies have been conducted to predict the factors involved in the early prediction of hypocalcemia following thyroidectomy. Parathyroid hormone assay was one of the most reliable tool to predict postoperative hypocalcemia within hours of total thyroidectomy or completion thyroidectomy ( 11-13).

Several published reports have demonstrated the marked utility of the PTH assay in predicting patients who will develop hypocalcemia after thyroidectomy. However, there is a substantial

variability among these reports about the sensitivity and specificity  of PTH in accurately predicting hypocalcemia. Lam and ker found that all patients with PTH values less than 8pg/mL measured one hour after surgery became hypocalcemic, and all patients with PTH level greater than 9pg/mole did not (14) . Higgins and his colleagues demonstrated that 64% of those patients who subsequently required calcium supplementation had more than 75%  decrease in PTH levels from baseline 20minutes post surgery. Another finding was that most of patients who did not  need calcium supplementation (74%) had  a decrease of less than 75% from baseline (15). For Lombardi and colleague. PTH less than 10 pg/mL measured four or six hours after surgery predicted hypocalcemia with an overall accuracy of 98% (3). Pattou and colleagues  reported that a postoperative PTH level of 12 pg/mL or less was a good predictor of hypocalcemia, but did not state how long after surgery PTH values were obtained (6). Payne and his colleagues found that 6 hours post-operation PTH level is the most accurate predictor for hypocalcaemia and accurately predicts also the normocalcaemia (7).

As we saw earlier, most of the studies are discussing the correct timing of taking the measurements of PTH levels post-operatively. In our study we performed the measurements at 6 and 12 hours after the operation. We saw that the sensitivity of  low PTH as a predictor of hypocalcaemia was higher at the 12 hours measurement. Despite this no absolute PTH levels or percentage decline has 100% sensitivity or specificity. Sensitivity of normal PTH levels predicting normocalcaemia was higher than sensitivity of  low PTH levels predicting hypocalcaemia.

There are a few limitations to the study. First, it is a retrospective non-random review, which may result in selection bias. Secondly, a small number of participants. Further randomised controlled are required.

 

 

 

 

 

 

 

CONCLUSION

In our study we saw that a single serum PTH level 12 hours postoperatively is an accurate predictor of normocalcaemia. Thus, patients with normal PTH and normal calcium level 12 hours post-operatively can be considered for discharge reducing unnecessary hospitalization and patients’ discomfort.

 

 

Acknowledgments

No acknowledgements

 

 

 

 

 

 

 

 

 

 

 

                  References

  1. Grodski, S., Serpell, J. Evidence for the Role of Perioperative PTH Measurement after Total Thyroidectomy as a Predictor of Hypocalcemia. World Journal of Surgery 2008; 32: 1367–1373.
  2. LoGerfo, P., Gates R., Gazetas, P. Outpatient and Short-stay Thyroid Surgery. Head and Neck;2006; 13 (2): 97 – 101.
  3. Lombardi, C.., Raffaelli, M., Princi, P. et al. Early prediction of postthyroidectomyhypocalcemia by one single iPTH measurement. Surgery;2006; 136: 1236-1241.
  4. Marohn M.R, LaCivita K.A. Evaluation of total/near-total thyroidectomy in a short-stay hospitalization: safe and cost-effective. Surgery;2006; 118:943–948.
  5. McHenry C. R. ‘‘Same-day’’ thyroid surgery: an analysisof safety, cost savings, and outcome. American Surgery:1997: 63:586–589.
  6. Pattou, F., Combemale, F., Fabre. et al. Hypocalcemia following Thyroid Surgery: Incidence and Prediction of Outcome. World Journal of Surgery:1998: 22, 718–724.
  7. Payne, R. J., Hier, M. P., Tamilia, M. et al. Same-Day Discharge After Total Thyroidectomy: The Value of 6-hour Serum Parathyroid Hormone and Calcium Levels. Head and Neck:2004; 27: 1 – 7.
  8. Kalmovich LM1, Cote V, Sands N, Thyroidectomy: Excatly how painful is it? J otology head and neck surgery; 2010:39(3),277-83.
  9. Payne, R. J., Tewfik, M. A., Hier, M. et al. Benefits Resulting from 1-and 6-Hour Parathyroid Hormone and Calcium Levels After Thyroidectomy. Otolaryngology — Head and Neck Surgery;2005; 133: 386-390.
  10. Sywak, M. S., Palazzo, F. F., Yeh, M. et al. Parathyroid hormone assay predicts hypocalcaemia after total thyroidectomy. ANZ Journal of Surgery;2007; 77: 667–670.
  11. McLeod IK, Arciero C, Noordzij JP, et al. The use of rapid parathyroid hor­mone assay in predicting postoperative hypocalcemia after total or comple­tion thyroidectomy. Thyroid. 2006;16:259–65
  12. Noordzij JP, Lee SL, Bernet VJ, et al. Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies. J Am Coll Surg. 2007;205:748–54
  13. Khafif A, Pivoarov A, Medina JE et al. Parathyroid hormone: A sensitive predictor of hypocalcemia following total Otolaryngol Head Neck Surg. 2006;134:907–10).
  14. Lam A, Kerr P. Parathyroid hormone: an early predictor of postthyroidectomy hypocalcemia. Laryngoscope. 2003;113(12):2196-200.
  15. Higgins KM, Mandell DL, Govindaraj S et al. The role of intraoperative rapid parathyroid hormone monitoring for predicting thyroidectomy-related hypocalcemia. Arch Otolaryngol Head Neck Surg. 2004;130(1):63-7

 

 

 

 

 

Table I. PTH and calcium level measurements at two different post-operation time points

  6 hours after the operation 12 hours after the operation
PTH level

(mean (SD))

3.36 (2.58) 3.27 (2.47)
Corrected calcium

(mean (SD))

8.04 (0.42) 8.04 (0.55)

 

 

 

 
 

Tags:

Order

 

 

A = 70, B = 0.95, C = 1000

 

A typical fish farming process might involve placing small fish (fingerlings) in a dam, waiting for them to grow, and then harvesting all of the remaining fish.

 

People who rely on growing fish as a source of food are faced with the problem of working out when is the best time to harvest the fish, because although the fish grow bigger as time passes, unfortunately some of them die before they are harvested for food.

 

Data was collected and analysed for a particular species of fish. The following information was obtained:

 

Fish Length

The following formula gives a relationship between the fish length (L) in centimetres and time elapsed (t) in months since the fingerlings were placed in the dam:

L  = A (1 – Bt )

 

Fish Weight

The following weight-length data is available for the species concerned:

 

Length (cm) 10.1 25.0 32.6 35.4 43.8 45.5 55.7
Weight (g) 15 236 520 660 1250 1425 2590

 

Length of Life

For every ‘C’ fingerlings of this species of fish placed in the dam, the number, n, still alive after t months is given by the formula:

N = C x Bt

 

 

Based on this information, find the best time to harvest all of the fish remaining in the dam in order to get the maximum weight of live fish. Validate your solution using technology.

 

 
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Posted by on July 23, 2018 in Academic Writing

 

Points of View Essay

The instructions for this assignment is posted below. I have also uploaded week 1 assignment.

In Week 1, you selected a topic to work with throughout the course to practice your critical thinking skills.

This week, you identify and discuss alternative points of view about that topic.

Resource: Week 1 topic and the “Opposing Viewpoints in Context.”

Optional Resource: Writing Resources lab

  1. Locate the topic you chose in Week 1 using the “Opposing Viewpoints in Context.”
  2. Select two viewpoints from those listed on the page.
  3. Write a 200- to 300-word essay on your topic that includes responses to the following:
    1. Introduce the topic you selected and briefly discuss why people might think differently about the topic. (50 to 75 words)
    2. Explain the two different viewpoints you selected. The goal of your explanation is to help your reader understand the reasoning for each viewpoint. (100 to 150 words total)
    3. For each viewpoint, identify one intellectual standard of thinking that is used well and one that is lacking. Review the intellectual standards of thinking discussed on p. 91 and Exhibit 5.1 on p. 102 of Ch. 5 of your text. (50 to 75 words total)
 
 

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Course Outcome

Course Outcomes – Find and list the official course outcomes for each of your other (non-externship) courses. This list should be broken down by course with the proper course prefix, number, and name.

Course 1. Information security System (BA63271G118).

Course 2. Project Management (BA63170H118).

My Job Description:

 

· Analyze, design, prototype, configure, test, document, and implement new or modify existing software to support various business processes.

· Develop an area of expertise within Sales, customer service, Order Entry/Order Management and Billing/Collections in due course of time.

· Learn overall business operations and help develop innovative solutions to improve productivity

· Assist key users in testing new functionality, documenting and retaining ERP knowledge

· Documented testing results and updated the same for verification to the management

· Involved in developing Test Plans and Test cases for the entire functionality of the portal.

· Understanding and analyzing the Business functionality of existing systems of Issue to Resolve

· Written Standard test scripts for Oracle Accounts Payable and Oracle accounts receivable Modules

 
 

Tags:

Management Information Systems

Management Information Systems

Chapter 9 – Systems Development and Project Management

Denver International Airport

One good way to learn how to develop successful systems is to review past failures. One of the most infamous system failures is Denver International Airport’s (DIA) baggage system. When the automatic baggage system design for DIA was introduced, it was hailed as the savior of modern airport design. The design relied on a network of 300 computers to route bags and 4,000 card to carry luggage across 21 miles of track. Laser scanners were to read bar-coded luggage tags, while advanced scanners tracked the movement of toboggan-like baggage carts.

When DIA finally opened its doors for reporters to witness its revolutionary baggage handling system, the scene was rather unpleasant. Bags were chewed up, lost, and misrouted in what has since become a legendary systems nightmare.

One of the biggest mistakes made in the baggage handling system fiasco was that not enough time was allowed to properly develop the system. In the beginning of the project, DIA assumed it was the responsibility of individual airlines to find their own way of moving the baggage from the plane to the baggage claim area. The automated baggage system was not involved in the initial planning of the DIA project. By the time the DIA developers decided to create an integrated baggage system, the time frame for designing and implementing such a complex and huge system was not possible.

Another common mistake that occurred during the project was that the airlines kept changing their business requirements. This caused numerous issues, including the implementation of power supplies that were not properly updated for the revised system design, which caused overloaded motors and mechanical failures. Besides the power supply design problem, the optical sensors did not read bar codes correctly, causing issues with baggage routing.

Finally, BAE, the company that designed and implemented the automated baggage system for DIA, had never created a baggage system of this size before. BAE had created a similar system in an airport in Munich, Germany, where the scope was much smaller. Essentially, the baggage system has an inadequate IT infrastructure because it was designed for a much smaller system.

DIA simply could not open without a functional baggage system so the city had no choice but to delay the opening date for more than 16 months, costing taxpayers roughly $1 million per day, which totaled around $500 million.

QUESTIONS

  1. One problem with DIA’s baggage system was inadequate testing. Why is testing important to a project’s success? Why do so many projects decide to skip testing?
  2. How could more time spent in the analysis and design phase have saved Colorado taxpayers hundreds of millions of dollars?
  3. Why couldn’t BAE take existing IT infrastructure and simply increase its scale and expect it to work?
 
 

Tags:

Management Information Systems

Management Information Systems

Chapter 8 Assignment

                           

Review Questions – give examples to support your answers

 

  1. List and describe the five primary activities in a supply chain?
  2. Why are customer relationships important to an organization? Do you agree that every business needs to focus on customers to survive in the information age?
  3. How can a sales department use CRM to improve operations?
  4. “The fly in the ointment is that typically only 20 percent of a firm’s customers are actually profitable. And many – often most – of a company’s profitable customers are not loyal”. Do you agree or disagree with this statement? Why?

 

 
 

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