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Technology in Biomedics Data Analysis Annotated ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Technology in Biomedics Data Analysis Annotated please read the attached file, the sourcing for Biomechanics topic. and then fill the Data Analysis Annotated Bibliography file. Technology in Biomedics Data Analysis Annotated attachment_1 attachment_2 Name: Mohammed Aldossary Write down your data analysis report background claim: The area of study is wearable technology. It is an area of study in biomechanics Part One: Search Terms Develop a list of at least 5 credible search terms. At least 3 of them must include a Boolean operator (e.g., AND, OR, NOT). Term #1: Biomechanics Term #2: Wearable technologies suitable for healthcare Term #3 with Boolean: Biomechanics and healthcare Term #4 with Boolean: Biomechanics and wearable technology Term #5 with Boolean: Wearable Blood Pressure Monitors Part Two: Finding Sources Find at least 5 credible sources that you will look up. All 5 sources must be a magazine, newspaper, or journal article from a Bierce Library academic database (e.g., Academic Search Complete, LexisNexis Academic, Newspaper Source, Article First). As an alternative to typing all the information below, you may print a copy of the database information page for each source. That way, you’ll have the information necessary to look up and read each source (which you’ll do in the follow-up lesson to this assignment). Source #1 (Article) Name of Database: The University of Akron Libraries Catalog Name of Author(s): Kharmanda, Ghias, El Hami, Abdelkhalak Title of Article or Book Chapter: Biomechanics : optimization, uncertainties and reliability Title of Book, Journal, Magazine, or Newspaper: Reliability of multiphysical systems set; volume 5 Publication Date: 2017 Volume and Issue Numbers: Volume 5 DOI Number: 10.1002/9781119379126 Key Words Used to Find This Source: Biomechanics Briefly explain why you chose this source: This source has a lot of information on Biomechanics. Source #2 (Article) Name of Database: Directory of Open Access Journals Name of Author(s): Amir Mehmood, Adnan Nadeem, Kashif Rizwan, Nadeem Mahmood, Ahmad Waqas Title of Article or Book Chapter: A Study of Wearable Bio-Sensor Technologies and Applications in Healthcare Title of Book, Journal, Magazine, or Newspaper: Sukkur IBA Journal of Computing and Mathematical Sciences, Publication Date: 2017 Volume and Issue Numbers: Vol 1, Iss 1, Pp 67-77 DOI Number: 10.30537/sjcms.v1i1.9 Key Words Used to Find This Source: Wearable technologies suitable for healthcare Briefly explain why you chose this source: The article clearly explains the use of wearable sensors in healthcare. Source #3 (Article) Name of Database: Science Citation Index Name of Author(s): Enix, Dennis E., Mayer, John M. Title of Article: Sacroiliac Joint Hypermobility Biomechanics and What it Means for Health Care Providers and Patients Title of Journal, Magazine, or Newspaper: PM&R, 11, S32–S39 Publication Date: AUG 2019, Volume and Issue Numbers: Supplement: 1 DOI Number: 10.1002/pmrj.12176 Key Words Used to Find This Source: Biomechanics and healthcare Briefly explain why you chose this source: This source gives a detailed explanation of the application of Biomechanics in healthcare. Source #4 (Article) Name of Database: IEEE Xplore Digital Library Name of Author(s): Veltink, P.H., De Rossi, D. Title of Article: Wearable technology for biomechanics: e-textile or micromechanical sensors? [Conversations in BME] Title of Journal, Magazine, or Newspaper: IEEE Engineering in Medicine and Biology Magazine Publication Date: 2010 Volume and Issue Numbers: 29(3):37-43 DOI Number: 10.1109/MEMB.2010.936555 Key Words Used to Find This Source: Biomechanics and wearable technology Briefly explain why you chose this source: This article discusses the relationship between wearable technology and biomechanics. Source #5 (Article) Name of Database: IEEE Xplore Digital Library Name of Author(s): Narasimhan, Ravi, Parlikar, Tushar, Verghesel, George, McConnell, Michael V. Title of Article: Finger-Wearable Blood Pressure Monitor Title of Journal, Magazine, or Newspaper: 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) Publication Date: 2018 Volume and Issue Numbers: 3792-3795 DOI Number: 10.1109/EMBC.2018.8513065 Key Words Used to Find This Source: Wearable Blood Pressure Monitors Briefly explain why you chose this source: This article explores the finger wearable blood pressure measurement device to assist in frequent daytime and night time monitoring. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Healthcare Promotion Discussion Healthcare Promotion Discussion The focus for discussion board this week is the State of the Science Quality Improvement Paper which is due in two parts, Week 4 and Week 6. The focus of the State of the Science (SOS) paper will be a quality improvement topic. Healthcare Promotion Discussion Focus for this discussion board: Quality improvement questions, related theories and completion of the Johns Hopkins PICO Development document. ** NOTE: Please Note: In the Week 2 Canvas readings you will read about PICO development. For this course you are not required to write your own PICO question. ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Activity Learning Outcomes Through this assignment, the student will demonstrate the ability to: Develop knowledge related to research and evidence-based practice as a basis for designing and critiquing research studies (CO 4). Analyze research findings and evidence-based practice to advanced holistic nursing care initiatives that promotes positive healthcare outcomes (CO 5) Due Date: Initial prompt due by Wednesday, 11:59 PM MT of week 2 Two peer posts due by Sunday 11:59 PM MT of week 2 Response to any faculty comments or questions by Sunday 11:59 PM MT of week 2. Peer posts should be made at a minimum of 2 separate days of the module/week. A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, regardless of the number of days late. Nothing will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59pm MT. Points: 50 points Assignment Requirements In week 2 you will choose a quality improvement question from the list below for your State of the Science Quality Improvement (SOS QI) Paper. You should also review both Part 1 and Part 2 of the SOS paper assignment at this time. You will use the question you choose to develop all sections of the SOS QI Paper. NOTE: More than one student may choose the same question. However, work must be independent for all aspects of the SOS QI Paper. Using your chosen question complete the Johns Hopkins PICO Question Development Tool. When completing this tool you will need to investigate the significance of the question you chose and identify the elements of the PICO question, for example, P=population, what population does your question focus on? To complete the tool you will need do a review of the literature related to your selected question and theory. You will use this review for your paper and to complete the Johns Hopkins Question Development Tool. Upload your completed Johns Hopkins Question Development Tool to the assignment dropbox. You will receive 20 points for submitting this document to the assignment dropbox. In the discussion board provide your chosen research question and theory for your initial posting. This posting should also include a minimum of one paragraph which summarizes a scholarly article related to your question. Citation is required. Post your question and tool by Wednesday of the week 11:59 PM MT. Respond to a minimum of two (2) peers on two (2) separate days of the week. Responding to any comments or questions from your course faculty is also required for this week’s discussion board. Question List: Does an 8-week, one day a week, brown-bag lunch on LGBTQ health care for primary health care employees influence knowledge and attitudes of employees for LGBTQ patients? Theory Choices: Campinha-Bacote (Culture), Bias Care Model Will text messaging appointment reminders to patients’ age’s 30-70 decrease no-shows for appointments? Theory Choices: Theory of Planned Behavior, Deming Will text messaging patients ages 30-70 each September increase yearly influenza vaccine rates? Theory Choices: Avedis Donabedian, Behaviorist Theory Is there a change in screening outcomes for child maltreatment when implementing an embedded screening tool in the electronic health record? Theory Choices: Cognitive Learning Theory, Deming How does the use of in-home monitoring for CHF impact re-hospitalization rates? Theory Choices: Health Promotion, Relationship-Based Care How does the use of culturally congruent interprofessional education for newly diagnosed diabetic patients age 40-70 impact A1C levels and weight? Theory Choices: Cultural Competency, Interprofessional Documents/Tools for reference: Johns Hopkins Nursing Evidence-Based Doc 1 (Links to an external site.) Johns Hopkins PICO Development Tool (Links to an external site.) Johns Hopkins Action Planning Tool (Not required but good guide.) (Links to an external site.) Johns Hopkins Dissemination Tool Guide (Not required but good guide.) (Links to an external site.) Johns Hopkins Evidence Level and Quality of Research Guide (Not required but good guide for rating levels of evidence.) (Links to an external site.) Johns Hopkins Practice Evidence Translation Doc (Not required but good guide). (Links to an external site.) SOS Quality Improvement Paper Part 1 (See week 4 assignment) SOS Quality Improvement Paper Part 2 (See week 6 assignment) Johns Hopkins ROL Table Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Technology Strategy and Presentation Analysis ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Technology Strategy and Presentation Analysis Prepare a 2-4 pages report (12-point, double spaced, 1” margins T/B/L/R). Discuss key learning points for 2 guest speakers ( John Avery and Shash Hegde ) and explain how these fit (or not) with our Technology Strategy class so far. Use the class discussion slides ( Weeks 1-7) and incorporate topics discussed in class slides that would correlate with the guest speakers discussion. Technology Strategy and Presentation Analysis *I attached John Avery’s and Shash Hegde’s slides below in attachements. *I also posted the class slides ( Weeks 1-7) as well, so you can reference the class discussions and incorporate into the paper too. attachment_1 attachment_2 attachment_3 attachment_4 attachment_5 1/31/2019 Technology Strategy in an Exponential world Scheller MBA Jan 31st, 2019 John Avery Agenda 1. How did we get here? 2. Where are we now? 3. How can we leverage? 4. Case Study 2 1 1/31/2019 The importance of Frameworks Cognition is never extracted from the situation. You don’t make sense from the situation, you impose sense upon the situation. Confusion is the absence of the framework, and known confusion just means that you have framework. You can label it. We have a nice saying in Belfast, “If you are not confused, you don’t understand anything.” https://www.presencing.org/aboutus/theory-u/leadershipinterview/W_Brian_Arthur We don’t describe the world we see, we see the world we can describe. – Rene Descartes https://www.azquotes.com/quote/879510 3 How did we get here? Evangelos Simoudis Steve Blank 4 https://steveblank.com/2015/11/21/at-the-center-of-the-frenzy-innovation-outposts-and-the-evolution-of-corporate-rd/ 2 1/31/2019 Corporate Innovation Centers in Atlanta 5 Startup ecosystem in Atlanta 6 3 1/31/2019 New model emerging: Engage Partners 7 The magic of exponential curves! Exponential curves are amazing things Every bit of ground we’ve covered from the beginning of computing until now (about 50 years) We will cover again in THE NEXT 2 YEARS https://en.wikipedia.org/wiki/Moore%27s_law 2 4 1/31/2019 The magic of exponential curves! https://waitbutwhy.com/2015/01/artificial-intelligence-revolution-1.html New innovation pressure! Compute Storage ALL ON EXPONENTIAL CURVES Bandwidth 10 http://www2.deloitte.com/content/dam/Deloitte/es/Documents/sector-publico/Deloitte_ES_Sector-Publico_From-exponential-technologies-to-exponential-innovation.pdf 5 1/31/2019 Side Bar: Building height Steel I-Beam https://en.wikipedia.org/wiki/History_of_the_world%27s_tallest_buildings Side Bar: Jeddah Tower Jeddah Tower in Saudi Arabia 1km (3281 ft) 30,000 people https://en.wikipedia.org/wiki/Jeddah_Tower 6 1/31/2019 Urbanization Megatrends 3,000,000 people moving to cities EVERY WEEK 20,000 football fields paved over EVERY DAY By 2030 around 50 cities with more than 10 million (up from 29 today) In 1950 83 cities of more than 1 Million people Today there are 468 cities of more than 1 Million https://graylinegroup.com/urbanization-catalyst-overview/ The last man to know everything? Aristotle (384-322 BC) Roger Bacon (1214-1294) Leonardo da Vinci (1452-1519) 14 http://www.eoht.info/m/page/Last+person+to+know+everything 7 1/31/2019 Systems: Network of Networks 15 http://blogs.bmj.com/bmj-journals-development-blog/2010/11/19/the-semantic-web-whats-the-point/ The Toaster Project Building from scratch is nearly impossible today Thomas Thwaites 16 https://www.ted.com/talks/thomas_thwaites_how_i_built_a_toaster_from_scratch 8 1/31/2019 Is it inevitable? Kevin Kelly • • • What Technology Wants Out of Control The Inevitable http://longnow.org/seminars/02014/nov/12/technium-unbound/ 17 Is it inevitable? Technology Strategy and Presentation Analysis Elon Musk “People are mistaken when they think that technology just automatically improves. It does not automatically improve. It only improves if a lot of people work very hard to make it better.” https://www.inverse.com/article/31049-elon-musk-best-quotes-ted-2017 18 9 1/31/2019 Economic Models: GPUs https://www.techspot.com/article/650-history-of-the-gpu/ 19 Economic Models: GPUs 20 10 1/31/2019 What GPUs enable Just try every possibility 21 https://rse-lab.cs.washington.edu/projects/mcl/ What GPUs enable Just try every possibility No if/then logic Just data 22 http://www.rsipvision.com/exploring-deep-learning/ 11 1/31/2019 Quick sidebar: What comes next? What comes after Deep Learning? 23 https://blog.piekniewski.info/2018/05/28/ai-winter-is-well-on-its-way/ Quick sidebar: What comes next? What comes after Deep Learning? Might there be a higher-order way to capture knowledge than correlation? 24 https://www.amazon.com/Book-Why-Science-CauseEffect/dp/046509760X/ref=sr_1_1?ie=UTF8&qid=1527657537&sr=81&keywords=the+book+of+why 12 1/31/2019 Quick sidebar: What comes next? Are we entering the age of Creatives rather than STEM? 25 So what does this mean for innovation? 26 13 1/31/2019 So what does this mean for innovation? 27 Correct? “The electric light did not come from the continuous improvement of candles.” – Oren Harari 28 14 1/31/2019 Take away: leverage the i-beams 1 2 3 Primary long running economic driver (PC Gaming) Drives enabling technology (GPUs) Enables new economic drivers (AI) Becomes an I-Beam 29 Enables new economic drivers (Bitcoin) Enables new economic drivers (AVs) What are today’s i-beams? Compute PLATFORMS: Storage Bandwidth AWS, Google Cloud, Azure AI platforms (Siri, Alexa, Google, Watson,…) Robotics (ROS, r-pi, …) Machine vision (CNTK, Tensorflow, OpenCV, …etc) … 30 15 1/31/2019 What are today’s i-beams? Andrew Ng: Artificial Intelligence is the New Electricity 31 https://www.youtube.com/watch?v=21EiKfQYZXc The Future: what are tomorrow’s i-beams Is it possible to ‘will’ i-beams into existence? 32 16 1/31/2019 The Future: what are tomorrow’s i-beams Elements: 1. Lot’s of people working very hard for a long time 2. Lot’s of up front investment capital 3. An economic driver to make revenue as you go (today) 4. A BIG VISION 33 Explosion in connected cars “ ” Over 380 million connected cars will be on the road by 2021 34 http://www.businessinsider.com/connected-car-forecasts-top-manufacturers-leading-car-makers-2015-3 17 1/31/2019 Explosion in data (just from connected cars) 2 1 Https://qz.Com/344466/connected-cars-will-send-25-gigabytes-of-data-to-the-cloud-every-hour/ 35 Https://www.Networkworld.Com/article/3147892/internet/one-autonomous-car-will-use-4000-gb-of-dataday.Html Http://www.Revdapp.Com/2017/02/04/5-things-you-must-know-about-my-car-my-data/ 3 6 Explosion in data (just from connected cars) 36 http://www.businessinsider.com/internet-of-things-connected-transportation-2016-10 18 1/31/2019 Hypothetical case study Let’s put a million people on mars (just hypothetically) SpaceX – Technology Strategy and Presentation Analysis Rocket Company – re-supply space station – launching satellites Starlink – Satellite communication company – global high speed internet today SolarCity – Solar power company – supplying distributed sustainable energy today The Boring Company – tunneling company – solving today’s traffic problems Hyperloop – tunnel transportation company – solving rapid mobilization problems today 37 38 19 1/31/2019 Hypothetical case study 1.Create a low volume car, which would necessarily be expensive 2.Use that money to develop a medium volume car at a lower price 3.Use that money to create an affordable, high volume car 4.Create stunning solar roofs with seamlessly integrated battery storage 5.Expand the electric vehicle product line to address all major segments 6.Develop a self-driving capability that is 10X safer than manual via massive fleet learning “This is part of Musk’s overall strategy that you see throughout his companies: build something really helpful to use now that finances the crazy stuff of the future.” 7.Enable your car to make money for you when you aren’t using it https://www.cbinsights.com/research/report/elon-musk-companies-disruption/?utm_source=CB+Insights+Newsletter&utm_campaign=4e69c97fdf39 ThursNL_01_18_2018&utm_medium=email&utm_term=0_9dc0513989-4e69c97fdf-89727953 Summary Set big long range goals trusting in the exponential curve Deliver value today (and every day) till you get there Leverage cross-value from today’s technologies whenever possible 40 20 “A computer on every desk and in every home.” Possible Disruptors? “You join Microsoft, not to be cool, but to make others cool.” Be Bold. And be right. Bold Moves ? Release Office on iOS ? Write off Nokia, kill Windows Phone ? Fire leadership. Fire 1000’s of employees. ? Reorg Sales, Engineering, Windows ? Revamp culture, mission, strategy ? Buy LinkedIn ? Embrace Open Source ? Buy Github The Platform Company https://stratechery.com/2018/the-bill-gates-line/ “A platform is when the economic value of everybody that uses it, exceeds the value of the company that creates it.” Platform https://stratechery.com/2018/the-bill-gates-line/ Apple https://stratechery.com/2018/the-bill-gates-line/ Aggregators Azure Timeline 2006 2010 2011 2014 2018 AWS launches focused on compute and storage Windows Azure and SQL Azure released Google Cloud Platform initial release ‘Windows Azure’ rebranded to ‘Microsoft Azure’ Linux dominates Azure. Microsoft acquires GitHub Follow the $$$ Communities >95% of Fortune 500 use Microsoft Azure Azure services Azure DevOps Azure data services Azure Active Directory Developer Platform DevOps Data Platform Identity Azure DevOps SQL Server, MySQL, PostgreSQL, NoSQL Azure Stack Active Directory Azure security & management Security & Management Azure security & management Technology Strategy and Presentation Analysis YOUR DATA ESTATE SQL Server HYBRID Easiest lift and shift with no code changes Azure Data Services Data Estate : Building blocks Azure Data Services SQL Server The Azure Data Landscape AZURE DATA FACTORY AZURE IMPORT EXPORT SERVICE AZURE CLI AZURE SDK AZURE SQL DB AZURE STORAGE AZURE DATA LAKE STORE BLOBS AZURE IOT HUB AZURE ANALYSIS SERVICES AZURE SQL DATA WAREHOUSE AZURE COSMOS DB AZURE DATA LAKE ANALYTICS AZURE HDINSIGHT AZURE STREAM ANALYTICS AZURE HDINSIGHT AZURE DATABRICKS AZURE ML ML SERVER POWER BI AZURE DATABRICKS AZURE EVENT HUBS AZURE SEARCH KAFKA ON AZURE HDINSIGHT AZURE EXPRESSROUTE AZURE ACTIVE DIRECTORY AZURE DATA CATALOG AZURE NETWORK SECURITY GROUPS AZURE KEY MANAGEMENT SERVICE AZURE DATABRICKS OPERATIONS MANAGEMENT SUITE BOT SERVICE COGNITIVE SERVICES AZURE FUNCTIONS VISUAL STUDIO The Azure Data Landscape AZURE DATA FACTORY AZURE IMPORT EXPORT SERVICE AZURE CLI AZURE SDK Data Warehouse Operational Data Stores Batch Data Movement AZURE SQL DB AZURE STORAGE AZURE DATA LAKE STORE BLOBS Event Ingestion AZURE IOT HUB AZURE EVENT HUBS Search & AZUREDiscovery SEARCH AZURE DATA CATALOG KAFKA ON AZURE HDINSIGHT AZURE ANALYSIS SERVICES AZURE SQL DATA WAREHOUSE AZURE COSMOS DB Storage BI Machine Learning Big Data Processing AZURE DATA LAKE ANALYTICS AZURE HDINSIGHT AZURE DATABRICKS AZURE ML Event Processing AZURE STREAM ANALYTICS AZURE HDINSIGHT POWER BI ML SERVER AZURE DATABRICKS AI AZURE DATABRICKS BOT SERVICE COGNITIVE SERVICES Other: Networking, Security, Monitoring, Serverless, DevOps AZURE EXPRESSROUTE AZURE ACTIVE DIRECTORY AZURE NETWORK SECURITY GROUPS AZURE KEY MANAGEMENT SERVICE OPERATIONS MANAGEMENT SUITE AZURE FUNCTIONS VISUAL STUDIO AI Data Estate A ZURE AI AI apps & agents Knowledge mining Machine learning Cognitive Services Cognitive Search Databricks Bot Service Machine Learning AI Infrastructure Other AI investments ? Cognitive Search ? Automated ML: Azure ML Azure Machine Learning Automated machine learning How much is this car worth? Model creation is typically a time consuming process Which features? Which algorithm? Mileage Mileage Gradient Boosted Gradient Boosted Parameter 1 Criterion Condition Nearest Neighbors Parameter 2 Loss Car brand brand SVM Parameter Min Samples 3 Split Year of of make make Bayesian Regression Parameter Min Samples 4 Leaf Regulations LGBM … Others … … Technology Strategy and Presentation Analysis Which parameters? Model Model creation is typically a time consuming process Which features? Which algorithm? Which parameters? Mileage Mileage Gradient Boosted Gradient Boosted Criterion N Neighbors Condition Condition Nearest Neighbors Nearest Neighbors Loss Weights Car brand brand SVM Min Samples Split Metric Year of of make make Bayesian Regression Min Samples Leaf P Regulations LGBM Others … … Iterate Model Model creation is typically a time consuming process Which features? Which algorithm? Iterate Which parameters? Azure Machine Learning accelerates model development with automated machine learning Input Intelligently test multiple models in parallel Output Optimized model Enter data Define goals Apply constraints Other AI investments ? Cognitive Search ? Automated ML: Azure ML ? Simulation: Airsim Other AI investments ? Cognitive Search ? Automated ML: Azure ML ? Simulation: Airsim ? Machine Teaching: Bons.ai ? Edge and containers + Cognitive Services ? Mixed Reality+AI ? Full duplex with Xiaoice etc. Thank you! Q&A Competitive strategy based on open source software Google’s Android Technology Strategy Week 7 Marco Ceccagnoli TO BE INNOVATIVE A FIRM CAN: INVEST IN R&D IN-HOUSE INTRODUCE NEW OR IMPROVED PRODUCTS AND PROCESSES PROFIT USING OTHER STRATEGIES PATENT PRODUCT MARKET COMPETITION BUY / PARTNER (IN-LICENSE, R&D JV, M&A, CVC OR OTHER TECHNOLOGY TRANSACTIONS) (TRADE SECRECY, LEAD TIMES, ETC.) OTHER STRATEGIES (PREEMPT, FREEDOM OF ACTION, NEGOTIATE/CROSS-LICENSE, “STICK” LICENSING…) MARKETS FOR TECHNOLOGY AND OTHER INTANGIBLE ASSETS SELL TECHNOLOGY (“CARROT” LICENSING) 1 Alternative appropriability strategies to profit from network effects (open vs close) ? Different pricing strategy relative to the underlying platform ? Typically better to charge one side and “subsidize” the other ? Microsoft strategy as proprietary platform owner: ? Profit from installed base of users charging license fee from a closed platform, subsidize ISVs ? Companies supporting Linux: ? ISV’s and OSVs using Linux: 1) profit from service, support, apps (mixed model); 2)Technology Strategy and Presentation Analysis maintain/subsidize/contribute to an open and shared platform Open vs close: Value creation and value captured When creating a new network, we can choose between an open vs. proprietary standard (or a hybrid) Share appropriated Proprietary Value appropriated Open Total value created 2 But a small share of a growing pie due to network effects and other related drivers….. Share appropriated Microsoft charging lower prices initially; WTP for Windows growing due to increasing returns Value appropri ated Total value created But a small share of a growing pie due to network effects and other related drivers….. Microsoft Share appropriated lowering prices again as Linux expands Linux ecosystem players share value created Total value created 3 Who profits from Linux, or OSS in general? ? Service, support, ISVs, OSVs… more so in business segment From MacOS to Windows, Apple lost the OS standard war in the 1990s for PCs Integrated business model, did not benefit of indirect network effect; weak incentives to upgrade OS 4 • …But got it right with its first successful diversification in digital music players in the early 2000s Indirect network effects got Apple out of trouble starting with the iPod Apple iPod Installed Base Demand for iPod + iTunes Music Store songs Value of iPod Positive feedback effect 5 Leveraged business model in mobile phones — iOS OS Installed Base Demand for OS + Apps Value of OS Network effects + Economies of Scale + Switching Costs contribute to lock-in users Android ? What is Android? OS license? ? How was Android able to challenge iOS? ? Key drivers of success? ? What makes Android attractive for App Developers? 6 Android platform architecture Kernel released as GPL, the rest using Apache https://developer.android.com/guide/platform/ The GPL family of licenses (Linux kernel) ? Basic rights under the GPL – access to source code, right to make derivative works ? “Copyleft” – cannot take modifications private 7 The Apache license (part of Android) ? Same basic rights as GPL – i.e. access to source code, right to make derivative works ? No copyleft provisions, i.e. licensees can take software licensed under Apache private ? Can re-release software under a different license ? Allowed OEM to differentiate/customize the OS How does Google profit from Android? 8 Potential problems for Android? 9 … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Case Study on Center for Practical Bioethics Case Study on Center for Practical Bioethics Assignment Content Read the following case study from the Center for Practical Bioethics : Walking the Tightrope https://practicalbioethics.org/case-studies-walking-the-tightrope.html Complete the Questions for Discussion following the case. Your answers may be brief. ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Write an 875-to-1,050-word paper in which you: Summarize the case, explaining the legal and ethical aspects of it. Research and explain any laws that pertain to the situation. Define and explain the ethical principles that pertain to this case. Determine if the legal and ethical responsibilities are in alignment with each other. Explain how you would recommend this care team resolve the situation by answering the following questions: What specific details of the case require resolution? What specific actions should the organization or nurse take to ensure an appropriate outcome? What resources and dependencies exist for your recommendation? Cite at least 3 peer-reviewed sources published within the last 5 years. Note: At least 1 of the sources should provide evidence for your resolution recommendation or plan of action. Include an APA-formatted reference list. Answer preview to read the following case study from the Center for Practical Bioethics You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Risk factors in acquisitions Essay Risk factors in acquisitions Essay Guided Response: Review the posts from your classmates and respond to at least two. Compare and contrast the points you and your classmates made regarding risk factors in acquisitions. Each response should have a minimum of 100 words. ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Kathleen Carlson Mar 4, 2021 at 2:55 PM The concept of risk can be described as “…the variability of possible outcomes from a given investment ” (Block et al., 2019). With big investments, large amounts of money are used. When projects are started, risks to them are unexpected outcomes. Our text used the example of Apache Corp., which helped us see that risk is not always straightforward and talking about a dollar amount. “An even greater threat to Apache Corp. is the proverbial ‘dry hole,’ in which millions of dollars are spent only to discover that there is no oil to be found (Block et al., 2019). The disaster of the “dry hole” for Apache is an environmental risk, which is one they unfortunately need to take. Risk levels can be measured by utilizing the following methods: probability distribution, standard deviation, coefficient of variation or by examining betas. “The smaller the standard deviation, the higher the probability distribution and accordingly the lower the riskiness of the project” (Tanwar, 2015). Utilizing these methods can help a company compare their options and make the best decision. Risk factors in acquisitions Essay When companies are facing acquisitions, they should consider unexpected costs associated with the deal, “for example, employee training, rebranding, and new salaries” (Lewis, 2021). They should also strategize in case of unforeseen market disruptions. IN the Deere/Wirtgen acquisition, the American and German-based companies, respectively, face risks of negative cultural effects and the possible lack of communication due to a language barrier. The companies should be mindful of the importance of harmonizing the two different cultures and keeping communication open. If the research and planning are not done ahead of time, the companies risk seeing their full potential. References: Block, S. B., Hirt, G. A., & Danielson, B. R. (2019). Foundations of financial management (17th ed.). Retrieved from https://www.vitalsource.com/ . Lewis, M. (2021, February 9). 10 Most Common M&A Risks and Ways to Mitigate Them. RSS. https://dealroom.net/blog/mergers-and-acquisitions-transaction-risks-and-ways-to-mitigate-them . Tanwar, M. (2015, December 21). Top 3 Methods for Measurement of Risk (With Formula). Your Article Library. https://www.yourarticlelibrary.com/accounting/capital-budgeting/risk-and-uncertainty/top-3-methods-for-measurement-of-risk-with-formula/71861 . Answer preview to compare and contrast the points you and your classmates made regarding risk factors in acquisitions. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Driving Pressure value ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Driving Pressure value Fully explain the step-by-step process of how to obtain an accurate Driving Pressure value on a mechanically ventilated patient? Driving Pressure value What ?P values should be targeted for ARDS patients and why? Fully explain the Open Lung Approach in regards to managing mechanically ventilated ARDS patients. Create your own question based upon the readings that you would like to pose to your fellow classmates which demonstrates you did more than simply skim the articles provided. attachment_1 attachment_2 Open Lung Approach for the Acute Respiratory Distress Syndrome: A Pilot, Randomized Controlled Trial* Robert M. Kacmarek, PhD, RRT, FCCM1,2; Jesús Villar, MD, PhD, FCCM3,4; Demet Sulemanji, MD1,2; Raquel Montiel, MD5; Carlos Ferrando, MD, PhD6; Jesús Blanco, MD, PhD3,7; Younsuck Koh, MD, PhD, FCCM8; Juan Alfonso Soler, MD, PhD9; Domingo Martínez, MD10; Marianela Hernández, MD11; Mauro Tucci, MD, PhD12; Joao Batista Borges, MD, PhD12; Santiago Lubillo, MD, PhD5; Arnoldo Santos, MD, PhD13; Juan B. Araujo, MD14; Marcelo B. P. Amato, MD, PhD12; Fernando Suárez-Sipmann, MD, PhD3,13; the Open Lung Approach Network *See also p. 237. ???1Department of Respiratory Care, Massachusetts General Hospital, Boston, MA. ????????2Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. ????????3CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain. ????????4Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain. ????????5Intensive Care Unit, Hospital Universitario NS de Candelaria, Santa Cruz de Tenerife, Spain. ????????6Department of Anesthesiology, Hospital Clinico de Valencia, Valencia, Spain. ????????7Intensive Care Unit, Hospital Universitario Río Hortega, Valladolid, Spain. ????????8Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. ????????9Intensive Care Unit, Hospital Universitario Morales Meseguer, Murcia, Spain. 10 Intensive Care Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. 11 Intensive Care Unit, Hospital Universitario de Txagorritxu, Vitoria, Spain. 12 Respiratory ICU, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil. 13 Intensive Care Unit, Hospital Universitario Fundacion Jiménez Díaz, Madrid, Spain. 14 Intensive Care Unit, Hospital Virgen de La Luz, Cuenca, Spain. Drs. Amato and Suárez-Sipmann contributed equally as senior authors. The complete list of investigators of the Open Lung Approach Network is provided in Appendix 1. Registered at ClinicalTrials.gov NCT00431158. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal). Copyright © 2015 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. DOI: 10.1097/CCM.0000000000001383 32 www.ccmjournal.org Dr. Kacmarek is a consultant for Covidien and Orange Med, has received research grants from Covidien and Venner Medical, and had airfare and expenses to study meetings paid by the Research Unit, Hospital Dr. Negrin Las Palmas de Gran Canaria, Spain. Dr. Villar received funding from Maquet (grant for partially supporting the study), from the Instituto de Salud Carlos III, Spain (PI07/0113), and received support from Asociación Científica Pulmón y Ventilación Mecánica (Spain) for supporting traveling expenses and for coordinating study-related activities among Spanish centers. Driving Pressure value Dr. Amato received support for article research from São Paulo, State Research Foundation and Brazilian Council for Scientific and Technological Development (Brazil). He received support for travel from Maquet, consulted for Covidien (mechanical ventilation), and received grant support from Dixtal LTDA (electrical impedance tomography). Dr. Suarez-Sipmann consulted for Maquet Critical Care. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: [email protected] Objective: The open lung approach is a mechanical ventilation strategy involving lung recruitment and a decremental positive end-expiratory pressure trial. We compared the Acute Respiratory Distress Syndrome network protocol using low levels of positive end-expiratory pressure with open lung approach resulting in moderate to high levels of positive end-expiratory pressure for the management of established moderate/severe acute respiratory distress syndrome. Design: A prospective, multicenter, pilot, randomized controlled trial. Setting: A network of 20 multidisciplinary ICUs. Patients: Patients meeting the American-European Consensus Conference definition for acute respiratory distress syndrome were considered for the study. Interventions: At 12-36 hours after acute respiratory distress syndrome onset, patients were assessed under standardized ventilator settings (Fio2?0.5, positive end-expiratory pressure ?10 cm H2O). If Pao2/Fio2 ratio remained less than or equal to 200 mm Hg, patients were randomized to open lung approach or Acute Respiratory Distress Syndrome network protocol. All January 2016 • Volume 44 • Number 1 Copyright © 2015 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Feature Articles patients were ventilated with a tidal volume of 4 to 8 ml/kg predicted body weight. Measurements and Main Results: From 1,874 screened patients with acute respiratory distress syndrome, 200 were randomized: 99 to open lung approach and 101 to Acute Respiratory Distress Syndrome network protocol. Main outcome measures were 60-day and ICU mortalities, and ventilator-free days. Mortality at day-60 (29% open lung approach vs. 33% Acute Respiratory Distress Syndrome Network protocol, p = 0.18, log rank test), ICU mortality (25% open lung approach vs. 30% Acute Respiratory Distress Syndrome network protocol, p = 0.53 Fisher’s exact test), and ventilator-free days (8 [0-20] open lung approach vs. 7 [0-20] d Acute Respiratory Distress Syndrome network protocol, p = 0.53 Wilcoxon rank test) were not significantly different. Airway driving pressure (plateau pressure – positive end-expiratory pressure) and Pao2/Fio2 improved significantly at 24, 48 and 72 hours in patients in open lung approach compared with patients in Acute Respiratory Distress Syndrome network protocol. Barotrauma rate was similar in both groups. Conclusions: In patients with established acute respiratory distress syndrome, open lung approach improved oxygenation and driving pressure, without detrimental effects on mortality, ventilator-free days, or barotrauma. Driving Pressure value This pilot study supports the need for a large, multicenter trial using recruitment maneuvers and a decremental positive end-expiratory pressure trial in persistent acute respiratory distress syndrome. (Crit Care Med 2016; 44:32–42) Key Words: acute respiratory distress syndrome; barotrauma; decremental positive end-expiratory pressure trial; mechanical ventilation; positive end-expiratory pressure; recruitment maneuver; ventilator-free days T he approach to ventilatory support affects outcome in the acute respiratory distress syndrome (ARDS) (1–5). The ARDS network (ARDSnet) (1) established the benefit on mortality of using small tidal volume (VT) in patients with ARDS. However, substantial controversy still exists over the application of positive end-expiratory pressure (PEEP) (3–9) and the use of lung recruitment (10, 11). There are 6 randomized controlled trials examining the effects of PEEP in patients with ARDS (3–8). However, the results of these trials vary greatly. In the majority of these studies, patients did not have established ARDS, defined as patients who on standard ventilator settings 24 hours after ARDS diagnosis still had a Pao2/Fio2 less than or equal to 200 mm Hg. Patients meeting the American-European Consensus Conference (AECC) criteria for ARDS whose Pao2/Fio2 is more than 200 mm Hg on standardized ventilator settings have an ICU mortality of about 12–23%, whereas those with a Pao2/ Fio2 up to 200 mm Hg on standardized ventilator settings have a mortality of about 45–55% (12–14). These figures are consistent with recent epidemiologic data (15–17). All of the studies with a positive effect on outcome also established a VT and plateau and driving pressure difference Critical Care Medicine between groups (3, 5, 9), applied PEEP based on the patient’s lung mechanics, and enrolled patients meeting the AECC criteria for ARDS (18). Speculation regarding the lack of benefit from higher PEEP in the Assessment of Low tidal Volume and elevated End-expiratory volume to Obviate Lung Injury (4), Lung Open Ventilation (6), and Express (7) trials is that it is not known how many of these patients had established ARDS and if those without established ARDS were harmed by inadvertently high PEEP levels. Appropriate patient selection is a critical aspect of enrollment criteria since it has been demonstrated that response to standardized ventilator settings identifies patients with established ARDS and predicts mortality (12–15). Several authors (19–24) have argued that the most appropriate method for setting PEEP is to recruit the lung and then to determine the least PEEP necessary to maintain the lung open by a decremental PEEP trial (open lung approach, OLA). Theoretically, this temporal sequence insures ventilation on the deflation curve of the respiratory system’s pressure-volume curve, improves lung mechanics, and decreases cyclic lung stress by avoiding derecruitment (20–24). Driving Pressure value Since hypoxemia in ARDS is primarily a result of intrapulmonary shunt, failure to recruit lung not only allows shunting to persist but may also result in overdistension of open alveoli (20). Recent data indicate that lung recruitment maneuvers are capable of safely recruiting lung volume and improving gas exchange and lung mechanics (11, 20–24). Based on these data, we hypothesized that the use of lung recruitment maneuvers and a decremental PEEP trial (individualized moderate to high PEEP) would result in a lower mortality than the original ARDSnet protocol (lower levels of PEEP) (1). Our goal was to compare 60-day all-cause mortality (patients were followed for 60 d following randomization) in patients with established ARDS managed with the OLA lung protective ventilation strategy compared with the ARDSnet protocol. METHODS This multicenter, pilot, randomized, controlled trial was performed in 20 ICUs (Appendix 1). The study was approved by the institutional review boards of all participating hospitals. All patients and/ or family members provided written informed consent. Patients All adult patients (> 18 yr) admitted to participating ICUs and meeting AECC criteria for ARDS (12) who were on mechanical ventilation for less than 96 hours were considered for enrollment. Inclusion criteria were Pao2/Fio2 up to 200 mm Hg, acute onset, bilateral infiltrates on anterior-posterior chest radiograph, no (clinical, echocardiographic, or hemodynamic) evidence of left heart failure, recruited into the trial within 48 hours of meeting above criteria. Exclusion criteria were age less than 18 years; weight less than 35 kg predicted body weight (PBW); body mass index greater than 50; intubation as a result of an acute exacerbation of chronic pulmonary disease: chronic obstructive pulmonary disease, asthma, cystic fibrosis, etc; acute brain injury or elevated intracranial pressure (> 18 mm Hg); immunosuppressed patients receiving chemotherapy or radiation therapy (< 2 mo after chemotherapy or www.ccmjournal.org Copyright © 2015 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. 33 Kacmarek et al radiation therapy); and severe cardiac disease: New York Heart Association class 3 or 4 or acute coronary syndrome or persistent ventricular tachyarrhythmias. See online data supplement (Supplemental Digital Content 1, http://links.lww.com/CCM/ B466) for additional details. During the subsequent 12–36 hours after enrollment, patients were ventilated according to the ARDSnet protocol (Table 1) (1) and then reassessed (qualifying blood gas) on specific ventilator settings for established moderate/severe ARDS (25). Baseline arterial blood gases were then obtained on 100% oxygen. Subsequently, patients’ were randomized to ARDSnet or OLA. Table 1. Protocol ARDSnet. ARDSnet patients were managed throughout the entire study by the original ARDSnet protocol (1) (Table 1) (online data supplement, Supplemental Digital Content 1, http://links.lww.com/CCM/B466). In both groups, permissive hypercapnia was allowed and target VT referred to a volume calculated based on the patients’ PBW (26). All patients were managed in the supine position, although head of bed elevation was not specified. OLA. A lung recruitment maneuver followed by a decremental PEEP trial was performed before establishing initial Mechanical Ventilation Protocol Standard ventilation settings All enrolled patients ?Ventilator mode VC ?VT range 4–8 mL/kg PBW ?Respiratory rate Adjusted to maintain Paco2 between 35 and 60 mm Hg ?PEEP Set using Fio2-PEEP table ?Driving Pressure value Fio2 Set using Fio2-PEEP table ?Recruitment maneuvers No ?Inspiratory time ?1s ?Plateau pressure goal ? 30 cm H2O Specific ventilation settings All enrolled patients ?Ventilator mode VC ?VT ? 6 mL/kg PBW ?Respiratory rate Adjusted to maintain Paco2 between 35 and 60 mm Hg ?PEEP ? 10 cm H2O ?Fio2 ? 0.5 ?Recruitment maneuvers No ?Inspiratory time ?1s ?Plateau pressure goal ? 30 cm H2O After randomization settings Open lung approach Acute Respiratory Distress Syndrome network protocol ?Ventilator mode PC VC ?VT target 6 mL/kg PBW 6 mL/kg PBW ?VT range 4–8 mL/kg PBW 4–8 mL/kg PBW ?Respiratory rate ? 35 breaths/min ? 35 breaths/min ?PEEP Set using decremental PEEP trial Set using Fio2-PEEP table ?Recruitment maneuvers Yes No ?Inspiration: expiration ratio 1:1–1:3 1:1–1:3 ?Arterial pH goal ? 7.30 and ? 7.45 ? 7.30 and ? 7.45 ?Plateau pressure goal ? 30 cm H2O ? 30 cm H2O ?Partial pressure of arterial oxygen goal 55–80 mm Hg 55–80 mm Hg ?Oxygen saturation by pulse oximetry 88–95% 88–95% VC = volume control, VT = tidal volume, PBW = predicted body weight, PEEP = positive end-expiratory pressure, PC = pressure control. 34 www.ccmjournal.org January 2016 • Volume 44 • Number 1 Copyright © 2015 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Feature Articles ventilator settings (19–24). After ensuring hemodynamic stability, a lung recruitment maneuver was performed using pressure control ventilation to a peak pressure between 50 and 60 cm H2O and PEEP 35–45 cm H2O depending on patient’s response (22). Patients were sedated to apnea before the recruitment maneuver and neuromuscular-blocking agents were used if necessary to insure patient safety during the maneuver by avoiding large increases in transpulmonary pressure. For details, see online data supplement (Supplemental Digital Content 1, http://links.lww.com/CCM/B466). For the decremental PEEP trial, mechanical ventilation mode was volume assist/control, VT 4–6 mL/kg, PEEP 25 cm H2O, and ventilatory rate set at the level prior to the recruitment maneuver. After a 3-minute stabilization period, dynamic compliance (VT divided by peak pressure – PEEP) was recorded. PEEP was then decreased in 2 cm H2O steps and compliance recorded after stabilization. Dynamic compliance was automatically calculated and displayed on the Servo-i ventilator with each breath (on a daily basis, static compliance was determined: VT divided by plateau pressure – PEEP). This process was continued until the PEEP level corresponding to the maximum compliance was identified. Once the maximum compliance PEEP was identified, the lung was again recruited and PEEP set at the maximum compliance PEEP + 3 cm H2O. Following the second recruitment maneuver, the mode was changed to pressure assist/control, maximum compliance PEEP + 3 cm H2O, pressure assist/control level set to establish a peak inspiratory pressure less than 30 cm H2O, VT 4–8 mL/kg. If VT was set less than 5 mL/kg PBW, plateau pressure was allowed to exceed 30 cm H2O. Finally, the Fio2 was reduced to the lowest level maintaining the target Pao2. For details, see online data supplement (Supplemental Digital Content 1, http://links.lww. com/CCM/B466). In addition, after PEEP was set, PEEP was not to be modified for 24 hours and then only when the Fio2 decreased to 0.40. When PEEP was decreased, it was decreased at a rate not to exceed 2 cm H2O every 8 hours; if the decrease in PEEP resulted in a loss of oxygenation or lung mechanics, PEEP was to be reestablished. Driving Pressure value of ventilation for OLA throughout the study followed the ARDSnet protocol. In both groups, patients were assessed daily for readiness for a spontaneous breathing trial based on the ARDSnet criteria (1) (for details, see online data supplement, Supplemental Digital Content 1, http://links.lww.com/CCM/B466). Those meeting criteria received a 30- to 60-minute spontaneous breathing trial. If the patients passed the trial, they were extubated, unless there was a specific reason not to extubate. Patients older than 65 years, hypercapnic (> 45 mm Hg after extubation), with an ineffective cough and excessive secretions, with more than one weaning failure, with more than one comorbid condition (any chronic organ failure), upper airway obstruction, or Acute Physiology and Chronic Health Evaluation (APACHE) II score greater than 12 on the day of extubation received noninvasive ventilation (bilevel positive airway pressure) for 24–48 hours until stable or requiring reintubation (for details, see online data supplement, Supplemental Digital Content 1, http://links. lww.com/CCM/B466). Critical Care Medicine Data Gathering Data were collected on day 0 (enrollment), day 1 (randomization), and days 2, 3, 4, 5, 6, 7, 10, 14, 21, 28, and every 7 days after randomization until extubation, including APACHE II (27), lung injury score, Simplified Acute Physiology Score (28), and Sequential Organ Failure Assessment (29) scores, and organ failures (30, 31). Data gathering after randomization included the highest and lowest value for each parameter within the specific 24-hour period. For details, see online data supplement (Supplemental Digital Content 1, http://links.lww.com/CCM/B466). The primary outcome was all-cause death at 60 days after randomization (patients were followed for 60 d). Secondary outcomes included ventilator-free days at day 28 (32), incidence of barotrauma, development of extrapulmonary organ failures, length of ICU and hospital stay, and ICU and hospital mortality. In addition, we compared PEEP, Fio2, driving pressure (plateau pressure minus PEEP), VT, respiratory rate, plateau pressure, gas exchange, number of organs failures, and APACHE II score between groups. Power Analysis/Study Design The power analysis was based on an expected 45% mortality in the ARDSnet group. This mortality was determined from the recent data on effect of standard ventilator setting trial conducted by the Spanish Hospitales Españoles para el estudio de la Lesión Pulmonar aguda network (5). In that study, patients with severe and persistent ARDS managed with a VT of 6–8 mL/kg PBW had a mortality of 45.5%. In the OLA group, a mortality of 33% was expected. This was based on the findings of the Spanish Acute Respiratory Insufficiency: España Study (14) Pflex trial in which the mortality in the Pflex group was 33%. Based on these data, it was expected that approximately 600 patients would need to be randomized into the 2 groups, ARDSnet protocol and OLA, with an ? of less than 0.05 and a ? of greater than 80%. Statistical Analysis … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Analysis of Toyotas TQM approach Model Analysis of Toyotas TQM approach Model Download the case study: https://www.researchgate.net/publication/317221833_Total_quality_management_and_business_excellence_The_best_practices_at_Toyota_motor_corporation After reading, write a 3 page analysis of Toyota’s TQM approach . Use Chapter three (3) as your foundational reading in analyzing their approach. Are there any familiar trends that you see in the case study in comparison to the reading? ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Answer preview to write a 3 page analysis of Toyota’s TQM approach You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. ADDITIONAL INSTRUCTIONS FOR THE CLASS Discussion Questions (DQ) Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. Weekly Participation Your initial responses to the mandatory DQ do not count toward participation and are graded separately. 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Treating Speech Language Pathologies Assignment Treating Speech Language Pathologies Assignment Written reflexion: After reading chapter 13 in our textbook, reflect on the role of a speech-language pathologist with clients who are diagnosed with disorders such as paradoxical vocal fold motion/vocal cord dysfunction, irritable larynx syndrome, and/or chronic refractory cough. Why and how do SLPs see/treat these patients? Please cite at least 2 scholarly research articles in addition to your textbook. When appropriate you should cite references in APA style, 6th edition. Use both in text citations and bibliography at the end of an entry. Your submission should be 2-3 pages double spaced. ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS attachment_1 attachment_2 Written Reflection #2 and #3 Rubric . Treating Speech Language Pathologies Assignment Please keep in mind that if you do not submit anything, you will receive a 0 for these assignments. Any submitted assignment will receive a minimum grade of 14 points out of 35 points possible. Treating Speech Language Pathologies Assignment Criteria Below Expectations Basic Proficient Exceeds Expectations Critical Thinking 4 Points Rudimentary and superficial; little consideration, analysis, or synthesis; little or no connections with any other material or off topic 6 Points Information is thin and common place; attempts made at consideration, analysis, or synthesis; connections are limited, vague generalities are made 8 Points Substantial information; evidence of consideration, analysis and synthesis; general connections are made, but are sometimes unclear or obvious 10 Points Rich in content; insightful considerations, analysis, and synthesis, with clear connections made to real-life situations or to previous content Personal Reflection and Creativity 4 Points Lack of connection to personal life or attempt to develop creative ideas 6 Points Little evidence of personal connection; connections need further explanation 8 Points Connects ideas and thoughts to personal life; evidence of personal connection to learning and community with creative ideas 10 Points Reflection is high quality, consisting of personal reflections that connect between real-life, learning, and course content Grammar, Style, and Structure 4 Points Obvious grammatical or stylistic errors; errors impact the structure and make content difficult to read 6 Points Obvious grammatical or stylistic errors; errors sometimes interfere with content 8 Points Few grammatical or stylistic error, minimal structure concerns 10 Points An occasional grammatical or stylistic error, no writing structure concerns References and Citations 2 Points Lacks in-text citations and reference section at the end. 3 Points Lacks in-text citations or reference section at the end. 4 Points Few errors in APA style in-text citations or references at the end. 5 Points Includes correct in-text citations as well as a reference section at the end in APA style – 6th edition. ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS CHAPTER 13- LARYNGEAL REFLEXES This chapter describes how the body uses sensory information to produce reflex actions, specifically in the larynx. A reflex is an involuntary, stereotypical motor (muscle) response that occurs from a defined stimulus (Pitts, 2014). By definition these actions can and do occur during sleep, while unconscious, and/or while anesthetized. The larynx is capable of a variety of reflexes due to the density and types of sensory receptors. Sensory Receptors The larynx is innervated by many types of sensory receptors also known as afferents. The criteria used to categorize sensory receptors are based upon: a) location of the nerve ending (terminal) in the tissue, b) stimulus response, and/or c) the elicited reflex response. Free Nerve Ending Receptors Free nerve endings are receptors located in the superficial layers of the skin and in deep tis- sue and visceral organs. There are two types of receptors: C fibers, which are unmyelinated, smaller in diameter and slower conducting (Figure 13–1), and Aä “a delta,” which are myelinated and have fast conductance velocity. These receptors respond to different types of stimuli, such as mechanical, chemical, pain (nociceptive) and temperature. Mechanoreceptors are stimulated by distention or deformation caused by vibration, touch and pressure. Chemoreceptors detect substances and chemicals via smell, taste, etc. Thermal receptors detect changes in temperature. Nociceptors are stimulated by tissue damage, or pain. Stimulation of laryngeal TRPV1 C-fibers by capsaicin triggers can trigger apnea (breath holding), bronchoconstriction (closing of the bronchi), and cough (Liu et al., 2015). One C fiber example is TRPV1 (transient receptor potential cation channel sub- family V member 1) which responds to capsaicin (main ingredient in chili peppers that serves as an airway irritant). TRPV1 is also classified as a thermal receptor, specifically to increases in temperature. When eaten, capsaicin stimulates TRPV1 producing a hot or burning sensation, classifying TRPV1 as a Figure 13–1. The left image depicts free nerve endings which are small and unmyelinated in the epidermis with the root in the dermis layer of skin. Epidermis is the outer layer of skin, dermis is the middle layer of skin, and hypodermis is the inner most layer of skin. The right image is a muscle spindle. The muscle spindle afferent are large Interarytenoid afferent nerve fibers that wrap around the center of the muscle spindle and synapse on the alpha motor neuron. As the muscle stretches/ contracts, the capsule round the muscle stretches/contracts with the muscle. This sends information to the brain about the length of the muscle. chemoreceptor. When capsaicin is in contact with skin, it elicits a burning sensation, classifying TRPV1 as a nociceptor as well. This burning sensation is identified as slow pain, which stimulates unmyelinated C fibers, and thus why it is called “hot sauce”! Cough can be stimulated by rapidly adapting receptors, RARs (Aä), and C-fibers in the laryngeal and tracheal mucosa that terminate on the second-order neurons in the nucleus tractus solitarius (NTS) and then project to the pontine and medullary respiratory neuron populations (Canning, 2008). TRPM8 (transient receptor potential cation channel mlastain-8) is expressed in both unmyelinated C-fibers and myelinated Aä rapid adapting receptors. It is a type of Ca2+ permanent, nonselective cation channel that is expressed at the terminals of laryngeal afferents. Menthol is a naturally occurring compound that gives substances a minty smell and flavor (used in gum, cough drops, cigarettes, etc.) that stimulates TRPM8 classifying it as a chemoreceptor. One of the major effects of menthol when applied to the skin or a mucosal surface is the cause of a sensation of coolness and stimulates and sensitizes sensory thermal cold fiber receptors. It is shown that menthol suppresses the enhanced laryngeal reflex activity and suppresses laryngeal C-fiber hypersensitivity to cigarette smoke (Liu et al., 2015). RARs are believed to induce cough via sensory pathway. C fibers, which central pathways inhibit cough, may stimulate cough peripherally by causing release of sensory neuropeptides that activate RARs (Dicpinigaitis, 2003). CHAPTER 13 Laryngeal Reflexes 427 Mechanoreceptors are Aä myelinated fibers, and either adapt slow (slowly adapting receptors, SAR) or fast (rapidly adapting receptors, RAR) to a repetitive mechanical stimulation. SARs fire when the stimulus is present, continuous, and RARs only fire at a rapid change. When the stimulus is continuous, the RARs rearrange their inner structure to adapt to the stimulus. These receptors lack the capacity to discriminate noxious (painful) stimuli and do not respond to chemical stimuli. Pulses of air to the hypopharyngeal and laryngeal mucosa, which is innervated by the internal branch of the superior laryngeal nerve, elicit laryngeal adductor reflex (LAR), or the closure of the glottis. This assesses laryngopharyngeal sensation used to assess dysphagia (Aviv et al., 2002). Intrafusal fibers are skeletal muscle fibers that serve as specialized sensory organs. They detect the amount and rate of change in length of a muscle. Extrafusal fibers are standard skeletal muscle fibers that are innervated by the alpha motor neuron. They generate tension by con- tracting and allow for skeletal movement. Treating Speech Language Pathologies Assignment Encapsulated Nerve Endings Muscles Spindles A muscle spindle (see Figure 13–1), com- prised of 8 to 10 intrafusal fibers arranged in parallel with extrafusal fibers, are attached to the origin and insertion tendons. Large Interarytenoid afferent nerve fibers are wrapped around the center of the muscle spindle, and synapse on the alpha motor neuron. The stretch of the muscle deforms the intrafusal fibers and initiates action potentials. The action potential is initiated by activating mechanical-gated ion channels in the afferent axons that are coiled around the muscle spindle. This action allows a muscle to be excited or inhibited by the muscle spindle. Thyroarytenoid muscle (TA) is the principal component of the vocal fold. It is broken into two distinct compartments, vocalis, which is involved in phonation, and muscularis, vocal fold adduction. The vocalis muscle can be further broken down into superior, which contains more connective tis- sue, and inferior. The muscle spindles in the TA are much shorter, narrower and contain fewer intrafusal fibers compared to muscle spindles in a limb. Muscle spindles in the TA are most concentrated in the superior vocalis, supporting the hypothesis that the function of this is more distinct than the other areas of the TA. The presence of both muscle spindles and slow fibers in the superior vocalis indicate that its primary role is to maintain posture or perform delicate and finely controlled movements for voice (Thach, 2001). There has been debate as to the nature and/or presence of muscle spindle afferents in the intrinsic muscles of the larynx (for sum- mary see Baken and Noback [1971]). It is obvious that there are structures (especially in the TA) that look identical to muscle spindles found in weight-bearing muscles, but upon closer inspection, these structures do have different properties. It is expected that future research will provide additional information about these specialized afferents, and their impact on voice and speech production. Treating Speech Language Pathologies Assignment Golgi Tendon Organs Golgi tendon organs (GTO) are encapsulated afferent nerve ending located at the junction of a muscle and tendon. It is innervated by a single group Ib sensory axon. Unlike muscle spindles, GTO are in parallel with extrafusal 428 Voice Disorders muscle fibers. When a muscle is passively stretched, most of the change in length occurs in the muscle fibers; but when a muscle actively contracts, the force directly acts on the ten- don. GTOs are highly sensitive to increases in muscle tension caused by muscle contraction, but unlike muscle spindles, insensitive to passive stretch. GTOs are likely very important for ballistic behaviors such as cough, throat clearing, or sneeze. Passive stretching is when an external force, such as gravity, acts upon the limb or muscle. Treating Speech Language Pathologies Assignment Pathway of Sensory Information Mechanoreceptors and chemoreceptors in the laryngopharyngeal (LP) mucosa receive innervation from the internal branch of the superior laryngeal nerve (SLN). Sensory information travels through the central nervous system via the NTS to the ipsilateral nucleus ambiguous (Xia, Leiter, & Bartlett, 2013). The cranial nerves, specifically the tri- geminal nerve (V) and facial nerve (VII) innervate the oral cavity and rostral pharynx, which function to give information about a bolus (a rounded mass) characteristic to the shape swallow motor response. Glossopharyngeal nerve (IX) and vagus nerve (X) are responsible for initiation of cough and swallow. The lingual branch of nerve IX innervates posterior tongue, tongue, vallate papillae and epiglottis. The pharyngeal branch of nerve IX directly involved in initiation of cough and swallow. Cranial nerve X divides into the SLN and recurrent laryngeal nerve (RLN). The internal branch of the SLN is critical for initiating reflexive cough and swallow (Tsujimura, Udemgba, Inoue, & Canning, 2013). Treating Speech Language Pathologies Assignment Laryngeal Reflexes (Table 13–1) Laryngeal Adductor Reflex What Is It? The laryngeal adductor reflex (LAR), also called the glottic closure reflex, is an involuntary protective response to stimuli in the larynx that can be initiated or triggered by laryngeal afferents. It is a mechanism of laryngeal protection, preventing material from inappropriately entering the upper airway. Figure 13–2 is an example electromyography (recording from muscle activity) for breathing, LAR, and swallow. Note the phasic TA activity during breathing, the increased activity during the LAR (in response to water), and the even greater activity during swallow. How Is It Tested? Pulses of air to the supraglottic space, innervated by the superior laryngeal nerve, elicit the LAR. In healthy individuals and patients with dysphagia, 50 msec laryngopharyngeal air pulses can stimulate LAR. These air pulse stimulations can be categorized by normal sensation (<5.4 cm H2O air pulse pressure to elicit the LAR), moderately impaired (5.4–8.2 cm H2O air pulse pressure to elicit the LAR), or severely impaired (>8.2 cm H2O air pulse pressure to elicit the LAR) (Aviv et al., 2002). Laryngospasm What Is It? A laryngospasm is a spasmodic closure of the glottis, or sudden forceful and abnormal closure of the vocal folds. Paradoxical vocal- cord dysfunction (PVCD) is characterized by CHAPTER 13 Laryngeal Reflexes 429 the inappropriate closure of vocal folds during inhalation, resulting in respiratory obstruction (Andrianopoulos, Gallivan, G. J., & Gallivan, K. H., 2000). During normal inspiration, the vocal cords are abducted, or open, and during expiration they adduct, or close slightly toward the midline. Under physical and emotional stress, laryngospasm can cause the vocal fold to adduct resulting in narrowing or even closure 430 Voice Disorders Figure 13–2. During breathing, water is infused into the airway stimulating the thyroarytenoid muscle and depressing the posterior cricoarytenoid, resulting in laryngeal adductor reflex. A swallow follows this reflex, stimulating the thyroid and thyroarytenoid muscles, and relaxing the upper esophageal sphincter (cricopharyngeus). of the glottis. An athlete with PVCD states that the neck and throat are the source of air- way restriction presenting with stridor. Stridor is a noise that is much harsher than wheezing, it resembles a high-pitched sawing noise (New- sham, Klaben, Miller, & Saunders, 2002). How Is It Tested? During exercise, full abduction of the vocal folds, dilation of the supraglottic and flattening of the epiglottis allow for increased airflow velocity and a decrease in resistance. Patients with PVCD have increased velocity and resistance at the laryngeal airway during inspiration due to inappropriate adduction of vocal folds (Gallena, Solomon, Johnson, Vossoughi, & Tian, 2015). The exaggeration of this reflex may result in complete glottis closure and blocked or delayed respiration, leading to hypoxia (low oxygen) and hypercapnia (high carbon dioxide). In the majority of patients, the prolonged hypoxia and hypercapnia eliminates the spastic reflex and the problem is self- limited (Alalami, Ayoub, & Baraka, 2008). Relaxed throat therapy is performed by inhaling through the nose and exhaling gently through pursed lips. Practitioners recommend that patient’s practice laryngeal control exercises daily and when they feel an upcoming episode (Newsham et al., 2002). Cough What Is It? Cough functions to clear materials that could be aspirated into the airways or already present in the airways. A cough starts with an inspiratory phase where the volume of air, generally larger than resting tidal volume, is rapidly inspired due to contraction of the diaphragm and external intercostal muscles. A brief compressive phase where the TA is activated to adduct the vocal folds and the expiratory muscles (abdominal and internal intercostal) contract against a closed glottis. The expiratory phase is marked by activation of the PCA with rapid abduction of the vocal folds and expiratory muscles are active (Nishino, 2000). How Is It Tested? Capsaicin cough challenge induces cough by the stimulation of TRPV1 receptor. Capsaicin can be delivered by the single dose method or the dose response method. The single dose method administers single concentrations of the tussive agent. The dose response method administers either single, vital capacity breaths of capsaicin via a nebulizer, or tidal breaths of incremental doses of capsaicin over a fixed period of time. The single dose method is favored due to its accuracy and reproducibility. It is advised to count the number of coughs within the initial 15 s after inhalation (Dicpinigaitis, 2007). A citric acid cough challenge administers citric acid in the same ways as capsaicin, but unlike capsaicin, it stimulates acid sensing ion channels (ASIC). This challenge has been associated with a choking sensation and pharyngeal discomfort more often than capsaicin challenge (Dicpinigaitis, 2007). Ultrasonically nebulized distilled water (UNDW) challenge is simply a fog that provokes severe coughing in healthy patients and patients with airway hyperactivity. This ultra- sonic nebulizer is considered a more useful research tool due to its ability to produce much larger output per unit volume than a standard conventional nebulizer (Dicpinigaitis, 2007). Arnold’s nerve ear-cough reflex: mechanical stimulation of the external auditory meatus activates the auricular branch of the vagus nerve (Arnold’s nerve) and evoke reflexive cough (Ryan, Gibson, & Birring, 2014). Cough can also be simulated with nasal irritation. It is well known that afferent nerves in the nasal mucosa are not able to initiate the cough reflex; but since afferent fibers from the nose project onto the NTS, it is speculated that they may converge onto and contribute to cough hypersensitivity. This was tested by having healthy participants inhale an aerosol of capsaicin solution. Application of the capsaicin into the nasal mucosa is immediately followed with a painful burning sensation. The cough response from the nasal capsaicin during nasal afferent stimulation increased compared to the control group, which used the intranasal saline (Plevkova, Brozmanova, & Tatar, 2004). Voluntary cough has been used to assess cough function when the above techniques are not possible, in a wide range of disease populations, including Parkinson’s disease and stroke (Smith Hammond et al., 2009; Pitts, Troche et al., 2010). Often the length of the compression phase is indicative of other respiratory reflex dysfunction, such as dysphagia. Cough During a Swallow Evaluation Common instruments used to evaluate swallow do have intrinsic measures for laryngeal sensations/reflexes. Penetration/aspiration scale (PA scale) is a measure developed and used by speech-language pathologists to evaluate pharyngeal dysphagia on video fluorographic examination of swallow. The highest degree on the PA scale is an 8. This is characterized by the bolus passes the glottis, visible subglottic CHAPTER 13 Laryngeal Reflexes 431 432 Voice Disorders residue, and no patient response, indicating this patient has aspirated, that is cough or throat clear (Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996). Laryngeal Chemoreflex (LCR) What Is It? The laryngeal chemoreflex (LCR) is an airway protective reflex that includes startle, rapid swallowing, apnea, laryngeal constriction, hypertension (increased blood pressure), and bradycardia (fast heart rate) (Thach, 2001). It is initiated when gastric contents, water and other low pH, acidic solutions or low chloride concentration activate chemoreceptors in the perilaryngeal mucosa. The physiological manifestations of the LCR change over the course of postnatal life. In human infants, the reflex is characterized by inhibitory response, such as apnea and bradycardia, which gradually wane and are replaced by coughing and swallowing as the infant matures. The apneas that predominate early in life can be long lasting and result in repeated episodes of profound hypoxia and hypercapnia. (Donnelly, Bartlett, & Leiter, 2016). To result in apnea, an inhibitory reflex must overcome the individuals underlying drive to breathe. When that drive is reduced laryngeal reflex, apnea may be pro- found, long lasting and occasionally fatal (Xia et al., 2013). How Is It Tested? The more natural way to test LCR is by initiating liquids into the pharynx to the point where levels in the pyriform sinus gradually increase until they contact the LCR at the entrance of the laryngeal airway. Another method consists of perfusion of the larynx from below the vocal fold in tracheotomized animals. Even though the first method presented shorter duration of apnea than the second, it is a more natural way to stimulate LCR. Studies of sleeping human infants stimulated with water infused into the pharynx resulted in repeated swallowing, apnea, airway closure resulting in obstruction and infrequent coughing (Thach, 2001). Treating Speech Language Pathologies Assignment Aerodigestive tract is the mixed airway/ gastrointestinal tract including oral cavity, pharynx, paranasal sinuses, Sino-nasal tract, larynx, pyriform sinus, and upper esophagus. Treating Speech Language Pathologies Assignment Upregulation of Sensory Afferents Reflux Gastroesophageal reflux disease (GERD) is caused by the backflow of gastric contents into the upper digestive tract. It is associated with enhanced laryngeal reflex activity resulting in heightened cough reflex sensitivity when treated with inhaled capsaicin aerosol. It has also been shown that laryngeal C-fiber hypersensitivity is responsible for enhanced laryngeal reflex reactivity to ammonia induced by laryngeal treatment with pepsin. Pharmacological drugs that may suppress laryngeal C-fiber hypersensitivity are potential therapies for the treatment of patients with GERD (Liu et al., 2015). Laryngopharyngeal reflux (LPR) is the result of retrograde flow of gastric contents to the laryngopharynx, where it comes in contact with tissues of the upper aerodigestive tract. It is often referred to as “silent reflux” due to the difficulty of its nature in diagnosis. LPR differs from GERD in that it is often not associated with heartburn and regurgitation symptoms. The larynx is vulnerable to gastric reflux, so it is common for patients to present with. Treating Speech Language Pathologies Assignment ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS laryngopharyngeal symptoms in the absence of heartburn and regurgitation (Ford, 2005). Viral Infections According to the Centers for Disease Control (CDC), in 2012, cough was the number one reason people go to the doctor. Upper and/or lower respiratory irritation caused by, sinusitis, common cold, flu all present with symptoms of runny nose, cough, sore throat, difficulty breathing and in some cases body aches and fatigue. In our everyday home remedies, it’s common to go to the drug store and load up on cough drops, vapor rub, decongestant, nasal sprays and cough syrup. What is it about these over-the-counter (OTC) drugs that make our infections better? Menthol is commonly used in cough drops, vapor rubs, and nasal sprays and works to block the cough reflex. As stated in a previous section, menthol activates TRPM8 receptors, which are located on C-fibers and Aä fibers, and gives a cool and soothing sensation leading to the suppression of irritation and cough. Brompheniramine malate is a first-generation antihistamine that is only the second reported drug that is able to reduce total symptom scores of rhinovirus colds. Total symptom scores include weight of nasal secretion, severity of rhinorrhea, sneeze, and cough; sneeze and cough count. It is unclear as to why brompheniramine suppresses cough but it is suggested that it has anticholinergic effects, which suppress cough and sneeze reflexes (Gwaltney & Druce, 1997). Irritable Larynx Syndrome (ILS) Diagnosis of ILS results from evidence of laryngeal tension, and/or presence of sensory triggers. It is hypothesized that ILS occurs when neural networks in the brainstem controlling the larynx are kept in a hyperexcitable state and react inappropriately to sensory stimulation. (Andrianopoulos et al., 2000). These patients often complain of chronic cough, laryngospasm, and high sensitivity to odors and gastric contents (Gillespie & Gart- ner-Schmidt, 2006). Odor-Induced Laryngeal Hypersensitivity Multiple chemical sensitivity (MCS), also known as idiopathic environmental intolerance (IEI), occurs when an individual has consistent and severe reactions to chemicals and odors that are commonly tolerated by the general population. Desensitization treatment uses multiple exposures at increasing levels to decrease the patient’s hypersensitivity responses (Gillespie & Gartner-Schmidt, 2006). Menthol serves as an additive in certain cigarette brands for flavor and to reduce/ hide the throat and sinus irritation caused by smoking (Millqvist, Ternesten-Hasse?us, & Bende, 2013). Chronic Cough A cough that persists for more than eight weeks is termed “chronic.” Cough hypersensitivity syndrome (CHS), coughing, is triggered by low levels of thermal, mechanical, or chemical exposure (Chung, 2011). Idiopathic cough is the chronic cough associated with conditions that are treated and do not lead to resolution of cough, and chronic cough is not associated with any conditions and unresponsive to any treatments (Chung, 2014). The initiating cause of the cough may disappear, but its effect on enhancing the cough reflex may have longer effects. For example, appearance of an upper CHAPTER 13 Laryngeal Reflexes 433 434 Voice Disorders respiratory tract infection or an exposure to toxic fumes that cause prolonged damage to airway mucosa may induce inflammatory neuropathic changes in the sensory nerves. The repetitive mechanical and physical effects of coughing bouts on airway cells could cause the release of various chemical media- tors that enhance chronic cough through inflammatory mechanisms, providing a positive feedforward system for cough persistence (Chung, 2014). Changes in airway nociceptors and mechanoreceptors can reduce the cough reflex threshold through the convergence of common second order neurons in the brainstem (Mazzone & Canning, 2002). This process may lead to the amplification of incoming signals received by the brainstem cough network. Amitriptyline and gabapentin are drugs used to treat chronic pain, but have been shown to reduce cough in chronic cough patients (Chung, 2014). Cigarette Smoking Cigarette smoking is one of the most common inhaled irritants of the respiratory tract. Smoking causes laryngeal sensory irritation due to the stimulation of laryngeal C-fibers by the activation and increased sensitivity of TRPV1, located on the laryngeal afferents (Liu et al., 2015). Studies show that long-term cigarette smoking significantly diminishes cough reflex. It is suggested this is due to desensitization of cough receptors within the airway epithelium. Long-term cigarette smoke also changes the character of airway mucus and could play a role in cough reflex sensitivity (Dicpinigaitis, 2003). Studies show that age-related vocal fold changes are one of the most common voice-related diagnoses in otolaryngology practices (Thomas, Harrison, & Stemple, 2008). Down Regulation of Sensory Afferents Aging Presbylarynx is the aging of voice, and atrophy of the thyroarytenoid (TA) is a primary fac- tor. Behavioral therapies such as strengthening the voice and surgical intervention involving augmentation or medialization of atrophic vocal folds have been found to reduce the glottal gap and improve voice and swallow functions. In aged rats there is a reduction in force, speed, and endurance of the TA muscle. With an increase in age, there are reductions in size and myelinated fibers of the SLN, and a decrease in density of sensory nerve endings in the larynx. This could be the reason as to why there is a reduction of laryngeal sensitivity with increased age. There is also presence of 4977-base pair deletion in the TA of aged human larynges with increased mitochondrial mutation. This indicates that mitochondrial changes play a role in laryngeal aging. There is a 42 to 60% reduction in laryngeal blood flow in aged rats, proposing that age-related vascular changes may alter the supply of oxy- gen (Thomas et al., 2008). Treating Speech Language Pathologies Assignment Neurodegenerative Diseases Parkinson’s Disease Parkinson’s disease (PD) is a chronic and progressive movement disorder. It involves the malfunction and death of neurons in the substantia nigra, which is one of the movement control centers in the brain located under the spinal cord. The substantia nigra produces the neurotransmitter dopamine, which controls movement and balance in the CNS. Symptoms of PD include tremors of the hands, legs, (etc.), bradykinesia (slow movement), rigidity stiffness of the limbs and trunk—and postural instability, which describes the impaired balance and coordination. CHAPTER 13 Laryngeal Reflexes 435 mediated pharyngeal response and laryngeal protection (Power et al., 2007). Dysphagia Altered LP sensation is a risk for the patient with impairment and possibly unsafe swallowing. It is found that isolated pharyngeal motor dysfunction with intact LP sensation predicted penetration and aspiration with pureed consistencies, whereas an isolated LP sensory deficit, with an intact pharyngeal squeeze maneuver (PSM), predicted penetration and aspiration with thin liquids. Most all patients with an absent LAR and PSM aspire both thin liquids and purees (Domer, Kuhn, & Belafsky, 2013). Treating Speech Language Pathologies Assignment Sudden Infant Death Syndrome Sudden infant death syndrome (SIDS) appears to occur when a presumed healthy sleeping infant experiences a challenge to cardiorespiratory homeostasis and fails to effectively respond (Donnelly et al., 2016). Studies show that prolonged apnea associated with LCR may be a cause of SIDS (Thach, 2001). References Alalami, A. A., Ayoub, C. M., & Baraka, A. S. (2008). Laryngospasm: Review of different pre- vention and treatment modalities. Paediatric Anaesthesia, 18(4), 281?288. Andrianopoulos, M. V., Gallivan, G. J., & Gal- livan, K. H. (2000). PVCM, PVCD, EPL, and irritable larynx syndrome: What are we talking about and how do we treat it? Journal of Voice, 14(4), 607?618. Aviv, J. E., Spitzer, J., Cohen, M., Ma, G., Belafsky, P., & Close, L. G. (2002). Laryngeal adductor reflex and pharyngeal squeeze as predictors of laryngeal penetration and aspiration. Laryngo- scope, 112(2), 338?341. Aspiration pneumonia is one of the lead- ing causes of death in patients with PD (Widdicombe & Singh, 2006). Those with PD may have a decreased ability to inflate the lungs, leading to the decrease in potential to generate high expiratory airflow for cough. High expiratory airflow velocity is created by narrowing the airways and adducting the vocal folds. High airflow velocity provides the force to aerosolize material and safely remove penetrants from the lungs during cough (Pitts et al., 2009). Reduced peak flows during voluntary cough are indications of increased risk of respiratory complications. Weaker expiratory peak airflow reduces the production of shearing forces, and decreases the ability to adequately clear mate- rial from the airway (Pitts et al., 2008). This can lead to aspiration pneumonia, which is swelling or infection of the lungs due to food, saliva, liquids, or vomit that is breathed into the lungs instead of being swallowed. Stroke A stroke occurs when blood flow to an area of the brain is cut off, resulting in lack of oxy- gen and brain cell death. Both voluntary and reflex cough, as well as expiration reflex, can be weak or absent, resulting in stroke patients at a higher risk for aspiration (Widdicombe & Singh, 2006). Hemispheric stroke patients have delayed pharyngeal response and delayed or absent swallow reflex, with impairments to pharyngeal sensation. It is hypothesized this is du

Prepare a professional portfolio Assignmnet Prepare a professional portfolio Assignmnet Reflection of Your Practicum Experience In a 1,000-1,250 words, address the following: ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Summarize your practicum experience. Describe how you have applied theory and/or knowledge from your course work into practice during your practicum experience (provide specific examples). What are the most important things you have learned from this practicum experience and how will you apply them to your public health career? How has this experience helped develop professionalism skills, such as networking, team building, communication, and professional competencies in public health? What leadership qualities do you possess and how do you envision applying them to your public health career? Articulate a personal mission, a set of core values, and vision regarding your role in public health. How will your core values help guide your ethical decision making in public health? Include two or three scholarly sources to support your narrative. Sample Practicum Work: In a second, separate document, submit a sample of your practicum work (e.g., health education materials, reports, presentation) Cover Letter and Resume: In a third, separate document, submit a cover letter and resume. Prepare a cover letter and resume for a potential (or actual) position in public health. APA format is required for essays only. Solid academic writing is expected for all presentation formats, and in-text citations and references should be presented using APA guidelines, which can be found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Assignment: Target Bull Eye Height Release Questions ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Target Bull Eye Height Release Questions An archer shoots an arrow at a 75 m distant target; the bull’s-eye of the target is at the same height as the release height of the arrow. If d = 75 m and v = 37 m/s. At what angle must the arrow be released to hit the bull’s-eye if its initial speed is 37m/s? Assignment: Target Bull Eye Height Release Questions You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. ADDITIONAL INSTRUCTIONS FOR THE CLASS Discussion Questions (DQ) Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. Weekly Participation Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. APA Format and Writing Quality Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition. Use of Direct Quotes I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. LopesWrite Policy For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score. Late Policy The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. Communication Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. Assignment: Target Bull Eye Height Release Questions Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10