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Aggregated Antibiograms and Monitoring of Drug-Resistant Streptococcus pneumoniae. Highlight and copy the desired format. Community-specific antimicrobial susceptibility data may help monitor trends among drug-resistant Streptococcus pneumoniae and guide empiric therapy. Because active, population-based surveillance for invasive pneumococcal disease is accurate but resource intensive, we compared the proportion of penicillin-nonsusceptible isolates obtained from existing antibiograms, a less expensive system, to that obtained from 1 year of active surveillance for Georgia, Tennessee, California, Minnesota, Oregon, Maryland, Connecticut, and New York. List Latex? For all sites, proportions of penicillin-nonsusceptible isolates from antibiograms were within 10 percentage points (median 3.65) of those from invasive-only isolates obtained through active surveillance. Only 23% of fahrenheit antibiograms distinguished between isolates intermediate and resistant to penicillin; 63% and 57% included susceptibility results for erythromycin and extended-spectrum cephalosporins, respectively. Aggregating existing hospital antibiograms is a simple and of abbreviations latex, relatively accurate way to estimate local prevalence of penicillin-nonsusceptible pneumococcus; however, antibiograms offer limited data on isolates with intermediate and cheap writing, high-level penicillin resistance and isolates resistant to of abbreviations latex other agents. Infections from Streptococcus pneumoniae tax the healthcare system in the United States and other countries. Scientific advances have been made in the treatment and prevention of pneumococcal infections through antibiotics and licensure of vaccines for both adults and children; however, the last few decades have witnessed the emergence of S. Privilege? pneumoniae resistance to antibiotics ( 1 ). In a multistate, population-based surveillance system that follows invasive disease from pneumococcus and other bacterial pathogens, the percent of thesis list of abbreviations isolates resistant to penicillin reached 24% in 1998; concurrent increases in resistance to other antimicrobial drugs have also been noted among penicillin-resistant pneumococci ( 1 , 2 ). Implications of drug-resistance extend beyond the laboratory and into clinical practice as treatment failures from drug resistance have been reported with meningitis ( 3 – 5 ) and available proquest dissertations, otitis media ( 6 , 7 ). In some studies, increased death and thesis list latex, disease in essay patients hospitalized with pneumonia caused by high-level ?-lactam-resistant pneumococci have been reported ( 8 , 9 ). Measuring pneumococcal resistance to penicillin and other antibiotics enables epidemiologists and healthcare providers to monitor trends, develop guidelines for optimal empiric therapy, and provide impetus for and ascertain the of abbreviations success of educational efforts promoting the judicious use of available dissertations database antibiotics. Antimicrobial resistance is not uniform across the United States ( 10 ). Nonsusceptibility to thesis list penicillin among invasive pneumococcal isolates has been shown to range from 15% to 35% among populations in the Centers for Disease Control and Prevention’s (CDC) national surveillance system ( 1 ).
The ideal method for executive privilege, accurate tracking of antimicrobial-resistance patterns in a community may be active, laboratory-based surveillance systems that collect strains for susceptibility testing in a reference laboratory. However, this method can be costly, time-consuming, and resource intensive. Thesis? Alternative methods of measuring local drug-resistant pneumococci that are less expensive and timelier are needed. One alternative is to effects in school use aggregated antibiograms. A study conducted by epidemiologists at the Oregon Health Division found that aggregating existing hospital antibiograms, also known as cumulative susceptibility data, provided relatively accurate, community-specific, drug-resistant S. Of Abbreviations Latex? pneumoniae data when compared with active-, laboratory-based surveillance, the cheap service standard criterion for invasive disease.
The investigators also found that use of local laboratory antibiograms was far less expensive and time-consuming when compared with active surveillance. Thesis List Of Abbreviations Latex? Whether Oregon’s results can be generalized is unknown; however, only 12 hospitals in one city (Portland) were surveyed, and the percent of S. pneumoniae infections nonsusceptible to penicillin was relatively low (14%) ( 11 ). We compared the titanic essay two methods of surveillance in a larger study that involved sites in geographically disparate areas and represented a larger fraction of the national population and varying degrees of drug resistance across the United States. Our objective was to determine if existing hospital antibiograms could be used to estimate the percent of community-specific, drug-resistant S. pneumoniae in multiple sites. We compared the proportions of drug-resistant S. Thesis Of Abbreviations Latex? pneumoniae isolates reported by participating clinical laboratories from the Active Bacterial Core Surveillance (ABCs) sites to proportions obtained by aggregation of existing antibiograms produced by fahrenheit the same ABCs laboratories. Active Laboratory-Based Surveillance. List Of Abbreviations? ABCs, a laboratory-based active surveillance system in CDC’s Emerging Infections Program, tracks invasive disease caused by S. pneumoniae and other bacterial pathogens of public health importance ( 12 ). Surveillance areas included in privilege this analysis were: California (CA) (San Francisco County), Connecticut (CT) (entire state), Georgia (GA) (20-county area, including Atlanta), Maryland (MD) (6-county area including Baltimore), Minnesota (MN) (7 counties), New York (NY) (7 counties), Oregon (OR) (3-county area including Portland), and thesis, Tennessee (TN) (5 counties). The total population under surveillance was 17 million. Executive? A case of invasive pneumococcal disease was defined as the isolation of of abbreviations latex S. Theses? pneumoniae from a normally sterile site (e.g., blood, cerebrospinal fluid) from a surveillance area resident. Of Abbreviations Latex? Surveillance personnel routinely contacted all clinical microbiology laboratories in their site to identify cases and conducted audits every 6 months to ensure complete reporting. Pneumococcal isolates collected through ABCs were sent to reference laboratories for available proquest dissertations, susceptibility testing by broth microdilution according to the methods of the National Committee for Clinical Laboratory Standards (NCCLS) ( 13 ). Isolates were defined as susceptible, having intermediate resistance, or resistant to of abbreviations latex agents tested according to executive NCCLS definitions ( 14 ). We requested existing antibiograms from all clinical laboratories participating in list of abbreviations ABCs. The antibiograms were to cover the most recent 12-month period for which completed data were available at the time of the inquiry (1997 for GA, TN, CA, MN, OR, MD, and CT; 1998 for NY).
Any identifying information (e.g., hospital name) obtained during collection of antibiogram data was removed before the data were forwarded to study investigators at CDC. Available Proquest Database? Surveillance personnel also used a standardized questionnaire to query each hospital’s infection control practitioner or microbiology supervisor regarding the production and distribution of local antibiograms and thesis of abbreviations, whether antibiogram data included sterile isolates, nonsterile site isolates, or duplicates isolates from a single patient. We compiled total numbers of S. pneumoniae isolates identified from the ABCs sites along with the percent of intermediate and executive privilege essays, resistant isolates, focusing on of abbreviations latex, nonsusceptibility to penicillin, macrolides, and extended-spectrum cephalosporins (e.g., cefotaxime, ceftriaxone). We defined nonsusceptible isolates as those that were of effects essay intermediate and high-level resistance or that were simply described as not susceptible to the antibiotic tested. We aggregated data obtained from the list of abbreviations participating hospitals within each ABCs site to produce summary antimicrobial susceptibility percentages. When generating tables comparing percent of nonsusceptible pneumococcal isolates estimated by antibiograms and by ABCs, we used only antibiogram data for the year in question (1997 for all sites excluding New York ); antibiograms covering other periods were excluded from fahrenheit, this portion of the analysis. Also, we used only antibiograms that included both the total number of isolates tested and the percent nonsusceptible for each of the antibiotics evaluated; this system allowed for aggregation of the laboratory’s data with those from other laboratories. If only of abbreviations a subset of isolates were tested against erythromycin and extended-spectrum cephalosporins, we excluded these results from the aggregated total for erythromycin, cephalosporins, or both. We also calculated the percent of laboratories that included S. pneumoniae susceptibility testing to a variety of other antimicrobial agents and the percent of laboratories generating antibiograms that included susceptibility testing of gram-negative bacteria. To compare the proportions of resistant and susceptible S. pneumoniae isolates detected by essay writing service australia the two surveillance methods, we examined the proportion of thesis list latex hospitals whose aggregated antibiogram data fell within a range of ± 5% and ± 10% compared with that detected through active surveillance.
One hundred and available, forty-five ABCs laboratories completed the surveys; these laboratories conducted antibiotic susceptibility and other testing for a total of thesis list 170 (85%) of the 199 hospital laboratories participating in ABCs at the time the study was undertaken. Of the 145 responding laboratories, 108 (74%) routinely generated antibiograms. The 108 antibiograms created include pneumococcal susceptibility testing results for 140 (70%) of the 199 ABCs hospital laboratories. Teenagers? In-house microbiologists typically generated the antibiograms (83%), while infection control practitioners (7%) and list latex, pharmacists (10%) created the remaining. Nearly all laboratories included both sterile site (98%) and nonsterile site (92%) isolates in writing service australia the antibiograms. Ninety-five percent included inpatient, and 79% included outpatient isolates. Forty-six laboratories (43%) included duplicate isolates from individual patients in their antibiograms. When asked how pneumococcal isolates with intermediate susceptibility were categorized, survey responders stated that their laboratory characterized these isolates as intermediate (37%), resistant (32%), susceptible (5%), and list of abbreviations latex, nonsusceptible (22%). This question did not specify the antibiotic tested. Only 25 (23%) laboratories generated antibiograms that included data distinguishing isolates intermediate and resistant to teenagers essay penicillin; 77% only indicated whether the isolates were susceptible or nonsusceptible.
The average number of isolates included in the summary antibiograms was nearly double the number collected through active surveillance; the mean number of pneumococcal isolates (per site) tested for penicillin susceptibility was 417 (range 69–850) for ABCs and 826 (range 383–1,291) for thesis latex, summary antibiograms. Hospitals (n=40) that excluded duplicate isolates from antibiograms averaged similar numbers of isolates (mean 89 isolates) tested for penicillin susceptibility as did hospitals (n=34) whose antibiograms included multiple isolates from a single patient (mean number of isolates tested 88). 451 Essay? Of the 140 hospital laboratories whose pneumococcal antibiotic susceptibility testing results were summarized in antibiograms, 96 (70%) created antibiograms with penicillin-susceptibility results in a format that could be aggregated for the year in question. The proportion of laboratories in each site that generated usable penicillin susceptibility data ranged from 70% (MD) to 100% (NY and MN). Antibiograms included susceptibility-testing results for macrolides (63%) and third-generation cephalosporins (57%). The proportion of laboratories for which this susceptibility information was in a format that could be aggregated, however, was smaller for macrolides (44%) and of abbreviations latex, third-generation cephalosporins (39%). For the eight sites, the proportion of penicillin-nonsusceptible isolates from ABCs ranged from 14.5% (NY) to work teenagers essay 38.4% (TN), whereas antibiograms yielded a range of 18.5% (CA) to 41.7% (TN) (Table 1).
For all sites the overall proportion of isolates nonsusceptible to penicillin according to list latex antibiograms was within 10 percentage points of the population- and laboratory-based surveillance (ABCs); for six sites it was within 5 percentage points. The proportion of cheap essay writing penicillin-nonsusceptible isolates for each site identified by antibiograms was higher than that generated by ABCs (median difference: 3.65%; range 8.6% to 1.8%). No correlation existed between site-specific levels of penicillin resistance and the magnitude of difference between site-specific penicillin resistance identified by the two methods. The proportions of pneumococcal isolates nonsusceptible to a third-generation cephalosporin and to erythromycin were lower than the list proportion of penicillin-nonsusceptible isolates, regardless of the method used (Tables 2 and 3). Similar to the results for penicillin, the effects of bullying essay percent of strains nonsusceptible to third-generation cephalosporins or erythromycin as detected by antibiograms tended to be greater than the percent nonsusceptible detected by ABCs. In contrast, the range of the differences for third-generation cephalosporins and erythromycin detected by the two surveillance methods was larger than the range of latex differences for penicillin as measured for each ABCs site. Essay? The magnitude of the difference in overall susceptibility to third-generation cephalosporins determined by the two surveillance methods was 10% for seven of thesis list latex eight sites and 5% for effects in school essay, five sites. The magnitude of the difference in susceptibility to erythromycin as determined by the two surveillance methods was 10% for all sites and thesis list of abbreviations, 5% for only four sites. In addition to penicillin, cephalosporins, and macrolides, submitted antibiograms included susceptibility testing results for fahrenheit 451 essay, a variety of other antibiotics that included the following: trimethoprim/sulfamethoxazole (35%), vancomycin (59%), clindamycin (47%), gentamycin (3.9%), and one or more fluoroquinolones (14%). Thesis Of Abbreviations Latex? Thirty-eight percent of cheap antibiograms returned for analysis also included antimicrobial susceptibility testing results for various gram-negative bacteria. The results of our study suggest that antibiograms may be an thesis list of abbreviations adequate method for conducting drug-resistant S. pneumoniae surveillance for many health departments, illustrating the comparability of aggregated antibiograms that include both sterile and nonsterile site isolates to active, laboratory- and effects of bullying in school essay, population-based surveillance for invasive isolates.
For more than half the comparisons between the two methods, the thesis difference in antibiotic resistance detected was 5 percentage points, and for 23 (96%) of the essay 24 comparisons the difference was 10 percentage points. No significant differences in comparability of the two methods were noted between high- and low-resistance areas. Thesis? This study indicates that antibiograms may be an alternative tool for evaluating penicillin nonsusceptibility in executive essays a region and validates the earlier findings of the Oregon study, conducted in list latex an area of relatively low antibiotic resistance ( 11 ). Although the outline estimates of level of resistance obtained from antibiograms approximated that from ABCs, aggregated antibiogram data tended to show a higher proportion of nonsusceptible isolates within each site and for each antibiotic evaluated. Thesis? This trend is effects, likely due to the inclusion of nonsterile (noninvasive) site isolates. In studies from centers that include both sterile and nonsterile isolates, nonsterile site isolates have been found to be equally or more resistant ( 15 – 17 ). The reason for this difference is unclear but may reflect differences in serotype distribution between strains causing invasive and noninvasive disease.
Disparity in results between clinical and list of abbreviations, reference laboratories could also contribute to this trend; use of the E test (AB Diodisk, Solna, Sweden) by clinical laboratories might vary from the referent method (broth microdilution) by one half or one dilution ( 18 ). Work? In this study, we were unable to examine the role of laboratory error or differences in susceptibility-testing methods as a reason for differences in results from antibiograms compared with those from list, active surveillance. Compared to penicillin, differences between the executive essays two surveillance methods were greater for extended-spectrum cephalosporins and erythromycin. This finding may be because of smaller numbers of isolates included in the antibiograms, fewer laboratories that included susceptibility testing of S. Thesis List Of Abbreviations? pneumoniae to these antibiotics, or greater disagreement between clinical and reference laboratory results. We could not include antibiogram-susceptibility testing results for some hospital laboratories because only a subset of the pneumococcal isolates that were tested for penicillin nonsusceptibility were also tested for susceptibility against third-generation cephalosporins (20 laboratories) and erythromycin (13 laboratories). The potential explanations for why these laboratories tested only a subset of pneumococcal isolates (i.e., only fahrenheit 451 essay penicillin-nonsusceptible isolates were tested) against thesis latex the same antibiotics were not indicated on the antibiograms. We chose to evaluate the comparability of the two surveillance methods by observing how often the work percent nonsusceptible isolates estimated by aggregated antibiograms differed by 5 and 10 percentage points from that estimated by ABCs active surveillance. As there exists no standardized or absolute level of list of abbreviations latex antimicrobial drug resistance that would dictate a change in empiric treatment of pneumococcal infections, we chose a priori two conservative thresholds of executive essays difference. A healthcare provider may not modify empiric therapy based on the differences found in our study, and the magnitude of differences reported here are likely not relevant from a public health perspective.
Trends of pneumococcal antibiotic resistance over time may be of more clinical and epidemiologic relevance than an absolute level. Knowledge of latex local trends may help communities assess regional antibiotic use and evaluate the effects of local educational measures promoting the judicious use of outline antibiotics. As this study did not span multiple years, we could not document the ability of antibiograms to thesis of abbreviations detect trends. However, given that sentinel surveillance conducted in ABCs sites has been shown to detect pneumococcal resistance trends over time ( 19 ) and that in our study antibiograms provided site-specific point estimates of antibiotic resistance similar to those measured by active sruveillance, antibiograms may be able to follow trends in pneumococcal antimicrobial resistance at the local level. Drawbacks to this surveillance method include the inability to evaluate resistance to writing multiple drugs. Relatively few drugs can be evaluated because of laboratory variations in antibiotics selected for of abbreviations, susceptibility testing by antibiograms. Health departments that wish to monitor emerging resistance patterns to antibiotics, such as vancomycin or fluoroquinolones, might consider a method other than aggregated susceptibility tables, or they might encourage hospital laboratories within a defined community to standardize their susceptibility panels to dissertations theses database facilitate aggregation of results. Another limitation of antibiograms is the inability to distinguish between intermediate- and high-level resistance to penicillin; 77% of antibiograms in our study expressed resistance as percent nonsusceptible rather than distinguishing between intermediate and resistant isolates. List Of Abbreviations? This distinction has become relevant for treatment of some infections. Titanic Essay? For example, NCCLS guidelines recommend different breakpoints by syndrome (meningitis vs. Of Abbreviations? nonmeningitis) for some agents ( 20 ). Aggregating antibiograms is useful for executive essays, infections that are generally community-acquired, but antimicrobial resistance in hospital-acquired infections should be evaluated based on the knowledge of the particular institution’s flora.
Finally, not all hospitals’ laboratories generate antibiograms or generate them in a manner facilitating aggregation across laboratories. However, we demonstrated the comparability of the two surveillance methods despite the fact that the thesis of abbreviations penicillin-nonsusceptibility results, as measured by antibiograms, was known for teenagers, only 96 (48%) of the 199 ABCs hospital laboratories. This study should help clinicians and public health personnel in state or local health departments determine which surveillance tool for obtaining estimates of latex antibiotic-resistant S. pneumoniae is best suited to their specific region or community by providing background information on two alternative systems; the benefits and limitations of each system may be reviewed to determine the most useful and practical surveillance tool for a particular region. Antibiograms are relatively inexpensive and easy to use. Although not measured in work teenagers essay our study, epidemiologists in Oregon found that the cost of active surveillance was approximately 70 times that of aggregating antibiograms for the three-county study area ( 11 ); the high cost of this type of surveillance, however, is partially due to the fact that ABCs is an integrated system that accomplishes multiple objectives in thesis of abbreviations addition to susceptibility testing of pneumococcal isolates ( 12 ). Most hospitals and laboratories routinely generate antibiograms; therefore, obtaining this information is relatively easy and within the capacity of local health departments. Active surveillance, on effects, the other hand, excludes duplicate isolates for a single patient or infection and thesis of abbreviations latex, is able to provide extensive additional information such as risk factors for effects in school, resistant infections, outcome data, and other laboratory testing such as serotype determination. Active surveillance also limits case and isolate collection to persons who are residents of the defined surveillance area, allowing for calculation of thesis list of abbreviations rates of disease. Furthermore, active surveillance provides individual patient-level data, allowing assessment of the titanic essay impact of specific interventions such as pneumococcal conjugate vaccination of infants and young children. Attainment of patient-level data through active surveillance also permits detection of possible changes in the incidence of resistant pneumococcal infections (e.g., because of a general decrease in cases of pneumococcal infection among children receiving pneumococcal conjugate vaccine) that might go unnoticed if only the proportion of resistant isolates were tracked (i.e., as done by antibiograms). Thesis Of Abbreviations? Increasing antibiotic drug resistance is a problem that is global in scale and that has practical implications for the treatment and outcome of invasive infections from S. pneumoniae and available database, other bacteria of public health importance.
Clinicians and researchers are now acknowledging the thesis of abbreviations importance of privilege preventing resistant infections through appropriate use of antibiotics and vaccines. Surveillance data are needed to monitor the thesis of abbreviations success of these campaigns and to raise awareness of the problem. Because most local laboratories generate antibiograms routinely, collecting aggregating antibiogram data is an inexpensive and readily available method of measuring local antibiotic resistance levels. Although providing less information than active surveillance, aggregated antibiogram data are a generally accurate way for health departments to generate needed community-specific estimates of pneumococcal resistance. Teenagers? Dr. Van Beneden is list, a medical epidemiologist in the Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention. Her research interests include public health surveillance systems for community-acquired bacterial infections, antimicrobial resistance among streptococci, study of vaccines against pneumococcal disease, and of bullying, group A streptococcal disease. We thank the surveillance officers, clinical microbiologists, laboratory directors, and of abbreviations latex, managers working in ABCs sites for contributing data for of bullying in school essay, this study and Paul Cieslak, Richard Besser, and Anne Schuchat for their helpful and insightful comments on the manuscript. Please use the form below to submit correspondence to list the authors or contact them at the following address: Chris Van Beneden, Respiratory Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop D65, Atlanta, GA 30333, USA; fax: 404-371-5445.
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Mapping Identity: Borich’s Body Geographic. This interview was prepared by Linda Avery, Polly Moore, Jan Shoemaker, and Aimee Young (current nonfiction students in the Ashland University MFA program, Bonnie J. Rough’s Spring 2013 section) with questions exploring the memoir, Body Geographic. PM : Your voice in this book is so wise, so at peace with all the different parts of thesis list of abbreviations, you that make up you. I marveled at your ability to be transparent when you could have “chickened out” or glossed over details. Privilege Essays? There’s fairly vivid lovemaking with Linnea, your beloved role of Auntie to Adria, a conference threesome, hanging with the drag kings, falling down drunk, and also Barrie the daughter, the thesis list of abbreviations, granddaughter, the sister. Did writing this book feel like an act of effects of bullying essay, courage?
Did you have conversations with loved ones prior to publication, and thesis list of abbreviations latex, have you encountered issues resulting from your transparency since the book came out? Borich: For as long as I’ve published, readers have asked if my writing feels to me to be an act of executive privilege essays, courage. The question sometimes pleases me, as it suggests I’ve succeeded in thesis reaching at least some readers in a primal or urgent manner, but in truth I rarely feel particularly brave while writing. I’m often afraid, especially if failing to of bullying in school engage with the page. Thesis Of Abbreviations Latex? Or frustrated. Or on better days, intensely, intuitively focused. Teenagers Essay? I might feel bold, or funny, or furious.
But courageous feels to me a word that doesn’t quite fit the writing process, perhaps because when I’m really writing the work itself is leading the charge. Some of this is cultural in that many of the subjects you list here—lovemaking or drinking or gender performance—are part of the daily parlance of worlds I’ve been a part of for many years. I came of age as an thesis list of abbreviations artist in both the queer arts world and available dissertations theses, the queer sober world of Minneapolis and St. Paul, Minnesota, so transparency, as you put it, about issues of sexuality and identity and addiction is normal to me. Even though the presence of these worlds is more common in mainstream venues than it once was, still these subjects are much less muffled in the LGBTQ worlds and I can think of a dozen queer artists off the thesis of abbreviations latex, top of essay, my head whose works are more explicit than mine.
What you notice in my work is likely the symbiosis of thesis list latex, my communities, my particular voice and privilege, my own quirky ways of thesis list latex, executing craft. When I’m actually writing I’m not thinking about courage or edge or consequence, and I don’t check out fahrenheit 451 essay what I’m doing with anyone but my spouse Linnea (who is usually my first reader) and list, even she doesn’t have veto power, just an open invitation to fahrenheit titles challenge me. More to the point, as a writer, whatever my subject, I value precise and embodied language. When I’m working I’m thinking first about bringing experience to language, about visceral rendering, about surprising myself by thesis list latex, what I discover on and from the page. As with any writer, this all comes to essay writing service me one word at a time. LA: What stood out most to me as I read Body Geographic was the originality of its structure and your ability to connect your own life story and family history with the geography of maps and thesis, places. About the project, you’ve written: “I came to consider my book a variety of map art–my own quirky attempt at counter-mapping my American body against the ‘true and accurate atlas’ any woman of my place and generation was supposed to fahrenheit follow.” Your use of maps and geography to list of abbreviations do this is extremely unique. Fahrenheit 451 Essay Titles? What were your difficulties in translating maps into language? BJB: I wouldn’t say that in Body Geographic I’ve translated maps into language but rather that the process occurred the other way around, that I translated language and thesis list of abbreviations, story into maps. At first all I meant to do was braid story fragments about place and work teenagers, the body that I felt belonged together—most significantly, my family’s immigration story and my own migration to queer identity story.
My first title for this book was This New World from a line in the Philip Levine poem “The New World” — Full-figured women in their negligees/streamed into of abbreviations, the streets from the dark doorways/ to demand in Polish or Armenian/ the ripened offerings of this new world . I wasn’t thinking of cheap writing service australia, maps at the start. Thesis List Latex? I’m not sure moving from form to fahrenheit 451 essay titles subject works very often; in my experience form rises out of subject. From the start of this project my aim was to bring these two personal migration narratives together, to intertwine them in some way around the ideas of place, movement, and change. The map form came to me in thesis list process (I don’t remember precisely when) after I’d come to the idea of the book being a kind of “female geography” with place as my primary lens through which to look at interlocking kinds of American experience. The first move toward maps came with the inclusion of the work teenagers essay, “insets.” Somewhere along the line, in the process of revision, I tried to reconfigure the fragments as a main text interrupted by these close-up views. I wish I could recall what led me to thesis list of abbreviations this move, but the moment of essay, invention is lost to latex me. All I remember is that I was so attracted to and inspired by the structural shift that I followed the cheap essay, impulse, eventually realizing I considered each essay a kind of map, and then challenging myself to make sure my use of the map-as-form was not too facile. So what then, I asked myself, do I mean when I call these essays maps? What do I need to list research, discover, and essay, revise toward in order to make this map form meaningful and integral to the project?
PM: I loved how you were able to interweave your love of geography and thesis list latex, your strong connection to place in Body Geographic by structuring your story as a map with overlays, underlays and insets. As a writing student, this feels to me like a real creative risk that you took. As writers, how do we know if the nontraditional, “quirky” idea will pay off or fall flat, preventing a beautiful story from getting “out there”? BJB : I wish I had better news here, but the truth is we never know if a risk will pay off. If we did, then risk wouldn’t be so risky, right? All we can ever do is attempt. I remember clearly the moment when one of my writing professors revealed the titanic outline, Montaignian root of the word “essay” meaning to attempt or try , a lesson I’ve repeated in list of abbreviations latex every nonfiction writing class I’ve taught since.
This understanding may be the single most important motivator of of bullying essay, anything I’ve written, this permission to attempt what I don’t yet know how to do or feel or think. Structure is list of abbreviations simply part of this larger essaying endeavor for me. I will attempt, and most of the time I will fail, but I attempt again, and hopefully (to borrow Zadie Smith’s language) I will fail better the next time, until finally I find the fahrenheit 451 essay titles, movement or change within the work that, to my ear, justifies the thesis list of abbreviations, form. Plenty of publishers passed on effects of bullying essay this book because they found the nonlinear form an unnecessary distraction. They said they liked my prose but wanted a more direct telling set on a redemptive linear arc. Such books sell better and are more widely read; I get it.
And familiar chronological structure can be beautiful if executed with skill and avoidance of of abbreviations latex, cliche and sentimentality. Sometimes I wish I did write that way because then perhaps I’d get to stay home and write all day everyday and make lots of money, but alas, I just don’t have any fire to write those kinds of books. This seems to be a born-this-way situation for me; narrative risk is a requisite part of my process. AY : In “The Craft of Writing Queer,”( Brevity , September 2012) you urged the synthesis of “queerish content” with “queerish form.” Will you discuss what this meant for you as you wrote Body Geographic ? We’ve sensed that Body Geographic resides in a space between memoir and extended essay. Do you see the book sitting nearer to one form or the other?
What does this in-between space allow a writer to do? What are its risks? As you wrote, did you envision a particular audience? BJB : I often think the executive essays, most queer thing about my work is not content but form, in that I can only seem to write in ways that break the thesis list latex, normative linear mode. Not that one has to be “a queer” to write a nonlinear narrative, but I do think my ways of inhabiting form and available dissertations theses database, voice are related to my life in thesis list that I don’t inhabit a socially normative community, family, or marriage and thus the forms within which I experience the world are themselves not the formal norm. Queers are now less “queer” than we were when I wrote My Lesbian Husband —in some American states and cities at least—but I still live in an unorthodox manner, and am part of what might be one of the titanic outline, last American generations to experience queerness as a profound outsiderhood, a coming-of-age that will always form me, no matter how social worlds change. But that times are changing matters here, in that I’d like to see those of us who have lived outside of thesis list of abbreviations, what has been the American norm to have an influence on what American form is, and will become. I’d like all of us to better embrace Americanness itself as a hybrid, multiple identity and resist singular ways of of bullying in school essay, defining ourselves.
That’s the fluid, “queerish” part of the equation. As for genre, I understand my work to reside in thesis list of abbreviations the space between memoir, long-form essay, and proquest theses database, poetry. I started writing as a poet and in many ways I still think like a poet, in terms of sound, breath, white space, and image-based structure. The gift and the risk of hybrid nonfiction form is list latex its potential for essay, breadth and complexity. At the same time, invented form is unfamiliar form. Thesis List Of Abbreviations? Unfamiliar forms scare readers who prefer the comfort of disappearing into dissertations database, the apparent real of thesis of abbreviations latex, linear narrative over work teenagers, the more active style of navigating forms that mimic the confusing palimpsest of actuality. So where does this form sit? I don’t know. Wherever she damn pleases? In the bookstore that seat might be with the memoirs or essays but also might be on of abbreviations the LGBTQ and available dissertations theses database, Feminist Studies shelf.
I consider myself more essayist than memoirist in that subject tends to list come before story in my process, but I’m OK with the memoir tag, especially if that descriptor invites more readers to brave an unfamiliar narrative structure. AY: I’ve been wondering about the of bullying in school essay, possibilities of shifting point-of-view in thesis writing about the self. In Body Geographic , I noticed that you created a 19th-century version of yourself arriving in Chicago for the World’s Fair. You wrote in third person about this “self,” as a way of describing one side of your own character. What did this help achieve that couldn’t be accomplished in the typical first-person voice of memoir writing? BJB : I don’t suppose it’s for me to say what any move I made in the book achieved.
I can only speak to what I wanted in effects of bullying the moment of thesis, making, which was, in the case of work, creating that 19th century woman fairgoer, another way to thesis of abbreviations inhabit history in a woman’s body. Effects In School Essay? I wanted a counter to the bland interior of the statuesque symbol of Columbia. I wanted the desiring woman to reach out from the past and include me. Thesis Of Abbreviations? I wanted to be a part of what I connect to so strongly in the literary version of that 19th century woman, such as that of Dreiser’s Sister Carrie, who comes to the city to change herself. I love studying the history of places, and in particular cities. Reading about what was here before brings me great intellectual and imaginative pleasure. Moments in the book such as the one you describe are my way of attempting to create embodied history. JS: I find Body Geographic to be a fascinating, therapeutic (in my case), and very complex book.
Its “insets” are marvelous for magnifying the people and events that dominate portions of proquest, your characters’ lives and so shape your characters’ identities. As I struggle to organize my own collection of essays, I would like to know how you kept track of the characters, events, images, and thesis list of abbreviations latex, themes that occur and recur throughout Body Geographic. Did you lay them out in some visual way (as I am trying to do with Post-It notes on a white wall) to check for balance, forward movement, repetition? Did you diagram the book? Did you try any strategies that didn’t work? BJB: I’m extremely intentional about the symphonic echoes and visual image design balances of all my books, but with Body Geographic —this is my third book— after many years into writing, I was able to see and hear the whole thing well enough to work without much of a visual map. I used to need a great deal by way of visual form props; in previous books I’ve made charts, graphs, color-coded tables of contents.
I made what I called form wheels where I used something like post-its to do exactly what you say—track visual balance, repetition, echoes, and so forth. But with this book I found I was able to keep more of the design in my head. Mostly what I did this time was keep these echoes in mind as I listened for where I needed return, repeat, and balance. I did keep the of bullying essay, table of contents hanging on walls and bulletin boards wherever I worked, which functioned as my diagram, but I was never wed to this plan. I changed the order and chapter focus more times than I can remember. The details and echoes came to the page this time by ear and memory and intuition, and with occasional guidance from draft readers who noted I’d lost hold of a thread. Also, I cut quite a bit of over-repetition in later drafts.
What I’ll say in general about form-mapping activities is that they often work for awhile and then stop working, seemingly mysteriously. List? We may just outgrow them as we move toward finishing a book. My best advice is that the titles, writer should devise the best way of working for her/his way of thinking and imagining, but never hesitate to abandon a process that’s stopped working. As writers, we have to list be as creative and flexible about our processes as we are about the cheap essay service australia, form of the work itself. LA : As you tell your story, you skillfully weave the theme of water throughout–from the three tiers of spouting water at Buckingham Fountain; to thesis Helen Keller’s bodily encounter with water and her thrill of connecting it to its name; to asking the reader to imagine what it would be like if their own city flooded. Essay? You write: “Water pulls the body forward. Thesis List Of Abbreviations? Water hems the body in. Cheap Essay Writing Service Australia? Nothing feeds longing like uncertainty, and list of abbreviations, nothing is more uncertain than a horizon line where the wide haze of water swallows the fahrenheit 451 essay, hard border of sky.” This made me especially curious about the thesis list, question you posed in the caption for the illustrated map, Mississippi River Meander: “For don’t we all live on waterfront property?” Could you offer your answer to this question and/or elaborate on this theme?
BJB : I was attracted to teenagers that map of the many shores of the thesis of abbreviations, Mississippi—so deeply attracted that I have a version of that map tattooed onto my right arm—because the executive, image looks to me like human life. Our shorelines shift. List Of Abbreviations? Change reroutes us. We can’t control time; we can’t control the earth turning and recalibrating. I started writing this book thinking I’d be able to pin down my understandings of identity, ethnicity, and the meaning of place but instead I found out there is no fixed meaning beyond this: places, our bodies, the effects in school, borders of things just keep changing. Barrie Jean Borich is the thesis of abbreviations latex, author of My Lesbian Husband , winner of the American Library Association Stonewall Book Award. Her new book, Body Geographic was published in the American Lives Series of the titles, University of Nebraska Press.
She’s the recipient of the 2010 Florida Review Editor’s Prize in thesis list of abbreviations latex the Essay and the 2010 Crab Orchard Review Literary Nonfiction Prize, and essay writing, her work has been named Notable in thesis list of abbreviations latex Best American Essays and Best American Non-Required Reading . Essay? She was the first nonfiction editor of the Water. Stone Review and a longtime faculty member in The Creative Writing Programs at Hamline University in St. Paul, Minnesota. She is currently a member of the creative writing faculty of the English Department and the MA in Writing and thesis list latex, Publishing program at Chicago’s DePaul University and splits her time between Minneapolis and cheap essay writing australia, Chicago. 2017 Brevity: A Journal of Concise Literary Nonfiction.
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Using LaTeX to Write a PhD Thesis - Dickimaw Books
17 Ways to Make Your Resume Fit on thesis list of abbreviations latex, One Page. You may look at your resume and think that everything on it is fahrenheit 451 essay titles, too important to be left off. Latex! But let#8217;s get real. You#8217;re looking for an internship or entry-level job, which means you have just a few years experience. While we#8217;re all about making your experience relevant, there isn#8217;t a single recruiter out there who thinks it#8217;s ok to have a resume longer than one page for cheap writing australia an internship or entry-level job. You may have plenty of experience for your level, but you don#8217;t have that much experience. Resumes longer than a page are only appropriate for thesis list of abbreviations latex those who have been in their industry, say, 10 years. So how do you cut down your resume to fahrenheit, something readable, while still getting across how awesome you are? These easy tips will help you easily achieve such a lofty goal. 1. Only talk about relevant experience. Even if you have a ton of thesis list of abbreviations, internship experience, it probably doesn#8217;t all need to essay writing service australia, be on your resume.
Read the job description carefully and highlight keywords and skills they#8217;re looking for. Thesis Latex! Then, look over titles, your experiences and only include the ones that demonstrate your ability in those areas. If you#8217;ve had similar roles at thesis of abbreviations latex different companies, you probably had some similar tasks. That#8217;s great! It means you have lots of experience in those areas. However, recruiters do not need to read #8220;Strategized social media content for various clients#8221; or #8220;Wrote and distributed press releases#8221; two or three times. If you had the same responsibilities at two different jobs, only mention the one where you had the best results. 3. Leave out #8220;References available upon request.#8221; Many people will use an entire line (and probably a blank space above it) to write this phrase.
If you#8217;re struggling to fahrenheit, fit your resume to a page, those two lines are valuable real estate. If an employer wants references, they#8217;ll request them. It#8217;s rare for an applicant not to have a single reference available, so don#8217;t waste precious resume space with this phrase. Many people choose to write their name across the top of their resume in 13940292 pt font. Thesis List Of Abbreviations! We get it it#8217;s dramatic, eye catching, etc., etc., but it#8217;s a total waste of space. It#8217;s plenty attention-grabbing to write your name in bold, maybe one or two font sizes larger than the rest of your resume. Fahrenheit! Recruiters know they can find your name at the top of the thesis list of abbreviations latex, page, so you don#8217;t need to make it so obvious for titanic them. We#8217;ve heard plenty of mixed feelings from list recruiters on the objective. Some find it helpful, some say it#8217;s a waste of space. In School Essay! We happen to latex, side with the latter.
Let your experience show your objective. If your experience doesn#8217;t seem obviously relevant to the position, then use your bullet points to demonstrate how those roles apply. Review the job description and reshape your bullets to show your relevant skills. Plus, your cover letter is the perfect place to elaborate on how your experience fits. A #8220;widow#8221; is one word that has it#8217;s own line. In resumes, this is of bullying in school essay, often seen in the #8220;skills#8221; section, and it#8217;s a major waste of space. Try reformatting sections like that to make the most of your space. For example, write your skills on one line and separate them with dots, slashes, or lines.
If you do this, however, be careful when uploading to application systems that pull the content of your resume into list of abbreviations a text box. The system may mess up your formatting, so be sure to cheap essay service, check it over thesis latex, and update it before submitting. Very rarely is your high school going to be relevant to a position you#8217;re applying for. Unless you went to a very specialized high school, or you know that the recruiter reviewing your application also went to essay, your high school, there#8217;s no reason to of abbreviations latex, include it. Your work experience and privilege essays, college education say a lot more about list latex you than where you went to school when you were 16, so just leave this out.
8. Put information about each position on one line. Proquest Theses! You might like the way your resume looks when the company, duration of your position, location, and your title each have their own line. But if it#8217;s pushing your resume over a page, it#8217;s time to thesis latex, move things around. Essay! Play around with ways to fit this information on one or two lines. Doing this for each of your positions will save you a ton of space. 9. Format relevant leadership experience under work experience. Having a separate #8220;leadership experience#8221; section uses more space than necessary. Evaluate your leadership and list, see which roles are truly relevant to the position you#8217;re applying for. Then, move the most relevant ones into your #8220;work experience#8221; section. Cutting out that header and teenagers essay, selecting only the thesis list of abbreviations latex, roles that are actually relevant will free up some room on the page. It might seem scary to have tiny margins it#8217;s against everything you learned in school but it actually makes your resume look much more impressive.
Try making your margins 0.5#8243; and see how much space you suddenly have. You can also play around with spacing between bullet points and sections. Work Essay! Single spacing your bullets but putting slightly larger spacing between sections will keep your resume readable without sucking up the space that double spacing does. Just based on the formatting which is all you see at first glance which of these is thesis, more likely to catch your eye? Spacing can make a huge difference. 11. Put your contact information on teenagers, one line. Thesis Of Abbreviations! The traditional address format is not your friend when putting together your resume. Use the same trick we used earlier for putting your skills on one line, and titanic essay, separate your contact information using dots, slashes, or lines. Thesis List Of Abbreviations! Just because 12 pt font was standard for essay your college essays doesn#8217;t mean the thesis of abbreviations latex, same goes for theses database your resume.
Play around with 11 or 11.5 pt font instead. You#8217;ll find that it#8217;s readable and gives you more room to play with. 13. Don#8217;t feel pressure to put three bullets. It may look nice to thesis list latex, have at least three bullet points under each title you#8217;ve held, but it#8217;s not necessary. If you didn#8217;t have three separate and available proquest theses, relevant roles in each position, then you don#8217;t need three bullets. If two of your bullet points are similar, try combining them into one line. Thesis! 14. Use bullet points that make you stand out. Forget the bullets that everyone in that sort of role performed.
Only include ones where you had great results (#8220;Increased ticket sales by 200%#8221;) or the context is impressive (#8220;Worked the door for a 500+ person event#8221;). 15. Only mention self-explanatory awards. Having awards on your resume is nice, unless you#8217;re using up all your space explaining what they#8217;re for. If the name of an executive privilege award doesn#8217;t obviously explain what it#8217;s for, and you find yourself adding bullets under it to explain, then just leave it out altogether. 16. Leave off irrelevant experience (yes, again!). List Of Abbreviations! Seriously. This one is so important, it#8217;s worth repeating.
If I#8217;m considering you for an editorial internship, I don#8217;t need to know that you were a member of essay, your school#8217;s ballroom dance club. Unless you can clearly show in your bullets how the experience applies to thesis of abbreviations latex, the role, don#8217;t include it. 17. Available Dissertations Database! Submit it as a PDF unless otherwise specified. Once you#8217;ve made all these changes, save your resume as a PDF. Employers want to see PDF resumes 99% of the time, so unless the application specifically says to submit it as a Word Document, you should save it as a PDF. Nothing says #8220;careless#8221; like submitting a Word document that highlights typos, and thesis list of abbreviations, you never know if the essay australia, formatting will change on the recruiter#8217;s computer, making it look sloppy and thesis of abbreviations latex, possibly over one page. Submit a PDF so you know exactly what they#8217;ll see when they open it.
Remember, you can always add more to your LinkedIn to cover additional experiences. Make sure you include your custom LinkedIn link in the contact section of your resume so employers can easily find out more about you. Cheap Essay! About the author of thesis list of abbreviations latex, this article, Christina Madsen. 2 comment on “ 17 Ways to Make Your Resume Fit on One Page ” My question on this is outline, that if you aren#8217;t applying to a entry level position or an internship does the lack of introduction summary on your resume still apply? As I am applying to different jobs and I have heard that most of the time when you write a cover letter, it gets seen by the first person to receive your application but then they discard it and just keep the resume, sometime being the person who looks at the cover letter will say, #8220;she/he meets the thesis list of abbreviations latex, criteria we are looking for based our advertisement#8221; then hands it to the person without the cover letter who actually does the hiring. I am trying to get used to the different ways to present a resume at this moment being originally from australia where some things in fahrenheit 451 essay titles, terms of the application process differs. Thoughts or advice? Thank you.
Hi Johanna! That#8217;s a great question. Thesis List! Unfortunately, the short answer is that it#8217;s different for every company. Some recruiters love to read cover letters, others never read them. I would say that if you#8217;re trying to make your resume fit on one page and have to effects of bullying, make a choice between including really great work experience and including an objective/summary, go with the thesis of abbreviations, experience. It will show why you#8217;re right for the job better than a brief summary. Again, that#8217;s a personal opinion and everyone will have a different view on the matter. But go with your gut and include what you think shows that you#8217;re the best candidate!
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Extracorporeal membrane oxygenation (ECMO) for list latex, critically ill adults in the emergency department: history, current applications, and executive privilege future directions. © Mosier et al. 2015. Published: 17 December 2015. Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that augments oxygenation, ventilation and/or cardiac output via cannulae connected to a circuit that pumps blood through an oxygenator and back into the patient. ECMO has been used for decades to support cardiopulmonary disease refractory to conventional therapy.
While not robust, there are promising data for the use of ECMO in acute hypoxemic respiratory failure, cardiac arrest, and list cardiogenic shock and the potential indications for ECMO continue to increase. This review discusses the existing literature on the potential use of ECMO in critically ill patients within the emergency department. Extracorporeal life support (ECLS) is available dissertations theses database a general term used to describe temporary support of cardiac or pulmonary function using mechanical devices. When using the “heart–lung machine” to completely bypass the cardiopulmonary circulation, it is referred to thesis list of abbreviations latex, as cardiopulmonary bypass. When ECLS is used in proquest dissertations theses the intensive care unit (ICU) or emergency department (ED) to augment oxygenation, ventilation, or cardiac output it is generally referred to list of abbreviations, as extracorporeal membrane oxygenation (ECMO).
As the science of ECLS has progressed internationally, ECLS use in United States ICUs has increased over 400 % since 2006 [ 1 ]. This has led to interest in potential earlier applications in executive the ED, and possibly even the prehospital setting. This review focuses on one modality of thesis list, ECLS, ECMO, and describes the history of ECMO, common current applications, and important considerations related to ECMO use in adult ED patients. ECLS was initially developed in the 1950s by executive privilege essays John Gibbon as a means of oxygenating blood via a membrane oxygenator during prolonged operations on cardiopulmonary bypass [ 2 ]. Given the lack of an list of abbreviations, open reservoir of blood and extreme anticoagulation required with a traditional cardiopulmonary bypass circuit, ECMO presented a less complex and more sustainable option for essay outline, treatment of refractory cardiovascular and respiratory failure outside the operating room. Several reports were published demonstrating successful use in “shock-lung syndrome”, “adult capillary leak syndromes”, and cardiopulmonary failure in the late 1970s [ 3 , 4 ]. In 1979, a randomized controlled trial conducted on adult patients with severe acute respiratory failure reported a 90 % mortality rate for patients in both groups [ 5 ]. Thus, enthusiasm stalled and over the next 30 years ECMO was used mostly for thesis, neonatal and pediatric patients with only a small number of in school essay, highly specialized centers pursuing ECMO in adult patients. Technological improvements and of abbreviations latex advances in other aspects of critical care have created an ECMO landscape that is very different from the early days of 90 % mortality. Executive Essays? For patients with severe hypoxemic respiratory failure, the publication of the Conventional Ventilatory Support versus Extracorporeal Membrane Oxygenation for Severe Adult Respiratory Failure (CESAR) trial and of abbreviations several reports of essay, improved survival in patients with acute respiratory distress syndrome (ARDS) treated with ECMO during the H1N1 influenza pandemic have led to thesis of abbreviations latex, a significant expansion of ECMO use [ 6 – 9 ]. Recent data show promise when ECMO is used early in patients with cardiac arrest to augment traditional cardiopulmonary resuscitation in executive the form of extracorporeal cardiopulmonary resuscitation (ECPR) [ 10 – 15 ]. ECPR may play a role in the prehospital [ 16 ] or ED management of list of abbreviations, refractory cardiac arrest, cardiovascular collapse due to pulmonary embolism [ 17 ], hypothermia [ 18 ], drowning [ 19 ], overdoses [ 20 ], airway obstruction [ 21 ], and severe electrolyte abnormalities [ 22 ]. Veno-venous ECMO for severe acute respiratory failure. Acute respiratory failure due to potentially reversible processes such as ARDS or utilization as a bridge-to-transplant have become the most common indications for ECMO therapy in adults [ 23 ]. It is well recognized that positive pressure ventilation can have deleterious effects leading to ventilator-induced lung injury, oxidative stress, and further lung damage. Utilizing ECMO in these patients allows “lung rest” through more protective ventilator settings [ 24 ]. Initial randomized trials of ECMO for respiratory failure did not show a benefit compared with traditional ventilator methods [ 5 , 25 ]. In the 1990s and 2000s, survival rates reported in case series with ECMO improved to 52–75 % [ 26 , 27 ]. Executive Essays? During the H1N1 pandemic in which patients frequently developed severe ARDS with refractory hypoxemia, patients treated with ECMO showed survival rates as high as 79 % [ 7 , 9 , 28 , 29 ]. The first modern randomized controlled trial of ECMO for adult patients with ARDS, the CESAR trial, was published in thesis list of abbreviations latex 2009. It evaluated outcomes in effects in school essay patients with severe ARDS transferred to list of abbreviations latex, an ECMO referral center versus patients treated with conventional therapy.
Although mortality at any point was not significantly different, the study identified significantly higher 6-month survival rates in the group transferred to the ECMO referral center—of which only 75 % of the patients received ECMO—versus the control group that were not transferred [ 30 ]. Thus, it may have been other aspects of care at the ECMO center, not necessarily the ECMO itself, that led to improved outcomes. The Extracorporeal Membrane Oxygenation for work essay, Severe Acute Respiratory Distress Syndrome (EOLIA) trial is currently underway, evaluating early ECMO within 3 hours of initiation of mechanical ventilation for thesis list latex, patients with refractory hypoxemia and severe ARDS [ 31 ]. If this trial finds a benefit of early ECMO for ARDS, coordinating transfer to ECMO-capable referral centers directly from the writing service australia, ED for early initiation of ECMO support may become important for patient outcomes [ 32 ]. In addition to of abbreviations latex, supporting oxygenation, ECMO may be a beneficial option in patients with hypercapneic respiratory failure that are unable to be managed with mechanical ventilation [ 33 ]. Veno-arterial ECPR for cardiac arrest. Despite advances in management, outcomes for essay, both in-hospital and out-of-hospital cardiac arrest remain poor. In-hospital cardiac arrest treated with conventional cardiopulmonary resuscitation (CPR) typically has a survival rate of 15–17 % and out-of-hospital cardiac arrest (OHCA) survival is even lower at only 8–10 % [ 34 , 35 ]. The worst outcomes are in patients with prolonged time to thesis, return of writing service australia, spontaneous circulation. Prolonged cerebral hypoperfusion leads to significantly worse neurologic sequelae and early initiation of ECPR with veno-arterial (VA) ECMO may be a useful adjunct to reducing the interval time from arrest to restoration of cerebral perfusion. Data for in-hospital arrest are the most promising, likely due to the shorter interval from the onset of arrest to initiation of ECMO flow. While there are no randomized trials to thesis list, date, observational studies have reported an association between ECPR and improved survival. In a retrospective, single-center, propensity-matched analysis, Shin et al. [ 12 ] showed improved survival with favorable neurologic outcome (Glasgow-Pittsburgh Cerebral Performance Category (CPC) score of 1 or 2) for patients with in-hospital arrest treated with ECPR versus conventional CPR (hazard ratio (HR) 0.17, 95 % confidence interval (CI) 0.04–0.68). Chen et al. [ 11 ] found similar 30-day (HR 0.47, 95 % CI 0.28–0.77) and 1-year (HR 0.53, 95 % CI 0.33–0.83) survival for ECPR when compared with conventional CPR.
Both studies indicated improved outcomes when the arrest was of cardiac origin. Another retrospective review of work teenagers essay, prolonged in-hospital arrests (15 minutes) or refractory shock after return of spontaneous circulation showed nearly half of the patients who survived had a CPC score of 1 or 2 with the of abbreviations, use of ECPR [ 10 ]. Effects Of Bullying Essay? Other observational studies have found variable improvements in mortality with the use of list, ECPR [ 36 , 37 ]. A recent meta-analysis performed by Cardarelli et al. [ 38 ] in 135 patients from 1990 to titles, 2007 showed a hospital survival rate to list latex, discharge with ECPR of 40 %. Reports from OHCA studies are not as robust, although there are dramatic reports of otherwise hopeless cases rescued by ECMO [ 39 ]. Haneya et al. [ 40 ] compared ECPR initiated in the ED for OHCA with ECPR initiated for in-hospital cardiac arrest, and found a survival rate of titanic, 42 % for in-hospital arrest patients versus only 15 % for of abbreviations, OHCA patients. ECPR combined with therapeutic hypothermia and intra-aortic balloon pump placement was recently shown to improve neurologic outcomes for OHCA patients with ventricular fibrillation or pulseless ventricular tachycardia. This study demonstrated survival with a favorable CPC score in 11.2 % of those with ECPR versus 2.6 % with conventional CPR at cheap 6 months [ 14 ]. Similar results were reported in thesis list of abbreviations latex a small observational pilot study in Australia combining mechanical compression devices, ECPR, and dissertations theses hypothermia for patients with refractory cardiac arrest. Thesis List Of Abbreviations Latex? In this small study, 5 of 11 OHCA patients and 9 of 15 in-hospital cardiac arrest patients survived, and cheap essay australia favorable neurological outcome was achieved in latex half of the survivors [ 15 ]. For witnessed OHCA of cardiac origin, ECPR has shown even greater improvements in neurologically favorable survival (29 % ECPR versus 8.9 % CPR) [ 13 ]. A very promising recent observational study in 26 patients with refractory cardiac arrest, either in-hospital or OHCA, reported a favorable neurological survival rate of 54 % when ECPR was combined with a mechanical compression device and therapeutic hypothermia [ 15 ]. However, these data have not been replicated and writing australia similar studies have reported survival rates ranging from 4–15 % [ 41 – 43 ]. When ECPR can be initiated rapidly, the latex, outcomes for OHCA may be similar to those seen with in-hospital cardiac arrest patients [ 44 , 45 ]. Fahrenheit 451 Essay Titles? Although there are no large prospective randomized trials and survival from refractory cardiac arrest is poor, ECPR may provide a tool to improve survival with good neurologic outcomes when initiated early in thesis list latex selected patients. While an optimistic estimate of survival from OHCA with the use of ECPR may be in executive the 15–20 % range, the list of abbreviations, critical factor that determines success appears to be the fahrenheit 451 essay, duration from the list of abbreviations, onset of work teenagers, arrest to achieving ECMO flow.
This may be why in-hospital cardiac arrest studies have generally reported better outcomes [ 45 – 47 ]. Furthermore, the of abbreviations latex, volume of patients meeting optimal criteria for titanic, ECPR, including witnessed ventricular fibrillation/tachycardia with a short interval to thesis list, initiation of CPR, refractory arrest despite optimal resuscitative efforts, and 75 years of age comprises a very small (10 %) subset of titles, all patients with OHCA [ 48 , 49 ]. Additionally, complication rates of thesis list of abbreviations latex, ECPR remain high [ 43 , 50 , 51 ]. Currently the American Heart Association’s position is that evidence does not support a recommendation for privilege, ECPR, although it may be considered in highly specialized centers in patients who have a potentially reversible disease and a short duration of cardiac arrest [ 52 ]. The recent Institute of Medicine report on cardiac arrest care states ECMO is an emerging technology that has promise in improving cardiac arrest care and should be developed and thesis list latex researched [ 53 ]. In addition to ECPR, ECMO may have a role in select patients with cardiogenic or septic shock [ 54 – 56 ], toxic ingestions [ 57 ], thyrotoxicosis [ 58 ], or trauma [ 59 ]. For patients with septic shock, high survival rates may be achievable, although survival rates are significantly diminished in the presence of multi-organ failure and in patients cannulated during cardiac arrest [ 55 , 60 ]. ECMO has shown promising results as a method of supporting hemodynamics in privilege patients with cardiogenic shock due to of abbreviations latex, acute myocardial infarction [ 61 ], massive pulmonary embolism [ 62 ] or myocarditis [ 63 ]. Proquest Theses Database? ECMO may be preferable to aortic balloon pumps as it can provide more robust biventricular support by thesis list latex increasing right ventricular drainage in addition to supporting gas exchange, and available proquest dissertations it can be employed quickly at thesis latex the bedside. However, the 451 essay titles, downside of list, ECMO for cardiac support is that because of the retrograde aortic flow, left ventricular afterload and oxygen demand increase without the executive privilege, placement of thesis of abbreviations latex, a left ventricular drain. ECMO can serve as a bridge to available theses database, recovery, device implantation, or cardiac transplantation. Thesis List? Small trials have shown improved survival rates in patients placed on ECMO as a bridge to a left ventricular assist device and fahrenheit 451 essay titles subsequently to transplantation [ 64 ]. Several small studies have shown success in treating cardiogenic shock with ECMO, but there are no data comparing outcomes with ECMO versus alternative rescue modalities [ 65 ]. Arranging the initiation of ECMO may be a viable option in patients with known severe cardiac dysfunction in shock refractory to list of abbreviations, conventional therapy in the ED. A successful ECLS program requires a significant multidisciplinary and organizational commitment to ensure necessary resources and personnel [ 66 ]. Teenagers? Hospitals with a higher volume of ECLS cases (30 cases/year) have shown improved mortality outcomes compared with hospitals with only a few cases per thesis latex, year (6) [ 67 ]. Initiating ECMO in teenagers essay a critically ill patient requires considerations related to equipment, blood bank capabilities, cannulation configuration, availability of list of abbreviations latex, necessary personnel, and coordination with the executive, receiving critical care physicians. Thesis List Of Abbreviations Latex? In a recent trial evaluating ECMO for OHCA, initiation of ECMO required two critical care physicians for cannulation, a third physician providing ultrasound guidance of cannula placement in the inferior vena cava, a fourth physician dedicated to leading the resuscitation, a nurse coordinator to initiate the circuit, and a sixth person to infuse cold saline for intra-arrest hypothermia [ 15 ]. Titanic Essay? Additionally, while cannulation may be feasible by non-surgeons in the ED [ 68 ], close collaboration with surgeons is imperative due to risks of vascular injury requiring surgical repair. A successful ECLS program requires physicians, nurses, perfusionists, and respiratory therapists trained and competent in thesis list cannulation and management of the ECLS circuit to be available in sufficient numbers to provide 24/7 coverage. A streamlined exit strategy from the ED should be established, whether that includes transfer to the cardiac catheterization lab, ICU, or transfer to executive privilege, an ECMO receiving hospital.
Predetermined inclusion and exclusion criteria, as well as guidelines on how and when to separate from thesis list of abbreviations ECMO in a patient who fails to improve are important to optimize outcomes and resource utilization. Finally, when considering initiating ECMO in the ED for a particular patient, current inpatient ECMO volume and capacity to essay outline, accommodate new patients must be considered. List Of Abbreviations? As a result, ECLS may not be a feasible option at many hospitals due to resource limitations. Cheap Essay? Local, regional, and inter-regional networks of thesis of abbreviations latex, hospitals with direct communication with the ECMO referral center that provides a mobile rescue team for cannulation and transport of patients with critical cardiopulmonary failure may be the optimal solution to alleviate many of these costly programmatic considerations. Veno-venous cannulation for ARDS. This chest X-ray demonstrates severe airspace disease in a patient with ARDS. The dual-lumen ECMO cannula ( arrows ) can be seen passing through the internal jugular vein, superior vena cava, and terminating in the inferior vena cava at the level of the hepatic vein. ECMO circuit components and flow. Titanic? Flow through the ECMO circuit starts with the venous drainage cannula (1), which is propelled forward by the pressure gradient generated by thesis of abbreviations latex the centrifugal pump head (2). The blood passes through the oxygenator (3) and then returns to the patient in the outflow tubing back into the right atrium (VV) or femoral artery (VA) (4).
Gas exchange is regulated by the amount of countercurrent “sweep” gas flowing through the fahrenheit 451 essay, oxygenator (5) and of abbreviations latex the blood is warmed by available proquest database the thermoregulator attached to the circuit (6). Flow, hemoglobin, hematocrit and latex venous saturation can be continuously monitored by ultrasonic meters attached to the circuit (7 and executive 8) Percutaneous VA ECMO in thesis list of abbreviations adults most commonly involves femoral artery and work essay vein cannulation where oxygenated blood is returned to the femoral artery and thesis of abbreviations flows retrograde into effects of bullying, the aorta. Thesis? Consequently, in the absence of any native cardiac output, VA ECMO provides near complete cardiopulmonary bypass. In the presence of cheap essay writing australia, native cardiac output, blood flow out of the list latex, left ventricle mixes with retrograde ECMO return flow in titanic the aorta. Thesis Latex? If there is no intrapulmonary shunt, the native cardiac output is well oxygenated and executive essays this mixing is not detrimental. Thesis? However, if the patient’s lungs are failing (e.g., because of privilege essays, ARDS), blood flow from the native cardiac output is deoxygenated and competes with retrograde flowing oxygenated blood from the ECMO circuit. Latex? These competing flows mix somewhere in the aorta and can create differential hypoxemia (“North–south” syndrome) whereby poorly oxygenated blood preferentially perfuses the outline, upper body, including the brain and heart, potentially leading to coronary and cerebral ischemia. Contraindications, complications, and ethical challenges. The decision to thesis list latex, use ECMO requires a thoughtful risk–benefit evaluation. Proquest Database? Contraindications are generally conditions that are known to be associated with a particularly poor outcome despite ECMO therapy.
Patients with severe neurologic injuries, intracranial hemorrhage, immunosuppression, irreversible multi-organ failure, untreatable malignancy, or those at thesis an advanced age are typically poor ECMO candidates. Patients with aortic dissections or severe aortic regurgitation are not ECMO candidates due to the risks of propagating the dissection and over-distending the left ventricle, respectively. For patients with ARDS, relative contraindications include prolonged mechanical ventilation that has required injurious airway pressures. For ECPR and cardiogenic shock, patients with unrecoverable heart disease, prolonged arrest time, and those who are non-transplant or ventricular assist device candidates are poor ECMO candidates. Titanic Essay Outline? If cannulated, these patients are relegated to a “bridge-to-nowhere”, which presents a complicated ethical dilemma in thesis list of abbreviations latex that they cannot survive without ECMO but recovery is improbable and they are not candidates for definitive therapy.
Patients generally require anticoagulation while on ECMO and, while it is not an absolute contraindication, an teenagers, inability to anticoagulate complicates both cannulation and of abbreviations long-term management strategies. Complication rates with ECMO are high. This is true during both cannulation and ongoing management [ 69 ]. Complications include hemorrhage, stroke, limb ischemia, thrombosis, and work infection from the list of abbreviations, indwelling lines/tubes. Data show at proquest theses least one significant complication occurs in latex over half of patients on work ECMO [ 65 ], with bleeding (30–40 %) [ 26 , 51 ] and infection (31 %) [ 51 ] being the most common. Hemorrhagic complications most commonly occur at the cannulation or surgical sites themselves and of abbreviations are generally related to fahrenheit 451 essay, anti-coagulation, of which VA ECMO requires more aggressive anticoagulation due to the risk of arterial thrombosis. VA cannulation carries a high risk of arterial injury—recently reported in 18 % of patients requiring VA ECMO, with most of the injuries requiring surgical repair [ 70 ]. Neurologic complications such as intracranial hemorrhage or infarct are also well-recognized and list latex can be devastating. Fahrenheit 451 Essay Titles? Other complications include hemolysis, pulmonary edema, and lower extremity ischemia from thesis latex occlusion of the arterial flow with placement of the arterial cannula, which can be prevented with the routine placement of an antegrade arterial cannula to that limb. Little is known about long-term complications and quality of life in adult patients who have undergone ECMO. While there are many anecdotal cases of complete recovery from critical illness in ECMO survivors, some studies report neurologic injury and long-term neurocognitive abnormalities in over 50 % of cases [ 71 , 72 ]. 451 Essay? In addition, ECMO survivors may experience a poor quality of life [ 73 , 74 ], anxiety, depression, and post-traumatic stress disorder [ 8 , 74 ]. List Of Abbreviations Latex? ICU lengths of stay tend to be long in ECMO patients [ 26 , 74 ] and their costs are generally much higher than patients receiving conventional therapy [ 75 ]. The challenges of complications, cost, and resource utilization, when taken together with the potential of titanic essay, creating a bridge-to-nowhere situation for some patients and lack of high-quality evidence, create an list latex, ethical obligation to consider the risks and benefits very carefully when considering ECMO in a patient’s treatment plan. Since its advent in the 1950s, ECLS has gone from the operating room to a promising rescue modality for cardiopulmonary failure in the ICU and beyond.
With expanding potential indications and improving outcomes, there is significant interest in the early application of ECMO in the ED, yet significant hurdles still exist. These include lack of definitive data on patient selection, complication rates, functional outcomes and survival as well as resource utilization and economic costs. The H1N1 pandemic, combined with improvements in general critical care, brought modern and improved ECMO technology into the limelight with good outcomes in the treatment of severe acute respiratory failure. Combined with recent data in effects in school patients with cardiac arrest and shock that show promising trends, there appears to be potential for the early application of ECLS to patients in the ED. Thesis? Currently, there are no data to support ECMO as anything other than a rescue therapy in experienced centers at this time. Titanic Essay Outline? Emergency physicians should consider early transfer to a specialized center in thesis of abbreviations the select patients in available dissertations theses database which ECMO has shown benefit.
Continuing research will likely spur further expansion of ECMO with increased utilization occurring in the ED and possibly even the prehospital setting. However, we encourage a cautious and evidence-based approach to future applications of list of abbreviations, ECMO prior to essay, widespread adoption given the logistical and ethical challenges of this technology that has the potential to outpace the supporting data. Acute respiratory distress syndrome. Conventional Ventilatory Support versus Extracoporeal Membrane Oxygenation for Severe Adult Respiratory Failure. Cerebral Performance Category. Extracorporeal life support. Extracorporeal membrane oxygenation. Extracorporeal cardiopulmonary resuscitation. Intensive care unit. Out-of-hospital cardiac arrest.
Open Access This article is thesis latex distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Proquest Dissertations Theses Database? The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated. The authors declare that they have no competing interests. All authors contributed to the literature review, manuscript preparation and approval of the final draft. J.M.M. is a dual-trained physician in thesis list of abbreviations latex emergency medicine and critical care and dissertations theses associate medical director of adult ECMO services at the University of Arizona. He is a member of the thesis of abbreviations, Arizona Emergency Medicine Research Center and the Arizona Respiratory Center. Effects In School? C.D.H. is a dual-trained physician in emergency medicine and critical care at the University of Arizona. S.P.W. is a dual-trained physician in latex emergency medicine and critical care at the University of Michigan.
K.J.G. is an associate professor of emergency medicine, internal medicine, and privilege essays anesthesiology at the University of of abbreviations latex, Michigan. He serves as the chief of the division of emergency critical care, medical director of the emergency critical care center, intensivist in the Cardiovascular ICU, and a core investigator in the Michigan Center for Integrative Research in Critical Care (MCIRCC). In School Essay? Y.R. is the thesis list of abbreviations, medical director of adult ECMO services at the University of Arizona. R.M. is the medical director of the pediatric ICU and ECMO services at the University of Arizona. Executive Essays? D.W.S. is a Professor and Distinguished Chair of Emergency Medicine, Co-Director of Emergency Medical Systems Research and the Associate Director of the Arizona Emergency Medicine Research Center at thesis list latex the University of Arizona. Sauer CM, Yuh DD, Bonde P. Extracorporeal membrane oxygenation use has increased by work teenagers essay 433 % in adults in the United States from 2006 to 2011.
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Predictors of list of abbreviations latex, neurological outcomes after successful extracorporeal cardiopulmonary resuscitation. Cheap Essay Service Australia? BMC Anesthesiol. Of Abbreviations? 2015;15:26. PubMed CentralPubMedView ArticleGoogle Scholar Poppe M, Weiser C, Holzer M, Sulzgruber P, Datler P, Keferbock M, et al. The incidence of effects of bullying, “loadgo” out-of-hospital cardiac arrest candidates for emergency department utilization of of abbreviations latex, emergency extracorporeal life support: a one-year review. Resuscitation. 2015;91:131–6.
PubMedView ArticleGoogle Scholar Patel JK, Schoenfeld E, Parnia S, Singer AJ, Edelman N. Venoarterial extracorporeal membrane oxygenation in available dissertations adults with cardiac arrest. J Intensive Care Med. 2015. Google Scholar Xie A, Phan K, Yi-Chin Tsai M, Yan TD, Forrest P. Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest: a meta-analysis. J Cardiothorac Vasc Anesth. 2015;29(3):637–45. Thesis Latex? PubMedView ArticleGoogle Scholar Cheng R, Hachamovitch R, Kittleson M, Patel J, Arabia F, Moriguchi J, et al. Proquest Dissertations Theses? Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann Thorac Surg. 2014;97(2):610–6. List Of Abbreviations Latex? PubMedView ArticleGoogle Scholar Cave DM, Gazmuri RJ, Otto CW, Nadkarni VM, Cheng A, Brooks SC, et al.
Part 7: CPR techniques and teenagers devices: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and thesis latex Emergency Cardiovascular Care. Circulation. Titanic Outline? 2010;122(18 Suppl 3):S720–8. PubMed CentralPubMedView ArticleGoogle Scholar Graham R, McCoy MA, Schultz AM. Strategies to thesis of abbreviations latex, improve cardiac arrest survival: a time to writing, act. The National Academies Press. 2015. Thesis Of Abbreviations Latex? http://www.nap.edu/catalog/21723/strategies-to-improve-cardiac-arrest-survival-a-time-to-act . Kar B, Basra SS, Shah NR, Loyalka P. Available Proquest Dissertations Theses? Percutaneous circulatory support in cardiogenic shock: interventional bridge to recovery. Circulation. List Of Abbreviations Latex? 2012;125(14):1809–17.
PubMedView ArticleGoogle Scholar Brechot N, Luyt CE, Schmidt M, Leprince P, Trouillet JL, Leger P, et al. Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock. Available Proquest Dissertations? Crit Care Med. 2013;41(7):1616–26. PubMedView ArticleGoogle Scholar Park TK, Yang JH, Jeon K, Choi SH, Choi JH, Gwon HC, et al. Extracorporeal membrane oxygenation for refractory septic shock in adults. Eur J Cardiothorac Surg. Thesis Of Abbreviations? 2015;47(2):e68–74. PubMedView ArticleGoogle Scholar Weinberg RL, Bouchard NC, Abrams DC, Bacchetta M, Dzierba AL, Burkart KM, et al.
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PubMedView ArticleGoogle Scholar Ried M, Bein T, Philipp A, Muller T, Graf B, Schmid C, et al. Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience. Crit Care. List Latex? 2013;17(3):R110. Work? PubMed CentralPubMedView ArticleGoogle Scholar Huang CT, Tsai YJ, Tsai PR, Ko WJ. Extracorporeal membrane oxygenation resuscitation in adult patients with refractory septic shock. J Thorac Cardiovasc Surg. 2013;146(5):1041–6. PubMedView ArticleGoogle Scholar Esper SA, Bermudez C, Dueweke EJ, Kormos R, Subramaniam K, Mulukutla S, et al. Extracorporeal membrane oxygenation support in acute coronary syndromes complicated by cardiogenic shock.
Catheter Cardiovasc Interv. 2015;86 Suppl 1:S45–50. Thesis List Of Abbreviations Latex? PubMedView ArticleGoogle Scholar Northey LC, Shiraev T, Omari A. Available Proquest Dissertations? Salvage intraosseous thrombolysis and extracorporeal membrane oxygenation for massive pulmonary embolism. J Emerg Trauma Shock. 2015;8(1):55–7. Thesis? PubMed CentralPubMedView ArticleGoogle Scholar Diddle JW, Almodovar MC, Rajagopal SK, Rycus PT, Thiagarajan RR. Dissertations Theses Database? Extracorporeal membrane oxygenation for the support of adults with acute myocarditis. Crit Care Med. 2015;43(5):1016–25.
PubMedView ArticleGoogle Scholar Pagani FD, Aaronson KD, Swaniker F, Bartlett RH. The use of list of abbreviations latex, extracorporeal life support in adult patients with primary cardiac failure as a bridge to implantable left ventricular assist device. Ann Thorac Surg. 2001;71(3 Suppl):S77–81. discussion S82–5. PubMedView ArticleGoogle Scholar Combes A, Leprince P, Luyt CE, Bonnet N, Trouillet JL, Leger P, et al. Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Cheap Essay Writing Service? Crit Care Med.
2008;36(5):1404–11. PubMedView ArticleGoogle Scholar Combes A, Brodie D, Bartlett R, Brochard L, Brower R, Conrad S, et al. Thesis Of Abbreviations Latex? Position paper for the organization of effects essay, extracorporeal membrane oxygenation programs for thesis, acute respiratory failure in adult patients. Am J Respir Crit Care Med. Theses Database? 2014;190(5):488–96. PubMedView ArticleGoogle Scholar Barbaro RP, Odetola FO, Kidwell KM, Paden ML, Bartlett RH, Davis MM, et al. Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry. Am J Respir Crit Care Med. 2015;191(8):894–901.
PubMedView ArticleGoogle Scholar Bellezzo JM, Shinar Z, Davis DP, Jaski BE, Chillcott S, Stahovich M, et al. Emergency physician-initiated extracorporeal cardiopulmonary resuscitation. List Of Abbreviations Latex? Resuscitation. 2012;83(8):966–70. Essay Service Australia? PubMedView ArticleGoogle Scholar Zangrillo A, Landoni G, Biondi-Zoccai G, Greco M, Greco T, Frati G, et al. Thesis Latex? A meta-analysis of complications and mortality of cheap writing, extracorporeal membrane oxygenation. Crit Care Resusc.
2013;15(3):172–8. PubMedGoogle Scholar Aziz F, Brehm CE, El-Banyosy A, Han DC, Atnip RG, Reed AB. Arterial complications in patients undergoing extracorporeal membrane oxygenation via femoral cannulation. Ann Vascular Surg. List Of Abbreviations? 2014;28(1):178–83.
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PubMedView ArticleGoogle Scholar Hodgson CL, Hayes K, Everard T, Nichol A, Davies AR, Bailey MJ, et al. Long-term quality of thesis, life in essays patients with acute respiratory distress syndrome requiring extracorporeal membrane oxygenation for refractory hypoxaemia. List? Crit Care. 2012;16(5):R202. PubMed CentralPubMedView ArticleGoogle Scholar Schmidt M, Zogheib E, Roze H, Repesse X, Lebreton G, Luyt CE, et al. The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for effects in school, severe acute respiratory distress syndrome. Thesis Latex? Intensive Care Med.
2013;39(10):1704–13. PubMedView ArticleGoogle Scholar Peek GJ, Elbourne D, Mugford M, Tiruvoipati R, Wilson A, Allen E, et al. Randomised controlled trial and cheap essay writing australia parallel economic evaluation of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR). Health Technol Assess. List Of Abbreviations? 2010;14(35):1–46. PubMedView ArticleGoogle Scholar. Share on Twitter Share on Facebook Share on LinkedIn Share on Weibo Share on Google Plus Share on Reddit.
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