Bicarbonate Supplementation Slows Progression of CKD and Improves Nutritional StatusIone de Brito-Ashurst, Mira Varagunam, Martin J. Raftery, and Muhammad M. Yaqoob LayAbstractChronic kidney disease (CKD) is the long-term damage of the kidney. Symptoms only start presenting when the disease is progressing towards the advanced stages. It is a disease of the elderly population, and with the UKs ageing population, cases are likely to increase in the near future. Metabolic acidosis (MA) is a common complication of CKD and treating this has been thought to slow down the decline in kidney function. Bicarbonate supplementation has previously been used as an experimental treatment on rat models to correct the MA but results have been inconclusive. There is also a lack of long-term trials investigating the effect on humans. The results showed bicarbonate supplementation was beneficial to kidney function and nutritional status of patients, while causing minimal side effects. More clinical trials need to be performed to consolidate these findings and to look at alternative treatment regimens before being implemented into clinical practice.Background Information and Rationale for Carrying Out the WorkChronic kidney disease (CKD) is the long-term decline in kidney function. It is defined as kidney damage resulting in a GFR ? 60 mL/min/1.73m2 for more than 3 months, or kidney damage for more than 3 months with evidence of structural or functional abnormalities, with GFR not necessarily reduced (1). In advanced stages it can lead to metabolic acidosis (MA) due to a decreased tubular bicarbonate secretion, which has been known to cause protein catabolism and increased insulin resistance (2), and impaired ammonium excretion (3).The lesser stages of CKD are quite common in communities but ESRD is quite rare in populations. CKD is a disease of the elderly with around 30-40% of the population > 75 years having CKD at stages 3-5 (1). It is usually asymptomatic until the later stages of the disease and during ESDR, the only possible life supporting treatments are transplantation or dialysis (4).Obesity is associated with an increased risk of CKD by over 2.5 times (5). With obesity, type 2 diabetes and hypertension all on the rise (6-8) , there is likely to be a boom in the number of CKD cases within the next couple of decades. There is clearly a need to address this future burden on the healthcare system.Correction of MA in dialysis patients has shown to slow down protein degradation in a small number of short term clinical trials (9, 10). Studies on rat models have shown inconsistent evidence where MA has been shown to slow down progression of renal failure (11). Due to the short term nature of these studies, there has been inadequate evidence on the impact of renal function.There have been very few studies investigating the correction of MA in CKD in humans and also the lack of long term studies of the effect on pre-dialysis patients, which were the main motives for carrying out this study.Approaches to the Question and Key ResultsThe research question raised was whether bicarbonate supplementation to patients with MA in CKD could slow its progression and improve nutritional status. A single-centre, open-label, randomised, parallel-group study was carried out to investigate this question.The inclusion and exclusion criteria were stated explicitly. 134 eligible patients were randomly assigned to either routine standard care or oral sodium bicarbonate tablets 600mg TID which was increased as necessary to maintain bicarbonate ? 23mmol/L. The treatment assignment procedure was done by an external statistician and involved block stratification, then randomisation carried out within each stratum of men, women, diabetics and non-diabetics. This method helped to balance each of the patients covariates and ensured adequate concealment. As a result, 67 patients were assigned to the control group and 67 patients to the treatment group. To reach a power of 90% which would allow an absolute difference of 30% to be detected, 63 patients in each group would have to be studied, but to allow for non-compliance, this was increased to 67. Calculation of statistical power ensured a large enough sample size. The 2 groups had similar baseline characteristics (Table 1) and apart from the bicarbonate supplementation, they were both treated equally.Patients were followed up every 2 months for 2 years for the primary outcome measurements while nutritional assessments were carried out at 0, 6, 12, 18 and 24 months by a single dietician. All patients were able to be analysed with none of the patients being lost to follow up or discontinuing the intervention, however 5 withdrew before receiving the treatment. Intention to treat analysis was performed. The investigators, statisticians and the single dietician were blinded to the initial group assignment as they were directly involved in assessing the outcomes, but since the trial was open-label, it suggests that patients and external clinicians were not.The outcomes were focused on the research question and were measured in a standard way. The primary outcomes were the decline in renal function, the number of patients with rapid progression of renal failure, and the development of ESRD that required dialysis.After 12 months, the rate in decline of CrCl was lower in the treatment group at 1.88 ml/min per 1.73 m2 (95% [CI] 0.39 to 4.15 ml/min per 1.73 m2) than the control group at 5.93 ml/min per 1.73 m2 (95% confidence interval [CI] 4.19 to 7.76 ml/min per 1.73 m2) (P<0.05). 9% of treatment patients underwent rapid CKD progression compared to 45% in the control group with a relative risk [RR] = 0.15 (95% [CI] 0.06 to 0.40; P<0.0001). Fewer patients receiving treatment developed ESRD requiring dialysis, 6.5% versus 33% in the control group ([RR]=0.13; 95% [CI] 0.04 to 0.40; P<0.001). All the P values are less than 0.05 indicating that these results are statistically significant and are highly unlikely to be due to chance.Secondary outcomes were measurements of changes in normalized protein nitrogen appearance (nPNA), dietary protein intake (DPI), serum albumin and mid-arm muscle circumference (MAMC) to identify the nutritional status of patients. Results showed an increase in DPI (P < 0.007) and decrease in nPNA (P < 0.002) in the treatment group compared to the control group, which led to an increase in lean body mass (LBM) as measured by MAMC. Serum albumin levels were increased in the treatment group relative to the control group, further demonstrating an improvement in nutritional status.Likely Impact of Research OutcomeThe fact that there was both a slowdown of the decline in kidney function and a reduction in the number of patients progressing to ESRD is clinically beneficial. However, the confidence interval for the treatment group is quite large (0.39 to 4.15 ml/min per 1.73 m2) and the upper limit is close to overlapping with the confidence interval of the control group at the lower limit (4.19 to 7.76 ml/min per 1.73 m2) for the rate in decline of CrCl. Statistically, the treatment may only offer a marginal improvement over the control, but the bicarbonate supplementation clearly does offer some benefit to stage 4 CKD patients. There are also significant nutritional benefits to CKD patients. Poor nutrition leads to protein energy wasting (PEW) and a low serum albumin which increase morbidity and mortality in dialysis patients (12), but this can be easily reduced with bicarbonate supplementation.The patients studied in this trial are not 100% representative of the population. This trial had to exclude 30 out of 184 potential subjects due to eligibility criteria. The exclusion criteria included morbid obesity, congestive heart failure, chronic sepsis, malignant diseases, cognitive impairment or uncontrolled hypertension so findings will not apply to patients that fall into these categories, however the findings will be important for the majority of patients with CKD. The trial was only a single centre study on patients at the Royal London Hospital in the East End of London. The demographic in this area of London is likely to vary from demographics in other parts of London and the UK.I think all the outcomes of interest to the patient were considered before the trial. Side effects of worsening hypertension and oedema that required an increase in therapy and loop diuretics respectively were minimal (Table 3). Blood pressures rose and oedema worsened more in the treatment group but these were not statistically significant (P=0.17 and P=0.5). The single main issue was that 6.5% of subjects experienced a bad taste taking the tablet of the sodium bicarbonate, which was then switched to a powder form.In the long term I think this trial will form the basis of a future change in clinical practice. The change will not be immediate as this is the first RCT on pre-ESRD patients with MA and more clinical trials need to be carried out in this area, with a subsequent systematic review and meta-analysis. Overall, the bicarbonate supplementation does offer an advantage over standard treatment, and the fact that bicarbonate itself is simple and very cheap to source and produce with minimal side effects also works in its favour.Future Work and ConclusionThere are some changes I would make to the trial. The confidence interval for the treatment group is quite large (0.39 to 4.15 ml/min per 1.73 m2) and the upper limit is close to overlapping with the confidence interval of the control group at the lower limit (4.19 to 7.76 ml/min per 1.73 m2) for the rate in decline of CrCl. So statistically, the treatment may only offer a marginal improvement over the control. In order to achieve a more precise CI, a larger sample size could be used, and a multi-centre trial could be conducted so that the findings can be applied to a wider population. I think the accuracy of the outcomes would also benefit from the use of a placebo and double-blinding.This study focused only on patients in stage 4 CKD. While these patients are likely to experience MA, it may also be beneficial to study the effect on patients in stage 3 CKD. Patients especially in stage 3b CKD (GFR 30-44 mL/min) are at risk of slipping into the stage 4 category and bicarbonate supplementation has potential to act as a preventative treatment.The serum bicarbonate level in the treatment group was maintained at 23 mmol/L or greater. There was no upper limit for the bicarbonate level and considering that the normal range of serum bicarbonate is 22-28 mmol/L, we can see that the trial looked at the lower end of the reference range. I think a future clinical trial should look at the effect of bicarbonate supplementation on stage 4 CKD patients when serum bicarbonate is controlled within a middle range of 24-26 mmol/L and at the upper end range of 26-28 mmol/L.It is encouraging to see that there have been more RCTs investigating the positive outcomes of bicarbonate supplementation on CKD (13-15), however further investigations still need to be carried out to reach an optimal and definitive treatment plan.References1.Barratt J, Topham PD, Harris KPG. Nephrology. Oxford: Oxford University Press; 2009.2.Kopple JD, Kalantar-Zadeh K, Mehrotra R. Risks of chronic metabolic acidosis in patients with chronic kidney disease. Kidney Int Suppl. 2005(95):S21-7.3.Bailey JL. Metabolic acidosis: an unrecognized cause of morbidity in the patient with chronic kidney disease. Kidney Int Suppl. 2005(96):S15-23.4.Smart NA, Dieberg G, Ladhani M, Titus T. Early referral to specialist nephrology services for preventing the progression to endâstage kidney disease. 2009.5.MacLaughlin HL, Hall WL, Sanders TA, Macdougall IC. Risk for chronic kidney disease increases with obesity: Health Survey for England 2010. Public Health Nutr2010. p. 1-6.6.Klahr S, Morrissey J. Progression of chronic renal disease. Am J Kidney Dis. 2003;41(3 Suppl 1):S3-7.7.Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4-14.8.Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis. BMC Public Health. 2009;9(1):88.9.Graham KA, Reaich D, Channon SM, Downie S, Goodship TH. Correction of acidosis in hemodialysis decreases whole-body protein degradation. J Am Soc Nephrol. 1997;8(4):632-7.10.Williams AJ, Dittmer ID, McArley A, Clarke J. High bicarbonate dialysate in haemodialysis patients: effects on acidosis and nutritional status. Nephrol Dial Transplant. 1997;12(12):2633-7.11.Jara A, Felsenfeld AJ, Bover J, Kleeman CR. Chronic metabolic acidosis in azotemic rats on a high-phosphate diet halts the progression of renal disease. Kidney Int. 2000;58(3):1023-32.12.Lowrie EG, Lew NL. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis. 1990;15(5):458-82.13.Kovesdy CP. Metabolic acidosis and kidney disease: does bicarbonate therapy slow the progression of CKD? 2012.14.Abramowitz MK, Melamed ML, Bauer C, Raff AC, Hostetter TH. Effects of oral sodium bicarbonate in patients with CKD. Clin J Am Soc Nephrol. 2013;8(5):714-20.15.Gaggl M, Cejka D, Plischke M, Heinze G, Fraunschiel M, Schmidt A, et al. Effect of oral sodium bicarbonate supplementation on progression of chronic kidney disease in patients with chronic metabolic acidosis: study protocol for a randomized controlled trial (SoBic-Study). Trials. 2013;14:196.Get Help With Your EssayIf you need assistance with writing your essay, our professional essay writing service is here to help!Find out more
Effect of Bicarbonate Supplement on Kidney Function
Mar 18, 2020 | Sciences
Our Service Charter
1. Professional & Expert Writers: Topnotch Essay only hires the best. Our writers are specially selected and recruited, after which they undergo further training to perfect their skills for specialization purposes. Moreover, our writers are holders of masters and Ph.D. degrees. They have impressive academic records, besides being native English speakers.
2. Top Quality Papers: Our customers are always guaranteed of papers that exceed their expectations. All our writers have +5 years of experience. This implies that all papers are written by individuals who are experts in their fields. In addition, the quality team reviews all the papers before sending them to the customers.
3. Plagiarism-Free Papers: All papers provided by Topnotch Essay are written from scratch. Appropriate referencing and citation of key information are followed. Plagiarism checkers are used by the Quality assurance team and our editors just to double-check that there are no instances of plagiarism.
4. Timely Delivery: Time wasted is equivalent to a failed dedication and commitment. Topnotch Essay is known for timely delivery of any pending customer orders. Customers are well informed of the progress of their papers to ensure they keep track of what the writer is providing before the final draft is sent for grading.
5. Affordable Prices: Our prices are fairly structured to fit in all groups. Any customer willing to place their assignments with us can do so at very affordable prices. In addition, our customers enjoy regular discounts and bonuses.
6. 24/7 Customer Support: At Topnotch Essay, we have put in place a team of experts who answer to all customer inquiries promptly. The best part is the ever-availability of the team. Customers can make inquiries anytime.
Recent Posts
- Develop a PowerPoint presentation on a clinical case for Anemia
- NURS6003N Module 6 Discussions
- WK 8: Ethics and the Role of IRB
- NURS 8310 Week 11 Final Paper Assignment : Major Assessment 7: Using an Epidemiological Approach to Critically Analyze a Population Health Problem
- NURS_8310 Week10 Assignment
Archives
- May 2024
- April 2024
- January 2024
- December 2023
- August 2023
- July 2023
- June 2023
- May 2023
- January 2023
- October 2022
- September 2022
- August 2022
- July 2022
- June 2022
- May 2022
- March 2022
- February 2022
- January 2022
- December 2021
- November 2021
- October 2021
- September 2021
- August 2021
- July 2021
- June 2021
- May 2021
- April 2021
- March 2021
- February 2021
- January 2021
- December 2020
- November 2020
- October 2020
- September 2020
- August 2020
- July 2020
- June 2020
- May 2020
- April 2020
- March 2020
- February 2020
- January 2020
- December 2019
- November 2019
- October 2019
- September 2019
Categories
- `
- .uul l illl'
- "" ""Qualitative Analysis Assignment: Transcript 3
- "" which is attached to this assignment.
- (15 points) Lot Ai? ?Xn be a random sample from a f/(0,0) population with unknown parameter 0 > 0. Find the likelihood ratio test (LRT) of size a for testing Ho : 0 > 0q .vs. H : 0 < Oq.
- { ""cell_type"": ""markdown""
- /files/-np-ex19-7b-xlsx
- /files/0886109913504154-pdf,/files/1363460706065057-pdf,/files/0886109914560741-pdf
- /files/11357-txt,/files/cavell-pdf
- /files/20191118150623part-vii-assessment-tool-development-rub1-pdf
- /files/20191119051422iom-report-future-of-nursing-rubric-xlsx
- /files/20200428035024defend-or-refute-guide-pdf
- /files/adjustmentdisorder-pdf,/files/depression1-pdf-6973733
- /files/assignment1j-docx-7815535,/files/assignment2j-docx
- /files/assignment2-docx-5634861,/files/networking14-pkt,/files/20200204-routers-table-docx,/files/20200204-network-infrastructure-design-pdf-5640375
- /files/assignment2-docx-8830717
- /files/bookaccess-docx-5088805
- /files/bookchap1-412-pdf,/files/bookchap1-412-pdf-7977187
- /files/businessculturaldimensionsanalysisgradingrubric-pdf-7789673"
- /files/casestudy2-docx-5603093
- /files/chapter5-pdf-7822037
- /files/crjs3001wk1studentreplies-docx
- /files/developingobjectives1-docx,/files/article3assignments3-41-pdf,/files/developingobjectives1-docx-7919359
- /files/discussionreflectionguide-docx,/files/introduction-to-criminology-10th-edition-9781544339023-pdf,/files/sample-docx-7598097
- /files/essay2-documentedargumentrevised22-pdf-6947741
- /files/frenchandindianwar-docx-7926377,/files/bostonteapartyaftermath-docx
- /files/homework2negotiationmorgan-docx,/files/homeworknegotiation1michele-docx
- /files/labassignmnetw8-docx-7665133
- /files/lessonweek4-docx
- /files/mat240houselistingpricebyregionpjct5-xlsx-7794861,/files/mat240modulefiveassignmenttemplatepjct5-docx-7794863
- /files/microm53question-docx
- /files/milecture-pdf,/files/motivationalinterviewing-thebmj-pdf
- /files/nrnpprac6635comprehensivepsychiatricevaluationtemplate-docx-8263023"
- /files/principlesofcorporatefinance13erichardbrealey-pdf-7629311,/files/wk71-docx,/files/wk72-docx,/files/wk73-docx,/files/wk74-docx
- /files/problemstatementchecklist-pdf-6967979,/files/week4article-pdf-6967981
- /files/prospectusfinaldraft-correctedversion-docx,/files/dissertationprospectusoriginalversion-docx
- /files/reflectionpaperguidelines-docx-7570139
- /files/rubricpandv-pdf-7584061,/files/page11-pdf-7584063,/files/page9-10-pdf-7584065,/files/implicationofpiagetsandvygotskytheories-summer2021socialstudiesmethodsforece-fieldece-3571-01-pdf
- /files/screenshot2021-02-27at11-35-38am-png"
- /files/sec-516-t6-meetingtheneedsofdiverselearners-docx"
- /files/spd-400-d-t6-studentgoalsandinterventionplantemplate-docx-7938583,/files/rub-docx-7938623
- /files/taskdifficultyandincubation1-docx
- /files/unitvinternationlstudyguide-pdf-7796117
- /files/visualcommunicationassessment23051-docx
- /files/week3assignmentg-docx
- /files/week4rubric-docx-7856191
- /files/week7readingdestructivebehavior-pdf-7890761,/files/bibliu-print-9781452236315table143-pdf
- /files/westernphilosophyananthologybycottinghamjohnz-lib-org-pdf"
- /files/woodch9-pdf,/files/chapter8-pdf-6111751
- /files/youthexposedtoviolenceindc-august2021-docx,/files/chapteronethenatureandtoolsofresearch-pdf
- ~I'vcrn I""theorems"" follow from it
- 1111 writing and reading is embedded in some Discourse
- 12 font
- 12 point font
- 2015
- 2021
- 2021). HTML pages are an excellent example that allows network shares hence makes the embedding of the resources possible. Therefore
- 3 PAGE ESSAY ON WHY I DONT WANT ANY TATTOOS. I NEED CLEAR EXAMPLES
- 4-6sentence · Sentence1-2:Author + Genre + Context of the Bible book (that the story is a part of) · Sentences 3-5: Brief Summary Including Story Genre (historical narrative, mythology, or parable).
- 4)."
- Acc 206
- ACC 206, BUSINESS FINANCE
- ACC201
- ACC544, BUSINESS FINANCE
- ACC556
- ACC573, Business & Finance
- ACC60171, Other
- Accounting & Finance
- Acct 101
- ACCTG406
- ACIS5104
- ACOL202
- acquire (at least) one initial Discourse. This initial Discourse
- actively engaging with course materials
- acts
- AD712, Business & Finance
- adding beliefs
- ADMIN565
- ADMN575, OTHER
- allocating specific time slots for coursework
- ALY6100
- American Military University
- AMERICAN MILITARY UNIVERSITY, BUSINESS FINANCE
- AMERICAN MILITARY UNIVERSITY, WRITING
- American Public University System
- AMERICAN PUBLIC UNIVERSITY SYSTEM, BUSINESS FINANCE
- AMERICAN PUBLIC UNIVERSITY SYSTEM, HUMANITIES
- AMH2020
- analyze and evaluate the following questions:
- and cost were controlled.
- and academic grammar and usage.
- and architecture the guys work execution at the program or system level. At the risk of falling victim to stating the obvious
- and describe the type of economic analysis that you would use in the evaluation.
- and external resources recommended by instructors. Utilize online libraries
- and interactive components. Take comprehensive notes
- and managing your time effectively
- and often write
- and personal health record (PHR)
- and related terms for two separate concepts. (examples: technology-computer
- and Transportation and Telecommunication. Using The World Factbook
- and users are able to inject SQL commands using the available input (Imperva
- ANM104
- ANM104 OL1
- ANTH130, SCIENCE
- ANTHROP 2200
- Anthropology 130
- Applied Science
- Applied Sciences
- Applied SciencesApplied Sciences
- Architecture and Design
- Architecture and DesignArchitecture and Design
- Arizona State University
- ARIZONA STATE UNIVERSITY, WRITING
- Art
- ART101
- ART2010
- ARTH102
- article
- Arts
- ARTS1301
- ASC400, BUSINESS FINANCE
- ashford university
- ASHFORD UNIVERSITY, BUSINESS FINANCE
- ASHFORD UNIVERSITY, HUMANITIES
- ASHFORD UNIVERSITY, OTHER
- ASHFORD UNIVERSITY, SCIENCE
- Ashworth College
- asking thoughtful questions and providing constructive feedback to your peers. Regularly check your course emails and notifications
- assignments
- at least
- Atlantic International University Online, Science
- attitudes
- BADM735
- BAM515, BUSINESS FINANCE
- BCJ3601, BUSINESS FINANCE
- BCN4431
- BEHS380, WRITING
- Berkshire Community College
- Bethel University
- BETHEL UNIVERSITY, HUMANITIES
- beyond the family and immediate kin and peer group. These may be 1111.
- BHR3352
- BHR3352 Human Resource Management
- BIO1100
- BIO1408
- BIO2401
- BIO3320
- BIO354, SCIENCE
- BIOCHEM202
- Biology
- Biology – Anatomy
- Biology – AnatomyBiology – Anatomy
- Biology – Ecology
- Biology – Physiology
- BIOLOGY 10, SCIENCE
- BiologyBiology
- Blog
- BME351
- body
- Bowie State University
- Bowie State University, Science
- brings with it the (poten- u.il) acquisition of social ""goods"" (money
- BROCK UNIVERSITY, BUSINESS FINANCE
- BROCK UNIVERSITY, OTHER
- BROOKDALE COMMUNITY COLLEGE, HUMANITIES
- BROOKLYN COLLEGE, WRITING
- BUAD326, Business & Finance
- BULE303
- BUS1001
- BUS120, Business & Finance
- BUS125, WRITING
- BUS187, Business & Finance
- BUS232
- BUS242
- BUS303, BUSINESS FINANCE
- BUS410, BUSINESS FINANCE
- BUS472, SCIENCE
- BUS475
- BUS499
- BUS520, Business & Finance
- BUS530
- BUS542
- BUS599
- BUS620
- BUS623
- BUS630
- BUSI320
- Business
- Business – Management
- Business & Finance
- Business & Finance – Financial markets
- Business & Finance – Financial marketsBusiness & Finance – Financial markets
- Business & Finance – Marketing
- Business & Finance – MarketingBusiness & Finance – Marketing
- Business & Finance – Supply Chain Management
- Business & Finance , BUS430
- Business & Finance , BUSN370
- Business & Finance , COMM240
- Business & Finance , COMS2302
- Business & Finance , ENT527
- Business & Finance , FIRE3301
- Business & Finance , G141COM1002
- Business & Finance , GB520
- Business & Finance , GB540
- Business & Finance , IBSU487
- Business & Finance , JWI515 Managerial Economics
- Business & Finance , MGT16
- Business & Finance , MGT496
- Business & Finance , MGT498
- Business & Finance , MGT521
- Business & Finance , MT460
- Business & Finance , PM586
- Business & Finance , RMI3348
- Business & Finance , SOC450
- Business & Finance , south university online
- Business & Finance , Strayer University
- Business & Finance , University of Phoenix
- Business & Finance , Wilmington University
- Business & Finance, Trident University
- Business & FinanceBusiness & Finance
- Business and Finance
- Business Finance – Accounting
- Business Finance – AccountingBusiness Finance – Accounting
- Business Finance – Economics
- Business Finance – EconomicsBusiness Finance – Economics
- Business Finance – Management
- Business Finance – ManagementBusiness Finance – Management
- Business Finance – Operations Management
- Business Finance – Operations ManagementBusiness Finance – Operations Management
- BUSINESS FINANCE, CBBU1001
- BUSINESS FINANCE, COLORADO STATE UNIVERSITY GLOBAL
- BUSINESS FINANCE, COLORADO TECHNICAL UNIVERSITY
- BUSINESS FINANCE, COLUMBIA SOUTHERN UNIVERSITY
- BUSINESS FINANCE, COM 510
- BUSINESS FINANCE, CRJ101
- BUSINESS FINANCE, DOC660
- BUSINESS FINANCE, EASTERN KENTUCKY UNIVERSITY
- BUSINESS FINANCE, ECN 501
- BUSINESS FINANCE, ECO2251
- BUSINESS FINANCE, ECO531
- BUSINESS FINANCE, FIN 500
- BUSINESS FINANCE, FIN31FMS12019
- BUSINESS FINANCE, GRANTHAM UNIVERSITY
- BUSINESS FINANCE, HLS3302
- BUSINESS FINANCE, HRC164
- BUSINESS FINANCE, HRM 500
- BUSINESS FINANCE, INDS 400
- BUSINESS FINANCE, INT113
- BUSINESS FINANCE, INTL3306
- BUSINESS FINANCE, ISDS 351
- BUSINESS FINANCE, LAWS OF EVIDENCE
- BUSINESS FINANCE, LIBERTY UNIVERSITY
- BUSINESS FINANCE, MAN3504
- BUSINESS FINANCE, MBA 5121
- BUSINESS FINANCE, MG260
- BUSINESS FINANCE, MGMT386
- BUSINESS FINANCE, MGT 521
- BUSINESS FINANCE, MGT211
- BUSINESS FINANCE, MICHIGAN STATE UNIVERSITY
- BUSINESS FINANCE, MIDDLE TENNESSEE STATE UNIVERSITY
- BUSINESS FINANCE, MKT331
- BUSINESS FINANCE, MKT419
- BUSINESS FINANCE, NORTHEAST MONTESSORI INSTITUTE
- BUSINESS FINANCE, OAKLAND UNIVERSITY
- BUSINESS FINANCE, PARK UNIVERSITY
- BUSINESS FINANCE, RASMUSSEN COLLEGE
- BUSINESS FINANCE, SOUTHERN NEW HAMPSHIRE UNIVERSITY
- BUSINESS FINANCE, TRIDENT INTERNATIONAL UNIVERSITY
- Business Strategy
- C11E
- Calculus
- California Baptist University
- California Coast University
- CALIFORNIA STATE UNIVERSITY NORTHRIDGE, OTHER
- can be studied
- can never 21 really be liberating literacies. For a literacy to be liberating it must contain both the Discourse it is going to critique and a set of meta-elements (language
- Capella University
- Capella University, Humanities
- Capital L. George Adams
- CATEGORY
- CE304
- CE445
- CEE792
- CEGR338
- Chamberlain College of Nursing
- Chapter 3
- Charles R Drew University of Medicine and Science
- charles sturt university
- Chaudhary Charan Singh University, Humanities
- CHEM101
- CHEM111
- CHEM1411, Science
- CHEM202, Science
- CHEM210, Science
- CHEM410
- Chemistry
- Chemistry – Chemical Engineering
- Chemistry – Organic chemistry
- Chemistry – Pharmacology
- Chemistry – Physical chemistry
- ChemistryChemistry
- Childcare
- CHMY373, SCIENCE
- Choose three problematic issues that are currently facing older people living in the community?
- CINE286U
- CIS210
- cis273
- CIS359
- CIS510, Other
- CIS524
- CIVL6603, Science
- CJ430, SCIENCE
- CJA444
- CJUS300, Other
- Classics
- CMIT495
- CMSC140
- Colorado Christian University
- COLORADO STATE UNIVERSITY GLOBAL, SCIENCE
- COLORADO STATE UNIVERSITY, SCIENCE
- Colorado State UniversityGlobal
- Colorado Technical University
- COLORADO TECHNICAL UNIVERSITY, OTHER
- Colorado Technical University, Programming
- Columbia Southern University
- COLUMBIA SOUTHERN UNIVERSITY, OTHER
- Columbia Southern University, Science
- COLUMBIA SOUTHERN UNIVERSITY, WRITING
- Commerce
- Communication
- Communications
- COMMUNITY-BASED CORRECTIONS
- COMP1007
- Computer Science
- Computer Science – Java
- Computer Science- Python
- Computer ScienceComputer Science
- Construction
- correctness
- Cosc1437
- counseling chemical dependency adolescents
- Criminology
- CRJ305
- cross-site scripting
- CS101
- CSIT 100, PROGRAMMING
- CSPM326
- CST 610, PROGRAMMING
- Cultural Studies
- culturally appropriate intervention to address childhood obesity in a low-income African American community.
- CUR535
- CUYAMACA COLLEGE, HUMANITIES
- CUYMACA COLLAGE, HUMANITIES
- Data Analysis
- DAVIDSON COLLEGE, OTHER
- defensive programming allows for more efficient processes while also protecting systems from attack.
- DES201
- Describe the difference between glycogenesis and glycogenin ? Explain in 10 to 12 lines.
- Design
- Digital Marketing Plan for Nissan Motor Co. The plan will identify the current marketing opportunity and/or problem(s) and propose digital marketing solutions. Please use header in the attachment."
- Discuss one way in which the Soviet Union fulfilled communist thought, and another way in which it did not with reference to O'Neil's Chapter 9.
- Discuss the pros and cons of free-market based economies and how they impact the modern, globalized economy? What comes to your mind when you hear the term "globalization?"
- Dissertation
- DMM612, Science
- DMM649, SCIENCE
- Draft and essay of 1,000 words minimum, stating the Most Important and Relevant aspects to be considered when carrying on INTERNATIONAL NEGOTIATIONS or MULTI-CULTURAL NEGOTIATIONS.
- Drama
- each time a user extracts the ZIP file
- Earth Science – Geography
- Earth Science – GeographyEarth Science – Geography
- Earth Science – Geology
- EAS1601
- ECD 541, HUMANITIES
- ECE 452
- Ecommerce
- ECON335
- Economics
- ECPI University
- EDUC696
- Education
- EducationEducation
- EEL3472C
- EEL3705
- EET110
- EFFAT UNIVERSITY JEDDAH, HUMANITIES
- elasticity
- ELI2055A
- EMDG 230, SCIENCE
- Emglish
- Emory University
- Employment
- EN106
- EN106, HUMANITIES
- EN109
- EN206, HUMANITIES
- ENC1102, Writing
- eng 100
- ENG100
- ENG101
- ENG101, Humanities
- ENG102
- ENG102, Humanities
- eng106
- ENG1102, WRITING
- ENG124
- ENG124, Humanities
- ENG124, Writing
- ENG1340, HUMANITIES
- ENG200, Humanities
- ENG207
- eng2206
- ENG2211
- ENG305
- ENG812
- Engineering
- Engineering – Chemical Engineering
- Engineering – Civil Engineering
- Engineering – Civil EngineeringEngineering – Civil Engineering
- Engineering – Electrical Engineering
- Engineering – Electrical EngineeringEngineering – Electrical Engineering
- Engineering – Electronic Engineering
- Engineering – Mechanical Engineering
- Engineering – Mechanical EngineeringEngineering – Mechanical Engineering
- Engineering – Telecommunications Engineering
- EngineeringEngineering
- ENGL 120
- ENGL 124, OTHER
- ENGL 124, WRITING
- ENGL 2030, HUMANITIES
- ENGL1102
- ENGL120, HUMANITIES
- ENGL120SP2019, WRITING
- ENGL126
- ENGL1302
- ENGL130E, HUMANITIES
- ENGL147N, HUMANITIES
- ENGL2, Humanities
- English
- English – Article writing
- English – Article writingEnglish – Article writing
- English Language
- English Literature
- EnglishEnglish
- ENGR350
- ENST202CORE274
- ensuring you allocate dedicated time for coursework
- Environment
- Environmental Science
- Environmental Sciences
- Environmental Studies
- especially for a small company
- Essay Writing
- etc¦). Please note at least five organizational activities and be specific when responding.
- ETH321
- ETHC445N
- Ethnic Studies 101
- European Studies
- EXNS6223
- Family
- Fashion
- February 20). What is defensive programming? EasyTechJunkie. Retrieved December 30
- film industry
- FILM INDUSTRY, HUMANITIES
- Film Studies
- FIN 500
- FIN330, MATHEMATICS
- FIN370
- Final Essay
- Find the uniform most powerful level of alpha test and determine sample size with the central limit theorem
- Florida International University
- Florida National University
- Florida State College at Jacksonville
- FoothillDe Anza Community College District
- Foreign Languages
- Foreign Languages – Spanish
- formulations
- from https://www.pcmag.com/news/fat32-vs-ntfs-choose-your-own-format
- G124/enc1101
- Gallaudet University
- General Studies
- General_Business
- GEO1206
- GEOG100, Science
- Geography
- GEOL3200, HUMANITIES
- Geometry
- George Mason University
- GERM1027
- GERO 101, SCIENCE
- GERON101
- GLG101, Science
- GO16
- Government
- GovernmentGovernment
- GOVT2305
- GOVT2305, Humanities
- GOVT2306
- Grand Canyon University, Science
- Grand Canyon University, Writing
- Grantham University
- GRANTHAM UNIVERSITY, PROGRAMMING
- GRANTHAM UNIVERSITY, WRITING
- GROSSMONT COLLEGE, HUMANITIES
- Grossmont-Cuyamaca Community College District
- GROSSMONT-CUYAMACA COMMUNITY COLLEGE DISTRICT, HUMANITIES
- GU299, WRITING
- Hawaii Pacific University
- HC310
- HCA415
- HCA521
- HCM550, SCIENCE
- Hcs370
- HCS446
- he focused on aspects of the U.S. that combined democratic and increasingly capitalist characteristics. THINK ABOUT the points De Tocqueville made.
- Health & Medical
- Healthcare
- HIM 2588, MATHEMATICS
- HIM 500, SCIENCE
- HIM301
- HIS 108
- HIS101
- HIS105
- HIS200
- HIST104A, Humanities
- HIST111
- HIST1301, HUMANITIES
- HIST1302
- HIST1320
- HIST1700
- HIST2620
- HIST350, Humanities
- HIST405N, HUMANITIES
- HIST459, Humanities
- History
- History – American history
- History – American historyHistory – American history
- History – Ancient history
- History – Ancient historyHistory – Ancient history
- History – World history
- History – World historyHistory – World history
- HISTORY4250, Humanities
- HistoryHistory
- HLSS508, OTHER
- HMP403
- Hospitality
- HOST1066, WRITING
- Housing
- How do the changes in ship technology effect port operations? Discuss at least 3 factors contributing to port operations and development. Address cargo and passenger liners.250 words
- How have Mary Calderone, SIECUS and other sex educators changed how sex education is perceived? (100 words minimum)
- HOWARD UNIVERSITY, SCIENCE
- HR Management
- HRM300
- HRT6050, Writing
- HSA305
- HSA535
- HSC3201
- HSN476
- HUM1002
- HUM115
- HUM115, Writing
- Human Resource
- Human Resource Management
- Human Resource ManagementHuman Resource Management
- Human Resources
- HUMAN RESOURCES DEVELOPMENT AND MANAGEMENT, SCIENCE
- Human Rights
- HUMANITIES
- Humanities, Alcorn State University
- HUMANITIES, HY 1110
- Humanities, LMC3225D
- HUMANITIES, LONG BEACH CITY COLLEGE
- HUMANITIES, MUSIC1306
- HUMANITIES, OAKLAND COMMUNITY COLLEGE
- HUMANITIES, PH 100
- HUMANITIES, POINT LOMA NAZARENE UNIVERSITY
- HUMANITIES, PRINCE GEORGE'S COMMUNITY COLLEGE
- Humanities, PSY105
- HUMANITIES, PSY330 THEORIES OF PERSONALITY
- Humanities, PSYC 1101
- HUMANITIES, PSYCH305
- HUMANITIES, PSYCH635 PSYCHOLOGY OF LEARNING
- HUMANITIES, RSCH8110
- HUMANITIES, SAN DIEGO STATE UNIVERSITY
- HUMANITIES, SAN JACINTO COLLEGE
- Humanities, SOC1010
- HUMANITIES, SOC401
- HUMANITIES, SOCIOLOGY OF RELIGION
- HUMANITIES, SOUTHERN NEW HAMPSHIRE UNIVERSITY
- HUMANITIES, STRAYER UNIVERSITY
- HUMANITIES, SWK110
- HUMANITIES, UNIVERSITY OF CALIFORNIA
- HUMANITIES, UNIVERSITY OF CALIFORNIA IRVINE
- HUMANITIES, UNIVERSITY OF HOUSTON-DOWNTOWN
- Humanities, University of Maryland University College
- i need the attached work to look like this. please redo and make it look like this.
- I need these questions answered fully. I have the assignment and the notes attached for it. Do not use chegg or course hero. This is due Wednesday 4/14 at 10:00 pm which is almost 4 full days. Thanks!
- I need to re organize a research paper I attached all my information and I attached you an example how is going to be. Please follow the instruction and the references has to be APA 7edition
- Identify a cardiac or respiratory issue and outline the key steps necessary to include for prevention and health promotion
- identify the leadership theory that best aligns with your personal leadership style
- if you suggest trying to do this
- IGLOBAL UNIVERSITY
- IHS2215
- Iii Mlch
- III nuistery of such superficialities was meant to
- Implement classifiers KMeans, Random Forest and Decision Tree, SVM,XGBoost and Naive Bayes for the given dataset of audio samples to findout top genre for an audio sample(which one fits best)
- In a cardiac issue what are the key steps necessary to include for prevention and health promotion.
- in any other way
- include a paragraph about which side of the case a forensic psychologists might support and why.
- indeed
- India
- INDIANA UNIVERSITY BLOOMINGTON, SCIENCE
- INF690
- INF690, Other
- Information Systems
- Information SystemsInformation Systems
- Information Technology
- INSTITUTE OF PUBLIC ADMINISTRATION SAUDI ARABIA, PROGRAMMING
- INT700, OTHER
- International Business
- International Relations
- International Studies
- Internet
- Introduction to Biology
- Is jury nullification sometimes justifiable? When?
- ISSC351
- It Research
- IT380
- IT550, Business & Finance , Southern New Hampshire University
- ITC3001
- ITP120
- ITS 631, PROGRAMMING
- ITS835, Other
- JEDDAH COLLEGE OF ADVERTISING, WRITING
- Journalism
- KNOWLEDGE IS POWER, OTHER
- Languages
- Law
- Law – Civil
- Law – CivilLaw – Civil
- Law – Criminal
- Law – CriminalLaw – Criminal
- LawLaw
- Leadership
- lecture slides
- Leisure Management
- Liberty University
- LIBERTY UNIVERSITY, WRITING
- lIlgll.Igt· (1II1In·d
- Linguistics
- literacy is always plural: literacies (there are many of them
- Literature
- Literature Review
- Literature review funnel on "cyber security"
- LiteratureLiterature
- MA105
- MAJAN COLLEGE, WRITING
- Management
- Manpower
- Marketing
- Math
- MATH 1030
- MATH144, MATHEMATICS
- Mathematics
- Mathematics – Algebra
- Mathematics – Calculus
- Mathematics – Geometry
- Mathematics – Numerical analysis
- Mathematics – Precalculus
- Mathematics – Probability
- Mathematics – Statistics
- Mathematics – StatisticsMathematics – Statistics
- Mathematics – Trigonometry
- MATHEMATICS, MGT3332
- Mathematics, National American University
- Mathematics, PSY325
- MATHEMATICS, PUBH8545
- Mathematics, QNT275
- MATHEMATICS, STAT 201
- MBA503
- McMaster University
- ME350B, SCIENCE
- MECH4430, SCIENCE
- Mechanics
- Media
- Medical
- Medical Essays
- MGMT2702
- MGMT410
- MGT173, SCIENCE
- MHR6451
- MIAMI UNIVERSITY, WRITING
- Military
- Military Science
- MKT501
- MKT690, OTHER
- MN576
- MN581
- MN610, SCIENCE
- MNGT3711
- Music
- MVC109
- N4685
- NATIONAL INSTITUTES OF HEALTH, SCIENCE
- NATIONAL UNIVERSITY, SCIENCE
- Needs to be at least 300 wordswithin the past five years.No plagiarism! What key aspects do you believe should guide ethical behavior related to health information, technology, and social media?
- no workable ""affirmative action"" for Discourses: you can't 19 Ill' let into the game after missing the apprenticeship and be expected to have a fnir shot at playing it. Social groups will not
- Northcentral University
- not writing)
- nothing can stand in her way once she has her mind set. I will say that she can sometimes be hard headed
- Nova Southeastern University
- NR447, SCIENCE
- NRS429VN
- NRS44V, OTHER
- NRS451VN
- NRSE4540
- NSG426
- NSG486
- NSG6102
- NSG6102, SCIENCE
- Numerical Analysis
- NUR231NUR2349, SCIENCE
- NUR647E
- NURS350
- NURS508
- NURS6640
- Nursing
- NURSING LEADERSHIP AND MANAGEMENT, SCIENCE
- NursingNursing
- Nutrition
- offering learners the flexibility to acquire new skills and knowledge from the comfort of their homes. However
- OHIO UNIVERSITY, SCIENCE
- Online Discussion Forums Grade and Reflection Assignment : Current Topic Artificial Intelligence HR Planning Career and Management Development Labour RelationsForum
- operation security
- Operations Management
- or do those companies have an ethical obligation to protect people? In this assignment
- ORG5800, OTHER
- Organisations
- OTHER
- Other, PAD631
- OTHER, PARK UNIVERSITY
- OTHER, PLA1223
- Other, POLI330N
- OTHER, PROFESSIONAL NURSING NU231 NUR2349
- Other, RTM404
- OTHER, SAINT LEO UNIVERSITY
- OTHER, SOC3210C1
- Other, SOCW6333
- OTHER, SOUTHERN NEW HAMPSHIRE UNIVERSITY
- Other, The University Of Southern Mississippi
- OTHER, TRIDENT UNIVERSITY INTERNATIONAL
- Other, UC
- OTHER, UNIVERSITY OF MARYLAND UNIVERSITY COLLEGE
- OTHER, UNIVERSITY OF SOUTH FLORIDA
- Other, Walden University
- paying attention to grammar and spelling. Actively participate in discussions
- Personal Development
- PhD Dissertation Research
- PHI 413V, SCIENCE
- Philosophy
- Photography
- PHY290
- PHYS204L206
- Physics
- Physics – Astronomy
- Physics – Electromagnetism
- Physics – Geophysics
- Physics – Mechanics
- Physics – Optics
- PhysicsPhysics
- Physiology
- PNGE332, SCIENCE
- Political Science
- Political SciencePolitical Science
- Politics
- PowerPoint slides
- privacy
- PROFESSIONAL NURSING NU231 NUR2349, SCIENCE
- PROFESSIONAL NURSING NU231NUR2349, SCIENCE
- Programming
- Programming , College of Applied Sciences
- PROGRAMMING, STRAYER UNIVERSITY
- PROGRAMMING, WILMINGTON UNIVERSITY
- Project Management
- proper grammar
- Protein
- provide a discussion on what could have been done better to minimize the risk of failure. If you have not yet been involved with a business process redesign
- PSYC8754, WRITING
- Psychology
- PsychologyPsychology
- PUB373, SCIENCE
- Purdue University
- Rasmussen College
- Read a poam and write a paragraph to prove "The table turned".
- Reading
- ReadingReading
- readings
- Reference this
- REL1030
- Religion
- RES861, Science RES861
- Research Methodology
- Research methods
- Research Proposal
- Research questions
- Retail
- Rutgers university
- SAFE4150
- safety statutes
- Santa Clara University
- SCI 220, SCIENCE
- SCI115, SCIENCE
- Science
- Science, Strayer University
- SCIENCE, THOMAS JEFFERSON UNIVERSITY
- SCIENCE, WEST COAST UNIVERSITY
- SCIENCE, WEST TEXAS A & M UNIVERSITY
- Sciences
- SCM371, Writing
- Search in scholarly sources the similarities and difference between PhD and DNP. Post three similarities and three differences found on your research. Do not forget to include your reference.
- Security
- self-actualization
- several things can happen
- Should the government operate public transportation systems?250 words
- so that it is not biased?
- so too
- SOC 450
- Social Policy
- Social Science
- Social Science – Philosophy
- Social Science – PhilosophySocial Science – Philosophy
- Social Science – Sociology
- Social Science – SociologySocial Science – Sociology
- Social Sciences
- Social ScienceSocial Science
- Social Work
- Society
- Sociology
- someone cannot engage in a Discourse in a less than fully fluent manner. You are either in it or you're not. Discourses are connected with displays of
- SP19, WRITING
- SPC2608
- SPD310
- Sports
- Statistics
- succeeding in online courses requires a different approach compared to traditional classroom settings. To help you make the most of your online learning experience
- such as notifications from social media or email. Organize your study materials and have a reliable internet connection to ensure seamless access to course materials.
- Technology
- that personal ethics and organizations ethics are two different and unrelated concepts. Others
- the attribute is useful
- The directions are attached. However you must read the PDF file first in order to answer the questions.
- the role of work and money
- Theatre
- then reply to a minimum of 2 of your classmates' original posts.
- Theology
- Threat of artificial intelligence 800 words.
- to be true of second language acquisition or socially situ ated cognition (Beebe
- to better promote the value and dignity of individuals or groups and to serve others in ways that promote human flourishing.
- to usc a Discourse. The most you can do is III It'! them practice being a linguist with you.
- total fat consumption
- Tourism
- Translation
- Transportation
- U110
- Uncategorized
- University of Central Missouri
- University of South Florida
- UNIVERSITY OF SOUTH FLORIDA, WRITING
- Video Games
- Watch this meditation https://www.youtube.com/watch?v=doQGx4hdF3M&feature=youtu.be and write a one page reflection
- WCWP10B
- we can always ask about how much ten- 12 """""" or conflict is present between any two of a person's Discourses (Rosaldo
- What approaches to the study of poverty does economic sociology offer? More specifically, what might sociologists studying poverty focus on besides poor households, neighborhoods, and individuals?
- What is the philosophical matrices for Behaviorism, Constructivism, and Reconstructivism
- What key aspects do you believe should guide ethical behavior related to health information, technology, and social media?
- what place did government have to improve markets? What does the concept of ""crowding out"" mean in all of this?
- What should be done to maintain optimum stock levels and why is it important to keep accurate and up-to-date records of stock in medical practice?
- whether good or bad. The intent of the short research projects is to dig a little deeper into some of the topics
- which triggers the vulnerability. As soon as the user downloads this shortcut file on Windows 10; windows explorer will
- Would somebody read these quotes and answer those three questions at the bottom for me?Disregard number two I will look for myself in the text.
- Write short essay based on evidence about the 2 cons of Sex Education 250-300 words 2 reference minimum no plagiarism
- WRITING
- writing assignment, you will analyze asymmetric and symmetric encryption. Evaluate the differences between the two of them and which one that you would determine is the most secure.
- Writing, Personal Code of Technology Ethics
- you believe you can provide the CIO with the information he needs.
- you will learn how to search for scholarly
- you will need to read the TCP standard. TCP was first defined in RFC 793. A link to this document is provided. https://tools.ietf.org/html/rfc793
- Young People
Recent Comments