Change of size and type of patent ductus arteriosus in a one year old infant during routine echocardiographic study

There are only very few publications which document reactivity of patent ductus arteriosus. This report documentes the reactivity of a patent arterial duct in a one year old infant, 6.5 kg weight during a routine echocardiographic color Doppler study. Echocardiographic images were obtained during conscious sedation.peer-reviewe

Reducing the Large Class Code Smell by Applying Design Patterns

Software systems need continuous developing to cope and keep up with everchanging requirements. Source code quality affects the software development costs. In software refactoring object-oriented systems, Large Class, in particular, hinder the maintenance of a system by letting it difficult for software developers to understand and perform modifications. Also, it is making the development process labor-intensive and time-wasting. Reducing the Large Class code smell by applying design patterns can make the refactoring process more manageable, ease developing the system and decrease the effort required for the maintaining of software. To guarantee object-oriented software stays clear to read, understand and modify over time, Fowler and Beck claimed that these classes should, therefore, be divided into several classes, or extract the subclasses from the Large Class. The study presents a methodology designed to reduce the Large Class code smell by understanding the feature of the Large Class then analyzing the causes of the Large Class code smell and depends on two features, complexity and cohesion, then classifying the causes to identical types and proposing a best fit design pattern to address each type and refactor the code to improve the quality of software by reducing the complexity and enhancing cohesion. Our methodology focuses on the Large Class code smell while analyzing the complexity and cohesion; however, the methodology itself can be used wherever the code fits in a category

Can a Super Bacteria Be Stopped?

Title: How Can Super Bacteria Be Stopped One person dies in the United States every 15 minutes because of drug-resistant bacteria that have learned to overcome the most advanced antibiotics, according to a new report by the US Centers for Disease Control and Prevention. Genetic research shows that germs have become particularly adept at teaching each other how to get rid of antibiotics. And that occurs when bacteria, viruses, parasites, and other microbes continuously change and evolve to ensure their survival. Some of them are highly adapted to medical treatment so that the medications that are usually used to prevent or kill them no longer work, and this is what creates drug-resistant bacteria. Antibiotic resistance is presumed to become one of the biggest health challenges worldwide in this century. The awareness of this problem is low, and the problem itself is not documented enough in the absence of a global data collection system. Furthermore, this study is intended to provide an overview of how these super bacteria are spread globally among people, in food commodities, animals and plants, and in the environment. The purpose of this study is to know how we can stop the super bacteria. Will it be stopped by adopting new strategies to keep germs and infections away from occurring in the first place? Is using fewer antibiotics is the key? Scientists aspire to find an alternative to the current antibiotics before one of these bacteria spreads significantly

Dandy–Walker syndrome

AbstractObjectivesDandy–Walker syndrome is a rare disorder characterised by complete or partial agenesis of the vermis, cystic dilatation of the fourth ventricle and an enlarged posterior fossa. The precise aetiology is unknown, although there have been reports of associations with risk factors like maternal virus infections (rubella, toxoplasma, and cytomegalovirus) and alcohol consumption. The reported incidence varies between one per 2500 births to one per 100,000 births. This huge difference may be due to the limited published case series, as most of the available data are sporadic case reports or series.MethodsA retrospective review was conducted of medical records of neonates with Dandy–Walker syndrome admitted to the neonatal intensive care unit of a university hospital between January 2001 and December 2010.ResultsEight infants with Dandy–Walker syndrome were admitted during the study period, giving an overall incidence of 1/400 live births. The female-to-male ratio was 1.7:1 (one infant had ambiguous gender but was later found to be male). The mean gestational age was 39.0 weeks (range, 36–40 weeks), and the mean birth weight was 2716 g (range, 1965–3335 g). The syndrome was diagnosed in half the infants prenatally. All infants had associated hydrocephalus, and five had other neurological anomalies; extra-cranial anomalies were seen in 50% of infants. All infants survived to discharge.ConclusionAlthough many of our results were consistent with published data, the incidence of Dandy–Walker syndrome in our study was much higher than any reported previously. Further research is required to elucidate this unexpected finding

Unemployment in spinal cord injury: understanding the lived experiences of unemployed individuals with spinal cord injury and those who provide spinal cord injury vocational support in the community

Unemployment resulting from spinal cord injury (SCI) is significant for those who experience job loss. A predominantly quantitative approach has typically focused on factors related to return to work (RTW) from the perspective of individuals living with SCI. This thesis sought to add to the qualitative research on the topic by providing contextual and subjective accounts of concrete experience on SCI unemployment. Moreover, it is important to understand the meaning of employment and/or lack of employment following SCI through the experiences of those providing vocational support to SCI sufferers. The literature on this topic has mainly been explored from the perspective of service providers to reflect on issues related to SCI people and their rehabilitation rather than issues related to the service providers themselves. Hence, this thesis also sought to focus on the experience of SCI vocational support providers in order to understand how they perceived their role. To achieve the above aims, this thesis comprised two separate studies, where data were collected through semi-structured interviews and analysed using interpretative phenomenological analysis (IPA). The first study explored the experience of nine men with SCI who became unemployed following their injuries. The findings of the first study demonstrated the mixed feelings of being nostalgic for pre-injury work and at the same time perceiving the self as a victim of SCI for losing work. The second study explored the experience of five supporters who provided SCI vocational services in the community. Findings demonstrated how those vocational support providers perceived their SCI clients as unique individuals, and how broad the ultimate goals they wanted to achieve with them were. The findings of the two studies are linked to each other in terms of the importance of support, empathy and customised care after SCI as well as setting comprehensive vocational goals. The two studies are linked to the existing literature through highlighting a particular contribution from an experiential and idiographic perspective. They also suggest different interesting avenues to pursue for future research

Strategies Human Resource Managers Use to Reduce Employee Turnover

One of the highest costs of employee turnover in the United States is in the pharmaceutical industry, where employee turnover is on the rise and affects profitability. Pharmaceutical leaders and resource managers are concerned with employee turnover because the estimated costs of employee turnover range between 70% and 300% of an employee’s annual salary. Using Bass’s transformational leadership theory as the conceptual framework, the purpose of this qualitative multiple case study was to explore strategies human resource managers in the pharmaceutical industry use to reduce employee turnover. Data were collected from a review of company documents and face-to-face semistructured interviews with 5 human resources managers of different pharmaceutical companies in the Northeast United States. Thematic analysis following Yin’s 5 step approach was performed for data analysis using data compilation, data disassembly, data reassembly, data interpretation, and conclusion. Three primary themes emerged: hiring and retention strategy, pay and benefits strategy, and career growth strategy. It is recommended managers offer incentive and benefits programs and expand training programs. The implications for positive social change include the potential to reduce employee turnover, which may lead to increased stability for families of employees, new employment opportunities, and the promotion of prosperity for the community

Unemployment in spinal cord injury: understanding the lived experiences of unemployed individuals with spinal cord injury and those who provide spinal cord injury vocational support in the community

Unemployment resulting from spinal cord injury (SCI) is significant for those who experience job loss. A predominantly quantitative approach has typically focused on factors related to return to work (RTW) from the perspective of individuals living with SCI. This thesis sought to add to the qualitative research on the topic by providing contextual and subjective accounts of concrete experience on SCI unemployment. Moreover, it is important to understand the meaning of employment and/or lack of employment following SCI through the experiences of those providing vocational support to SCI sufferers. The literature on this topic has mainly been explored from the perspective of service providers to reflect on issues related to SCI people and their rehabilitation rather than issues related to the service providers themselves. Hence, this thesis also sought to focus on the experience of SCI vocational support providers in order to understand how they perceived their role. To achieve the above aims, this thesis comprised two separate studies, where data were collected through semi-structured interviews and analysed using interpretative phenomenological analysis (IPA). The first study explored the experience of nine men with SCI who became unemployed following their injuries. The findings of the first study demonstrated the mixed feelings of being nostalgic for pre-injury work and at the same time perceiving the self as a victim of SCI for losing work. The second study explored the experience of five supporters who provided SCI vocational services in the community. Findings demonstrated how those vocational support providers perceived their SCI clients as unique individuals, and how broad the ultimate goals they wanted to achieve with them were. The findings of the two studies are linked to each other in terms of the importance of support, empathy and customised care after SCI as well as setting comprehensive vocational goals. The two studies are linked to the existing literature through highlighting a particular contribution from an experiential and idiographic perspective. They also suggest different interesting avenues to pursue for future research

The impact of alternative pricing methods for drugs in California Workers’ Compensation System: fee-schedule pricing

Introduction California’s Workers’ Compensation System (CAWCS) Department of Industrial Relations questioned the adequacy of the current Medi-Cal fee-schedule pricing and requested analysis of alternatives that maximize price availability and maintain budget neutrality. Objectives To compare CAWCS pharmacy-dispensed (PD) drug prices under alternative fee schedules, and identify combinations of alternative benchmarks that have prices available for the largest percentage of PD drugs and that best reach budget neutrality. Methods Claims transaction-level data (2011–2013) from CAWCS were used to estimate total annual PD pharmaceutical payments. Medi-Cal pricing data was from the Workman’s Compensation Insurance System (WCIS). Average Wholesale Prices (AWP), Wholesale Acquisition Costs (WAC), Direct Prices (DP), Federal Upper Limit (FUL) prices, and National Average Drug Acquisition Costs (NADAC) were from Medi-Span. We matched National Drug Codes (NDCs), pricing dates, and drug quantity for comparisons. We report pharmacy-dispensed (PD) claims frequency, reimbursement matching rate, and paid costs by CAWCS as the reference price against all alternative price benchmarks. Results Of 12,529,977 CAWCS claims for pharmaceutical products 11.6% (1,462,814) were for PD drugs. Prescription drug cost for CAWCS was over $152M;$63.9M, $47.9M, and$40.6M in 2011–2013. Ninety seven percent of these CAWCS PD claims had a Medi-Cal price. Alternative mechanisms provided a price for fewer claims; NADAC 94.23%, AWP 90.94%, FUL 73.11%, WAC 66.98%, and DP 14.33%. Among CAWCS drugs with no Medi-Cal price in PD claims, AWP, WAC, NADAC, DP, and FUL provided prices for 96.7%, 63.14%, 24.82%, 20.83%, and 15.08% of claims. Overall CAWCS paid 100.52% of Medi-Cal, 60% of AWP, 97% of WAC, 309.53% of FUL, 103.83% of DP, and 136.27% of NADAC. Conclusions CAWCS current Medi-Cal fee-schedule price list for PD drugs is more complete than all alternative fee-schedules. However, all reimbursement approaches would require combinations of pricing benchmarks. We suggest keeping primary reimbursement at 100% of Medi-Cal and for drugs without a primary Medi-Cal price calculating the maximum fee as 60% of AWP and then 97% of WAC. Alternatively, we suggest using NADAC as a primary fee-schedule followed by either 60% AWP and 97% WAC or AWP-40% for drugs with no NADAC price. Fee-schedules may not offer the best price and a formulary approach may provide more flexibility