Return of the Great Spaghetti Monster : Learnings from a Twelve-Year Adventure in Web Software Development

The widespread adoption of the World Wide Web has fundamentally changed the landscape of software development. Only ten years ago, very few developers would write software for the Web, let alone consider using JavaScript or other web technologies for writing any serious software applications. In this paper, we reflect upon a twelve-year adventure in web development that began with the development of the Lively Kernel system at Sun Microsystems Labs in 2006. Back then, we also published some papers that identified important challenges in web-based software development based on established software engineering principles. We will revisit our earlier findings and compare the state of the art in web development today to our earlier learnings, followed by some reflections and suggestions for the road forward.Peer reviewe

Regional Variation in Arterial Saturation and Oxygen Delivery during Venoarterial Extracorporeal Membrane Oxygenation

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be lifesaving in patients with cardiopulmonary collapse. However, observation studies have implied that oxygenated blood does not pass in a retrograde fashion from the VA-ECMO circuit to the aortic root and arch when the femoral artery (FA) is used. This study aims at accurately measuring the oxygen saturation in various arteries during VA-ECMO through different cannula sites. A total of 20 patients with VA-ECMO were in the study. Fourteen patients had FA cannulation, two patients received axillary arterial (AA) cannulation, and four patients received cannulation of the ascending aorta. Oxygen saturation was measured simultaneously in the radial artery and oxygenator outlet. In the patient group with FA cannulation, the oxygen saturation was lower in the radial artery (97%) when compared with the oxygenator outlet (>99%). In the subset group of patients with severe lung dysfunction, oxygen saturation was even lower in the radial artery (73% saturation). In the patient group with AA cannulation, the oxygen saturation and partial oxygen pressure (PO2) in the oxygenator outlet and radial artery were similar (99% or greater). In the patient group with direct ascending aorta cannulation, the oxygen saturation and PO2 in the oxygenator outlet and radial artery were similar as well. Regional variations occur in the blood oxygen saturation depending on the site of the arterial cannulation in patients with VA-ECMO. With FA cannulation, the oxygen saturation in the radial artery is significantly lower than the one in the oxygenator outlet. This may imply that the coronaries and the brain receive hypoxic blood from the left ventricle. These results suggest that antegrade cannulation for VA-ECMO improves oxygen delivery to the proximal aorta distribution

A Novel Method for Percutaneous Insertion of a Right Ventricular Assist Device

Right heart failure is a rare but often fatal complication both in the pre- and postoperative setting. Right heart support with a ventricular assist device inserted in the operating room through median sternotomy can be a time-consuming procedure that requires a reoperation for removal. In cases of urgent need of right heart support, a percutaneous technique option may be of benefit. We present our initial experience with a percutaneously inserted right ventricular assist device (RVAD) in an elderly patient with severe right heart failure. An 81-year-old female patient underwent combined aortic and mitral valve replacement at our institution. During the first postoperative evening, the patient sustained sudden cardiovascular collapse and a bedside transesophageal echocardiogram revealed severe right heart failure. A coronary angiogram showed thrombosis of the right coronary artery, which was cleared with a suction device. As a result of the patient’s critical condition, it was decided that an RVAD was needed as a bridge to recovery. The patient’s condition improved significantly almost immediately. Her right heart function recovered over the next few days and the RVAD was removed at the bedside. She made a complete recovery and was discharged home. This patient is a prime example that a totally RVAD can be inserted in urgent situations easily and safely under fluoroscopic and echocardiographic guidance. More clinical experience with percutaneous RVADs is required to establish this technique as an alternative equivalent to the traditional open method. Right heart failure complicates many heart diseases both in the pre- and the postoperative setting. In cases of urgent need of right heart support, a percutaneous technique of a RVAD is needed for a successful outcome. We present our initial experience with a percutaneously inserted RVAD in an elderly patient with severe postoperative right heart failure

Testing in a DevOps Era: Perceptions of Testers in Norwegian Organisations.

To better understand the challenges encountered by testers in DevOps development, we have performed an empirical investigation of what are the trends and challenges for the testers in the DevOps environment. We have discussed the quality assurance in the difference focus areas of DevOps: Social Aspects, automation, leanness, sharing, measurement. The results were then themed in five different topics of concern to testers: collaboration, roles and responsibilities, types of tests, automation and monitoring and infrastructure. In Testing, there has been a change on the roles and responsibilities of testers, where there is much more focus on the responsibilities for testing across the teams, instead of a sole responsibility of the tester. Testers are also forced to collaborate more with other stake- holders as operations and business. Testing is brought to another level of automation in DevOps but there is still need for manual tests, that have to be much more risk-based than before. And finally, testing transparency is a must in this process and should involve not only development team but also operations and customers. This paper contributes to the body of knowledge on what are the areas we need to focus for improvement in testing for the DevOps environment. This paper also contributes to practitioners to improve their testing focusing on specific areas that needs attention.acceptedVersio

Isolated Extra-Corporeal Coronary Perfusion Circuit for Use During Off-Pump Coronary Artery Bypass Grafting

Cardiovascular surgery would not have developed into its present form without the heart–lung machine. In coronary artery bypass grafting (CABG), cardiopulmonary bypass allows accurate, all site, complete revascularization in a way convenient to the surgeon. The aim of this circuit is to find new ways to reduce invasiveness of CABG and to create new basis conditions for successful coronary bypass grafting on the beating heart. Manipulation of the heart compromises collateral coronary flow, especially to critically narrowed coronaries. This circuit standardizes our method for perfusing blood through the coronary bypass grafts with controlled positive pressure as each distal anastomosis is made, and it preserves collateral coronary flow, while facilitating construction of the remaining distal anastomoses