“A new analysis from U.S. federal government actuaries say that Americans spent $3.65 trillion on healthcare in 2018, according to a report from Axios. “1 This impacts on companies, where health insurance benefits are the second largest cost in a service business, and 3rd largest in manufacturing business2. Back pain alone accounted for $86 billion a year in 2008 3. The top 5 expenses for a commercial line of insurance were for back pain, osteoarthritis, childbirth, injuries, and non-hip/non- spine fractures4. Work related injuries cost an estimated $1.2 trillion annually, which includes lost wage payment, medical care, and short and long term disability5. Of all health care expenses paid by a company, workers’ compensation becomes the most expensive, since the company pays not only for medical care, but also the lost wage of the employee. This is usually 66% of the employee’s salary, which come to the employee tax free. This provides the employee with essentially the same income received when at work. These generous benefits lead insurance adjusters to suspect potential for abuse. Estimates of fraudulent claims range from 1% to 80% depending on unsubstantiated reports in the insurance literature6,7,8,9. However, methods to identify fraudulent cases are not always productive. The State Auditor of the State of California reported that the $30,000,000 a year spent by the State of California to detect workers’ compensation fraud was not cost effective10. Detection methods used include Functional Capacity Evaluations (FCEs). However, Feeler and Schapmire in a review of 180,000 patients found that FCEs were subjective and had no predictive nor diagnostic value11. Attempts to blame prolonged recovery on psychological issues, using the Minnesota Multiphasic Personality Inventory MMPI are consistently thrown out of court often 12. The most reliable method of fraud detection is the Pain Validity Test, which can predict with 95%…
Disaster management strategy for avoiding the future losses by a slope failure at Nanhuan road, Fuxin area, Northeast China
Many surrounding areas in the vicinity of failed slope at Nanhuan road, Fuxin area, Northeast China are witnessed as the signs of disaster. The observed settlement as wastage of an active mass in the area has been observed after the excessive precipitation in 2012 (May to October) which caused infrastructural damages (Roads at the top and bottom of the failure zone), agricultural fields and residential areas. Therefore, the paper proposes examining this subject. An extensive field investigation was conducted in the area of Fuxin, west of Liaoning province China. It is recommended and suggested that a series of disaster prevention and both structural and non-structural mitigation measures with the involvement of government and local community are required, to be prepared in advance for avoiding the future economic loss as well as the impending disaster in the area. This paper also highlights the need of investigation in response mechanism and forward planning for awareness initiatives: to avoid the future hazard in the remotest failure zones of Fuxin area, Northeast China.
Aiming at the conceptual design stage of semi-submersible support platform, the optimal primary scale scheme is designed. Latin hypercube design is adopted to sample the sample space. At the same time, SESAM software is used for parametric modeling based on sample point parameters to obtain the model of all schemes. According to the existing data of semi-submersible platforms, the main scale constraints of platforms are determined, and the mathematical model with the minimum heave, trim and roll response as the objective function is established. The multi-island genetic algorithm was used to optimize the main scale of the supporting platform model, and the scheme with the highest stability and suitable displacement was selected. The results show that the model and algorithm are feasible, and the smallest scale scheme of each response can be obtained under the constraint conditions. The multi-island genetic algorithm is proposed to optimize the primary scale of the platform, which has a strong reference value for the determination of the primary scale scheme in the conceptual design stage of the platform.
The patient is a 15-year-old girl who presented with a 4-day history of fever, a persistent cough, and x-ray evidence of a right middle lobe pneumonia. On day 10 of her illness, at a time when she was afebrile and her pneumonia had cleared, she developed a severe headache and within hours lapsed into coma. Cerebral spinal fluid analysis and serological tests were diagnostic of a post-infectious meningoencephalitis due to Mycoplasma pneumoniae.
Evaluation of laboratory risk indicator for necrotizing fasciitis (Lrinec) scoring system for diagnosis of necrotizing fasciitis in patients presenting with soft tissue infection
Necrotizing soft tissue infection represents a diverse process; the term itself encompasses a continuum ranging from pyoderma to life threatening infections (clostridial gas gangrene with myonecrosis, anaerobic cellulitis, and severe, necrotizing vibrio infections). These can occur in any anatomical area but the commonest site is the extremities. Necrotizing fasciitis is often underestimated because of the lack of specific clinical findings in the initial stages of the disease. The paucity of specific cutaneous signs to distinguish necrotizing fasciitis from other soft tissue infections such as cellulitis makes the diagnosis extremely difficult. The first and most important consideration for an accurate, prompt diagnosis is to have a high index of suspicion. It has been shown by numerous studies in the past that early recognition and surgical intervention at the earliest is the sole factor in preventing the morbidity and mortality in patients with necrotizing fasciitis [1-3]. So a scoring system which is easy to follow and cost effective with high positive and negative predictive value is required. One such scoring system is the LRINEC scoring system devised by Wong et al  in 2005 which claims to have a positive predictive value of 92.0% and negative predictive value of 96.0%. The mortality in necrotizing fasciitis is as high as 34%.  We evaluated LRINEC scoring system in patients presenting with symptoms and signs suggestive of soft tissue infection that progresses to necrotizing fasciitis in Sri Ramachandra Medical College and Hospital, Porur, Chennai over a period of two years.
The evaluation index system and evaluation method for the reliability of current workshop facility layout have not yet formed the standard. Taking the facility layout plan of valve production workshop as the research object, 9 evaluation indexes were put forward from four aspects of working environment, layout cost, production flexibility and management convenience, and a comprehensive evaluation system of valve production workshop layout was established. The AHP- entropy weight method was used to calculate the index weight. Based on the survey data and experts’ opinions, the evaluation model is used for analysis and evaluation. The evaluation results of the facility layout plan of valve production workshop are consistent with the reality. The results show that the weight method of this model not only considers the objective opinions of workshop personnel, but also uses the knowledge and experience of experts, which makes the workshop facility layout evaluation more objective and accurate, and provides reference for the standards of workshop facility layout evaluation.
Intra Cholecystic Papillary Tubular Neoplasm – A Case Report Of A Rare Differential Diagnosis Of Carcinoma Gall Bladder
We present a case report of a 57 year old lady who presented with complaints of right sided upper abdominal pain. The patient was initially diagnosed with carcinoma gall bladder(CAGB) by CECT Abdomen and PET CT imaging studies. Intra cholecystic papillary tubular neoplasm of the gall bladder(ICPN) was diagnosed after histopathological examination of the radical cholecystectomy specimen. ICPN can be managed with a cholecystectomy if the diagnosis is known pre operatively as the prognosis for ICPN is much better as compared with that for gallbladder adenocarcinoma.
Integration through friendships in school classes – A study of pupils with a migrant background in school friendship networks at primary and secondary schools in Germany
This paper deals with the integration of migrant children in informal communication networks in primary and secondary schools in Germany. The basic assumption is that these networks can serve as an indicator for the networking and embedding that take place within the class community and therefore can be used to investigate the integration of pupils with a migrant background. The initial results of our network analytical study reveal that pupils with a migrant background are well integrated into class networks. The study discloses that the migrant background does not serve as a conclusive characteristic of the pattern of class networks. The pupils are more or less networked with each other regardless of their migrant background, though it did emerge that children and adolescents born abroad, in particular, are far more likely to have outgoing relationships that remain unreciprocated. Remarkable is, that results from primary school correspond with data from secondary school.
The Use of ICT Resources for Teaching Social Studies: Does the Availability of ICT Resources Matter?
The paper explored the availability of information and communication technology (ICT) resources and the extent to which these resources influence the use of ICT in teaching Social Studies. The study setting was in the Awutu Senya district of Ghana. A descriptive survey design and quantitative approach were adopted for the study. From a target population of fifty-seven (57), 46 were sampled from which 39 participated in the survey. Means and standard regression were employed for the investigation. The testing of hypothesis was made possible through the use of structured equation modelling. The study concluded that ICT resources were inadequate for teaching Social Studies and that the use of ICT resources in teaching Social Studies in the district was low. The reason was evident based on the low level of ICT resources in the district. The study also concluded that there was a positive significant relationship between availability of ICT resources and its use in the teaching of Social Studies.
In order to ensure the safe navigation of ships and reduce the occurrence of marine accidents, through the analysis of ship historical navigation safety accident data and related accident literature research, taking into account various aspects such as marine meteorology, cargo loading, ship status and crew quality. Construct a ship navigation safety evaluation body. The BP neural network algorithm is used to design the ship navigation safety risk network structure. The sea damage data is used as the network input sample to train the BP neural network and data fitting. At the same time, the genetic algorithm is introduced to find the individual corresponding to the optimal fitness, and the weight and threshold of the network are further optimized. The purpose is to improve the accuracy of data fitting. The optimized BP neural network evaluation results show that there are many indicators affecting the safety of the ship’s navigation, and the relationship between the indicators is complicated. The optimized BP neural network utilizes the characteristics of online adaptive learning, which eliminates the construction of complex relationships among various indicators within the structure, and solves the difficult problems in ship risk assessment to a certain extent.