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Processing the data These examples show that there are different processes in- volved in qualitative data analysis order 10 mg torsemide otc. X You need to think about the data from the moment you start to collect the information generic torsemide 20mg without prescription. X You need to judge the value of your data order 10 mg torsemide free shipping, especially that which may come from dubious sources torsemide 20 mg lowest price. X As your research progresses you need to interpret the data so that you cheap torsemide 10 mg without a prescription, and others, can gain an understand- ing of what is going on. X Finally, you need to undertake the mechanical process of analysing the data. HOW TO ANALYSE YOUR DATA/ 121 It is possible to undertake the mechanical process using computing software which can save you a lot of time, although it may stop you becoming really familiar with the data. There are many dedicated qualitative analysis programs of various kinds available to social researchers that can be used for a variety of different tasks. For exam- ple, software could locate particular words or phrases; make lists of words and put them into alphabetical order; insert key words or comments; count occurrences of words or phrases or attach numeric codes. Some software will retrieve text, some will analyse text and some will help to build theory. Although a computer can undertake these mechanical processes, it cannot think about, judge or inter- pret qualitative data (see Table 10). QUANTITATIVE DATA ANALYSIS If you have decided that a large survey is the most appro- priate method to use for your research, by now you should have thought about how you’re going to analyse your data. You will have checked that your questionnaire is properly constructed and worded, you will have made sure that there are no variations in the way the forms are administered and you will have checked over and over again that there is no missing or ambiguous information. If you have a well-designed and well-executed survey, you will minimise problems during the analysis. Computing software If you have computing software available for you to use you should find this the easiest and quickest way to ana- lyse your data. The most common package used by social scientists at this present time is SPSS for windows, which 122 / PRACTICAL RESEARCH METHODS TABLE 10: USING COMPUTERS FOR QUALITATIVE DATA ANALYSIS: ADVANTAGES AND DISADVANTAGES ADVANTAGES DISADVANTAGES Using computers helps to In focus groups the group moves alleviate time-consuming and through a different sequence of monotonous tasks of cutting, events which is important in the pasting and retrieval of field analysis but which cannot be notes and/or interview recognised by a computer. Computers are a useful aid to Programs cannot understand those who have to work to tight the meaning of text. Programs can cope with both Software can only support the multiple codes and over-lapping intellectual processes of the codes which would be very researcher – they cannot be a difficult for the researcher to substitute for these processes. Some software can conduct Participants can change their multiple searches in which more opinions and contradict than one code is searched much themselves during an interview. Programs can combine codes in The software might be beyond complex searches. Programs can pick out instances User-error can lead to of pre-defined categories which undetected mistakes or have been missed by the misleading results. Computers can be used to help Using computers can lead to an the researcher overcome over-emphasis on mechanical ‘analysis block’. HOW TO ANALYSE YOUR DATA/ 123 has become increasingly user-friendly over the last few years. However, data input can be a long and laborious process, especially for those who are slow on the key- board, and, if any data is entered incorrectly, it will influ- ence your results. Large scale surveys conducted by research companies tend to use questionnaires which can be scanned, saving much time and money, but this op- tion might not be open to you. If you are a student, how- ever, spend some time getting to know what equipment is available for your use as you could save yourself a lot of time and energy by adopting this approach. Also, many software packages at the push of a key produce profes- sional graphs, tables and pie charts which can be used in your final report, again saving a lot of time and effort. Most colleges and universities provide some sort of statis- tics course and data analysis course. Or the computing de- partment will provide information leaflets and training sessions on data analysis software. If you have chosen this route, try to get onto one of these courses, especially those which have a ‘hands-on’ approach as you might be able to analyse your data as part of your course work. This will enable you to acquire new skills and complete your re- search at the same time.

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In the case of some bacterial infections cheap 10mg torsemide fast delivery, it is possible to eradicate the infection without removing the shunt buy torsemide 10mg lowest price. However order torsemide 10mg overnight delivery, in situ treatment of shunt infections is fraught with hazards and does not uniformly lead to success order 20 mg torsemide mastercard. Shunt devices are to be viewed as mechanical devices that can become obstructed or malfunction anywhere in their course and anytime during their life- time purchase torsemide 10 mg. The most common scenarios occur weeks, months, or years after insertion, Hydrocephalus 33 when choroid plexus or debris has occluded the proximal ventricular catheter tip. Another common shunt malfunction scenario is the child who has obstructed his dis- tal catheter or has outgrown his peritoneal catheter, and presents with an obstruction after the distal catheter tip has slipped out of the peritoneal cavity. In addition, shunt valves can malfunction, and shunt tubing can break, disconnect or dislodge from its previous location. A child with a shunt malfunction often presents with signs and symptoms of increased ICP. Infants with a shunt malfunction usually present with irritability, poor feeding, increased head circumference, and=or inappropriate sleepiness. Children with a shunt malfunction usually present with headache, irritability, lethargy, nausea, and=or vomiting. However, it is important to inquire if the signs and symptoms that the child is presenting with are the same as those during a shunt malfunction in the past. The child can present with waxing and waning symptoms, or can alternatively present with a progressively worsening picture that does not improve until the shunt is revised. A child complaining of pain with a clinical picture consistent with shunt obstruction should not be given narcotics because of possible respiratory depression or arrest. When a shunt malfunction is suspected, neuroimaging studies should be obtained after a careful history and physical examination. A head CT, as well as anteroposterior and lateral skull, chest, and abdominal radiographs are obtained to evaluate for increased ventricular size and shunt hardware continuity. Even though a majority of children with a shunt malfunction present with increased ven- tricular size on neuroimaging studies, there are those whose ventricular size does not change because of decreased brain compliance (i. In these chil- dren, a shunt tap through the reservoir or valve is indicated to test the adequacy of CSF flow and the intracranial pressure. Children who are diagnosed with a shunt malfunction are taken promptly to the operating room for shunt revision. The presence of a fluid collection in the subcutaneous tissue in proximity to the shunt track is sugges- tive. A collapse of the valve without quick refilling of CSF may indicate a shunt obstruction. Finally, the shunt reservoir can be accessed by a 23- or 25-gauge butterfly needle. The presence of spontaneous flow with good respiratory variations up the tubing or in a manometer connected to the butterfly indicates patency of the ventricular catheter. If there is no CSF flow up the manometer and the ventricles are large, a presumed shunt obstruction is confirmed. In some institutions, a nuclear medicine patency study may be performed to evaluate a presumed shunt malfunc- tion, by occluding the valve and injecting through the butterfly needle a radioactive isotope, such as indium [111In] into the reservoir. The radioactive isotope can then be traced from the ventricular system, through the shunt device, and into the distal collection site. Uncommon Shunt Complications Table 4 lists several uncommon shunt complications. Subdural hygromas and hema- tomas may develop after the insertion of a ventricular shunt into a child with very large ventricles and a thin cerebral cortical mantle. Treatment of symptomatic subdural hygromas and hematomas consists of changing the shunt valve to a higher 34 Avellino pressure setting and=or by introducing a catheter into the subdural effusion and connecting it to the distal shunt system. Ventricular catheter migration out of the ventricular system occurs if the shunt has not been properly fixed at the burr hole site where it exits the skull. Abdominal pseudocysts can develop around the distal end of the peritoneal catheter. They often develop in young children secondary to indolent bacterial infec- tions. In addition to presenting with a clinical picture of a shunt infection, the patient may also complain of abdominal pain and distension. The cysts may be percutaneously aspirated, and the fluid can be cultured.

For example buy generic torsemide 10mg line, the minimum severity of myasthenic symptoms necessary to justify operative thymectomy buy 20 mg torsemide with visa, the minimum and maximum ages for which the relative benefits outweigh the risks buy 10mg torsemide, and the effect of duration of myasthenia prior to thymectomy on the efficacy of thymectomy remain controver- sial in the absence of data order torsemide 10mg online. Of importance to children is that no abnormality of immune function appears to be seen in patients who have had thymectomy even in early school years purchase torsemide 10mg fast delivery. On the other hand, spontaneous remissions of myasthenic symptoms may be more common among affected children, making the interpreta- tion of improvement in any one child more difficult to interpret. Fastidious preoperative preparation for thymectomy is an essential element of its success. Reduction of the severity of symptoms with preoperative plasmapheresis can substantially increase respiratory function and reserve, diminishing perioperative respiratory insufficiency. Establishment of the dose for optimum anticholineresterase inhibition with continuous neostigmine infusions preoperatively can improve respiratory function in a steady state postoperatively. Fastidious treatment of infec- tion and other catabolic stresses is equally important. Corticosteroid treatment is the mainstay for long-term therapy of children with symptomatic generalized myasthenia. Initiation of corticosteroid therapy may be associated with transient worsening, so that patients with incipient respiratory com- promise should be watched in the hospital. In those who have not experienced wor- sening with the initiation of steroids, treatment with high-dose pulse IV methylprednisolone may be beneficial. Patients receiving chronic prednisone should have weaning dosing adjustments slowly, because the tendency for relapse can build over time and rapid weaning frequently tends to lead to the need for a significant increase in dosage—hence increasing disease morbidity. In those patients with new onset generalized myasthenia in whom thymectomy is anticipated, it is better if pos- sible to withhold corticosteroid therapy until after surgery, given its impact on peri- operative infection risk and wound healing. IVIG has been associated with short-term improvement of myasthenic weakness. Onset of action is over days, and duration of expected benefit generally measures in weeks. Though expensive, it can be useful to tide over difficult patients until other immunosuppressives can begin to have an effect, and may be useful for the care of patients in crisis when plasmapheresis is not an option. Pheresis can be useful to prepare a patient for surgery, or in response to a myasthenic crisis. Longer term therapy is limited by the expense and morbidity associated with large caliber catheters necessary for the exchange. The risk associated with these catheters increases substantially with the smaller size of young children. Other immunosuppressive medications can clearly be useful in the treatment of myasthenia. Because these agents will be needed for years, however, there are real concerns about potentiating later malignancy and other serious side effects. The most common treatment is with azathioprine (Imuran), which is generally best used as a steroid sparing agent after attempts to slowly withdraw daily prednisone is met with disease worsening, or when daily steroid therapy is helpful but not sufficient to maintain sufficient control of symptoms. New to the treatment of myasthenia is the use of mycophenolate mofetil (CellCept), which has shown promise in the treatment of adults with myasthenia. Passive Transfer Myasthenia (Neonatal MG) Infants born to a mother with autoimmune MG are at risk for developing weakness that may be more dramatic than that seen in the mother due to the passive transfer of AChR antibodies into the baby. This is a transient disorder, which will improve as the infant replaces this acquired immunoglobulin with that synthesized endogen- ously. Most affected infants are only mildly weak, manifesting with ptosis or dimin- ished feeding. Treatment is usually not necessary, but use of acetylcholinesterase inhibitors would generally be the mainstay if necessary. A rare disorder, caused by maternal antibody directed exclusively against a fetal isoform of the AChR, manifests with fetal akinesia that manifests after birth with lethal weakness and arthrogryposis. Once this antibody develops, subsequent pregnancies would be expected to have similar difficulty. Treatment with maternal plasmapheresis throughout pregnancy was shown in one case to result in a normal infant after a series of 4 affected infants with lethal weakness and deformity. Genetic (Congenital) Myasthenia Syndromes (CMS) An array of different genetic defects (Table 2) have been described that lead to fail- ure of neuromuscular transmission. Like autoimmune MG, these can have widely varying presentation and course. The possibility of a CMS should be considered in any child with a fatiguable neuromuscular disorder, or unexplained static weak- ness with prominent bulbar, facial, and extraocular signs and symptoms, that is long standing.

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