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Both pediatric and adult rheumatology care teams play a central role in health care transition, the shift from child- and family-centered to adult-oriented health care. Components of transition preparation include readiness assessment, setting self-management goals, and spending time in clinical visits without a parent present. Pediatric providers and families should work together to create a transfer plan, identifying a new adult rheumatology care provider, providing a medical summary before transfer, and anticipating changes in health insurance. For high-risk transfers, direct communication between providers is recommended. Finally, adult rheumatologists need to build rapport with young adults to support future engagement in care.

This paper analyses the major ethical issues raised by direct-to-consumer communications (DTCC) of pharmaceutical drugs, with a view to proposing ethical standards of practice for the marketing pro...

Objective: Social cognition does not exist within a vacuum. One’s culture and surrounding social environment influence 1) development of social skills and behaviors, and 2) society’s expectations r...

Sarcoidosis is an inflammatory multisystemic disease of unknown etiology characterized by the formation of noncaseating epithelioid cell granulomas. Cardiac sarcoidosis might be life-threatening and its diagnosis and treatment remain a challenge nowadays. The aim of this review is to provide an updated overview of cardiac sarcoidosis and, through 10 practical clinical questions and real-life challenging case scenarios, summarize the main clinical presentation, diagnostic criteria, imaging findings, and contemporary treatment. Résumé: La sarcoïdose est une maladie inflammatoire multisystémique de cause inconnue, caractérisée par la formation de granulomes non caséeux composés de cellules épithélioïdes. La sarcoïdose cardiaque est une pathologie potentiellement mortelle qui demeure, à ce jour, difficile à diagnostiquer et à traiter. L'objectif de cet article est de présenter les données les plus à jour concernant la sarcoïdose cardiaque et de résumer, à l'aide de 10 questions cliniques et de cas réels, la présentation clinique, les critères diagnostiques, les trouvailles à l'imagerie et le traitement contemporain.

Brain metastases from hepatocellular carcinoma (HCCBM) are encountered very rarely in clinical practice, especially in western countries. Only a minority of patients undergoes resective surgery, as clinical picture is usually complex and presentation is often catastrophic with intra-cerebral hemorrhage (ICH). Neurosurgical intervention can be not only life-saving but may also alleviate significantly the burden of symptoms. We present the case of a patient with six metachronous hemorrhagic HCCBM in which emergent surgery extended survival by 9 months, of which seven spent in near-normal life quality, stressing the role of neurosurgery in the evaluation of HCCBM patients.

Author(s): Jabola, Raymond; Boswell, Benjamin; Lutz, Robert H.; Casey, Jack; Ceraulo, Anthony | Abstract: Introduction: Spinal cord injuries are a common reason for presentation to the emergency department (ED). Sports-related spinal injuries are one of the least common spinal injuries, falling behind vehicular accidents, acts of violence, and falls.Case Report: This case report describes a case of transient quadriplegia in a 17-year-old male who presented to the ED after a helmet-to-helmet collision while participating in football.Conclusion: Emergency physicians should be cognizant of potential spinal cord injury using clinical decision tools and radiologic imaging to properly disposition a patient presenting with cervical spine injury.

In South Africa, tuberculosis (TB) and multidrug-resistant TB (MDR-TB) frequently occur in people living with HIV. World Health Organization guidelines recommend the integration of MDR-TB and HIV care but, in practice, fully integrated care is difficult to achieve. In this article, we use five elements of the Chronic Care Model as a framework for evaluating a case of integrated MDR-TB/HIV care and to highlight opportunities for nurses to improve care delivery and patient outcomes. We apply the Chronic Care Model framework to a concrete example by examining the case of a 33-year-old man who developed MDR-TB treatment failure while concurrently taking a powerful new MDR-TB antiretroviral therapy regimen for his HIV.

Childhood obesity is one of the major public health problems in the twenty-first century. Up to 90% of all obesity cases in children and adolescents occur in a constitutional exogenous (simple) form. Treatment of obesity in its simple form in children is most appropriate to carry out on an outpatient basis. The main principle of prevention and treatment of overweight and obesity in children is the correction of nutrition and the development of healthy eating behavior. In order to improve the availability and quality of primary health care in the field of “dietetics”, a case-based approach to nutritional correction in overweight and obese children and adolescents has been developed. The proposed case-based approach has a modern scientific and methodological rationale, takes into account time norms for consulting patients during an outpatient appointment, is a plan of thematic consultations for the healthy diet development, ensures a gradual change in patient’s eating habits and individualization of the eating behavior correction, is aimed at the possibility of regular patient monitoring in the treatment process on an outpatient basis and promotes adherence to treatment. The development of the case-based approach is due to the high social significance of obesity, the tendency towards an increase in the number of overweight and obese children and adolescents in the Russian Federation and is aimed at implementing the main directions of the National Projects “Health” and “Demography”. Key words: children and adolescents, dietetics, healthy eating, case-based approach, nutritional correction, obesity, primary health care, eating behavior

Primary care physicians frequently evaluate patients with constipation. The history is crucial in uncovering warning symptoms and signs that warrant colonoscopy. Particular elements in the history and rectal examination also can provide clues regarding the underlying etiology. Regardless of etiology, lifestyle modifications, fiber, and laxatives are first-line therapies. Patients who fail first-line therapies can be offered second-line treatments and/or referred for testing of defecatory function. In those with severely refractory symptoms, referrals to a gastroenterologist and a surgeon should be considered.

Streaming services have emerged as increasingly important access points for cultural content, often promising, as Netflix does, ‘unlimited entertainment’. However, the actual conditions of availability remain under-examined. While streaming services typically contain a vast selection of objects, they certainly do not hold the total amount of all possible items. Streaming services thus pose new challenges for policy makers who wish to ensure access to, and availability of culture. In this paper, we build on previous research (Tallerås, Colbjørnsen, & Øfsti, 2019) to develop the term ‘contingent availability’ and discuss how cultural items are made available in streaming contexts. Departing from a pyramid model of availability, we investigate these levels empirically through a case-based approach. Nine Norwegian award-winning or critically acclaimed books, movies and TV series were strategically selected to highlight how availability in streaming services is contingent upon multiple conditions. For each case, we assess the ways in which Norwegian cultural policy influences production, distribution and availability of culture. We discuss how cultural policy measures do secure availability for most of the cases, but is unable to effectively combat fragmentation of availability. This work was supported by the Norges Forskningsråd [263076]

Over the last few decades, emerging hybrid understandings of multilingualism and language belonging have contributed to a more inclusive perspective on language rights and policies. However, it is still debated how similar challenging views on language itself can also contribute to constructing inclusive policies of language maintenance, especially in a kaleidoscopic linguistic landscape such as that shaped by migratory phenomena. Against this background, this paper highlights a series of preliminary considerations regarding the interlocking dynamics among standardisation processes, language variation and international migration. Through an analysis of several relevant cases, it aims to identify how a hybrid understanding of language and its internal variation can contribute to a more effective, sensible and inclusive perspective on heritage language maintenance. Received: 26 February 2020Accepted: 06 November 2020

BACKGROUND: Adverse events following immunisation (AEFIs) are often attributed to vaccine hypersensitivity. However, many of these possible allergic reactions are unlikely to be confirmed as true vaccine allergies but rather coincidental symptoms that may mimic an allergic reaction. OBJECTIVE: By using case studies, the authors show the variation of presentations of potential hypersensitivity AEFIs. Case studies are used to illustrate a general approach to investigation and management of these reactions. DISCUSSION: AEFIs are commonly seen in general practice, and it can often be difficult to differentiate between the underlying mechanisms. It is important to be able to identify a potential hypersensitivity reaction so that it can be reported to the appropriate local pharmacovigilance system and patients can be reviewed by immunisation specialists to evaluate, investigate and manage future immunisations where required.

A variety of neoplastic and non-neoplastic lesions of the pancreas can present with a predominantly cystic architecture. These lesions are increasingly being detected as incidental findings on routine cross-sectional imaging following technological advances in these techniques and their widespread use. The different histopathological behaviors show various common and uncommon imaging findings, and some cases show similar appearance in spite of different histopathology. Each lesion requires specific management because of the differing risk of progression to malignancy, and an accurate imaging diagnosis is crucial. The typical imaging characteristics that differentiate pancreatic cystic lesions have been well described and fully summarized. However, in addition to a small percentage of cases that shows uncommon imaging findings, a substantial percentage of cystic lesions shows overlapping imaging findings that can lead to radiological misdiagnosis. For appropriate diagnosis and optimal treatment strategy, it is important to know the uncommon and overlapping imaging findings of these lesions, in addition to familiarity with the typical aspects. In this article, we reconfirm the well-known characteristic imaging features of pancreatic cystic lesions and present several diagnostically challenging cases, focusing on the uncommon and overlapping imaging findings.

Planning and business plan, as a its product represent essential part of the overall business management. The business plan covers all important aspects of the business and the key factors that affect its performance. The business plan is used to increase the opportunities for development, growth and raise additional capital. This paper discusses the importance of business plan, its contents and provides some rules that should be taken into consideration during its writing, etc. In this paper is used the case-based methodology, where a practical example of a business plan is provided. The paper ends with discussion and conclusion section and limitations, practical implication and future research avenues as well. Keywords— planning; business pan; entrepreneur; marketing; capital

Cardiovascular disease is commonly encountered in the adult population and has large impacts on morbidity and mortality. The ever-expanding evidence base for the use of integrative medicine in cardiology necessitates providers caring for patients with cardiovascular disease to be familiar with these therapies. However, providers may find it difficult to adequately discuss these therapies in an average office visit. Through a case-based, question-and-answer approach, the authors review some clinically relevant and helpful research that addresses the incorporation of integrative medicine in cardiovascular disease prevention.

This chapter will explore the connection between diversifying health profession student demographics, diversifying challenges these students face, and the new obstacles presented by shifting curriculum delivery to remote and hybrid learning during the coronavirus disease 2019 (COVID-19) pandemic. The chapter will explore challenges that may seem especially difficult to address in a remote learning model: the desire to develop community among fellow learners when in a hybrid or fully remote program and when learners are from varied backgrounds; cultivating in students coping mechanisms to manage anxiety from the economic uncertainty of today's world, balancing commitments between educational pursuits and other responsibilities (e.g., child or parent care, etc.); and facilitating learning for students with physical and/or mental disabilities or chronic medical conditions.

Use of functional neuroimaging capabilities such as fMRI, DTI, MRP, MRS, AS-PET-CT, SPECT, and TMS as noninvasive tools to visualize intrinsic brain and spine morphology in relation to function have developed over the past 30 years. Amongst these imaging modalities, functional magnetic resonance imaging (fMRI) is of particular interest since it follows the physiological coupling between neuronal electrical activity and metabolic structural (cellular) activity as it relates to tissue vascularity and perfusion states. This structure–function synesis (from the Greek noun, σύνεσις = being together), leads to three effects that contribute to the fMRI signal: an increase in the blood flow velocity, a change in the mean blood volume, and most importantly, alterations in the blood oxygenation level. The latter effect has lent to the development of blood-oxygenation-level-dependent or BOLD fMRI, which has been used in establishing the topographic relationship between eloquent cortex and neurosurgical planning. As an adjunct to this modality, MRI-based diffusion tensor imaging (DTI) allows further detailed radiographic assessment of fiber tracts in the brain in relationship to the surgical lesion of interest. Herein we review the roles of fMRI and DTI for presurgical mapping to allow for maximal safe resection procedures in neurosurgery with case-based illustrations.

Background Primary cystic neoplasms of the peritoneum are rare lesions and not commonly encountered in practice. Many intra-abdominal processes may mimic cystic masses within the peritoneal cavity and pose a diagnostic challenge to both the pathologist and radiologist. Clinical presentation is diverse and varied. These lesions are usually benign. Hence complete surgical excision is the treatment of choice in most of the cases. Methods Study design: Descriptive Retrospective study. Cystic peritoneal lesions were identified and studied from data over a period of 5 years in the Histopathology Section at a tertiary care hospital in Pune, India. Mode of presentation, imaging findings in addition to gross and histopathologic findings of these lesions were studied. Results Out of 50 peritoneal lesions studied over a period of 5 years, only 7 were identified to be cystic peritoneal masses. Of these two were found to be peritoneal cysts, two mesenteric cysts, one an infected mesenteric cyst and one each a mucinous cystadenoma and lymphangioma. Conclusions Correct diagnosis rests in the hands of the pathologist and ensures that the patient receives appropriate and timely management. Hence knowledge of the spectrum of these rare cystic peritoneal masses is necessary to distinguish from other potential cystic abdominal mimicker masses and avoid a potential pitfall.

Acquired Language Disorders. A Case-Based Approach, constitutes a comprehensive case-based guide through different scenarios of language loss. This format aims at supplying (new) clinicians and stu...

Introduction: Systemic lupus erythematosus (SLE)-related thrombocytopenia during pregnancy and the postpartum period have been associated with adverse pregnancy outcomes and perinatal compl...

Depression in older adults is a mood disorder associated with physical and/or cognitive impairment. Though it may be present in a variety of settings, depression is a prominent health concern among long-term care and nursing facility residents. Pharmacologic therapy may be considered in patients with depression who have not responded to nonpharmacologic therapy or are experiencing considerable disability. There are a variety of commonly prescribed antidepressant drug options for this indication. Examples may include selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, or serotonin modulators. As the use of these agents continues in older adults, senior care pharmacists should be familiar with the evaluation of its safe and combined use (e.g., drug interactions, adverse effects).

The urological literature grows immensely by the day. Identifying practice-changing papers poses further difficulties. The purpose of this paper is to provide a common, case-based approach to applying the findings of some key papers in functional urology over the last 24 months. The cases described encompass: an elderly female with overactive bladder (OAB), a male patient with storage symptoms, a female patient with ulcerative interstitial cystitis, and a post-menopausal woman with recurrent urinary tract infections (UTI).

Laynor reviews Structural Competency in Mental Health and Medicine: A Case-Based Approach to Treating the Social Determinants of Health edited by Helena Hansen and Jonathan Metzl.

The rapid integration of highly sensitive next-generation sequencing technologies into clinical oncology care has led to unparalleled progress, and yet these technological advances have also made genetic information considerably more complex. For instance, accurate interpretation of genetic testing for germline/inherited cancer predisposition syndromes and somatic/acquired pathogenic variants now requires a more nuanced understanding of the presence and incidence of clonal hematopoiesis and circulating tumor cells, with careful evaluation of pathogenic variants occurring at low variant allele frequency required. The interplay between somatic and germline pathogenic variants and awareness of distinct genotype-phenotype manifestations in various inherited cancer syndromes are now increasingly appreciated and can impact patient management. Through a case-based approach, we focus on three areas of particular relevance to the treating clinician oncologist: (1) understanding clonal hematopoiesis and somatic mosaicism, which can be detected on germline sequencing and lead to considerable confusion in clinical interpretation; (2) implications of the detection of a potentially germline pathogenic variant in a high-penetrance cancer susceptibility gene during routine tumor testing; and (3) a review of gene-specific risks and surveillance recommendations in Lynch syndrome. A discussion on the availability and difficulties often associated with direct-to-consumer genetic testing is also provided.

The School of Veterinary Medicine, University College Dublin, Ireland, restructured the teaching of general pathology, parasitology, and microbiology in third year in 2018 as part of the development of an outcome-based curriculum. A new integrated teaching module was created, called Veterinary Pathobiology, which encompassed the three paraclinical subjects, worth 20 ECTS credits. Subject integration was driven and supported by case-based learning (CBL) activities, and practical classes, which were aimed at facilitating the understanding of basic disease processes, infectious agents, and the application of diagnostic tests. The disciplines maintained their identities within lectures which were aligned by content. The restructuring led to a reduction of contact hours by 20% and of assessment time by 40%. The examinations included integrated questions with an emphasis on the material students had covered in their CBL. Despite positive outcomes, which included equivalent examination scores and positive written feedback by students on teaching and learning, understanding, assessment, relevance, CBL, group work, and generic skills, the average scores for overall student satisfaction dropped dramatically in the second academic year of implementation. This followed the introduction of new regulations by the University relating to student progression, which was capped at "carrying" 10 ECTS credits, thus preventing students that failed the new module from progressing. Other criticisms of the new module by students included too little communication on the changes implemented in its first iteration and a workload perceived to be too heavy. Further restructuring is therefore necessary. This study highlights the process/pitfalls of integration/curricular innovation.

Summary:. The field of vascular anomalies (VA) has been subject to changes during the last few decades. The current classification of the International Society for the Study of Vascular Anomalies (ISSVA) offers a simple diagnostic structure. Hand surgeons commonly appear to have limited exposure to VA. Already recognized for more than 120 years, pyogenic granuloma (PG) is by far the most commonly described VA by different disciplines with accordingly diverse treatment strategies and theories behind it. Arteriovenous fistula (AVF), venous aneurysms (VAN), and venous malformations (VM) are, however, rare in hand surgery. With a compilation of four illustrative cases of posttraumatic entities such as AVF, VAN, VM, and PG, we would like to highlight possible daily exposure to VA in the general hand surgery practice. We discuss diagnostic and therapeutic options as well as the current literature with focus on posttraumatic VA.

A 12-year-old boy with rapidly progressive Focal Segmental Glomerulosclerosis and end-stage renal disease (ESRD) admitted to our pediatric hemodialysis (HD) unit. He presented with dyspnea and cough. He was on HD for 2 months and was on the waitlist for kidney transplantation. He was anxious and pale, had periorbital edema, bibasilar crackles in the lungs, and pitting edema in the lower extremities. His vital signs were: RR = 45/min, PR = 110/min, BP = 150/100 mmhg. His serum chemistries were: Cr = 7 mg/dL, BUN = 95 mg/dL, Albumin = 2.8 g/dL, Hb = 8.8 g/dL, Na = 145 meq/L, K = 5 meq/L, HCO3 = 12, PCO2 = 25, and PH = 7.24. Considering his first admission in a new HD unit, the critical situation, and the time limit for further examination, the clinician assessed the cardiovascular conditions at the bed of HD by point of care ultrasound (Focused echocardiogram).

Research on eXplainable AI (XAI) is continuously proposing novel approaches for the explanation of image classification models, where we can find both model-dependent and model-independent strategies. However, it is unclear how to choose the best explanation approach for a given image, as these novel XAI approaches are radically different. In this paper, we propose a CBR solution to the problem of choosing the best alternative for the explanation of an image classifier. The case base reflects the human perception of the quality of the explanations generated with different image explanation methods. Then, this experience is reused to select the best explanation approach for a given image.

International audience; We present, in this paper, teaching material and experience report on teaching software testing to 3rd year bachelor's degree students. Our approach covers a wide range of techniques from unit testing, to functional testing, through test-first design and black-box testing. To motivate students, we rely on the use of a running case study, that is developed and tested all the way through. This paper presents both teaching material and experience report based on the feedback that we get from the students, and the observations we made regarding the discovery of the software testing aspects.

In this study, a belief function theory based supervised classifier that is able to determine the class of a ship automatically is developed. Transferable belief model is used to model the uncertainty and impreciseness about the measurements obtained from sensors. The case-based classifier developed in the context of the transferable belief model is realized and its accuracy is measured on an artificial database.

In this work, we analyze the formalization and the role of the Clinical Pathway (CP): it is growing up as a main instrument for the implementation of clinical guidelines and evidence-based medicine. Its primary objective is the improvement of the care process monitoring the unjustified variations in clinical practices to reach faster the best fit care and to reduce the costs of the health system. In a generalized context of an aging population and the ever-increasing diffusion of chronic diseases, we introduce a CP methodological and technological approach with the aim to improve the way patients are monitored during their pathway, to help physicians to read the clinical picture in the best and fast way and to reduce the general clinical complexity.

The Use of Force in International Law: A Case-Based Approach is an essential addition to the jus ad bellum scholar’s toolkit and a ‘must have’ for anyone more generally interested in armed conflict...

In this two-part publication (see Chirkov & Anderson, 2018), we compare two paradigms—statistical positivism and critical scientific realism—in their application to research on academic motivation. In the first part, the propositions of statistical positivism and their applications to psychological research are presented. An empirical study in this part combined self-determination and achievement goal theories and built a statistically integrated model of motivation of 385 college students using path analysis. Part 1 ended with a critical analysis of this statistical model and the knowledge about motivation that it provided. In the second part, the propositions of critical scientific realism are articulated. An empirical study utilizes these propositions and initiates realist interviewing of 12 purposefully selected students. Using within- and between-case analyses, a model of a motivational mechanism of successful university students is proposed. The authors conclude that the continued use of statistical positivism generates minimal new knowledge about the mechanisms of academic motivation. This paradigm should be replaced with the realist one and a case-based methodology, which have a better chance to advance research and improve understanding of academic motivation.

In this two-part publication, we compare two paradigms—statistical positivism and critical scientific realism—in their application to research on academic motivation. In the first part, the propositions of statistical positivism and their applications to psychological research are presented. An empirical study in this part combines self-determination and achievement goal theories and builds a statistically integrated model of motivation of 385 college students using path analysis. This part ends with a critical analysis of this statistical model and the knowledge about motivation that it provides. In the second part, the propositions of critical scientific realism are articulated. An empirical study in Part 2 utilizes these propositions and initiates realist interviewing of 12 purposefully selected students. Using within- and between-case analyses, a model of a motivational mechanism of successful university students is proposed. The authors conclude that the continued use of statistical positivism generates minimal new knowledge about the mechanisms of academic motivation. This paradigm should be replaced with the realist one and a case-based methodology, which have a better chance to advance research and improve understanding of academic motivation.

In cardiology practice, anticoagulation and antiplatelet therapies are essential for most patients. As of yet, there is no high quality evidence regarding these treatments in thrombocytopenic patients, which continues to be an issue. Thrombocytopenia is defined as a platelet count of 50x109/L, a half-dose of LMWH is recommended in patients with thrombocytopenia between 25 and 50x109/L. According to the current guidelines, avoiding antiplatelet and anticoagulant treatment should be restricted to patients with very severe thrombocytopenia (i.e., a platelet count

During the last decade, many researchers have focused on joint consideration of various operations planning aspects like production scheduling, maintenance scheduling, inventory control, etc. Such ...

Conventional approaches to the study of SME finance tend to focus on the changing financing options and preferences as small businesses move through different stages. However, one of the limitation...

Persistent pupillary membranes (PPMs) are a common congenital anomaly seen in 95% of neonates. Extensive PPMs, occluding the visual axis and resulting in reduced visual acuity, are relatively uncommon. We describe a case of bilateral total PPM in a 36-year-old female who presented with complaints of blurred vision in both the eyes. Dense pupillary membranes obscuring the visual axis need early surgical treatment. It is essential that the lens status remains clear along the visual axis both before and after pupilloplasty.