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Pathologists are responsible for rapidly providing a diagnosis on critical health issues. Challenging cases benefit from additional opinions of pathologist colleagues. In addition to on-site colleagues, there is an active worldwide community of pathologists on social media for complementary opinions. Such access to pathologists worldwide has the capacity to improve diagnostic accuracy and generate broader consensus on next steps in patient care. From Twitter we curate 13,626 images from 6,351 tweets from 25 pathologists from 13 countries. We supplement the Twitter data with 113,161 images from 1,074,484 PubMed articles. We develop machine learning and deep learning models to (i) accurately identify histopathology stains, (ii) discriminate between tissues, and (iii) differentiate disease states. Area Under Receiver Operating Characteristic (AUROC) is 0.805-0.996 for these tasks. We repurpose the disease classifier to search for similar disease states given an image and clinical covariates. We report precision@k = 1 = 0.7618 ± 0.0018 (chance 0.397 ± 0.004, mean ±stdev ). The classifiers find that texture and tissue are important clinico-visual features of disease. Deep features trained only on natural images (e.g., cats and dogs) substantially improved search performance, while pathology-specific deep features and cell nuclei features further improved search to a lesser extent. We implement a social media bot (@pathobot on Twitter) to use the trained classifiers to aid pathologists in obtaining real-time feedback on challenging cases. If a social media post containing pathology text and images mentions the bot, the bot generates quantitative predictions of disease state (normal/artifact/infection/injury/nontumor, preneoplastic/benign/low-grade-malignant-potential, or malignant) and lists similar cases across social media and PubMed. Our project has become a globally distributed expert system that facilitates pathological diagnosis and brings expertise to underserved regions or hospitals with less expertise in a particular disease. This is the first pan-tissue pan-disease (i.e., from infection to malignancy) method for prediction and search on social media, and the first pathology study prospectively tested in public on social media. We will share data through http://pathobotology.org . We expect our project to cultivate a more connected world of physicians and improve patient care worldwide.

Pre-reading and early childhood literacy skills are important for brain development and fundamental to a child's long-term cognitive and social well-being. As such, the fostering of these skills is an important preventive health measure. Family physicians can play key roles in encouraging parents to routinely read with their children. However, in Romania, early childhood literacy screening and promotion are not currently integrated into medical practice. This paper summarizes mixed-methods research into the feasibility of implementing a physician-promoted early childhood literacy programme in Romania based on the American 'Reach Out and Read' initiative; it describes and evaluates a small-scale implementation of a pilot early childhood literacy programme, Citesc Zilnic ('Read Everyday'), in 15 medical practices. Results indicate that most Romanian family physicians recognize that early childhood literacy is important for child development, but do not screen for early childhood literacy skills, nor promote early childhood literacy as a preventive medical strategy. With institutional and cultural adaptations to a 'Reach Out and Read'-based model, this research concludes that a high proportion of family physicians are very interested in a programme to screen for and promote early childhood literacy and may also find strong potential for promoting the basic concept of preventive health measures to the Romanian public, going beyond the initial goals of an early childhood literacy-promotion programme.

This study analyses the practice of medical pluralism in contemporary Romania, addressing the phenomenon of alternative medicine through the Foucauldian concept of counter-conduct. Employing in-depth interviews with general and alternative practitioners from two towns in Transylvania, and participant observations in spaces where they practice their knowledge, I describe how certain discursive acts reformulate the body and the subject-patient. Alternative therapists construct their practice in direct opposition to several parameters of biomedicine, such as the logic of diagnosis, treatment, and the praxis of patient’s visit to the general practitioner’s office, discussed in the paper. They define their approach as psychosomatic, and set-up the medical space as a confessional space, envisioning a holistic corporeality and the idea of the “inner doctor” in each patient. This conduct would supposedly make the subject “active” and “empowered”, as opposed to the “passive” patient succumbed to the diagnosis of conventional doctors.

The article presents a case study of a 50-year-old woman with a unique presentation of tender, erythematous, dermal plaques on the face. It proceeds to discuss the correct diagnosis, which is "Neutrophilic Eccrine Hidradenitis" (NEH). It further includes clinical photographs of the lesions, histopathology findings from a biopsy, and discusses the differential diagnosis and management of the condition.

The quality of services should be treated as a resultant derived from the satisfaction of the costumers participating in the service consumption, which requires prior knowledge on the predictable behaviour and reactions of the clients to the offered services. In its turn, the service monitoring system’s design must be shaped according to these behaviours: service delivery, service delivery management and service quality control are therefore inherently subject to a double purpose: obtaining consumer satisfaction and stimulating them to seek, in the future the services of the same tender. It is obvious that, in the case services, their intangible character makes quality aspects to be rarely identified in physical or quantifiable indicators, which means that service quality measurements remains largely subjective or up to the client. As a result, each manager must choose some criteria for establishing the principles used in quality assessment and, ultimately, the practice under market competition conditions, is the one that will approve or not, on the long run those criteria, therefore the service’s quality and its adequacy for a particular customer segment.

The evaluation of the educational services quality by the students represents an important element of the internal quality monitoring process for the identification of the necessary actions required in the continuous improvement of the offered educational quality, and on the other hand it represents an indicator of the university interest of having access at the students point of view. Starting from the student needs, together with the staff involved in the evaluation and quality assurance committee of the Faculty of Economic Sciences Cluj-Napoca, Dimitrie Cantemir Christian University Bucharest, we elaborated a questionnaire for the evaluation of the educational services quality by the students, concerning: teaching-learning activities, available admission information, tutorial system, class schedule, material base, laboratory, course and seminar rooms equipments, administrative services, student organizations, counselling services offered by the faculty. The conclusions of the study were discussed with the faculty's management, decisions being made to take actions in order to increase the student satisfaction level. By developing and implementing their own strategy to quality policies and procedures, the higher education institution is explicitly committed to develop a quality culture in all its activities.

At present, taking into consideration the economic situation and the aspects related to the social life, the students need permanent guarantees that the standards of their diplomas are acknowledged by the future employees at a national and international level, and the employees need guarantees that they may choose from well trained future employees. Among the important elements of quality assurance, the feedback of the employers or potential employers – respectively of the business market, represents a strategic element of a competitive and efficient quality assurance system of any university.

Demographic trends play an important role in the development of workforce diversity. Population expansion and immigration are two examples of demographic changes that have created more diverse environments and made it crucial for organizations to be able to adapt and manage change. Organizations constantly need to reassess their methods and come up with new, original ideas for managing people as a result of demographic and global changes. Positive adjustments could boost an organization's performance in matters of innovation and strengthen its ties to its customers as well as to the entire community. The research purpose of our paper is to provide an analysis of various viewpoints on the perceived image of the organization while taking into account the influence of three aspects: workforce diversity, creativity and innovation capacity, and corporate social responsibility. The perception of these three important organizational aspects was examined among employees from organizations of all sizes and in a range of activities from Romania. A questionnaire was used as an information gathering tool. The study is based on the quantitative approach, which considers the statistical analysis of numerical data. Based on the study findings and due to the inductive reasoning, today's leaders are responsible both for managing employees, but also for meeting the needs of customers who are increasingly ethnically and culturally diverse. It is necessary to pay attention to aspects related to diversity. Whether the goal is to be a valued employer, to provide excellent products and services to customers, or to maintain a competitive advantage, diversity is recognized and used as an important organizational resource. [ABSTRACT FROM AUTHOR]

Syphilis is a sexually transmitted infectious disease caused by the bacterium Treponema pallidum and can cause a wide variety of cutaneous manifestations, most commonly, a papulosquamous eruption of the trunk and extremities. Treatment with penicillin is curative. We report a case of a 69-year-old man who presented with recent onset of blurry vision and a nonpainful, nonpruritic eruption of pink-toviolaceous dermal nodules on his upper trunk and upper extremities. Biopsies of two separate locations revealed a dense superficial and deep perivascular atypical lymphocytic infiltrate with admixed plasma cells, histiocytes, and eosinophils. Some scattered cells expressed CD30, PD1, BCL-6, and ICOS. T-cell receptor (TCR)-rearrangement showed an identical TCR-gamma clone between both biopsy specimens. The patient was subsequently seen by ophthalmology and diagnosed with acute anterior uveitis. Rapid plasma reagin was reactive and cerebrospinal fluid studies showed findings consistent with a diagnosis of neurosyphilis. A T. pallidum immunostain of the skin biopsies was performed upon re-review, and was diffusely positive for spirochetes at the dermal-epidermal junction and within injured vessels. The patient was treated with penicillin G with near-resolution of his skin lesions. This case highlights the unusual ability of syphilis to mimic a T-cell lymphoma with matching clones across two different biopsy sites. [ABSTRACT FROM AUTHOR]

Cutaneous mucormycosis is a rare, often fatal fungal infection that most commonly affects patients with underlying immunosuppression but also can occur in premature neonates. We report the case of an extremely premature boy (<25 weeks) who developed primary cutaneous mucormycosis shortly after birth. Although surgical debridement has been a mainstay of treatment in combination with antifungal therapy, our patient was successfully treated with amphotericin B alone—the management only reported in three other cases to date. We present this case to highlight that prompt initiation of treatment with amphotericin B alone may be an appropriate alternative to surgical intervention, particularly in patients with non‐angioinvasive disease who are poor surgical candidates. [ABSTRACT FROM AUTHOR]

The case study is presented which offers information on skin health relation condition of vesicular rash and its diagnosis. Topics include different types of available diagnosis for it; a potassium hydroxide (KOH) preparation, fungal culture, and punch biopsy of the right ventral wrist was performed; and diagnosis of tine corporis bullosa is clinical if the lesion is typical and can be confirmed using KOH preparation and fungal culture.

Background & Aims: Several non‐invasive tests (NITs) have been developed to diagnose oesophageal varices (EV), including the recent Baveno VI criteria to rule out high‐risk varices (HRV). Spleen stiffness measurement (SSM) with the standard FibroScan® (SSM@50Hz) has been evaluated. However, the EV grading could be underestimated because of a ceiling threshold (75 kPa) of the SSM@50Hz. The aims were to evaluate SSM by a novel spleen‐dedicated FibroScan® (SSM@100Hz) for EV diagnosis compared with SSM@50Hz, other validated NITs and Baveno VI criteria. Methods: This prospective multicentre study consecutively enrolled patients with chronic liver disease; blood data, endoscopy, liver stiffness measurement (LSM), SSM@50Hz and SSM@100Hz were collected. Results: Two hundred and sixty patients met inclusion criteria. SSM@100Hz success rate was significantly higher than that of SSM@50Hz (92.5% vs 76.0%, P <.001). SSM@100Hz accuracy for the presence of EV (AUC = 0.728) and HRV (AUC = 0.756) was higher than in other NITs. SSM@100Hz AUC for large EV (0.782) was higher than SSM@50Hz (0.720, P =.027). AUC for HRV with SSM@100Hz (0.780) was higher than with LSM (0.615, P <.001). The spared endoscopy rate of Baveno VI criteria (8.1%) was significantly increased by the combination to SSM@50Hz (26.5%) or SSM@100Hz (38.9%, P <.001 vs others). The missed HRV rate was, respectively, 0% and 4.7% for combinations. Conclusions: SSM@100Hz is a new performant non‐invasive marker for EV and HRV providing a higher accuracy than SSM@50Hz and other NITs. The combination of Baveno VI criteria and SSM@100Hz significantly increased the spared endoscopy rate compared to Baveno VI criteria alone or combined with SSM@50Hz. Clinical trial number: NCT02180113. [ABSTRACT FROM AUTHOR]

The world which we all live in, is going through a process of continuous change. We are the authors of this change, influencing more of less the entire process of human community's development. And in this context, the role of schools in general, especially universities is undeniable. The paper aims to analyze significant issues related to quality management in Romanian universities, both in terms of educational service providers and in terms of direct beneficiaries of these services - the students and indirect beneficiaries - the employers. At present, ensuring quality education becomes increasingly important, both nationally as well as internationally. Students are becoming more aware of the benefit of adequate training, appropriate for the requirements of the world they live in. Since quality management is imperative in educational activities it is only natural for universities to be evaluated in the context of quality management implementation, based on the achievement of the proposed strategic objectives. For these reasons, the need to focus on ensuring the quality of all processes in higher education is being felt increasingly. The implementation of an efficient and effective quality management system in each university would help to identify and evaluate opportunities and deficiencies, for the problem areas to be corrected in time, implementing necessary improvements in the whole academic system. [ABSTRACT FROM AUTHOR]

The real "asset" of the performing companies is the sum of knowledge and experience gained from the relationships with their clients, which will determine their future market value. The customer orientation principles dominate and will dominate, in any competitive economy, the business mission of any company. The impeccable customer service must represent the reason why companies exist; and this because it will determine the client's loyalty towards the company and its products, loyalty which in turn will generate a high profitability. [ABSTRACT FROM AUTHOR]

Purpose:  Clinically significant portal hypertension (CSPH) is responsible for most of the complications in patients with cirrhosis. Liver stiffness (LS) measurement by vibration-controlled transient elastography (VCTE) is currently used to evaluate CSPH. Bi-dimensional shear wave elastography from General Electric (2D-SWE.GE) has not yet been validated for the diagnosis of PHT. Our aims were to test whether 2D-SWE.GE-LS is able to evaluate CSPH, to determine the reliability criteria of the method and to compare its accuracy with that of VCTE-LS in this clinical setting., Materials and Methods:  Patients with chronic liver disease referred to hepatic catheterization (HVPG) were consecutively enrolled. HVPG and LS by both VCTE and 2D-SWE.GE were performed on the same day. The diagnostic performance of each LS method was compared against HVPG and between each other., Results:  2D-SWE.GE-LS was possible in 123/127 (96.90 %) patients. The ability to record at least 5 LS measurements by 2D-SWE.GE and IQR < 30 % were the only features associated with reliable results. 2D-SWE.GE-LS was highly correlated with HVPG (r = 0.704; p < 0.0001), especially if HVPG < 10 mmHg and was significantly higher in patients with CSPH (15.52 vs. 8.14 kPa; p < 0.0001). For a cut-off value of 11.3 kPa, the AUROC of 2D-SWE.GE-LS to detect CSPH was 0.91, which was not inferior to VCTE-LS (0.92; p = 0.79). The diagnostic accuracy of LS by 2D-SWE.GE-LS to detect CSPH was similar with the one of VCTE-LS (83.74 % vs. 85.37 %; p = 0.238). The diagnostic accuracy was not enhanced by using different cut-off values which enhanced the sensitivity or the specificity. However, in the subgroup of compensated patients with alcoholic liver disease, 2D-SWE.GE-LS classified CSPH better than VCTE-LS (93.33 % vs. 85.71 %, p = 0.039)., Conclusion:  2D-SWE.GE-LS has good accuracy, not inferior to VCTE-LS, for the diagnosis of CSPH., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)