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Parosteal osteosarcomas are uncommon malignant bone tumors that arise from the bone surface. Their heterogenous components can present challenges in diagnosis. We present a case of a rare variant of this tumor known as an osteochondroma-like parosteal osteosarcoma, which was initially misdiagnosed as a cartilaginous tumor on core needle biopsy. Surgical resection of the tumor ultimately allowed for definitive diagnosis. Our case demonstrates the limitations of needle biopsy in diagnosing variants of parosteal osteosarcoma and the vital role of multidisciplinary discussions in guiding diagnosis and treatment. Furthermore, our case utilizes 3-dimensional printing technology in the surgical treatment, and illustrates the recent advances in patient-specific surgical techniques.

BackgroundSince 2015, the American College of Radiology (ACR) has recommended staging for lung metastasis via chest computed tomography (CT) without contrast for extremity sarcoma staging and surveillance. The purpose of this study was to determine our institutional compliance with this recommendation.MethodsThis was a retrospective chart review of patients diagnosed with sarcoma in the extremities who received CT imaging of the chest for pulmonary staging and surveillance at our institution from 2005 to 2023. A total of 1916 CT studies were included for analysis. We scrutinized ordering patterns before and after 2015 based on the ACR-published metastasis staging and screening guidelines. An institutional and patient cost analysis was performed between CT modalities.ResultsThe prevalence of CT scans ordered and performed with contrast was greater than those without contrast both prior and post-ACR 2015 guidelines. Furthermore, 79.2% of patient's final surveillance CTs after 2015 were performed with contrast. A cost analysis was performed and demonstrated an additional $297 704 in patient and institutional costs.ConclusionsAt our institution, upon review of CT chest imaging for pulmonary staging and surveillance in patients with extremity sarcoma the use of contrast has been routinely utilized despite a lack of evidence for its necessity and contrary to ACR guidelines.

Parosteal osteosarcomas are uncommon malignant bone tumors that arise from the bone surface. Their heterogenous components can present challenges in diagnosis. We present a case of a rare variant of this tumor known as an osteochondroma-like parosteal osteosarcoma, which was initially misdiagnosed as a cartilaginous tumor on core needle biopsy. Surgical resection of the tumor ultimately allowed for definitive diagnosis. Our case demonstrates the limitations of needle biopsy in diagnosing variants of parosteal osteosarcoma and the vital role of multidisciplinary discussions in guiding diagnosis and treatment. Furthermore, our case utilizes 3-dimensional printing technology in the surgical treatment, and illustrates the recent advances in patient-specific surgical techniques.

Chondroblastoma is a rare, benign neoplasm of chondroblast cell origin, accounting for less than 1% of primary bone tumors. It is usually diagnosed in the second decade of life with most of the cases involving the long bones such as the femur and humerus. Furthermore, over 90% of cases are in individuals under 30 years of age. In older adults, chondroblastomas are typically found in bones in the foot, such as the talus and calcaneus. Treatment is usually local curettage of the lesion with a relatively low rate of recurrence. In this case report, we present a patient with an atypical age of initial presentation at 49 years, a rare location of the chondroblastoma in the acetabulum, and a recurrence 14 years after surgical resection in the same location. The lesion's radiographic findings of intralesional calcifications alongside the high-signal, heterogeneous composition on T2-weighted MRI were supportive of the atypical diagnosis of chondroblastoma in this patient.

Chondroblastoma, a rare benign bone tumor, is typically found in the epiphysis of long bones, with hand involvement being particularly uncommon. We present a case of an 11-year-old female with chondroblastoma involving the fourth distal phalanx of the hand. Imaging revealed a lytic, expansile lesion with sclerotic margins and no soft tissue component. A preoperative differential diagnosis included intraosseous glomus tumor, epidermal inclusion cyst, enchondroma, and chronic infection. The patient underwent open surgical biopsy and curettage for both diagnostic and treatment purpose. The final histopathologic diagnosis was chondroblastoma.

We examine the design and implementation of the Canada Housing Benefit (CHB), which is a rent subsidy provided to low-income tenants and an important part of the National Housing Strategy. Focusing on three Atlantic provinces, we explore to what extent the CHB adheres to just housing, based on the perspectives of stakeholders (n=18) who work with people living in poverty. We find that the CHB fails to provide assistance to many marginalized renters, thus perpetuating their exclusion. The CHB also falls short in providing housing that is affordable and secure, and lacks involvement in decision-making on the part of those with lived experience. Finally, the current state of the rental market, including a lack of units and landlord discrimination, poses significant limitations to its implementation. We conclude that the design of the CHB needs to be overhauled to comply with just housing, but that the housing terrain in which allowances are provided needs to be transformed or just housing will remain unrealized.

IntroductionMany youth with pain lack access to pediatric pain expertise. There is a critical shortage of pediatric pain physicians, due partly to a paucity of training programs in Pediatric Pain Medicine. Pain fellowships are Anesthesiology-based and there is no pathway to fellowship training or Pain Medicine board certification for pediatricians. This workforce assessment sought to examine the current state of Pediatric Pain Medicine in the United States and future interest in pursuing Pain Medicine among pediatricians.MethodsA multidisciplinary working group of Pain Medicine clinicians designed three surveys to examine pediatric comprehensive pain programs in the US, practice patterns of pediatricians and their motivations and opinions regarding Pain Medicine board certification, and current residents’ exposure to and interest in Pediatric Pain Medicine.ResultsWait times for initial evaluations are two months or longer for two-thirds of responding centers, and barriers to increase staff size and resources were reported, including an inadequate number of trained or available physicians. Pediatricians expressed interest in earning board certification in Pain Medicine, given the opportunity. Additionally, there is interest among pediatric residents in pursuing Pediatric Pain Medicine, and qualitative data highlight information residents perceived needing in order to pursue a career in the field.DiscussionResults demonstrate the need for increased training opportunities in pediatric pain medicine. A formal pathway to Pain Medicine for Pediatricians should be developed to increase the potential workforce and to address the lack of trained pediatric pain specialists, thereby improving access to care for youth with pain.

Summary: Gastrointestinal microbes modulate peristalsis and stimulate the enteric nervous system (ENS), whose development, as in the central nervous system (CNS), continues into the murine postweaning period. Given that adult CNS function depends on stimuli received during critical periods of postnatal development, we hypothesized that adult ENS function, namely motility, depends on microbial stimuli during similar critical periods. We gave fecal microbiota transplantation (FMT) to germ-free mice at weaning or as adults and found that only the mice given FMT at weaning recovered normal transit, while those given FMT as adults showed limited improvements. RNA sequencing (RNA-seq) of colonic muscularis propria revealed enrichments in neuron developmental pathways in mice exposed to gut microbes earlier in life, while mice exposed later—or not at all—showed exaggerated expression of inflammatory pathways. These findings highlight a microbiota-dependent sensitive period in ENS development, pointing to potential roles of the early-life microbiome in later-life dysmotility.

Patients with bone metastases may experience debilitating pain, neurological conditions, increased risk of pathological fractures, and death. A deeper understanding of the bone microenvironment, the molecular biology of cancer types prone to metastasis, and how bone physiology promotes cancer growth, may help to uncover targeted treatment options. The purpose of this paper is to outline the current concepts relevant to topics including bone remodeling, angiogenesis, and immunomodulation as it relates to metastatic bone disease.

Reliance on trusted secondary sources, such as clinical practice guidelines, has emerged as a pragmatic solution for evidence-based practice. This editorial underscores the necessity of adapting medical education to equip clinicians with skills aligned with practical clinical demands and introduces a streamlined version of Shaughnessy's G-TRUST tool tailored for swift guideline assessment in clinical settings.

The need to establish real collaboration between teachers and remedial teachers is highlighted by several studies and ministerial documents. Despite the potential benefits of this collaboration, several obstacles hinder the implementation of these collaborative practices. This multi-case study, carried out as part of doctoral studies, aims to document the collaboration between teachers and remedial teachers in the context of the implementation of the RtI model in elementary school. To do this, three dyads, each composed of a teacher and a remedial teacher, were studied in depth based on interviews, direct observation, documentary analysis and a logbook. The results highlight favorable conditions for the establishment of a real collaboration between teachers and remedial teachers, as well as the presence of a parity imbalance within certain dyads. These results reiterate the importance of further research on collaboration between teachers and remedial teachers to further guide practitioners, managers and university trainers. Keywords: Response to intervention model (RtI), general educator, special educator, special education teacher, collaboration, co-teaching, learning disabilities Plusieurs etudes et documents ministeriels soulignent la necessite d'etablir une reelle collaboration entre les enseignants et les orthopedagogues. Malgre les avantages de cette collaboration, plusieurs obstacles en entravent la mise en oeuvre. Cette etude multicas, realisee dans le cadre d'une recherche menee au doctorat, a pour objectif d'examiner la collaboration entre enseignantes et orthopedagogues dans un contexte d'implantation du modele RaI au primaire. Pour ce faire, trois dyades composees d'une enseignante et d'une orthopedagogue ont ete etudiees a partir d'entretiens, d'observation directe, d'une analyse documentaire et d'un journal de bord. Les resultats font ressortir des conditions favorables a l'instauration d'une veritable collaboration entre les enseignantes et les orthopedagogues, ainsi que la presence d'un desequilibre paritaire au sein de certaines dyades. Ces resultats reiterent l'importance de poursuivre les recherches sur la collaboration entre les enseignants et les orthopedagogues pour orienter davantage les praticiens, les gestionnaires et les formateurs universitaires. Mots-cles : modele de reponse a l'intervention (Ral), orthopedagogue, enseignant, collaboration, coenseignement, difficultes d'apprentissage, Introduction Depuis 20 ans, il est connu que le nombre grandissant d'eleves ayant des besoins divers, presents dans les classes ordinaires, requiert une collaboration accrue entre l'enseignant et l'orthopedagogue (Daane [...]

This article is based on the results of a survey carried out in 2019 to document health managers and professionals' knowledge concerning their linguistic obligations and the tools promoting active offer in the field of mental health in French, in Ontario and Manitoba. The working hypothesis is that knowledge of the obligations and available tools can contribute to a successful offer of services in French. The more professionals and managers understand their obligations, the more tools they can use to fulfill them. The study shows that there is indeed a link between knowledge of obligations and the use of tools to provide an active offer of mental health services in French. It also highlights the key role of tools to provide French services actively. Cet article presente les donnees d'un sondage realise en 2019 sur la connaissance des gestionnaires et des professionnels ceuvrant dans le domaine de la sante mentale en Ontario et au Manitoba de leurs obligations linguistiques et des outils qui favorisent la pratique de l'offre active de services francais. Letude permet de souligner que plus les professionnels et les gestionnaires comprennent leurs obligations, tant en Ontario qu'au Manitoba, plus ils peuvent profiter des outils existants pour sen acquitter. L'etude montre qu'il existe en effet un lien entre la connaissance des obligations et l'utilisation des outils pour faire de l'offre active de services de sante mentale en francais. Elle permet aussi d'insister sur le role cie des outils pour faire de l'offre active de services en francais., Cette recherche s'inscrit dans le cadre des travaux du GRIPOAS, un partenariat entre des chercheurs universitaires et communautaires qui a pour objectif de favoriser la co-construction des savoirs et la [...]

Abstract As the demand for bacteriophage (phage) therapy increases due to antibiotic resistance in microbial pathogens, strategies and methods for increased efficiency, large-scale phage production need to be determined. To date, very little has been published on how to establish scalable production for phages, while achieving and maintaining a high titer in an economical manner. The present work outlines a phage production strategy using an enterotoxigenic Escherichia coli-targeting phage, ‘Phage75’, and accounts for the following variables: infection load, multiplicity of infection, temperature, media composition, harvest time, and host bacteria. To streamline this process, variables impacting phage propagation were screened through a high-throughput assay monitoring optical density at 600 nm (OD600) to indirectly infer phage production from host cell lysis. Following screening, propagation conditions were translated in a scalable fashion in shake flasks at 0.01 L, 0.1 L, and 1 L. A final, proof-of-concept production was then carried out in a CellMaker bioreactor to represent practical application at an industrial level. Phage titers were obtained in the range of 9.5–10.1 log10 PFU/mL with no significant difference between yields from shake flasks and CellMaker. Overall, this suggests that the methodology for scalable processing is reliable for translating into large-scale phage production.