Leaders' Experiences with High School-College Writing Center Collaborations: A Qualitative Multiple-Case Study

Science.gov (United States)

Story, Julie A.

2014-01-01

The purpose of this qualitative multiple-case study was to explore academic leaders' experiences with the organizational elements of their own high school-college writing center collaborations. Conjoining theories framed this study: collaborative leadership theory, Kenneth Bruffee's notion of social constructionism and collaborative learning…

Customer service strategy options : a multiple case study in a B2B setting

NARCIS (Netherlands)

Wouters, J.P.M.

2004-01-01

This study addresses the question whether customer service actually has order winning potential in B2B situations, which customer service strategies are deployed, and what determines customer service relevance. A literature review was followed by a multiple case study, using 12 organizations from

Key aspects in managing safety when working with multiple contractors: A case study

NARCIS (Netherlands)

Drupsteen, L.; Rasmussen, H.B.; Ustailieva, E.; Kampen, J. van

2015-01-01

Working with multiple contractors in a shared workplace can introduce and increase safety risks due to complexity. The aim of this study was to explore how safety issues are recognized in a specific case and to identify whether clients and contractors perceive problems similarly. The safety issues

An Exploration of Infant and Toddler Child Care Consultation: A Multiple Case Study

Science.gov (United States)

John, Christine Marie

2015-01-01

This qualitative, multiple case study was an exploration of the professional development (PD) experience of consultation as it occurred within infant and toddler child care settings. Consultation is dependent upon the establishment of a relationship between the consultant and the consultee and offers opportunities for professional growth and…

Multiple Study of Case Involving Implementation of Lean Manufacturing

Directory of Open Access Journals (Sweden)

Delvio Venanzi

2018-03-01

Full Text Available This article aims to show some factors that can cause companies to succeed or fail in their attempts to use lean manufacturing, by performing a multiple case study which presents two successful cases and three conditions of failure, in a survey of five large companies, all belonging to the metal-mechanical sector, located in Campinas and Sorocaba, both in the state of São Paulo, Brazil. The data were collected using exploratory research between the periods of January 2013 and February 2015. The results show that successful cases of lean manufacturing implementation are the result of a more organized work environment, standardization of production and service areas, employee satisfaction, productivity results and quality of the final product. Unsuccessful deployments result from poor execution and faulty planning, that has no benefit and ultimately decrease the morale of its employees, creating more distrust and frustration directly influencing the results and productivity. In other words, lean manufacturing implementation requires hard and continuous work and these procedures should be aligned with the mission and goals of companies and mainly focus on the maintenance result by using tools to monitor and track the process systematically and also making investments to eliminate waste.

Where Adults Go: A Multiple Case Study of Adult Serving Undergraduate Colleges and Universities

Science.gov (United States)

Dixon-Williams, Shelley B.

2010-01-01

This research is an exploratory multiple case study of adult serving undergraduate colleges and universities. Using the Council of Adult and Experiential Learning (CAEL) Principles of Effective Practice for Serving Adult Learners, this study examines the differences of adult serving undergraduate colleges across the three sectors of higher…

Does decision documentation help junior designers rationalize their decisions? A comparative multiple-case study

NARCIS (Netherlands)

Heesch, U. van; Avgeriou, P.; Tang, A.

Software architecture design is challenging, especially for junior software designers. Lacking practice and experience, junior designers need process support in order to make rational architecture decisions. In this paper, we present the results of a comparative multiple-case study conducted to find

[Association of Kaposi sarcoma--multiple myeloma. A new case].

Science.gov (United States)

Cohen, J D; Thomas, E; Garnier, N; Hellier, I; Durand, L; Guilhou, J J; Baldet, P; Blotman, F

2000-11-01

Kaposi's disease is an angiogenic multifocal cancer process that has several forms, namely Mediterranean, African, HIV-associated, and secondary to a preexisting immunodepressive state (hematological disorder, corticosteroid therapy, immunodepressive treatment). Whatever its form, Kaposi's sarcoma is probably associated with a chronic viral human herpes type 8 infection (HHV8). This virus has been implicated in the pathogenesis of multiple myeloma (17 cases recorded to date). In the present study, a further case of Kaposi's sarcoma associated with multiple myeloma has been reported. However, Epstein-Barr virus, cytomegalovirus, hepatitis B and C, HIV and HHV8 serologies were negative. Radiotherapy on the lower limbs was initiated. It is concluded that HHV8 does not appear to play a pathogenic role in cases of multiple myeloma, given the rarity of the association between Kaposi's sarcoma/multiple myeloma/HHV8.

Negotiating jurisdiction in the workplace: a multiple-case study of nurse prescribing in hospital settings.

NARCIS (Netherlands)

Kroezen, M.; Mistiaen, P.; Dijk, L. van; Groenewegen, P.P.; Francke, A.L.

2014-01-01

This paper reports on a multiple-case study of prescribing by nurse specialists in Dutch hospital settings. Most analyses of interprofessional negotiations over professional boundaries take a macro sociological approach and ignore workplace jurisdictions. Yet boundary blurring takes place and

Negotiating jurisdiction in the workplace: A multiple-case study of nurse prescribing in hospital settings

NARCIS (Netherlands)

Kroezen, M.; Mistiaen, P.; van Dijk, L.; Groenewegen, P.P.; Francke, A.L.

2014-01-01

This paper reports on a multiple-case study of prescribing by nurse specialists in Dutch hospital settings. Most analyses of interprofessional negotiations over professional boundaries take a macro sociological approach and ignore workplace jurisdictions. Yet boundary blurring takes place and

Negotiating jurisdiction in the workplace : A multiple-case study of nurse prescribing in hospital settings

NARCIS (Netherlands)

Kroezen, M.; Mistiaen, P.; van Dijk, L.; Groenewegen, P. P.; Francke, A. L.

2014-01-01

This paper reports on a multiple-case study of prescribing by nurse specialists in Dutch hospital settings. Most analyses of interprofessional negotiations over professional boundaries take a macro sociological approach and ignore workplace jurisdictions. Yet boundary blurring takes place and

Examining Education Leadership Communication Practices around Basic and Advanced Skill Sets: A Multiple Case Study

Science.gov (United States)

Minger, Leslie

2017-01-01

The purpose of this multiple case study was to explore and describe the leadership communication practices of school principals in Southern California schools with demonstrated high levels of academic performance in order to identify practices that might be replicated in other schools. Communication practices were studied in relation to two…

The MORPG-Based Learning System for Multiple Courses: A Case Study on Computer Science Curriculum

Science.gov (United States)

Liu, Kuo-Yu

2015-01-01

This study aimed at developing a Multiplayer Online Role Playing Game-based (MORPG) Learning system which enabled instructors to construct a game scenario and manage sharable and reusable learning content for multiple courses. It used the curriculum of "Introduction to Computer Science" as a study case to assess students' learning…

Multiple orthokeratinized odontogenic cysts: a case report.

Science.gov (United States)

Cheng, Yi-Shing Lisa; Liang, Hui; Wright, John; Teenier, Tom

2015-03-01

The purpose of this report is to document the clinical, radiographic, pathological and molecular findings of the first case of multiple orthokeratinized odontogenic cysts (OOCs). Multiple odontogenic keratocysts are one of the major features of nevoid basal cell carcinoma syndrome (NBCCS), and loss of heterozygosity in the PTCH gene, the culprit gene for NBCCS, has recently been found in sporadic OOC cases. Therefore, in this presenting case, we also investigated the possibility that this patient might also have NBCCS, by comparing the available clinical information and the molecular findings of this case to the diagnostic criteria for NBCCS (as proposed by the First International Colloquium on NBCCS in 2011). However, this patient with multiple OOCs showed no evidence of having NBCCS. This conclusion supports the findings from previous case series based on sporadic cases that OOC does not appear to be associated with NBCCS.

Multiple myeloma: 45 cases

International Nuclear Information System (INIS)

Yang, Hee Chul; Suh, Jin Suck; Park, Chang Yun

1990-01-01

We evaluated 45 cases of multiple myelomas retrospectively confirmed in Severance Hospital from the period of 1983-1989. In order to assess the radiologic features of the multiple myeloma and to assist in possible early diagnosis and treatment. The result were as follows: 1. IgG(41%) was the most common immunoglobulin type secreted followed by light chain(36%). IgA(19%) and IgD(2%). Two percent of the patients had non-secretory type. 89% of patients were in their stage III of the disease. 2. Among the 45 patients, 96% had abnormal plain radiographic findings with average number of 4.5 lesions. Common sites were the spine, rib, skull, pelvis, and humerus in descending orders. The findings were localized or diffuse osteolytic bone destruction(85%). osteoporosis(49%), pathologic fracture and endosteal scalloping(55%). Osteoporosis was more prominent in stage III than stage II. 3. Both plain X-ray and radioisotope study was available for comparison in 28 patients. Concordance between the two studies were 44%, lesions detected only on plain X-ray film were 51%, and lesions detected only on the radioisotope were 5%. The plain radiography was able to detect only 54% of bone lesions confirmed by bone marrow biopsy. With the above results, accurate evaluation of bone lesions in multiple myeloma may be difficult with radiologic studies only. But familiarity with these radiologic findings of the this disease entity is necessary for early suspicion of the disease, thus for early diagnosis and treatment

Final report on case studies

DEFF Research Database (Denmark)

Ljungberg, Daniel; McKelvey, Maureen; Lassen, Astrid Heidemann

2012-01-01

Case study as a research design means investigating a single or multiple instance(s) or setting(s) (i.e. a case) and its entire context to explain a phenomenon and its processes. This is achieved through detailed understanding, usually comprised of multiple sources of information. In this way, case...... studies attempt to provide as a complete an understanding of a (complex) phenomenon as possible. Within the AEGIS project, survey and case study research are complementary. They are complementary in the sense that the former can provide more generalizable evidence on a phenomenon in terms of cross......-sectional data, while the latter can provide more in-depth (qualitative) understanding on specific issues. In systematically examining the case studies, however, this report goes beyond a typical single case study. Here we provide a synthesis of 86 case studies. Multiple case studies, following similar focus...

A Case Study of Tack Tiles[R] Literacy Instruction for a Student with Multiple Disabilities Including Congenital Blindness

Science.gov (United States)

Klenk, Jessicia A.; Pufpaff, Lisa A.

2011-01-01

Research on literacy instruction for students with multiple disabilities is limited. Empirical research on braille instruction for students with multiple disabilities that include congenital blindness is virtually nonexistent. This case study offers initial insight into possible methods of early braille literacy instruction for a student with…

A comprehensive grid to evaluate case management's expected effectiveness for community-dwelling frail older people: results from a multiple, embedded case study.

Science.gov (United States)

Van Durme, Thérèse; Schmitz, Olivier; Cès, Sophie; Anthierens, Sibyl; Maggi, Patrick; Delye, Sam; De Almeida Mello, Johanna; Declercq, Anja; Macq, Jean; Remmen, Roy; Aujoulat, Isabelle

2015-06-18

Case management is a type of intervention expected to improve the quality of care and therefore the quality of life of frail, community-dwelling older people while delaying institutionalisation in nursing homes. However, the heterogeneity, multidimensionality and complexity of these interventions make their evaluation by the means of classical approaches inadequate. Our objective was twofold: (i) to propose a tool allowing for the identification of the key components that explain the success of case management for this population and (ii) to propose a typology based on the results of this tool. The process started with a multiple embedded case study design in order to identify the key components of case management. Based on the results of this first step, data were collected among 22 case management interventions, in order to evaluate their expected effectiveness. Finally, multiple correspondence analyses was conducted to propose a typology of case management. The overall approach was informed by Wagner's Chronic Care Model and the theory of complexity. The study identified a total of 23 interacting key components. Based on the clustering of response patterns of the 22 case management projects included in our study, three types of case management programmes were evidenced, situated on a continuum from a more "socially-oriented" type towards a more "clinically-oriented" type of case management. The type of feedback provided to the general practitioner about both the global geriatric assessment and the result of the intervention turned out to be the most discriminant component between the types. The study design allowed to produce a tool that can be used to distinguish between different types of case management interventions and further evaluate their effect on frail older people in terms of the delaying institutionalisation, functional and cognitive status, quality of life and societal costs.

The Interplay of Virtual Communities: A Multiple Case Study of E-Retailers in Yahoo E-Auctions

Directory of Open Access Journals (Sweden)

Julia Zhi-Xian Zhao

2012-06-01

Full Text Available This study investigated how businesses operate e-shops in a transaction-oriented virtual community. This research employed a multiple case study approach by observing three cases of e-retailers, as being new e-commerce initiates, operating their businesses on the Yahoo! e-auction website. The results showed that e-shops displaying amusing stories can attract site visitors and “spick and span” e-shop design format can be helpful for converting visitors into buyers.

Comorbidity of Bipolar Disorder and Multiple Sclerosis: A Case Report

Directory of Open Access Journals (Sweden)

Necla Keskin

2013-08-01

Full Text Available Multiple sclerosis is a chronic demyelinating disease of a central nervous system. Neuropsychiatric symptoms are common in multiple sclerosis and bipolar disorder is one of the most common psychiatric disorders that coexist with multiple sclerosis. Manic episodes may be the first presenting symptom of multiple sclerosis as comorbid pathology or as an adverse effect of pharmacotherapies used in multiple sclerosis. The comorbidity of bipolar disorder and multiple sclerosis is well-proven but its etiology is not known and investigated accurately. Recent studies support a common genetic susceptibility. Management of bipolar disorder in multiple sclerosis is based on evidence provided by case reports and treatment should be individualized. In this report, the association between bipolar disorder and multiple sclerosis, epidemiology, ethiology and treatment is discussed through a case had diagnosed as multiple sclerosis and had a manic episode with psychotic features. [Cukurova Med J 2013; 38(4.000: 832-836

The impact of science teachers' epistemological beliefs on authentic inquiry: A multiple-case study

Science.gov (United States)

Jackson, Dionne Bennett

The purpose of this study was to examine how science teachers' epistemological beliefs impacted their use of authentic inquiry in science instruction. Participants in this multiple-case study included a total of four teachers who represented the middle, secondary and post-secondary levels. Based on the results of the pilot study conducted with a secondary science teacher, adjustments were made to the interview questions and observation protocol. Data collection for the study included semi-structured interviews, direct observations of instructional techniques, and the collection of artifacts. The cross case analysis revealed that the cases epistemological beliefs were mostly Transitional and the method of instruction used most was Discussion. Two of the cases exhibited consistent beliefs and instructional practices, whereas the other two exhibited beliefs beyond their instruction. The findings of this study support the literature on the influence of contextual factors and professional development on teacher beliefs and practice. The findings support and contradict literature relevant to the consistency of teacher beliefs with instruction. This study's findings revealed that the use of reform-based instruction, or Authentic Inquiry, does not occur when science teachers do not have the beliefs and experiences necessary to implement this form of instruction.

Family Owned Business Succession and Governance: a multiple case study in Brazil

Directory of Open Access Journals (Sweden)

Leonardo Roth

2017-08-01

Full Text Available One of the main threats to the continuity of family owned business is the poor management of the succession process between generations of the family. This risk factor can be avoided when the process works properly and can also become a renewal and strengthening tool for organizations. The aim of this study is to evaluate the different factors that trigger the succession, as well as the various ways in which companies act and react to the process and the succession’s turbulence. The methodology used was a qualitative study of multiple cases in four representatives family owned organizations in south of Brazil. These families are going, either have passed or have chosen not to go through generational succession processes. The results show the process can be an opportunity to improve the company’s management. Moreover, it shows that there is no single model to follow, but good practices that can be applied to each case.

A Case Study in Support of Multiple Post Mortem Assessments (Invited Paper

Directory of Open Access Journals (Sweden)

Jill Pable

2015-02-01

Full Text Available Creative projects in various fields are often subjected to afterthe- fact 'post-mortem' assessments to better understand their successes and failures. Names for these include project retrospectives or post occupancy evaluations (POEs depending on their field of origin. This case study from the architecture field will show the utility of engaging in multiple rounds of post-mortem activities in order to assess the solution from multiple stakeholder perspectives and in doing so, more fully recognize its strengths and weaknesses. The design of a homeless shelter bedroom was subjected to two POE analyses: a 'demand side' focused study that analyzed user accommodation, and a 'supply side' study that addressed issues including budget and funding. The two POEs yielded both corroborative and contrasting findings that sometimes worked at cross purposes. Three evaluation tactics emerged that could be extended to other fields' post mortem assessment activities: 1 conduct two or more POEs; 2 vary the POE criteria so that one is deep and focused 'demand side' user analysis and the other is 'supply side' operational and installation issues; and 3 conduct the POEs over a broad time period.

Exploring Content Management Issues in Air Force On-Line Communities of Practice: A Multiple Case Study Approach

National Research Council Canada - National Science Library

Jaime

2004-01-01

.... Addressing existing or potential content management issues will help do so. This multiple-case study research observed and interviewed managers and members of eight active CoPs busted by AFMC/DRW...

The Impact of Five VDR Polymorphisms on Multiple Sclerosis Risk and Progression: a Case-Control and Genotype-Phenotype Study.

Science.gov (United States)

Křenek, Pavel; Benešová, Yvonne; Bienertová-Vašků, Julie; Vašků, Anna

2018-04-01

Vitamin D receptor polymorphisms have been the target of many studies focusing on multiple sclerosis. However, previously reported results have been inconclusive. The objective of this study was to investigate the association between five vitamin D receptor polymorphisms (EcoRV, FokI, ApaI, TaqI, and BsmI) and multiple sclerosis susceptibility and its course. The study was carried out as a case-control and genotype-phenotype study, consisted of 296 Czech multiple sclerosis patients and 135 healthy controls. Genotyping was carried out using polymerase chain reaction and restriction analysis. In multiple sclerosis men, allele and/or genotype distributions differed in EcoRV, TaqI, BsmI, and ApaI polymorphisms as compared to controls (EcoRV, p a = 0.02; Taq, p g = 0.02, p a = 0.02; BsmI, p g = 0.02, p a = 0.04; ApaI, p g = 0.008, p a = 0.005). In multiple sclerosis women, differences in the frequency of alleles and genotypes were found to be significant in ApaI (controls vs multiple sclerosis women: p g = 0.01, p a = 0.05). Conclusive results were observed between multiple sclerosis women in the case of EcoRV [differences in Expanded Disability Status Scale (p = 0.05); CT genotype was found to increase the risk of primary progressive multiple sclerosis 5.5 times (CT vs CC+TT p corr = 0.01, sensitivity 0.833, specificity 0.525, power test 0.823)] and FokI [borderline difference in Multiple Sclerosis Severity Score (p = 0.05)]. Our results indicate that the distribution of investigated vitamin D receptor polymorphisms is a risk factor for multiple sclerosis susceptibility and progression in the Czech population. The association between disease risk and polymorphisms was found to be stronger in men. The association of disease progression with polymorphisms was observed only in women.

Resilience Processes Supporting Adolescents With Intellectual Disability: A Multiple Case Study.

Science.gov (United States)

Hall, Anna-Marié; Theron, Linda C

2016-02-01

Resilience, or the process of adjusting well to risk, relies on constructive collaboration between youths and their social ecologies. Although the literature details the risks of an intellectual disability (ID), there is little explanation of why some young people cope well despite these risks. Accordingly, we report a multiple case study that affords insight into the resilience of 24 adolescents with ID. Using a draw-and-talk methodology, these young people explained their resilience as enabled primarily by supportive social ecologies (which facilitated behavioral and emotional regulation, encouraged mastery, treated them as agentic beings, and offered safe spaces). Adolescents' positive orientation to their life-worlds co-facilitated their resilience. These insights advance effective ways to champion the resilience of young people with ID.

Deltoid contracture: a case with multiple muscle contractures.

Science.gov (United States)

Chen, Hsin-Chang; Huang, Tung-Fu; Chou, Po-Hsin; Chen, Tain-Hsiung

2008-11-01

Deltoid contracture is relatively uncommon. The literature consists primarily of case reports and few articles on large case series. The pathogenesis has been well studied. Muscle contractures can occur in the deltoid, biceps, triceps, gluteus and quadriceps muscles; however, cases of multiple muscle contractures are rare. We reported a patient with multiple contractures of the bilateral deltoid, bilateral gluteus, and bilateral quadriceps muscles, who had received repeated intramuscular injections during childhood and adulthood. The radiographic, including magnetic resonance imaging (MRI), features of the bone and joint abnormalities are presented. Some literatures reported that damage to the structures of the body due to intramuscular injection is related to the site of injection, age of the patient, and the volume, pH, chemical composition, and diffusional capacity of the injectate. Our patient had muscular contracture induced by needle injection regardless of her age, medication and injection site.

Organizational Crises and Reactions from a Legitimacy Perspective - Results from Two Multiple-case Studies

OpenAIRE

Heiko Breitsohl

2009-01-01

Organizational crises can be conceptualized as interactions between organizations and stake-holders around the breach and reestablishment of common norms and social codes, i.e. per-ceptions of legitimacy. This paper contributes to the understanding of organizational crises by exploring the roles of dimensions of legitimacy in organizational crises as well as the role of different reactions in the resolution of crises. Results of two qualitative multiple-case studies based on analyses of media...

Multiple Personality Disorder: Concepts and Cases.

Science.gov (United States)

Lindsley, Hope L.

1992-01-01

Presents two case examples illustrating nature and etiology of multiple personality disorder in two clients and describing their entry into counseling and progress through treatment. Compares and contrasts cases in areas of diagnosis, symptoms, history, and treatment. Suggests that mental health counselors combine firmness with flexibility in…

A case-control study of risk factors for multiple sclerosis in Iran.

Science.gov (United States)

Alonso, Alvaro; Cook, Stuart D; Maghzi, Amir-Hadi; Divani, Afshin A

2011-05-01

Numerous studies have assessed risk factors for multiple sclerosis (MS), although none have been conducted previously in Iran. The objective of this study was to study lifestyle and environmental risk factors of MS in the Iranian population. A case-control study, including 394 MS cases and 394 matched controls, was conducted in MS clinics in different Iranian cities. Information on lifestyles, environmental exposures, and past medical history was obtained from medical charts and phone interviews. In multivariable analysis, sunlight exposure was associated with a lower risk of MS: the odds ratio (OR) and 95% confidence interval (CI) of MS associated with a 1-h increment in daily sunlight was 0.62 (0.53-0.73). Smoking was associated with MS risk in women (OR: 6.48, 95% CI: 1.46-28.78), but not in men (OR: 0.72, 95% CI: 0.31-1.68) (p=0.002 for interaction). Finally, past history of common surgical procedures, infectious disorders, or exposure to pets and farm animals was not associated with MS risk. Different modifiable lifestyles, including sunlight exposure and smoking, were associated with lower MS risk in Iran. Interventions aimed at promoting smoking cessation and, more importantly, at increasing exposure to sunlight might contribute to the prevention of MS.

MULTIPLE RETAINED TEETH IN MANDIBLE: A Case Report

Directory of Open Access Journals (Sweden)

Cvetan Cvetanov

2010-07-01

Full Text Available Purpose: The aim of this science report is to show a rare case of multiple impacted teeth at adult patient and our propose clinical approach.Materials and methods: The clinical case is showed from adult man /64-year old/ with multiple impacted teeth (6 impacted teeth in the anterior place on the mandible were not suggestive of any syndrome or metabolic disorder. The extraction of the impacted teeth was made on two stage with piezosurgery unit under local anaesthesia. For prevention of postsurgical complications, as a swelling and prevention of postsurgical resorbtion were used coneshapes from pressure xeno colagen. To base on clinical and radiological examination we will discuss the differential diagnosis and we will offer a clinical approach about decided the case.Result and Conclusion: The incidence of multiple retained teeth by literature research range from 10.9% to 40.4%, most frequently is the retention of the third molars. In the literature most rarely have clinical reports about multiple retained teeth which differ from third molars at adult patients. The rare clinical case we showed is very demonstrative and the medicative approach which we used gave excellent result.

Multiple myeloma of the jaw: A case report

Directory of Open Access Journals (Sweden)

Shubhasini A Raghavan

2014-01-01

Full Text Available Multiple myeloma is a systemic B-cell lymphoproliferative disease that causes osteolytic lesions in the vertebra, ribs, pelvic bone, skull and jaw. Rarely jaw lesions are seen as the first sign in multiple myeloma. This is a case report with follow up of a 57-year-old female patient, previously treated for osteoporosis, who presented with a swelling of the jaw. On radiographic examination, she was found to have osteolytic lesions in the mandible and skull bones. These conventional aids led to the diagnosis of multiple myeloma thereby proving that the osteoporotic lesions were a part of the spectrum of multiple myeloma. The patient underwent chemotherapy and is currently on follow-up. This case report emphasizes the importance of early diagnosis of multiple myeloma in the jaw using readily available technologies and illustrates the contribution that oral assessment can provide.

Multiple primary cancer in cases of atomic bomb survivors

International Nuclear Information System (INIS)

Tanaka, Tsuneo; Matsuda, Masahiro; Matsugu, Yasuhiro; Ishimoto, Tatsuro; Nakahara, Hideki; Kagawa, Naoki; Fukuda, Yasuhiko

2006-01-01

Multiple primary cancer was investigated in individual atomic bomb survivors more than 50 years after exposure. During the decade from 1995 to 2004, double cancer was detected in 275 individuals visiting our facility. These 275 patients with multiple primary cancer were divided into an atomic bomb-exposed group and a non-exposed group. In terms of age at the time of definite diagnosis of double cancer and age upon onset of the first cancer, there was no significant difference between the atomic bomb-exposed group and the non-exposed group. In both groups, the percentage of males was higher than that of females. However, the percentage of females was higher in the exposed group than in the non-exposed group. Synchronous double cancer (cases where a second cancer develops within one year after onset of the first cancer) was seen in 32 individuals from the exposed group. Triple cancer was seen in 3 cases. In the exposed group, the site affected by cancer was the stomach in 28% and the colon/rectum in 27% of cases. Thus, cancer affected the stomach or colon/rectum in the majority of cases. The most frequent combination of organs affected by double cancer was the stomach+colon/rectum (20 cases, 25%). In a study of multiple primary cancer patients, the percentage of females was higher in the atomic bomb exposed group compared to the non-exposed group. There was no other difference between the two groups. (author)

How Multiple Interventions Influenced Employee Turnover: A Case Study.

Science.gov (United States)

Hatcher, Timothy

1999-01-01

A 3-year study of 46 textile industry workers identified causes of employee turnover (supervision, training, organizational communication) using performance analysis. A study of multiple interventions based on the analysis resulted in changes in orientation procedures, organizational leadership, and climate, reducing turnover by 24%. (SK)

Multiple cranial nerve palsies complicating tympanomastoiditis: case ...

African Journals Online (AJOL)

Otitis media either acute or chronic, is not uncommon in childhood. Multiple cranial nerve palsies occuring as a complication of either form of otitis media is unusual. A case of a nine year old boy with chronic suppurative otitis media with associated mastoiditis complicated with ipsilateral multiple cranial nerve palsies is ...

Case Report: Multiple Myeloma with Gangrene of Extremities

Directory of Open Access Journals (Sweden)

N Gharahi

2009-07-01

Full Text Available Introduction: Multiple myeloma represents a malignant proliferation of plasma cells derived from a single clone and it results in bone pain or fracture, renal failure, susceptibility to infections, anemia and hypercalcemia. The hyper viscosity syndrome is rare. Cryoglobulins are immunoglubulins that precipitate at temperatures less than 37degrees Celsius. Monoclonal cryoglobulins are usually present along with a specific hematologic disorder and are often asymptomatic. We report a second case of multiple myeloma with gangrene of all four extremities. Case: The Patient was a 77 year–old farmer with a 2 weeks history of coldness, pain and discoloration of the fingers of both the extremities which had extended to the mid forearm and shin regions. It was accompanied by skin erosions of the lower extremities, dark spots on the ear auricles and discoloration of the tip of the nose. On physical examination, quadrigangrene associated with ischemia of the auricles and tip of nose was seen. Serum proteins electrophoresis demonstrated monoclonal gammopathy and serum was positive for cryoglobulin, Bone marrow study showed neoplastic plasma cells infiltration. The patient was diagnosed as cryoglobulinemia based on multiple myeloma and treated accordingly.

The impact of secure messaging on workflow in primary care: Results of a multiple-case, multiple-method study.

Science.gov (United States)

Hoonakker, Peter L T; Carayon, Pascale; Cartmill, Randi S

2017-04-01

Secure messaging is a relatively new addition to health information technology (IT). Several studies have examined the impact of secure messaging on (clinical) outcomes but very few studies have examined the impact on workflow in primary care clinics. In this study we examined the impact of secure messaging on workflow of clinicians, staff and patients. We used a multiple case study design with multiple data collections methods (observation, interviews and survey). Results show that secure messaging has the potential to improve communication and information flow and the organization of work in primary care clinics, partly due to the possibility of asynchronous communication. However, secure messaging can also have a negative effect on communication and increase workload, especially if patients send messages that are not appropriate for the secure messaging medium (for example, messages that are too long, complex, ambiguous, or inappropriate). Results show that clinicians are ambivalent about secure messaging. Secure messaging can add to their workload, especially if there is high message volume, and currently they are not compensated for these activities. Staff is -especially compared to clinicians- relatively positive about secure messaging and patients are overall very satisfied with secure messaging. Finally, clinicians, staff and patients think that secure messaging can have a positive effect on quality of care and patient safety. Secure messaging is a tool that has the potential to improve communication and information flow. However, the potential of secure messaging to improve workflow is dependent on the way it is implemented and used. Copyright © 2017 Elsevier B.V. All rights reserved.

Clinico-MRI study of hemispheric disorder in long-term follow-up cases of multiple system atrophy

International Nuclear Information System (INIS)

Konagaya, Masaaki; Miwa, Shigeru; Matsuoka, Yukihiko; Konagaya, Yoko

1998-01-01

Twelve cases of multiple system atrophy (MSA) were studied for clinical and MRI findings of the cerebral hemispheric involvement. The subjects consisted of five olivopontocerebellar atrophy (OPCA) type and seven striatonigral degeneration (SND) type. The age at onset was 56.7±8.0 (M±SD) years, duration of illness at the first MRI study 3.2±1.1 years, duration of illness at the last study 8.1±2.2 years, and the following up duration 4.9±2.0 years. The grasping phenomenon was observed in 70% of the cases examined, snout reflex in 80%, slowness of verbal response in 88%, and decrease of spontaneous speech in 100%. Three cases finally fell into the state of mutism. Three out of ten cases were categorized as dementia by HDS-R (Hasegawa Dementia Scale-Revised) test. Besides the progression of the pontocerebellar atrophy and putaminal changes, MRI study revealed progressive frontal lobe atrophy in most cases. At six years after the onset, SND type showed significantly higher incidence of conspicuous frontal lobe atrophy and dilatation of the Sylvian fissure than OPCA type. Cerebral ventricular dilatation was common feature, and atrophy of the temporal and occipital lobes were observed in several cases. We indicated the possible involvement of the cerebral hemisphere, especially the frontal lobe, and higher nervous function in MSA. (author)

Clinico-MRI study of hemispheric disorder in long-term follow-up cases of multiple system atrophy

Energy Technology Data Exchange (ETDEWEB)

Konagaya, Masaaki; Miwa, Shigeru; Matsuoka, Yukihiko [Suzuka National Hospital, Mie (Japan); Konagaya, Yoko

1998-12-01

Twelve cases of multiple system atrophy (MSA) were studied for clinical and MRI findings of the cerebral hemispheric involvement. The subjects consisted of five olivopontocerebellar atrophy (OPCA) type and seven striatonigral degeneration (SND) type. The age at onset was 56.7{+-}8.0 (M{+-}SD) years, duration of illness at the first MRI study 3.2{+-}1.1 years, duration of illness at the last study 8.1{+-}2.2 years, and the following up duration 4.9{+-}2.0 years. The grasping phenomenon was observed in 70% of the cases examined, snout reflex in 80%, slowness of verbal response in 88%, and decrease of spontaneous speech in 100%. Three cases finally fell into the state of mutism. Three out of ten cases were categorized as dementia by HDS-R (Hasegawa Dementia Scale-Revised) test. Besides the progression of the pontocerebellar atrophy and putaminal changes, MRI study revealed progressive frontal lobe atrophy in most cases. At six years after the onset, SND type showed significantly higher incidence of conspicuous frontal lobe atrophy and dilatation of the Sylvian fissure than OPCA type. Cerebral ventricular dilatation was common feature, and atrophy of the temporal and occipital lobes were observed in several cases. We indicated the possible involvement of the cerebral hemisphere, especially the frontal lobe, and higher nervous function in MSA. (author)

The multiple imputation method: a case study involving secondary data analysis.

Science.gov (United States)

Walani, Salimah R; Cleland, Charles M

2015-05-01

To illustrate with the example of a secondary data analysis study the use of the multiple imputation method to replace missing data. Most large public datasets have missing data, which need to be handled by researchers conducting secondary data analysis studies. Multiple imputation is a technique widely used to replace missing values while preserving the sample size and sampling variability of the data. The 2004 National Sample Survey of Registered Nurses. The authors created a model to impute missing values using the chained equation method. They used imputation diagnostics procedures and conducted regression analysis of imputed data to determine the differences between the log hourly wages of internationally educated and US-educated registered nurses. The authors used multiple imputation procedures to replace missing values in a large dataset with 29,059 observations. Five multiple imputed datasets were created. Imputation diagnostics using time series and density plots showed that imputation was successful. The authors also present an example of the use of multiple imputed datasets to conduct regression analysis to answer a substantive research question. Multiple imputation is a powerful technique for imputing missing values in large datasets while preserving the sample size and variance of the data. Even though the chained equation method involves complex statistical computations, recent innovations in software and computation have made it possible for researchers to conduct this technique on large datasets. The authors recommend nurse researchers use multiple imputation methods for handling missing data to improve the statistical power and external validity of their studies.

What Factors Influence States' Capacity to Report Children's Health Care Quality Measures? A Multiple-Case Study.

Science.gov (United States)

Christensen, Anna L; Petersen, Dana M; Burton, Rachel A; Forsberg, Vanessa C; Devers, Kelly J

2017-01-01

Objectives The objective of this study was to describe factors that influence the ability of state Medicaid agencies to report the Centers for Medicare & Medicaid Services' (CMS) core set of children's health care quality measures (Child Core Set). Methods We conducted a multiple-case study of four high-performing states participating in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program: Illinois, Maine, Pennsylvania, and Oregon. Cases were purposively selected for their diverse measurement approaches and used data from 2010 to 2015, including 154 interviews, semiannual grant progress reports, and annual public reports on Child Core Set measures. We followed Yin's multiple-case study methodology to describe how and why each state increased the number of measures reported to CMS. Results All four states increased the number of Child Core Set measures reported to CMS during the grant period. Each took a different approach to reporting, depending on the available technical, organizational, and behavioral inputs in the state. Reporting capacity was influenced by a state's Medicaid data availability, ability to link to other state data systems, past experience with quality measurement, staff time and technical expertise, and demand for the measures. These factors were enhanced by CHIPRA Quality Demonstration grant funding and other federal capacity building activities, as hypothesized in our conceptual framework. These and other states have made progress reporting the Child Core Set since 2010. Conclusion With financial support and investment in state data systems and organizational factors, states can overcome challenges to reporting most of the Child Core Set measures.

Addressing Gender-Based Violence at Schools for Learners with Intellectual Disability in Gauteng, South Africa: A Multiple Case Study

Science.gov (United States)

Phasha, T. N.; Nyokangi, D.

2012-01-01

This paper reports part of the findings of the study which investigated sexual violence at two schools catering specifically for learners with mild intellectual disability in Gauteng Province. It looks particularly on participants' suggestions for addressing sexual violence in such school. A multiple case study within the qualitative research…

System-wide lean implementation in health care: A multiple case study.

Science.gov (United States)

Centauri, Federica; Mazzocato, Pamela; Villa, Stefano; Marsilio, Marta

2018-05-01

Background Lean practices have been widely used by health care organizations to meet efficiency, performance and quality improvement needs. The lean health care literature shows that the effective implementation of lean requires a holistic system-wide approach. However, there is still limited evidence on what drives effective system-wide lean implementation in health care. The existing literature suggests that a deeper understanding of how lean interventions interact with the organizational context is necessary to identify the critical variables to successfully sustain system-wide lean strategies. Purpose and methodology: A multiple case study of three Italian hospitals is conducted with the aim to explore the organizational conditions that are relevant for an effective system-wide lean implementation. A conceptual framework, built on socio-technical system schemas, is used to guide data collection and analysis. The analysis points out the importance to support lean implementation with an integrated and coordinated strategy involving the social, technical, and external components of the overall hospital system.

Understanding Information Technology Investment Decision-Making in the Context of Hotel Global Distribution Systems: a Multiple-Case Study

OpenAIRE

Connolly, Daniel J.

1999-01-01

UNDERSTANDING INFORMATION TECHNOLOGY INVESTMENT DECISION-MAKING IN THE CONTEXT OF HOTEL GLOBAL DISTRIBUTION SYSTEMS: A MULTIPLE-CASE STUDY by Daniel J. Connolly Dr. Michael D. Olsen, Chair Department of Hospitality and Tourism Management ABSTRACT This study investigates what three large, multinational hospitality companies do in practice when evaluating and making IT investment decisions. This study was launched in an attempt to 1) learn more about ...

PORTFOLIO MANAGEMENT IN NEW PRODUCTS DEVELOPMENT IN THE TELECOMMUNICATION SECTOR IN BRAZIL: A MULTIPLE CASES STUDY

Directory of Open Access Journals (Sweden)

Roque Rabechini Jr.

2017-06-01

Full Text Available This study aimed to understand how the use of portfolio management practices influence the development of new products in the Brazilian telecommunications operators. The chosen alternative methodology was the multiple case study. The results showed that the processes of identification, selection and prioritization projects influence the development of new products. Specifically, we found that the optimization of resources and product launch projects in short periods of time, are indicators to reveal the possibilities of organizations to remain competitive in the market.

Free Material Design with Multiple Load Cases

DEFF Research Database (Denmark)

Pedersen, Pauli; Pedersen, Niels Leergaard

2012-01-01

Multiple load cases and the consideration of strength is a reality that most structural designs are exposed to. Improved possibility to produce specific materials, say by fiber lay-up, put focus on research on free material optimization. A formulation for such design problems together with a prac......Multiple load cases and the consideration of strength is a reality that most structural designs are exposed to. Improved possibility to produce specific materials, say by fiber lay-up, put focus on research on free material optimization. A formulation for such design problems together...... with a practical recursive design procedure is presented and illustrated with examples. The presented finite element analysis involve many elements as well as many load cases. Separating the local amount of material from a description with unit trace for the local anisotropy, gives the free materials formulation...... a more physical interpretation of the material constraint....

Multiple Hereditary Osteochondromatosis: A Case Report

OpenAIRE

K???kesmen, ?i?dem; ?zen, Bu?ra; Ak?am, Mustafa

2007-01-01

Objectives Common carious lesions owing to vomiting are not widespread in children. In this case, we aimed to report an 11-years-old male patient with common carious lesions due to repeated vomitings, chewing and eating difficulty and retarded growth with Multiple Hereditary Osteochondromatosis (MHO). Case Report An 11-years-old boy was referred to Department of Pediatric Dentistry in Faculty of Dentistry because of eating difficulty owing to common carious lesions. It was seen that the patie...

Stakeholders: Organizational Strategy and Relationship a Multiple Case Study in the Hotel Sector

Directory of Open Access Journals (Sweden)

Rosemeire Rodrigues Junqueira

2011-12-01

Full Text Available Research into organizational management that focuses on relationships with stakeholders refers to the importance of the commitment of the various groups in the business development prioritizing the creation and distribution of values. For a better view and understanding of strategy-oriented management with stakeholders and the usage of this strategy in hotel chains, a qualitative approach to the methodology, focused on multiple case studies, was the most suitable for empirical investigation. Three hotel chains were selected, with features that allowed a comparative analysis of the study according to the method suggested by Yin (2010, with three sources of evidence: interviews, direct observations and documentation. Through this research, it was found that, through transparency, ethics, values and especially mutual respect clearly shown by the management, a strategy can be more collaborative and result in increasing the sustainability of organizations.

Multiple large solar lentigos on the upper back as clinical markers of past severe sunburn: a case-control study.

Science.gov (United States)

Derancourt, C; Bourdon-Lanoy, E; Grob, J-J; Guillaume, J-C; Bernard, P; Bastuji-Garin, S

2007-01-01

Multiple solar lentigos commonly seen on the upper back and shoulders of adults are classically considered as a sign of photodamage, although epidemiological studies are scarce. To assess whether these lesions are clinical markers of past severe sunburn. A case-control study in two outpatient dermatology clinics in French university hospitals. Past episodes of moderate and severe sunburn were compared between 145 adult patients with multiple solar lentigos on the upper back and 145 matched controls. In multivariate analysis adjusted for potential confounders, recalled episodes of sunburn during childhood, adolescence and adulthood were independently associated with the presence of multiple solar lentigos (adjusted odds ratios, 95% confidence intervals: 2.3 (1.1-5.2) and 28.1 (10.4-75.6) for moderate and severe sunburn, respectively). Multiple solar lentigos on the upper back and shoulders of adults are potential clinical markers of past severe sunburn which may thus be used to identify a population at higher risk of developing cutaneous malignant melanoma.

Neophyte experiences of football (soccer) match analysis: a multiple case study approach.

Science.gov (United States)

McKenna, Mark; Cowan, Daryl Thomas; Stevenson, David; Baker, Julien Steven

2018-03-05

Performance analysis is extensively used in sport, but its pedagogical application is little understood. Given its expanding role across football, this study explored the experiences of neophyte performance analysts. Experiences of six analysis interns, across three professional football clubs, were investigated as multiple cases of new match analysis. Each intern was interviewed after their first season, with archival data providing background information. Four themes emerged from qualitative analysis: (1) "building of relationships" was important, along with trust and role clarity; (2) "establishing an analysis system" was difficult due to tacit coach knowledge, but analysis was established; (3) the quality of the "feedback process" hinged on coaching styles, with balance of feedback and athlete engagement considered essential; (4) "establishing effect" was complex with no statistical effects reported; yet enhanced relationships, role clarity, and improved performances were reported. Other emic accounts are required to further understand occupational culture within performance analysis.

Critical operations capabilities in a high cost environment: a multiple case study

Science.gov (United States)

Sansone, C.; Hilletofth, P.; Eriksson, D.

2018-04-01

Operations capabilities have been a popular research area for many years and several frameworks have been proposed in the literature. The current frameworks do not take specific contexts into consideration, for instance a high cost environment. This research gap is of particular interest since a manufacturing relocation process has been ongoing the last decades, leading to a huge amount of manufacturing being moved from high to low cost environments. The purpose of this study is to identify critical operations capabilities in a high cost environment. The two research questions were: What are the critical operations capabilities dimensions in a high cost environment? What are the critical operations capabilities in a high cost environment? A multiple case study was conducted and three Swedish manufacturing firms were selected. The study was based on the investigation of an existing framework of operations capabilities. The main dimensions of operations capabilities included in the framework were: cost, quality, delivery, flexibility, service, innovation and environment. Each of the dimensions included two or more operations capabilities. The findings confirmed the validity of the framework and its usefulness in a high cost environment and a new operations capability was revealed (employee flexibility).

Childhood Mourning: Prospective Case Analysis of Multiple Losses

Science.gov (United States)

Kaufman, Kenneth R.; Kaufman, Nathaniel D.

2005-01-01

Multiple losses within short time periods make one question life and can exponentially influence one's coping skills. But what are the effects on a child and what should be done when the next loss occurs? This case addresses the multiple losses suffered by a child while assessing coping skills of the child and coping strategies used by the parents…

SU-F-T-637: Single-Isocenter Versus Multiple-Isocenter VMAT SRS for Unusual Multiple Metastasis Case with Two Widely Separated Lesions

Energy Technology Data Exchange (ETDEWEB)

Thomas, EM; Popple, RA; Fiveash, JB [The University of Alabama at Birmingham, Birmingham, AL (United States)

2016-06-15

Purpose: Single-isocenter (SI) volumetric modulated arc therapy has been shown to be an effective and efficient approach to multiple metastasis radiosurgery. However, certain extreme cases raise the question of whether multiple-isocenter (MI) approaches can still generate superior plans. In this study, we ask this question with respect to a clinical case with two very widely separated lesions. Methods: A patient with two widely separated (d = 12cm) tumors was treated with SI-VMAT SRS using 10MV flattening filter free (FFF) beam with high-definition multi-leaf collimator (HD-MLC, 2.5/5mm) in two non-coplanar arcs using concentric rings to enforce steep gradient. Because of lesion positioning with respect to collimator angle selection, lesions were treated by 5mm leaves. We re-planned the case with a congruent arc arrangement but separate isocenter for each lesion. In this manner, lesions were treated by 2.5mm leaves. Conformity index (CI), V50%, and mean brain dose were compared. Results: Neither conformity (CI-SI = 1.12, CI-MI = 1.08) nor V50% (V50%-SI =8.82cc, V50%-MI =8.81cc) were improved by utilizing a separate isocenter for each lesion. Mean brain dose was slightly reduced (dmean-SI = 118.4 cGy, dmean-MI = 88.7 cGy) by using multiple isocenters. Conclusion: For this case with a lesion at the apex of the brain and another distantly located at the base of skull, employing a separate isocenter for each target did not meaningfully improve plan quality. Single-isocenter VMAT has been shown feasible and equivalent to multiple-isocenter VMAT for multiple metastasis cases in general. In this extreme case, single- and multiple- isocenter VMAT were also equivalent. If rotational setup errors are appropriately corrected, the increased delivery efficiency of the single-isocenter approach renders it preferable to the multiple isocenter approach. Dr’s Thomas, Popple, and Fiveash have all received honoraria from Varian Medical Systems for discussing their experiences with

Cooperation and organization in decision making : a more decisive road safety policy ? : results from a multiple case study in the Netherlands.

NARCIS (Netherlands)

Bax, C.

2005-01-01

This study examines the administrative processes that led to the implementation of road safety measures in Dutch Regional Traffic and Transport Plans. The design of the study is a multiple case study in six regions in the Netherlands. The road safety policy is evaluated by looking at the

Case Study: Puttin' on the Ritz: How to Put Science into Cases

Science.gov (United States)

Herreid, Clyde Freeman

2017-01-01

There are multiple ways to put science into a case. This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This month's issue discusses different ways of presenting science in case studies.

Distribution of maternal age and birth order groups in cases with unclassified multiple congenital abnormalities according to the number of component abnormalities: a national population-based case-control study.

Science.gov (United States)

Csermely, Gyula; Czeizel, Andrew E; Veszprémi, Béla

2015-02-01

Multiple congenital abnormalities are caused by chromosomal aberrations, mutant major genes and teratogens. A minor proportion of these patients are identified as syndromes but the major part belonging to the group of unclassified multiple CAs (UMCAs). The main objective of this study was to evaluate the maternal age and birth order in pregnant women who had offspring affected with UMCA. The strong association between numerical chromosomal aberrations, e.g., Down syndrome and advanced maternal age is well-known and tested here. The Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980 to 1996, yielded a large population-based national data set with 22,843 malformed newborns or fetuses ("informative cases") included 1349 UMCA cases with their 2407 matched controls. Case-control comparison of maternal age and birth order was made for cases with UMCA, stratified by component numbers and their controls. In addition, 834 cases with Down syndrome were compared to 1432 matched controls. The well-known advanced maternal age with the higher risk for Down syndrome was confirmed. The findings of the study suggest that the young age of mothers associates with the higher risk of UMCA, in addition birth order 4 or more associates with the higher risk for UMCA with 2 and 3 component CAs. This study was the first to analyze the possible maternal and birth order effect for cases with UMCA, and the young age and higher birth order associated with a higher risk for UMCA. © 2014 Wiley Periodicals, Inc.

The case of a multiple myeloma with hyperlipoproteinaemia

International Nuclear Information System (INIS)

Paluszewska, M.; Bobilewicz, D.; Gigier, A.; Zwolinski, J.; Kuratowska, Z.

1994-01-01

The case of a 52-year-old women with hyperlipoproteinaemia, xantomathosis and multiple myeloma was discussed. The lipid disorder was one of the first symptoms and the base for diagnosis. Hyperlipoproteinaemia was probably due to the monoclonal immunoglobulin and lipoprotein interaction or their impaired catabolism. Lipoprotein lipase activity was normal. Cytostatic therapy led to partial remission of multiple myeloma and lipoproteins concentration became normal. (author)

Sympathetic skin response in multiple sclerosis: a meta-analysis of case-control studies.

Science.gov (United States)

Margaritella, Nicolò; Mendozzi, Laura; Garegnani, Massimo; Gilardi, Elisabetta; Nemni, Raffaello; Pugnetti, Luigi

2018-01-01

The usefulness of sympathetic skin responses (SSR) in multiple sclerosis (MS) has been advocated by several studies in the last 20 years; however, due to a great heterogeneity of findings, a comprehensive meta-analysis of case-control studies is in order to pinpoint consistencies and investigate the causes of discrepancies. We searched MEDLINE, EMBASE and Cochrane databases for case-control studies comparing SSR absence frequency and latency between patients with MS and healthy controls. Thirteen eligible studies including 415 MS patients and 331 healthy controls were identified. The pooled analysis showed that SSR can be always obtained in healthy controls while 34% of patients had absent SSRs in at least one limb (95% CI 22-47%; p studies (I 2  = 90.3%). Patients' age explained 22% of the overall variability and positive correlations were found with Expanded Disability Status Scale and disease duration. The pooled mean difference of SSR latency showed a significant increase in patients on both upper (193 ms; 95% CI 120-270 ms) and lower (350 ms; 95% CI 190-510 ms) extremities. We tested the discriminatory value of SSR latency thresholds defined as the 95% confidence interval (CI) upper bound of the healthy controls, and validated the results on a new dataset. The lower limb threshold of 1.964 s produces the best results in terms of sensitivity 0.86, specificity 0.67, positive predicted value 0.75 and negative predicted value 0.80. Despite a considerable heterogeneity of findings, there is evidence that SSR is a useful tool in MS.

Case studies: Soil mapping using multiple methods

Science.gov (United States)

Petersen, Hauke; Wunderlich, Tina; Hagrey, Said A. Al; Rabbel, Wolfgang; Stümpel, Harald

2010-05-01

Soil is a non-renewable resource with fundamental functions like filtering (e.g. water), storing (e.g. carbon), transforming (e.g. nutrients) and buffering (e.g. contamination). Degradation of soils is meanwhile not only to scientists a well known fact, also decision makers in politics have accepted this as a serious problem for several environmental aspects. National and international authorities have already worked out preservation and restoration strategies for soil degradation, though it is still work of active research how to put these strategies into real practice. But common to all strategies the description of soil state and dynamics is required as a base step. This includes collecting information from soils with methods ranging from direct soil sampling to remote applications. In an intermediate scale mobile geophysical methods are applied with the advantage of fast working progress but disadvantage of site specific calibration and interpretation issues. In the framework of the iSOIL project we present here some case studies for soil mapping performed using multiple geophysical methods. We will present examples of combined field measurements with EMI-, GPR-, magnetic and gammaspectrometric techniques carried out with the mobile multi-sensor-system of Kiel University (GER). Depending on soil type and actual environmental conditions, different methods show a different quality of information. With application of diverse methods we want to figure out, which methods or combination of methods will give the most reliable information concerning soil state and properties. To investigate the influence of varying material we performed mapping campaigns on field sites with sandy, loamy and loessy soils. Classification of measured or derived attributes show not only the lateral variability but also gives hints to a variation in the vertical distribution of soil material. For all soils of course soil water content can be a critical factor concerning a succesful

Two Cases Of Multiple Sclerosis Accompanying Psychiatric Symptoms

Directory of Open Access Journals (Sweden)

Ayşegül Şengel

2007-10-01

Full Text Available Scientific bacground: It has been reported that; Multiple Sclerosis (MS may be presented with many psychiatric symptoms such as anxiety, depression, mania and psychosis. MS cases, presented with psychiatric symptoms were also reported. Cases: Two MS cases, diagnosed as psychotic and bipolar disorder respectively, were reported in this paper. Both of the cases were responded to the steroid treatment, and neurological and psychiatric examinations were found to be normal after one month. CONCLUSION: MS cases might be presented with psychiatric complaints and symptoms except neurological ones. We conclude that; psychiatric evaluation as well as the neurological evaluation is important in the MS cases presented with psychiatric symptoms

Appropriating Scientific Vocabulary in Chemistry Laboratories: A Multiple Case Study of Four Community College Students with Diverse Ethno-Linguistic Backgrounds

Science.gov (United States)

Cink, Ruth B.; Song, Youngjin

2016-01-01

This multiple case study investigated how college students with diverse ethno-linguistic backgrounds used chemistry vocabulary as a way to look at their discursive identities and cultural border crossings during first semester general chemistry laboratories. The data were collected in two major forms: video-taped laboratory observations and…

Application of Probabilistic Multiple-Bias Analyses to a Cohort- and a Case-Control Study on the Association between Pandemrix™ and Narcolepsy.

Directory of Open Access Journals (Sweden)

Kaatje Bollaerts

Full Text Available An increase in narcolepsy cases was observed in Finland and Sweden towards the end of the 2009 H1N1 influenza pandemic. Preliminary observational studies suggested a temporal link with the pandemic influenza vaccine Pandemrix™, leading to a number of additional studies across Europe. Given the public health urgency, these studies used readily available retrospective data from various sources. The potential for bias in such settings was generally acknowledged. Although generally advocated by key opinion leaders and international health authorities, no systematic quantitative assessment of the potential joint impact of biases was undertaken in any of these studies.We applied bias-level multiple-bias analyses to two of the published narcolepsy studies: a pediatric cohort study from Finland and a case-control study from France. In particular, we developed Monte Carlo simulation models to evaluate a potential cascade of biases, including confounding by age, by indication and by natural H1N1 infection, selection bias, disease- and exposure misclassification. All bias parameters were evidence-based to the extent possible.Given the assumptions used for confounding, selection bias and misclassification, the Finnish rate ratio of 13.78 (95% CI: 5.72-28.11 reduced to a median value of 6.06 (2.5th- 97.5th percentile: 2.49-15.1 and the French odds ratio of 5.43 (95% CI: 2.6-10.08 to 1.85 (2.5th-97.5th percentile: 0.85-4.08.We illustrate multiple-bias analyses using two studies on the Pandemrix™-narcolepsy association and advocate their use to better understand the robustness of study findings. Based on our multiple-bias models, the observed Pandemrix™-narcolepsy association consistently persists in the Finnish study. For the French study, the results of our multiple-bias models were inconclusive.

Middle school science teachers' reaction and pedagogical response to high stakes accountability: A multiple case study

Science.gov (United States)

Tse, Kenneth

The purpose of this study was to understand how science teachers reacted to the high stakes accountability and standardized testing in California. In a multiple case study of middle and intermediate schools in Southern California, four research questions focused on the perceptions of secondary science teachers and how they responded to the changes in the accountability specifically geared towards science as a content area, the pedagogical skills teachers were using both outside and inside of the classroom that impact instruction, the pedagogical training received that related specifically to the content standards, the tools or impediments that existed for teachers to successfully utilize these pedagogical methods and types of support and assistance the school site administration and/or school district offered in learning about the California Science Standards and the STAR test. Interviews were conducted with multiple middle/intermediate school teachers, science department chairpersons and school site administrators to gather information about what the classroom teachers were doing pedagogically to improve student performance on the STAR tests. Moreover, the study described the issues that supported the professional development of the teacher and what schools and districts were doing to support them.

The Relation of Shadow Systems and ERP Systems—Insights from a Multiple-Case Study

Directory of Open Access Journals (Sweden)

Melanie Huber

2016-01-01

Full Text Available ERP systems integrate a major part of all business processes and organizations include them in their IT service management. Besides these formal systems, there are additional systems that are rather stand-alone and not included in the IT management tasks. These so-called ‘shadow systems’ also support business processes but hinder a high enterprise integration. Shadow systems appear during their explicit detection or during software maintenance projects such as enhancements or release changes of enterprise systems. Organizations then have to decide if and to what extent they integrate the identified shadow systems into their ERP systems. For this decision, organizations have to compare the capabilities of each identified shadow system with their ERP systems. Based on multiple-case studies, we provide a dependency approach to enable their comparison. We derive categories for different stages of the dependency and base insights into integration possibilities on these stages. Our results show that 64% of the shadow systems in our case studies are related to ERP systems. This means that they share parts or all of their data and/or functionality with the ERP system. Our research contributes to the field of integration as well as to the discussion about shadow systems.

Vocabulary skills are well developed in university students with dyslexia: Evidence from multiple case studies.

Science.gov (United States)

Cavalli, Eddy; Casalis, Séverine; El Ahmadi, Abdessadek; Zira, Mélody; Poracchia-George, Florence; Colé, Pascale

2016-01-01

Most studies in adults with developmental dyslexia have focused on identifying the deficits responsible for their persistent reading difficulties, but little is known on how these readers manage the intensive exposure to written language required to obtain a university degree. The main objective of this study was to identify certain skills, and specifically vocabulary skills, that French university students with dyslexia have developed and that may contribute to their literacy skills. We tested 20 university students with dyslexia and 20 normal readers (matched on chronological age, gender, nonverbal IQ, and level of education) in reading, phonological, vocabulary breadth (number of known words), and vocabulary depth (accuracy and precision) tasks. In comparing vocabulary measures, we used both Rasch model and single case study methodologies. Results on reading and phonological tasks confirmed the persistence of deficits in written word recognition and phonological skills. However, using the Rasch model we found that the two groups performed at the same level in the vocabulary breadth task, whereas dyslexics systematically outperformed their chronological age controls in the vocabulary depth task. These results are supplemented by multiple case studies. The vocabulary skills of French university students with dyslexia are well developed. Possible interpretations of these results are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Using Multiple Big Datasets and Machine Learning to Produce a New Global Particulate Dataset: A Technology Challenge Case Study

Science.gov (United States)

Lary, D. J.

2013-12-01

A BigData case study is described where multiple datasets from several satellites, high-resolution global meteorological data, social media and in-situ observations are combined using machine learning on a distributed cluster using an automated workflow. The global particulate dataset is relevant to global public health studies and would not be possible to produce without the use of the multiple big datasets, in-situ data and machine learning.To greatly reduce the development time and enhance the functionality a high level language capable of parallel processing has been used (Matlab). A key consideration for the system is high speed access due to the large data volume, persistence of the large data volumes and a precise process time scheduling capability.

Epidemiologic study of neural tube defects in Los Angeles County. I. Prevalence at birth based on multiple sources of case ascertainment

Energy Technology Data Exchange (ETDEWEB)

Sever, L.E. (Pacific Northwest Lab., Richland, WA); Sanders, M.; Monsen, R.

1982-01-01

Epidemiologic studies of the neural tube defects (NTDs), anencephalus and spina bifida, have for the most part been based on single sources of case ascertainment in past studies. The present investigation attempts total ascertainment of NTD cases in the newborn population of Los Angeles County residents for the period 1966 to 1972. Design of the study, sources of data, and estimates of prevalence rates based on single and multiple sources of case ascertainment are here discussed. Anencephalus cases totaled 448, spina bifida 442, and encephalocele 72, giving prevalence rates of 0.52, 0.51, and 0.08 per 1000 total births, respectively, for these neural tube defects - rates considered to be low. The Los Angeles County prevalence rates are compared with those of other recent North American studies and support is provided for earlier suggestions of low rates on the West Coast.

[A case of multiple cavernous angioma with dementia].

Science.gov (United States)

Kariya, S; Kawahara, M; Suzumura, A

2000-10-01

We reported a 65-year-old man who developed dementia since 50 years of age. His consciousness was clear but he was indifferent to his illness. Also, the luck of attention was recognized when we underwent examinations and the result of intellectual test varied every time we performed. His memory function was almost normal on the examination which was performed when he was cooperative. Magnetic resonance imaging (MRI) disclosed multiple tiny lesions (more than 130 in all) in cerebrum, brainstem, cerebellum and spinal cord. These lesions were compatible with multiple cavernous angioma. Most of lesions manifested high-density area on cranial CT. Though the multiplicity of foci indicated the possibility of familial occurrence, he was considered to be a sporadic case on his lineage investigation and the brain MRI of his only son. In this case, neither headache nor seizures which were known as the major clinical features of intracerebral cavernous angioma was observed. He was diagnosed as having white matter dementia characterized by attentional dysfunction, decrement of volition and less memory disturbance. We speculated that he developed symptomatic dementia by the sum of multiple minor degeneration, especially in frontal lobe white matter, caused by repeated minor bleeding from cavernous angiomas.

Rigour in qualitative case-study research.

Science.gov (United States)

Houghton, Catherine; Casey, Dympna; Shaw, David; Murphy, Kathy

2013-03-01

To provide examples of a qualitative multiple case study to illustrate the specific strategies that can be used to ensure the credibility, dependability, confirmability and transferability of a study. There is increasing recognition of the valuable contribution qualitative research can make to nursing knowledge. However, it is important that the research is conducted in a rigorous manner and that this is demonstrated in the final research report. A multiple case study that explored the role of the clinical skills laboratory in preparing students for the real world of practice. Multiple sources of evidence were collected: semi-structured interviews (n=58), non-participant observations at five sites and documentary sources. Strategies to ensure the rigour of this research were prolonged engagement and persistent observation, triangulation, peer debriefing, member checking, audit trail, reflexivity, and thick descriptions. Practical examples of how these strategies can be implemented are provided to guide researchers interested in conducting rigorous case study research. While the flexible nature of qualitative research should be embraced, strategies to ensure rigour must be in place.

Automatic feedback to promote safe walking and speech loudness control in persons with multiple disabilities: two single-case studies.

Science.gov (United States)

Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Green, Vanessa A; Alberti, Gloria; Boccasini, Adele; Smaldone, Angela; Oliva, Doretta; Bosco, Andrea

2014-08-01

Assessing automatic feedback technologies to promote safe travel and speech loudness control in two men with multiple disabilities, respectively. The men were involved in two single-case studies. In Study I, the technology involved a microprocessor, two photocells, and a verbal feedback device. The man received verbal alerting/feedback when the photocells spotted an obstacle in front of him. In Study II, the technology involved a sound-detecting unit connected to a throat and an airborne microphone, and to a vibration device. Vibration occurred when the man's speech loudness exceeded a preset level. The man included in Study I succeeded in using the automatic feedback in substitution of caregivers' alerting/feedback for safe travel. The man of Study II used the automatic feedback to successfully reduce his speech loudness. Automatic feedback can be highly effective in helping persons with multiple disabilities improve their travel and speech performance.

Multiple symmetrical lipomatosis (Madelung's disease) - a case report

International Nuclear Information System (INIS)

Vieira, Marcelo Vasconcelos; Abreu, Marcelo de; Furtado, Claudia Dietz; Silveira, Marcio Fleck da; Furtado, Alvaro Porto Alegre; Genro, Carlos Horacio; Grazziotin, Rossano Ughini

2001-01-01

Multiple symmetrical lipomatosis (Madelung's disease) is a rare disorder characterized by deep accumulation of fat tissue, involving mainly the neck, shoulders and chest. This disease is associated with heavy alcohol intake and it is more common in men of Mediterranean origin. This disease can cause severe aesthetic deformities and progressive respiratory dysfunction. We report a case of a patient with multiple symmetrical lipomatosis and describe the clinical and radiological features of this disorder. (author)

A Qualitative Exploration of Multiple Case Studies of the Perception of School Social Workers Concerning Their Roles in Public Schools

Science.gov (United States)

Morrison, Alesha Nicole

2016-01-01

This qualitative exploration in the form of multiple case studies interviewed a group of seven social workers from the St. Louis Metropolitan area to gain their perception as school social workers concerning their roles in public schools. The literature on school social workers indicated that school social workers brought unique knowledge and…

Multiplicity: An Explorative Interview Study on Personal Experiences of People with Multiple Selves.

Science.gov (United States)

Ribáry, Gergő; Lajtai, László; Demetrovics, Zsolt; Maraz, Aniko

2017-01-01

Background and aims: Personality psychology research relies on the notion that humans have a single self that is the result of the individual's thoughts, feelings, and behaviors that can be reliably described (i.e., through traits). People who identify themselves as "multiple" have a system of multiple or alternative, selves, that share the same physical body. This is the first study to explore the phenomenon of multiplicity by assessing the experiences of people who identify themselves as "multiple." Methods: First, an Internet forum search was performed using the terms "multiplicity" and "multiple system." Based on that search, people who identified themselves as multiple were contacted. Interviews were conducted by a consultant psychiatrist, which produced six case vignettes. Results: Multiplicity is discussed on Twitter, Tumblr, Google+ and several other personal websites, blogs, and forums maintained by multiples. According to the study's estimates, there are 200-300 individuals who participate in these forums and believe they are multiple. Based on the six interviews, it appears that multiples have several selves who are relatively independent of each other and constitute the personality's system. Each "resident person" or self, has their own unique behavioral pattern, which is triggered by different situations. However, multiples are a heterogeneous group in terms of their system organization, memory functions, and control over switching between selves. Conclusions: Multiplicity can be placed along a continuum between identity disturbance and dissociative identity disorder (DID), although most systems function relatively well in everyday life. Further research is needed to explore this phenomenon, especially in terms of the extent to which multiplicity can be regarded as a healthy way of coping.

Combined interpretation of multiple geophysical techniques: an archaeological case study

Science.gov (United States)

Riedl, S.; Reichmann, S.; Tronicke, J.; Lück, E.

2009-04-01

subsurface structures and relevant geometries. From this data set, we interpret the depth and the extent of foundation and wall remains in the southern and central part of the site indicating the extent of the old orangery. This case study clearly illustrates the benefit of using multiple geophysical methods in archaeological studies. It further illustrates the advantage of 3-D GPR surveying at sites where anthropogenic disturbances (such as metallic pipes and other utilities) might limit the applicability of commonly applied mapping techniques such as magnetic gradiometry or EM38 conductivity mapping.

Multiplicity: An Explorative Interview Study on Personal Experiences of People with Multiple Selves

Directory of Open Access Journals (Sweden)

Gergő Ribáry

2017-06-01

Full Text Available Background and aims: Personality psychology research relies on the notion that humans have a single self that is the result of the individual's thoughts, feelings, and behaviors that can be reliably described (i.e., through traits. People who identify themselves as “multiple” have a system of multiple or alternative, selves, that share the same physical body. This is the first study to explore the phenomenon of multiplicity by assessing the experiences of people who identify themselves as “multiple.”Methods: First, an Internet forum search was performed using the terms “multiplicity” and “multiple system.” Based on that search, people who identified themselves as multiple were contacted. Interviews were conducted by a consultant psychiatrist, which produced six case vignettes.Results: Multiplicity is discussed on Twitter, Tumblr, Google+ and several other personal websites, blogs, and forums maintained by multiples. According to the study's estimates, there are 200–300 individuals who participate in these forums and believe they are multiple. Based on the six interviews, it appears that multiples have several selves who are relatively independent of each other and constitute the personality's system. Each “resident person” or self, has their own unique behavioral pattern, which is triggered by different situations. However, multiples are a heterogeneous group in terms of their system organization, memory functions, and control over switching between selves.Conclusions: Multiplicity can be placed along a continuum between identity disturbance and dissociative identity disorder (DID, although most systems function relatively well in everyday life. Further research is needed to explore this phenomenon, especially in terms of the extent to which multiplicity can be regarded as a healthy way of coping.

Configuration of supply chains in emerging industries: a multiple-case study in the wave-and-tidal energy industry

OpenAIRE

Bjørgum, Øyvind; Netland, Torbjørn H.

2017-01-01

Companies in emerging industries face particular challenges in configuring effective supply chains. In this paper, we build on transaction cost economics to explore how supply chains can be configured in emerging industries. We focus on two key aspects of supply chain configuration: the make-or-buy decision and the strength of the ties between a focal firm and its suppliers. We utilise a multiple-case study methodology, including seven start-up companies in the emerging wave-and-tidal energy ...

Magnetic resonance imaging correlates of bee sting induced multiple organ dysfunction syndrome: A case report.

Science.gov (United States)

Das, Sushant K; Zeng, Li-Chuan; Li, Bing; Niu, Xiang-Ke; Wang, Jing-Liang; Bhetuwal, Anup; Yang, Han-Feng

2014-09-28

Occasionally systemic complications with high risk of death, such as multiple organ dysfunction syndrome (MODS), can occur following multiple bee stings. This case study reports a patient who presented with MODS, i.e., acute kidney injury, hepatic and cardiac dysfunction, after multiple bee stings. The standard clinical findings were then correlated with magnetic resonance imaging (MRI) findings, which demonstrates that MRI may be utilized as a simpler tool to use than other multiple diagnostics.

Factors influencing the implementation of a lifestyle counseling program in patients with venous leg ulcers: a multiple case study

Directory of Open Access Journals (Sweden)

van de Glind Irene M

2012-10-01

Full Text Available Abstract Background Implementation of lifestyle interventions in patient care is a major challenge. Understanding factors that influence implementation is a first step in programs to enhance uptake of these interventions. A lifestyle-counseling intervention, Lively Legs, delivered by trained nurses, can effectively improve the lifestyle in patients with venous leg ulcers. The aim of this study was to identify factors that hindered or facilitated implementation of this intervention in outpatient dermatology clinics and in home care. Methods A mixed-methods multiple case study in five purposefully selected healthcare settings in the Netherlands was conducted. Measurements to identify influencing factors before and after implementation of Lively Legs included interviews, focus groups, questionnaires, and nurses’ registration. Analyses focused on qualitative data as the main data source. All data were compared across multiple cases to draw conclusions from the study as a whole. Results A total of 53 patients enrolled in the Lively Legs program, which was delivered by 12 trained nurses. Barriers for implementation were mainly organizational. It was difficult to effectively organize reaching and recruiting patients for the program, especially in home care. Main barriers were a lack of a standardized healthcare delivery process, insufficient nursing time, and a lack of motivated nurses to deliver the program. Facilitating factors were nurse-driven coordination of care and a standardized care process to tie Lively Legs into, as this resulted in better patient recruitment and better program implementation. Conclusions This study identified a range of factors influencing the implementation of a lifestyle-counseling program, mainly related to the organization of healthcare. Using a case study method proved valuable in obtaining insight into influencing factors for implementation. This study also shed light on a more general issue, which is that leg ulcer

Surgical management of symptomatic spinal cord and intracerebral cavernomas in a multiple cavernomas case

Directory of Open Access Journals (Sweden)

Gorgan R.M.

2016-03-01

Full Text Available Multiple cavernous malformations are associated with familial cases and are present in 10-20% of all cavernoma cases. 5% of cavernomas are located intramedullary and of these only 10% present multiple cavernomas. With the availability of echo gradient MRI the cases of multiple cavernomas are diagnosed earlier and it is not rare that it uncovers multiple cavernomas in cases where only a single lesion can be identified on regular MRI sequences. We present the case of a 55 years old woman presented with a two years history of mild backache, followed by progressive lower legs motor deficit and urinary retention. The spine MRI showed an intramedullary T2/3 lesion and the cerebral MRI established the diagnosis of multiple cavernomas. One year after the intramedullary cavernoma was operated with success, she developed generalized seizures and a new cerebral MRI showed bleeding and volume growth of one right temporal pole cavernoma. The cerebral lesion was resected successfully and the patient was discharged free of seizures. This familial type multiple cavernomas cases should be screened and followed with repeated brain and spine MRI’s every year.

A case of multiple tuberculomas in brain presenting as hemiparesis

Directory of Open Access Journals (Sweden)

Amit Gupta

2011-03-01

Full Text Available Tuberculosis of central nervous system can be present in many different clinical and radiological patterns with disseminated or miliary brain tuberculomas as a rare presentation. Multiple central nervous system tuberculoma is commonly associated with human immunodeficiency virus (HIV infection. Tuberculomas develop following haematogenous dissemination of bacilli from an infection elsewhere in the body, usually lung. Here we describe a case of immunocompetent host with a past history of pulmonary tuberculosis, presenting with headache and generalised weakness, and later was diagnosed as a case of multiple tuberculoma brain.

A case of multiple brown tumors with primary hyperparathyroidism.

Science.gov (United States)

Mori, Hiroko; Okada, Yosuke; Arao, Tadashi; Shimaziri, Shohei; Tanaka, Yoshiya

2013-01-01

We report a case of large multiple brown tumors in a patient with primary hyperparathyroidism. A 52-year-old woman suffered from pain in the ribs and developed left facial swelling and deformity. CT showed a large destructive osteolytic lesion in the left maxillary sinus. Biopsy showed a lesion with newly formed bone tissue, diffuse giant cells and deposits of hemosiderin. In addition, similar lesions were also observed in the ribs, iliac bones and pelvis. The laboratory data showed hypercalcemia and hyperparathyroidism. Cervical echo and (201)Tl-(99m)TcO(4-) scintigraphy demonstrated a right lower swollen parathyroid adenoma. The diagnosis was multiple brown tumors with primary hyperparathyroidism and parathyroidectomy was performed. Follow-up CT showed marked decreases in the size of osteolytic lesions with calcification in the brown tumors compared to pre-treatment findings. These changes were associated with marked improvement in pain and facial deformity. We described a rare case of multiple brown tumors appeared in the maxilla associated with primary hyperparathyroidism.

Blood erythrocyte concentrations of cadmium and lead and the risk of B-cell non-Hodgkin's lymphoma and multiple myeloma: a nested case-control study.

Directory of Open Access Journals (Sweden)

Rachel S Kelly

Full Text Available BACKGROUND: Cadmium (Cd and lead (Pb are hypothesised to be risk factors for non-Hodgkin's lymphoma (NHL, a group of haematological malignancies with a suspected environmental aetiology. Within the EnviroGenoMarkers study we utilised pre-diagnostic erythrocyte concentrations of Cd and Pb to determine whether exposure was associated with risk of B-cell NHL and multiple myeloma. METHODS: 194 incident cases of B-cell NHL and 76 cases of multiple myeloma diagnosed between 1990 and 2006 were identified from two existing cohorts; EPIC-Italy and the Northern Sweden Health and Disease Study. Cases were matched to healthy controls by centre, age, gender and date of blood collection. Cd and Pb were measured in blood samples provided at recruitment using inductively coupled plasma-mass spectrometry. Logistic regression was applied to assess the association with risk. Analyses were stratified by cohort and gender and by subtype where possible. RESULTS: There was little evidence of an increased risk of B-cell NHL or multiple myeloma with exposure to Cd (B-cell NHL: OR 1.09 95%CI 0.61, 1.93, MM: OR 1.16 95% CI: 0.40, 3.40 or Pb (B-cell NHL: 0.93 95% CI 0.43, 2.02, multiple myeloma: OR 1.63 95%CI 0.45, 5.94 in the total population when comparing the highest to the lowest quartile of exposure. However, gender and cohort specific differences in results were observed. In females the risk of B-cell NHL was more than doubled in those with a body burden of Cd >1 µg/L (OR 2.20 95%CI; 1.04, 4.65. CONCLUSIONS: This nested case-control study does not support a consistent positive association between Cd or Pb and NHL, but there is some indication of a gender specific effect suggesting further research is warranted.

Food and dietary patterns and multiple sclerosis: a case-control study in Belgrade (Serbia

Directory of Open Access Journals (Sweden)

Tatjana D. Pekmezovic

2009-03-01

Full Text Available

Background: The aetiology of multiple sclerosis (MS is unclear, but numerous studies suggest that different exogenous factors can lead to the development of the disease in genetically susceptible individuals. The objective of this case-control study was to determine the role of food and dietary patterns in patients with MS in the population of Belgrade (Serbia.

Methods: In this matched case-control study, we included 110 cases with definite MS according to McDonald’s criteria, in whom the onset symptoms occurred up to 2 years prior to the interview, who were followed-up at the Institute of Neurology, Clinical Centre of Serbia, Belgrade. The identical number of controls from the same institution, individually matched by sex, age and area of residence, was recruited from patients with various non-autoimmune neurological disorders. Dietary information was obtained by using a frequency history approach.

Results: According to univariate conditional logistic regression analysis the following factors were significantly related to MS: body mass index (BMI less than 25 (OR=2.2, p=0.009, frequent consumption of beef (OR=1.7, p=0.043, chicken (OR=2.0, p=0.045, meat of the lamb (OR=2.1, p=0.013, butter (OR=1.7, p=0.056 and ice-cream (OR=1.8, p=0.031, with dose-response relationship. Consumption of majority of various fruit was more frequently reported by controls. According to multivariate conditional logistic regression analysis, BMI less than 25 (OR=2.3, p=0.008, consumption (weekly of beef (OR=2.0, p=0.017 and butter (OR=1.9, p=0.027 was significantly related to MS, while regular consumption of cherry (OR=0.4, p=0.024 had protective role.

Conclusions: This study might assist in potential defining of the dietary factors that could contribute to the risk of developing MS.

Is it about money or marketing? : international marketing strategies in the luxury cosmetic industry : exploratory multiple case study of Chanel, Guerlain and La Mer

OpenAIRE

Ivančová, Andrea

2014-01-01

The aim of this study is to investigate how do the luxury cosmetic companies shape their global strategies. The Global Marketing Strategy model used in this paper helps to investigate challenges companies face among their international markets and how do they endure their international prestige and exclusivity. The multiple-case study is used to explore between cases and draw relevant conclusions. First part includes literature review and provides reader relevant background ...

An unusual case of non-syndromic occurrence of multiple dental anomalies

Directory of Open Access Journals (Sweden)

Suprabha B

2009-01-01

Full Text Available Dental anomalies have been known to occur in humans due to a variety of genetic and environmental factors. Combinations of dental anomalies are known to be associated with specific syndromes. A few cases of multiple dental anomalies have been reported in patients with no generalized abnormalities. This case report describes an unusual occurrence of a combination of dental anomalies in an apparently normal healthy 12-year-old female patient. The dental anomalies in this patient were multiple dens invaginatus, generalized enamel hypoplasia, generalized microdontia, root resorption and multiple periapical lesions, shovel shaped incisors, cup shaped premolars, taurodontism, hypodontia and supernumerary teeth.

Late diagnosis of multiple myeloma: a case report

Science.gov (United States)

Syahreza, A.; Gatot, D.; Mardia, A. I.

2018-03-01

Multiple myeloma is a challenging hematologic case to handle. Sometimes the disease is diagnosed too late for the patient and doctor. Therefore, careful approaches are needed to manage the patient. A 66-year-old mansuffersfrom low back pain since one year before he came to the hospital. He was diagnosed multiple compression fractures by orthopedic and had undergone two surgeries in one year. Punched out lesions werein skull radiology and lumbar compression in lumbar MRI. After further investigation, plasmacytoma and M protein in urine electrophoresis were founded. Significant improvement found after bortezomib and dexamethasone were given.Diagnosis and management of multiple myeloma is a challenge for a doctor. Systematically approach is needed for a patient with a recurrent fracture. Even a novel therapies are not widely available in our country.We reported a late diagnosis of multiple myeloma and had a significant improvement after bortezomib and dexamethasone therapy.

Multiple Dentogerous Cysts With a Complex Odontoma: An Unusual Case Report

Directory of Open Access Journals (Sweden)

Sheikhi

2016-03-01

Full Text Available Introduction Multiple dentigerous cysts are rare and mostly associated with syndromes. Case Presentation The present case report is unique, as the dentigerous cysts enclosed the lateral incisor, canine, first and second premolars of the mandible and were accompanied by a complex odontoma, instead of first mandibular molar. Conclusions Multiple unilateral nosyndromic dentigerous cysts with complex odontoma are found only rarely. The periapical inflammation of non-vital deciduous teeth and trauma may be considered ethiological factors.

Development of Integrative STEM Curriculum: A Multiple Case Study of Multi-Disciplinary Teams in Two Pennsylvania High Schools

Science.gov (United States)

Rider-Bertrand, Joey H.

At the start of the 21st century, STEM education was a new priority in many schools as the focus shifted from separate disciplines to integrative STEM education. Unfortunately, there was limited research to offer guidance to practitioners (Brown, 2012; Honey, Pearson & Schweingruber, 2014). This qualitative, multiple case study explored the experiences of two multi-disciplinary teams of secondary teachers from Pennsylvania who developed and implemented integrative STEM curriculum. Four teachers from a rural high school and four teachers from a suburban high school participated in the study. A document review of integrative STEM curriculum and semi-structured interviews were conducted to learn about the curriculum development process and teachers' perceptions regarding conditions that support or hinder success. Individual and cross-case analyses were performed to establish findings and themes. Although the individual case themes varied slightly, the cross-case themes and assertions that emerged provided highly sought after guidance to practitioners and added to the limited body of research on integrative STEM education. This study found that current curriculum models do not fit integrative STEM curriculum, the development process is fluid, and substantial administrative support and resources are necessary to develop, implement, and sustain integrative STEM education programs. The results offered implications for all educators, as well as two examples of how teachers navigated the terrain of integrative STEM curriculum.

APPLICATION OF FAILURE MODE & EFFECT ANALYSIS (FMEA FOR CONTINUOUS QUALITY IMPROVEMENT - MULTIPLE CASE STUDIES IN AUTOMOBILE SMES

Directory of Open Access Journals (Sweden)

Jigar Doshi

2017-06-01

Full Text Available Failure Mode and Effects Analysis (FMEA is a quality tool used to identify potential failures and related effects on processes and products, so continuous improvement in quality can be achieved by reducing them. The purpose of this research paper is to showcase the contribution of FMEA to achieve Continuous Quality Improvement (CQI by multiple case study research. The outcome research conducted by implementing FMEA; one of the Auto Core Tools (ACTs, in the automobile Small and Medium Enterprises (SMEs in Gujarat, India is presented in this paper which depict various means of Continuous Quality Improvements. The case study based research was carried out in four automobile SMEs; all of them are supplied to automotive Original Equipment Manufacturer (OEM. The FMEA was implemented with the help of Cross Functional Team (CFT to identify the potential failure modes and effects, in overall effect on Continuous Quality Improvement. The outcome of FMEA at four companies' reveals the scope of improvement exists in the manufacturing process. Implementation of those improvement points shows the definite signs of continuous improvement of the quality of process and product as well. The FMEA and subsequent implementations had reduced the quality rejections around 3% to 4% in case companies.

Primary laryngeal localization of multiple myeloma: A case report

OpenAIRE

Allegra, Eugenia; Marino, Nicol?; Modica, Domenico; Emmanuele, Carmela; Saita, Vincenzo

2017-01-01

Multiple myeloma is a lymphoproliferative disease that may involve the bone marrow as well as extramedullary soft tissues. However, laryngeal localization of multiple myeloma is extremely rare. We herein present the case of a 68-year-old male patient with a history of dyspnea, dysphonia and dysphagia. Laryngoscopic examination revealed a lesion involving the right glottis and right vestibular (false) vocal fold, with absence of ipsilateral laryngeal motility and constriction of the airway. Co...

GAINING SUSTAINABLE COMPETITIVE IT ADVANTAGES: MULTIPLE CASE STUDIES IN INTERNATIONALIZED BUSINESSES

Directory of Open Access Journals (Sweden)

Eduardo Armando

2010-07-01

Full Text Available This research studies how the studied firms gain sustainable competitive advantages (SCAs. The issue has been studied in the literature on business strategy: the challenge for managers is to identify, develop, protect and use resources and skills that provide the firm with SCAs. Eight cases were studied. All concerned Information Technology firms that sell to other companies. The variables used were qualitative. Data was collected from primary and secondary sources of information. The primary sources consisted of the studied firms, where interviews with management were held. The main results are: (1 One firm develops products abroad and this aspect is a competitive advantage. (2 There are cases that resort to a model that provides them with great operating flexibility. (3 One firm obtained SCAs by developing a strategy whereby it implemented a franchise model for development and distribution. The franchise system encourages entrepreneurial behavior among the franchisees. (4 One case gained a competitive advantage through the complexity and sophistication of its products. (5 Some of the cases searched for market niches that were less exposed to competition.Key-words: Strategic management. Strategic planning. Advanced Technology firms. Management of multinationals. 

Clinical evaluation of multiple exostoses (17 cases) on bonescintigraphy

Energy Technology Data Exchange (ETDEWEB)

Yamada, Takayuki; Nakamura, Mamoru; Sugita, Reiji; Satou, Akihiro; Sakamoto, Kiyohiko (Tohoku Univ., Sendai (Japan). School of Medicine)

1991-03-01

Seventeen patients with multiple exostoses were examined on bone scintigraphy. Inheritance was recognized on seven patients (41%). Onset age of 15 patients was under 20 years old and 10 patients were under 10. The number of lesions was 211 and they were usually recognized at metaphyses of long bones. The degree of accumulation was classified into four grades: 0 (non increased), 1 (slightly-mild), 2 (moderate), and 3 (strong). One hundred and fifty-three lesions (73%) did not show definite increased activity (Grade 0, 1). Grade 3 included 14 lesions and they tended to be strongly calcified on X-P. This disease was said to transform into chondrosarcoma in 10 to 20%. Transformation was said to occur preferably in adults at heavily calcified lesion or one which showed irregularly thick hyaline cartilage. Such lesions showed more increased accumulation than normal bones. In our cases three cases were resected for this reason but turned out to be benign histologically. One case showed malignant transformation. In this case, a large malignant tumor replaced the parent bone and bone scan showed the cold lesion. Bone scintigraphy was considered useful to evaluate the biological activity of multiple exostoses. (author).

How School Leaders Prioritize and Allocate Resources to Improve Teacher Quality through Teacher Professional Development: A Multiple Case Study in Suburban North Carolina

Science.gov (United States)

Tyson, Deonte Rashawn

2017-01-01

This multiple case study examined the methods by which school leaders determined and planned teacher professional development, as well as what teachers perceived as their professional development needs and how they believe school leaders take those needs into account. The study took place at two suburban elementary schools (1 traditional public, 1…

[Intestinal perforation due to multiple magnet ingestion: a case report].

Science.gov (United States)

Cevizci, Mehmet Nuri; Karadağ, Cetin Ali; Demir, Mesut; Dokucu, Ali Ihsan

2012-03-01

Multiple magnet ingestion during childhood may result in emergency situations. A single magnet may be discharged with intestinal peristalsis, but multiple magnets may stick together and cause significant intestinal complications. Here we present a case with intestinal perforation due to ingestion of multiple magnets and metal pieces. An eight-year-old girl presented with abdominal pain and vomiting. She had abdominal tenderness and defense on the physical examination. Abdominal X-ray showed air and fluid levels. Metallic images were not considered at first as important in the diagnosis. Abdominal ultrasonography was reported as acute appendicitis. During the abdominal exploration, the appendix was normal, but there were dense adherences around the ileum and cecum. After adhesiolysis, intestinal perforations were seen in the cecum and 15 and 45 cm proximal to the cecum. Magnet and metal pieces were present in the perforated segments. Wedge resection and primary repair was performed. There were no postoperative complications, and she was discharged on the postoperative fifth day. Pediatric surgeons should be aware of the complications of multiple magnet ingestion. If the patient has a history of multiple magnet ingestion, follow-up with daily abdominal X-rays should be done, and in cases where magnets seem to cluster together or if acute abdominal signs develop, surgical exploration should be considered.

Multiple bone metastasis of medulloblastoma; a case report

International Nuclear Information System (INIS)

Oh, Jae Cheon; Lee, Seoung Ro; Kim, Yong Soo; Park, Dong Woo; Joo, Kyung Bin; Hahm, Chang Kok

1996-01-01

Medulloblastoma is one of the most undifferentiated primitive neuroectodermal tumors and represents about 30% of all posterior fossa tumors in children. Disseminated medulloblastoma, mainly involving cerebral surfaces, ventricles and the subarachnoid space can, in 50% of patients, be identified on intial imaging studies. One third of these lesions metastasize to an extracranial sity, primarily to bone. Osseous metastases, which occur mainly after craniectomy are typically lytic, but osteoblastic lesions also may occur. We experienced the case of a 14 year-old female patient with multiple bone metastases of medulloblastoma after craniectomy. Bone metastatic lesions were present in the right femur and thoracic spine and were osteoblastic or osteolytic

Two cases of multiple skeletal tuberculosis with spina ventosa

Energy Technology Data Exchange (ETDEWEB)

Jeon, Byung Hee; Choi, Sung Wook; Kim, Byung Soo [Busan National University College of Medicine, Busan (Korea, Republic of)

1974-10-15

Two cases of multiple skeletal tuberculosis with spina ventosa proved by radiological and pathological methods, were reported. One of the cases was 3 years old boy who had multiple abscess formations in both lower legs, intermittent high fever and soft tissue swelling in both hands, and the other was 19 years old boy who had soft tissue swelling in both hands and feet. Radiologically, the former showed active hilar tuberculosis of the chest, and destructive changes with cortical expansion in the left humerus, left tibra, left calcaneus and both hands; the latter showed almost fibroconsolidated lesions of the chest, and the bony lesions in both radii, left calcaneus, and both hands and feet. Biopsy specimen showed tubercles composed of epithelial cells, small round cells and fibroblasts with caseous necrosis in part.

CT scan findings in three cases of multiple sclerosis with homonymous hemianopsia

International Nuclear Information System (INIS)

Arikado, Takuji; Ariga, Hiroko; Kase, Manabu; Nagata, Renpei; Tashiro, Kunio

1983-01-01

Three cases of clinically definite multiple sclerosis manifested homonymous hemianopsia. A 35-year-old female, in whom right optic neuritis developed as the initial symptom, manifested right homonymous hemianopsia 4 months later followed by cerebral symptoms another 4 months later. A 25-year-old male developed sudden brain stem and cerebellar symptoms associated with right abducens palsy and right homonymous hemianopsia. In a 26-year-old female developed right homonymous hemianopsia 13 years after the first attack of recurrent optic neuritis. CT-scan in these three cases revealed the presence of a ''plaque'' located in the white matter of the left occipital lobe in cases 1 and 2 and in the left peririgone white matter in case 3 as the causative lesion for the right homonymous hemianopsia. These findings indicate that the optic radiation may be involved in multiple sclerosis resulting in homonymous hemianopsia. CT scan is of value in determining the location of the affected intracranial lesion in multiple sclerosis. (author)

Provincial prenatal record revision: a multiple case study of evidence-based decision-making at the population-policy level

Directory of Open Access Journals (Sweden)

Olson Joanne

2008-12-01

Full Text Available Abstract Background There is a significant gap in the knowledge translation literature related to how research evidence actually contributes to health care decision-making. Decisions around what care to provide at the population (rather than individual level are particularly complex, involving considerations such as feasibility, cost, and population needs in addition to scientific evidence. One example of decision-making at this "population-policy" level involves what screening questions and intervention guides to include on standardized provincial prenatal records. As mandatory medical reporting forms, prenatal records are potentially powerful vehicles for promoting population-wide evidence-based care. However, the extent to which Canadian prenatal records reflect best-practice recommendations for the assessment of well-known risk factors such as maternal smoking and alcohol consumption varies markedly across Canadian provinces and territories. The goal of this study is to better understand the interaction of contextual factors and research evidence on decision-making at the population-policy level, by examining the processes by which provincial prenatal records are reviewed and revised. Methods Guided by Dobrow et al.'s (2004 conceptual model for context-based evidence-based decision-making, this study will use a multiple case study design with embedded units of analysis to examine contextual factors influencing the prenatal record revision process in different Canadian provinces and territories. Data will be collected using multiple methods to construct detailed case descriptions for each province/territory. Using qualitative data analysis techniques, decision-making processes involving prenatal record content specifically related to maternal smoking and alcohol use will be compared both within and across each case, to identify key contextual factors influencing the uptake and application of research evidence by prenatal record review

Case study: Malingering or multiple personality disorder?

Directory of Open Access Journals (Sweden)

Alba García-Cortés

2017-03-01

Full Text Available The dissociative identity disorder (DID can be considered a rare disorder because of its seemingly low prevalence. However, in recent years it points to the possible underdiagnosis because its complexity and confusion at the time of differential diagnosis. On the other hand, the malingering of mental psychopathology can have a major socio-economic and legal impact, particularly important in this type of disorder, given the inability it generates and its complex diagnostic. This paper refers the case of a patient admitted to the short-term hospitalization unit of Dr. Rodríguez Lafora Hospital (Madrid with depressive symptoms. Then the patient seemed to become a TID case. The evaluation consisted of a psychological history and the application of the Structured Inventory of Malingered Symptoms (SIMS and the Millon Clinical Multiaxial Inventory (MCMI-II. The results showed an altered personality profile as well as likely malingered symptoms, what prevented us from a DID diagnosis. In view of the results, possible implications of this case for the clinical setting are discussed.

A Multiple Case Study Discovering Part-Time Faculties' Perceptions of Their Professional Needs, Working Conditions, Social Network, and Job Satisfaction at Three Community Colleges

Science.gov (United States)

Millner-Harlee, Tanya

2010-01-01

This study employed a multiple case study design to evaluate the perspectives of part-time faculties at three community colleges in the Northeast. The purpose of this study was to discover how needs, working conditions, and social networks influence the part-time faculties' job satisfaction. Maslow (1954), Bourdieu (1986), and Herzberg, Mausner,…

The Fashion Retail and the value creation with sustainable products: a multiple case study

Directory of Open Access Journals (Sweden)

Eleonora Alves Baptista

2016-06-01

Full Text Available This study aims to understand how the development of sustainable products in Brazilian fashion retail businesses creates value for the companies themselves, society and the environment. A qualitative approach to multiple case study method investigates practices and processes at four companies from Rio de Janeiro State. The study collected primary information from direct observation and interviews with the firms’ directors, and secondary data from industry reports and other documents. Three overall dimensions of the study - environmental management, value creation and product development in fast fashion companies - encoded into seven categories, when considered in data crosssynthesis, elucidate the following conclusions: (1 the firms do not have economic, ethical and legal fields integrated view; (2 the companies do not believe that the fashion consumer market values environmental practices and thus not motivated to invest in practices and products; (3 a fragmented supply chain makes it difficult to control activities and appears as a major constraint to the development of sustainable products; (4 access to information on best environmental practices and tax incentives are important inductors’ mechanisms to leverage the development of sustainable products in the Brazilian fashion retail; (5 the development of strategic capabilities in pollution prevention area, management products and clean technology create value for the production chain.

A rare case of multiple meningiomas with different histology

Directory of Open Access Journals (Sweden)

Toma I. Papacocea

2017-11-01

Full Text Available Meningiomas are generally benign tumors but sometimes they manifest tendency to progress towards malignancy. It is not yet clear if anaplastic meningiomas have an innate malignancy characteristic, or an initially beginning histological appearance that degenerates malignantly in time. According to literature data, the risk of a benign meningioma to progress towards malignant phenotype is about 0.16-2%, such malignant transformation occurring after a variable period of time (2-16 years. A still unanswered question is how many of the malignant meningiomas present this appearance as an innate feature and how many of them originate from benign meningiomas. Multiple meningiomas are defined as the presence of two or more distinct meningiomas. They occur in 6-10% of all patients that present meningiomas. Multiple meningiomas with a distinct histological appearance are rarely discovered. They support the theory of meningiomas that develop independently in the same patient. Different histology of multiple meningiomas is found in less than a third of the patients who suffer from this pathology. We are presenting the case of a patient with multiple meningiomas with distinct histology, one being benign and the other malignant. In connection with this case we are raising a question of therapeutic management in patients diagnosed with malignant meningiomas, namely if other possible small/ benign meningiomas should be also entirely resected.

Study on the clinical usefulness of magnetic resonance imaging in cases of multiple cerebral infarction

International Nuclear Information System (INIS)

Miyashita, Kotaro

1991-01-01

The clinical significance of MRI in thrombotic multiple cerebral infarction was examined in 9 patients having recent lacunar stroke. Recent infarct was identified on Gd-enhanced MRI in 4 patients. For patients multiple small infarction, Gd-enhanced MRI made it possible to differentiate recent from other lesions. To clarify the significance of periventricular high intensity lesion (PVH) on T2-weighted MRI, hemodynamic and neuropsychologic examinations were carried out in 41 patients with multiple cerebral infarction. All the patients had PVH, which was classified into three grades as follows: grade I (n=16) showing only a thin high intensity band along the body of lateral ventricles; grade 2 (n=15) showing a definite high intensity area around the lateral ventricles; grade 3 (n=10) showing diffuse thick and irregular foci around the whole ventricle. In these patients, rCBF was measured by 133 Xe inhalation methods. Initial slope index was significantly higher in patients with grade 3 than those with grade I. Mini-mental state test score was significantly higher in patients with grade l than those with grade 2 and 3. Progression of PVH may be related with the reduction of the cerebral circulation and mental function in cases of multiple cerebral infarction. Ischemic and hemorrhagic lesions can be distinguished by MRI, because old intracerebral hemorrhage appear as hypointensity areas with or without hyperintensity area on T2w images. In 92 patients with multiple infarction, MRI was used to evaluate the incidence and distribution of coexisting old intracerebral hemorrhage. Old hemorrhage were found in 15 patients (16.3%). locating the site where hypertensive hemorrhage commonly occurred. High-field MRI is useful for assessing the coexistence of hemorrhage in hypertensive patients with multiple cerebral infarction. (N.K.)

Administrative support of novice science teachers: A multiple case study

Science.gov (United States)

Iacuone, Leann

Novice science teachers leave the confines of colleges and universities to embark on a new adventure in education where they aim to influence young minds, make a difference in the world, and share their love for their content. They have learned their pedagogical skills with the support and assistance of fellow classmates, a supporting professor, and a cooperating teacher. These teachers enter their new place of employment and are met with many unexpected challenges, such as a lack of resources, no one to ask questions of, and a busy staff with already established relationships, causing them to feel an overall lack of support and resulting in many new teachers rethinking their career choice and leaving the field of education within 5 years of entering. This multiple-case study investigated the administrative support 4 novice science teachers received during an academic year and the novice teachers' perceptions of the support they received to answer the following research question: How do novice science teachers who have consistent interactions with administrators develop during their first year? To answer this question, semistructured interviews, reflection journals, observations, resumes, long-range plans, and student discipline referrals were collected. The findings from this study show novice science teachers who had incidents occur in the classroom requiring administrative assistance and guidance felt more confident in enforcing their classroom management policies and procedures as the year progressed to change student behavior. The novice science teachers perceived administrators who provided resources including technology, office supplies, science supplies, and the guidance of a mentor as supportive. Novice science teachers who engaged in dialogue after administrative observations, were provided the opportunity to attend professional development outside the district, and had a mentor who taught the same discipline made more changes to their instructional

An unusual case of multiple self-inflicted punctures to the precordium

LENUS (Irish Health Repository)

Borhan, F

2017-06-01

Sewing needles, albeit a rare case of penetrating cardiac injury, are potentially life-threatening. We report a case of successful intra-cardiac needle removal from a 32 year old who inserted multiple needles into the chest and abdomen.

Enhancement of Cognitive Processing by Multiple Sclerosis Patients Using Liquid Cooling Technology: A Case Study

Science.gov (United States)

Montgomery, Leslie D.; Montgomery, Richard W.; Ku, Yu-Tsuan; Luna, Bernadette (Technical Monitor)

1997-01-01

Cognitive dysfunction is a common symptom in patients with multiple sclerosis (MS). This can have a significant impact on the quality of life of both the patient and of their primary care giver. This case study explores the possibility that liquid cooling therapy may be used to enhance the cognitive processing of MS patients in the same way that it provides temporary relief of some physical impairment. Two MS patients were presented a series of pattern discrimination tasks before and after being cooled with a liquid cooling garment for a one hour period. The subject whose ear temperature was reduced during cooling showed greater electroencephalographic (EEG) activity and scored much better on the task after cooling. The patient whose ear temperature was unaffected by cooling showed less EEG activity and degraded performance after the one hour cooling period.

Gender-Based Violence Causing Severe Multiple Injuries; a Case Report

Directory of Open Access Journals (Sweden)

Adalard Falschung

2018-04-01

Full Text Available Introduction: Gender-based violence (GBV against women has been identified as a global health and development issue. We reported a case of GBV causing sever, multiple injuries in a middle-aged female. Case report: A 47-year-old woman presented to emergency room with disturbed level of consciousness, shortness of breath and multiple patches of skin discoloration. On examination, the patient was semi-conscious, with multiple ecchymosis and bilateral decreased air entry. Computed tomography scan of the neck and chest showed six rib fractures on the left side, and eight rib fractures on the right side, sternal fracture, manubriosternal dislocation, bilateral hemothorax, fracture of body of eleventh thoracic vertebra, and fracture of cervical spine of fifth and seventh vertebrae. The patient was intubated and admitted to intensive care unit. She was discharged with good health condition after 23 days of hospital admission. Conclusion: GBV is still a cause of severe trauma that puts the patient’s life at risk.

Imaging Finding of Multiple Endocrine Neoplasia Type 1: Case Report

International Nuclear Information System (INIS)

Yum, Tae Jun; Cho, Hee Woo

2012-01-01

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant inherited syndrome with characteristic clinical and radiological manifestations. Many reports on MEN1 have been published; however, no cases of radiologically diagnosed MEN1 have been reported. Therefore, we report on a radiologically diagnosed case of MEN1 with clinical symptoms of gastroduodenal ulcer.

Multiple intraoral neurofibromas: Case report and review of the literature

Directory of Open Access Journals (Sweden)

C Krithika

2009-01-01

Full Text Available Neurofibromatosis type I (NF I is an autosomal dominant disease transmitted with a high degree of penetrance. The disease is expressed in different forms. NF I accounts for almost 90% of the cases although nine types have been described to date. We report one such case of a 40-year-old male who presented with multiple nodules on the body and multiple intraoral soft tissue swellings. He was diagnosed to have NF I, having satisfied the diagnostic criteria for the same. This paper highlights the clinical features and diagnostic criteria of NF, the prevalence and the significance of intraoral neurofibromas and the need for the general practitioner to be aware of this condition.

Successful treatment of multiple bilateral impactions - a case report

OpenAIRE

Schubert, Michael; Proff, Peter; Kirschneck, Christian

2016-01-01

Background Successful treatment of patients with multiple bilateral impactions can be an orthodontic challenge, but few reports on treatment planning and execution exist. Case presentation In this case report, we describe the successful orthodontic treatment of a 16.3-year old female patient without systemic or genetic disease with initially nine persisting deciduous and nine impacted permanent teeth with complete root formation and closed apices in both jaws. After extraction of th...

A case of multiple cardiac calcified amorphous tumours

Directory of Open Access Journals (Sweden)

Amrit Chowdhary

2017-05-01

Full Text Available Cardiac calcified amorphous tumours of the heart are rare non-neoplastic cardiac masses that can present like a malignant mass or an intra-cardiac thrombus. We report an extremely unusual case of a 73 year old man who presented to hospital with dyspnoea and subsequent investigations revealed multiple cardiac CATs.

Tracking the Gender Pay Gap: A Case Study

Science.gov (United States)

Travis, Cheryl B.; Gross, Louis J.; Johnson, Bruce A.

2009-01-01

This article provides a short introduction to standard considerations in the formal study of wages and illustrates the use of multiple regression and resampling simulation approaches in a case study of faculty salaries at one university. Multiple regression is especially beneficial where it provides information on strength of association, specific…

Farmer responses to multiple stresses in the face of global change: Assessing five case studies to enhance adaptation

Science.gov (United States)

Nicholas, K. A.; Feola, G.; Lerner, A. M.; Jain, M.; Montefrio, M.

2013-12-01

The global challenge of sustaining agricultural livelihoods and yields in the face of growing populations and increasing climate change is the topic of intense research. The role of on-the-ground decision-making by individual farmers actually producing food, fuel, and fiber is often studied in individual cases to determine its environmental, economic, and social effects. However, there are few efforts to link across studies in a way that provides opportunities to better understand empirical farmer behavior, design effective policies, and be able to aggregate from case studies to a broader scale. Here we synthesize existing literature to identify four general factors affecting farmer decision-making: local technical and socio-cultural contexts; actors and institutions involved in decision-making; multiple stressors at broader scales; and the temporal gradient of decision-making. We use these factors to compare five cases that illustrate agricultural decision-making and its impacts: cotton and castor farming in Gujarat, India; swidden cultivation of upland rice in the Philippines; potato cultivation in Andean Colombia; winegrowing in Northern California; and maize production in peri-urban central Mexico. These cases span a geographic and economic range of production systems, but we find that we are able to make valid comparisons and draw lessons common across all cases by using the four factors as an organizing principle. We also find that our understanding of why farmers make the decisions they do changes if we neglect to examine even one of the four general factors guiding decision-making. This suggests that these four factors are important to understanding farmer decision-making, and can be used to guide the design and interpretation of future studies, as well as be the subject of further research in and of themselves to promote an agricultural system that is resilient to climate and other global environmental changes.

Role Clarification Processes for Better Integration of Nurse Practitioners into Primary Healthcare Teams: A Multiple-Case Study

Directory of Open Access Journals (Sweden)

Isabelle Brault

2014-01-01

Full Text Available Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined roles can become a source of conflict in clinical teams and reduce the effectiveness of care and services delivered to the population. Our objective in this paper is to outline processes for clarifying professional roles when a new role is introduced into clinical teams, that of the primary healthcare nurse practitioner (PHCNP. To support our empirical analysis we used the Canadian National Interprofessional Competency Framework, which defines the essential components for role clarification among professionals. A qualitative multiple-case study was conducted on six cases in which the PHCNP role was introduced into primary care teams. Data collection included 34 semistructured interviews with key informants involved in the implementation of the PHCNP role. Our results revealed that the best performing primary care teams were those that used a variety of organizational and individual strategies to carry out role clarification processes. From this study, we conclude that role clarification is both an organizational process to be developed and a competency that each member of the primary care team must mobilize to ensure effective interprofessional collaboration.

Role clarification processes for better integration of nurse practitioners into primary healthcare teams: a multiple-case study.

Science.gov (United States)

Brault, Isabelle; Kilpatrick, Kelley; D'Amour, Danielle; Contandriopoulos, Damien; Chouinard, Véronique; Dubois, Carl-Ardy; Perroux, Mélanie; Beaulieu, Marie-Dominique

2014-01-01

Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined roles can become a source of conflict in clinical teams and reduce the effectiveness of care and services delivered to the population. Our objective in this paper is to outline processes for clarifying professional roles when a new role is introduced into clinical teams, that of the primary healthcare nurse practitioner (PHCNP). To support our empirical analysis we used the Canadian National Interprofessional Competency Framework, which defines the essential components for role clarification among professionals. A qualitative multiple-case study was conducted on six cases in which the PHCNP role was introduced into primary care teams. Data collection included 34 semistructured interviews with key informants involved in the implementation of the PHCNP role. Our results revealed that the best performing primary care teams were those that used a variety of organizational and individual strategies to carry out role clarification processes. From this study, we conclude that role clarification is both an organizational process to be developed and a competency that each member of the primary care team must mobilize to ensure effective interprofessional collaboration.

Extranodal Rosai Dorfman disease in multiple sites: A case report

Energy Technology Data Exchange (ETDEWEB)

Shim, Jong Joon; Kim, Ho Kyun; Shim, Jae Chan; Lee, Kyoung Eun; Lee, Ghi Jai; Suh, Jung Ho; Hong, Seong Woo; Lee, Hye Kyung [Seoul Paik Hospital/Inje Univ. College of Medicine, Seoul (Korea, Republic of)

2012-07-15

Rosai Dorfman disease involves an abnormal proliferation of histiocytes. This abnormal growth tends to occur within the lymph nodes, with occasional extranodal presentation. Rosai Dorfman disease is a rare disease, and the extranodal cases are even more uncommon. We report a rare case of extranodal Rosai Dorfman disease in multiple sites in a 56 year old male patient. Abdominopelvic CT revealed soft tissue attenuation masses, encasing both the renal pelvis and both ureters, as well as the thoracic vertebra. Following the neck sonography, both submandibular glands had an enlarged honey combed appearance. Although Rosai Dorfman disease is rare, it should be considered as a potential differential diagnosis when multiple sites involving soft tissue attenuation masses are observed with sonogram and CT.

Non-syndromic multiple keratocyst odontogenic tumor: A rare case report

Directory of Open Access Journals (Sweden)

Abhijeet Alok

2015-01-01

Full Text Available Keratocystic odontogenic tumors (KCOTs are one of the most frequent features of nevoid basal cell carcinoma syndrome (NBCCS. The condition is linked with mutation in the PTCH gene. Partial expression of the gene may result in occurrence of multiple recurring odontogenic keratocysts (OKCs. Although KCOTs are common in clinical practice, simultaneous occurrence of multiple cysts in both the maxilla and mandible of a patient is rare. These patients have early propensity to develop multiple neoplasms like basal cell carcinoma and medulloblastoma. Hence, early diagnosis and treatment is of utmost importance in reducing the severity of the long-term sequelae of NBCCS. We report a rare case of multiple KCOTs in a non-syndromic male patient, with emphasis on its diagnosis, radiographic features, and treatment.

A 5-year follow-up case of multiple intrusive luxative injuries

Directory of Open Access Journals (Sweden)

Seema Thakur

2012-01-01

Full Text Available Introduction: Traumatic intrusive luxation is one of the most severe forms of dental injuries, usually affecting the maxillary incisors. The consequence of such an occurrence is a high risk of healing complications such as pulp necrosis, external inflammatory resorption, and external replacement resorption (ankylosis. Case Report: This report presents a case of severe intrusive luxation of multiple anterior teeth in an 11-year-old girl. The teeth were repositioned successfully by endodontic and orthodontic management. The case was monitored for 5 years. Discussion: Depending on the severity of the injury, different clinical approaches for treatment of intrusive luxation may be used. Despite the variety of treatment modalities, rehabilitation of intruded teeth is always a challenge and a multidisciplinary approach is important to achieve a successful result. In this case, intruded teeth were endodontically treated with multiple calcium hydroxide dressings and repositioned orthodontically. The follow-up of such cases is very important as the repair process after intrusion is complex. After 5 years, no clinical or radiographic pathology was detected.

Qualitative case study data analysis: an example from practice.

Science.gov (United States)

Houghton, Catherine; Murphy, Kathy; Shaw, David; Casey, Dympna

2015-05-01

To illustrate an approach to data analysis in qualitative case study methodology. There is often little detail in case study research about how data were analysed. However, it is important that comprehensive analysis procedures are used because there are often large sets of data from multiple sources of evidence. Furthermore, the ability to describe in detail how the analysis was conducted ensures rigour in reporting qualitative research. The research example used is a multiple case study that explored the role of the clinical skills laboratory in preparing students for the real world of practice. Data analysis was conducted using a framework guided by the four stages of analysis outlined by Morse ( 1994 ): comprehending, synthesising, theorising and recontextualising. The specific strategies for analysis in these stages centred on the work of Miles and Huberman ( 1994 ), which has been successfully used in case study research. The data were managed using NVivo software. Literature examining qualitative data analysis was reviewed and strategies illustrated by the case study example provided. Discussion Each stage of the analysis framework is described with illustration from the research example for the purpose of highlighting the benefits of a systematic approach to handling large data sets from multiple sources. By providing an example of how each stage of the analysis was conducted, it is hoped that researchers will be able to consider the benefits of such an approach to their own case study analysis. This paper illustrates specific strategies that can be employed when conducting data analysis in case study research and other qualitative research designs.

Analysis of multiple primary cancer autopsy cases associated with breast cancer: 2002-2010.

Science.gov (United States)

Shibahara, Yukiko; Sugawara, Yumi; Miki, Yasuhiro; Hata, Shuko; Takahashi, Hiroaki; Nakamura, Yasuhiro; Suzuki, Takashi; Ohuchi, Noriaki; Tsuji, Ichiro; Sasano, Hironobu

2016-12-01

Breast cancer patients have a generally increased risk of developing second cancers. The object of this study was to clarify the increased as well as decreased incidence of cancers in breast cancer patients using autopsy cases. 164 211 autopsy cases in the Annual of Pathological Autopsy Cases in Japan from 2002 to 2010 were analyzed for multiple primary cancer (MPC). Female MPC cases (4222 cases) were selected. We investigated the cancer incidence observed in breast cancer associated MPC. The Chi-squared test was used for analysis. All P-values were two-sided, and differences at P autopsy data on MPC which provide new evidence clinically and pathologically. © 2016 Japanese Society of Pathology and John Wiley & Sons Australia, Ltd.

Peer Support in Full-Service Partnerships: A Multiple Case Study Analysis.

Science.gov (United States)

Siantz, Elizabeth; Henwood, Benjamin; Gilmer, Todd

2017-07-01

Peer providers are integral to Full Service Partnerships (FSPs), which are team-based mental health service models. Peer providers use principles of recovery to engage clients, but FSPs can vary in their recovery orientation. Whether and how peer recovery orientation reflects the organizational environments of FSPs is unclear. This qualitative study explored peer provider attitudes towards recovery within the organizational contexts of FSPs where they are employed. Case study analysis was conducted on eight purposively sampled FSPs using qualitative interviews with peer providers and program directors. In two cases, peer recovery attitudes diverged from those of their organizational context. In these cases, peer providers were champions for recovery, and used practice-based strategies to promote client autonomy despite working in settings with lower recovery orientation. Peer providers could be uniquely positioned to promote client autonomy in settings where organizational factors limit consumer choice.

Multiple adenomatoid tumours in the Epididymis and Tunica vaginalis: Case report

Directory of Open Access Journals (Sweden)

Ahmed Abroaf

2014-03-01

Full Text Available We describe the case of a 65 year-old male presenting with a tender right testicular mass, confirmed to be a tumour on ultrasound. The patient underwent a radical inguinal orchidectomy and histology revealed multiple adenomatoid tumours in epididymis and tunica vaginalis. This is an infrequent benign tumour of mesothelial origin that has rarely been reported as multiple lesions in the literature. Immunohistochemistry demonstrates that adenomatoid tumour and mesotheliomas share the expression of podoplanin (D2-40 which is helpful to differentiate them from carcinomas. On the other hand adenomatoid tumour is differentiated from mesothelioma on morphological grounds since the former does not exhibit cellular atypia, mitotic activity or bland focal tumour necrosis. Although testis preserving surgery can be an option for benign adenomatoid tumours, most patients (as in our case proceed to orchidectomy as diagnosing them confidently can be difficult.---------------------------Cite this article as: Abroaf A, Veeratterapillay R, Vasdev N, Majo J, Sherif AE, Paez E. Multiple adenomatoid tumours in the Epididymis and Tunica vaginalis : Case Report. Int J Cancer Ther Oncol 2014; 2(1:02021.DOI: http://dx.doi.org/10.14319/ijcto.0202.1

Building Adaptive Capacity of Pathways in Technology Early College High School Stakeholders: A Multiple-Case Study on the Influence of Performance, Leadership, and Organizational Learning

Science.gov (United States)

Michaud-Wells, Amy

2016-01-01

The purpose of this qualitative study was to explore the perceptions and beliefs of Pathways in Technology Early College High School (P-TECH) leaders and stakeholders regarding the personal and professional experiences that contributed to the development of adaptive capacity. This embedded multiple-case study was anchored by the interrelated…

Epidemiological study of multiple sclerosis in La Rioja.

Science.gov (United States)

Bártulos Iglesias, M; Marzo Sola, M E; Estrella Ruiz, L A; Bravo Anguiano, Y

2015-01-01

Multiple sclerosis is a demyelinating disease that causes severe disability in younger patients. Many epidemiology studies have confirmed a variable prevalence. The objective of this study was to analyse the prevalence of this disease in La Rioja (Spain), using such variables as age and sex; type of progression, initial form of the disease, EDSS and number of relapses; disease-modifying treatment and reasons for treatment withdrawal; personal and family history of cancer; and incidence and mortality. Analysis of patients in La Rioja diagnosed with MS (according to Poser criteria or the 2005 McDonald criteria) during a 10-year period (2001-2011). Data were collected from hospital records, multiple sclerosis associations, and personal records kept by neurologists. The MS prevalence rate in La Rioja is 65 patients/100 000 inhabitants with an incidence rate of 3.5 cases/100 000 residents per year. Relapsing-remitting MS is present in 67.6% of the patient total. Mean age of onset is 20-29 years (range, 12 to 70). Most EDSS scores were mostly ≤ 2. Untreated MS cases account for 47.6% of the total and the most commonly used therapy is interferon. We detected 4 haematological tumours and 7 families with multiple members affected by MS. Prevalence and incidence are similar to those found in other regions Spain. The average age at onset age for primary progressive MS is slightly higher than in other papers (40-49 years). In families with multiple patients, MS may be more aggressive. Disability in these patients remains very severe. We require more epidemiology studies with a variety of data gathering methods to support findings for prevalence obtained in different provinces. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

[A case of focal epilepsy manifesting multiple psychiatric auras].

Science.gov (United States)

Ezura, Michinori; Kakisaka, Yosuke; Jin, Kazutaka; Kato, Kazuhiro; Iwasaki, Masaki; Fujikawa, Mayu; Aoki, Masashi; Nakasato, Nobukazu

2015-01-01

We present a case of epilepsy with multiple types of focal seizures that were misdiagnosed as psychiatric disorders. A 20-year-old female patient presented with a variety of episodes, including loss of consciousness, deja vu, fear, delusion of possession, violent movements, and generalized convulsions. Each of these symptoms appeared in a stereotypic manner. She was initially diagnosed with a psychiatric disorder and treated with psychoactive medications, which had no effect. Long-term video electroencephalography revealed that her episodes of violent movement with impaired consciousness and secondarily generalized seizure were epileptic events originating in the right hemisphere. High-field brain magnetic resonance imaging for detecting subtle lesions revealed bilateral lesions from periventricular nodular heterotopia. Her final diagnosis was right hemispheric focal epilepsy. Carbamazepine administration was started, which successfully controlled all seizures. The present case demonstrates the pitfall of diagnosing focal epilepsy when it presents with multiple types of psychiatric aura. Epilepsy should thus be included in differential diagnoses, considering the stereotypic nature of symptoms, to avoid misdiagnosis.

A case of disseminated hydatid disease by surgery involving multiple organs

Directory of Open Access Journals (Sweden)

Asli Tanrivermis Sayit

2014-09-01

Full Text Available Hydatid disease is the most common parasitic infection in the world, and is caused by the parasite Echinococcus granulosus. The most common site of this disease is the liver (75%, followed by the lungs, kidney, bones, and brain. Multiple abdominal organ and peritoneal involvement can also be seen in some cases. The dissemination of hydatid cyst disease can develop spontaneously or secondary to trauma or surgery. Here, we present the case of a 69-year-old man with multiple cyst hydatidosis, who underwent surgery for acute appendicitis approximately 20 years previously. Computed tomography of the abdomen shows the multiple active and inactive cystic lesions in the liver, spleen, right kidney, and mesentery. This patient required surgery several times, as well as medical treatment, after the rupture of a mesenteric hydatid cyst during the appendectomy. Combined anthelmintic treatment was recommended to the patient who refused further surgical treatment.

Sexual habits before multiple sclerosis: a national case-control study

DEFF Research Database (Denmark)

Lidegaard, O.; Svendsen, Anne Louise; Lidegaard, Øjvind

2008-01-01

The trigging off agent for multiple sclerosis (MS) is despite intensive epidemiological and biomedical research still unknown. The disease is typically diagnosed in reproductive age and recent findings have suggested that MS could be a sexually transmitted disease.......The trigging off agent for multiple sclerosis (MS) is despite intensive epidemiological and biomedical research still unknown. The disease is typically diagnosed in reproductive age and recent findings have suggested that MS could be a sexually transmitted disease....

On strength design using free material subjected to multiple load cases

DEFF Research Database (Denmark)

Pedersen, Pauli; Pedersen, Niels Leergaard

2013-01-01

Multiple load cases and the consideration of strength is a reality that most structural designs are exposed to. Improved possibility to produce specific materials, say by fiber lay-up, put focus on research on free material optimization. A formulation for such design problems together with a prac......Multiple load cases and the consideration of strength is a reality that most structural designs are exposed to. Improved possibility to produce specific materials, say by fiber lay-up, put focus on research on free material optimization. A formulation for such design problems together...... with a practical recursive design procedure is presented and illustrated with examples. The presented finite element analysis involve many elements as well as many load cases. Separating the local amount of material from a description with unit trace for the local anisotropy, gives the free materials formulation...

Environmental risk factors in the aetiology of multiple sclerosis in Kayseri: a case control study

Directory of Open Access Journals (Sweden)

Servin Yeşil Günal

2013-06-01

Full Text Available Background: our purpose is to evaluate the possible relationship between multiple sclerosis (MS and environmental factors in Kayseri.Methods: this case control study was conducted on 100 patients with MS and 100 sex-aged and residential area matched control. Data was collected by using face to face interviews. Questionnaire consisted of two parts. The first part was comprised of items related with the participants’ sociodemographic features. The second part was related with factors thought to be involved in the occurrence or aggravation of the disease. The Chi-square test and logistic regression were used for analysis.Results: logistic regression analysis revealed the following as possible risk factors in MS cases: economic status (Odds Ratio (OR: 0.14 adjusted 7.19; Confidence Interval 95% (CI: 0.05-0.43, having a sensitive personality (OR:4.51; 95% CI: 1.10-18.45, familial history of MS (OR:3.28; 95% CI: 1.3-8.27, history of cranial and spinal injury (OR: 2.99; 95% CI: 1.11-8.08, cooking oil consumption (OR:0.07 adjusted 13.5; 95% CI: 0.03-0.20, consumption of legumes and grains (OR: 0.11 adjusted 8.9; 95% CI: 0.03-0.41, and living in dwellings within a distance of 500 meters from transformer basestations (OR: 6.5; 95% CI: 1.54-28.21.Conclusions: we believe that it is necessary to inform the individuals about the risk of MS and their relatives of the results of large-scale joint studies and to offer suggestions based on the data obtained.

Hereditary multiple exostosis with secondary malignization: case report

Energy Technology Data Exchange (ETDEWEB)

Coutinho, A.M.N.; Pitella, F.A.; Coura Filho, G.B.; Costa, P.L.A.; Ono, C.R.; Watanabe, T.; Sapienza, M.T.; Hironaka, F.; Cerri, G.G.; Buchpiguel, C.A. [Universidade de Sao Paulo (USP), SP (Brazil). Inst. de Radiologia. Centro de Medicna Nuclear

2008-07-01

Full text: Introduction: Hereditary Multiple Exostosis (HME) or multiple osteochondromatosis is a skeletal development anomaly which is characterized by generalized exostoses in the bones, mainly in long bone metaphyses, appearing during childhood and adolescence. The transmission is autosomal dominant, its prevalence varies from 1/50,000 to 9/1,000,000 in Europe, and around 10% of cases show no family history. Case Report: Description of an HME case with two secondary malignization episodes. The data was taken from the patient's chart and from imaging exams from the hospital files. WASB, a 19-year-old male, hospitalized after being pre-diagnosed with HME and complaints of bone-consistent mass in the right gluteal region and a lump in the posterior region of the right leg, associated to multiple bone lumps all over the body. A magnetic resonance imaging (MRI) was performed along with a bone scintillography with {sup 99m}Tc-MDP which showed multiple osteogenic lesions in the thorax, pelvic bones and long bones with periarticular prevalence in the lower limbs. The suspicion of malignancy in the right iliac area was raised due to the MRI result and to the higher intensity captured in the scintillography, confirming chondrosarcoma grade I of malignancy in the biopsy. The patient suffered interileo abdominalis amputation of the right lower limb with good evolution and control scintillography performed after 1 and 1,5 years. In the second controlling procedure, the patient complained about pain in the left knee, and a MRI suggested a new secondary malignization. The hypothesis of a head of left fibula osteochondroma with signs of aggressiveness was confirmed following surgery. Discussion: In HME, the exostoses grow along with the individual, ceasing with the epiphyseal fusion. The growth of these formations after skeletal maturation suggests activity of exostoses and, in most times, it is a sign of malignant transformation, which turns almost every time into

Anesthetic management of a patient with multiple sclerosis - case report

Directory of Open Access Journals (Sweden)

Eduardo Barbin Zuccolotto

Full Text Available Abstract Background and objectives: Multiple sclerosis is a demyelinating disease of the brain and spinal cord, characterized by muscle weakness, cognitive dysfunction, memory loss, and personality disorders. Factors that promote disease exacerbation are stress, physical trauma, infection, surgery, and hyperthermia. The objective is to describe the anesthetic management of a case referred to urological surgery. Case report: A female patient, 44 years of age, with multiple sclerosis, diagnosed with nephrolithiasis, referred for endoscopic ureterolythotripsy. Balanced general anesthesia was chosen, with midazolam, propofol and remifentanil target-controlled infusion; sevoflurane via laryngeal mask airway; and spontaneous ventilation. Because the patient had respiratory difficulty presenting with chest wall rigidity, it was decided to discontinue the infusion of remifentanil. There was no other complication or exacerbation of disease postoperatively. Conclusion: The use of neuromuscular blockers (depolarizing and non-depolarizing is a problem in these patients. As there was no need for muscle relaxation in this case, muscle relaxants were omitted. We conclude that the combination of propofol and sevoflurane was satisfactory, not resulting in hemodynamic instability or disease exacerbation.

Older Sibling Support of Younger Siblings' Socio-Emotional Development: A Multiple-Case Study of Second-Generation Mexican and Honduran Children's Initiative and Co-Construction

Science.gov (United States)

Palacios, Natalia; Kibler, Amanda K.; Yoder, Michelle; Baird, Ashley Simpson; Bergey, Rebecca

2016-01-01

Siblings play a critical role in the socialization experiences of their younger siblings. Societal values, standards, and customs are transmitted and created through the process of modeling and the construction of shared meaning. It follows, therefore, that the process of socialization may be culturally dependent. Using multiple case studies of…

Rare case of multiple meningiomas in nonneurofibromatosis patient at unusual locations

Directory of Open Access Journals (Sweden)

Setia Vikrant

2017-06-01

Full Text Available Multiple meningioma is a condition in which more than one intracranial lesion is seen in different location and these lesions may occur with or without signs of neurofibromatosis. Incidence of multiple meningioma range from 1 to 10% in different series. We report a case of multiple meningioma in a 33 years old female who had 14 intracranial lesions both supratentorially and infratentorially, and underwent surgery for large right lateral intraventricular meningioma. She had two meningiomas located in posterior fossa associated with supratentorial meningioma, which has been rarely reported.

Multiple sclerosis risk loci and disease severity in 7,125 individuals from 10 studies

DEFF Research Database (Denmark)

George, Michaela F; Briggs, Farren B S; Shao, Xiaorong

2016-01-01

associated with disease severity after accounting for cohort, sex, age at onset, and HLA-DRB1*15:01. After restricting analyses to cases with disease duration ≥10 years, associations were null (p value ≥0.05). No SNP was associated with disease severity after adjusting for multiple testing. CONCLUSIONS......OBJECTIVE: We investigated the association between 52 risk variants identified through genome-wide association studies and disease severity in multiple sclerosis (MS). METHODS: Ten unique MS case data sets were analyzed. The Multiple Sclerosis Severity Score (MSSS) was calculated using the Expanded...

Multiple Supernumerary Teeth in a Non-Syndromic Patient: A Case Report

Directory of Open Access Journals (Sweden)

Majid Eshgh Pour

2013-01-01

Full Text Available Introduction: Multiple supernumerary teeth are a rare phenomenon. It occurs more often in patients with syndromes such as Gardner's syndrome, cleidocranial dysplasia and so on. This phenomenon in absence of such syndromes is rare. The purpose of this report was to introduce a case of non-syndromic multiple supernumerary impacted teeth.Case Report: A 29-year-old woman with no skeletal, metabolic, systemic and mental disorder was referred to oral and maxillofacial department of Mashhad dental school. In clinical evaluation, seven Permanent teeth were missing. In radiographic evaluation, there were a total of 15 impacted teeth which 7 of them were supernumerary.Conclusion: Missing or Excess of one or more teeth usually leads to occlusal and functional problems. In these cases, a complete clinical and radiographic examination accompanieal by a precise history should be performed to plan a suitable surgical-orthodontic-prosthetic treatment.

Student ownership of projects in an upper-division optics laboratory course: A multiple case study of successful experiences

Science.gov (United States)

Dounas-Frazer, Dimitri R.; Stanley, Jacob T.; Lewandowski, H. J.

2017-12-01

We investigate students' sense of ownership of multiweek final projects in an upper-division optics lab course. Using a multiple case study approach, we describe three student projects in detail. Within-case analyses focused on identifying key issues in each project, and constructing chronological descriptions of those events. Cross-case analysis focused on identifying emergent themes with respect to five dimensions of project ownership: student agency, instructor mentorship, peer collaboration, interest and value, and affective responses. Our within- and cross-case analyses yielded three major findings. First, coupling division of labor with collective brainstorming can help balance student agency, instructor mentorship, and peer collaboration. Second, students' interest in the project and perceptions of its value can increase over time; initial student interest in the project topic is not a necessary condition for student ownership of the project. Third, student ownership is characterized by a wide range of emotions that fluctuate as students alternate between extended periods of struggle and moments of success while working on their projects. These findings not only extend the literature on student ownership into a new educational domain—namely, upper-division physics labs—they also have concrete implications for the design of experimental physics projects in courses for which student ownership is a desired learning outcome. We describe the course and projects in sufficient detail that others can adapt our results to their particular contexts.

The use of the bootstrap in the analysis of case-control studies with missing data

DEFF Research Database (Denmark)

Siersma, Volkert Dirk; Johansen, Christoffer

2004-01-01

nonparametric bootstrap, bootstrap confidence intervals, missing values, multiple imputation, matched case-control study......nonparametric bootstrap, bootstrap confidence intervals, missing values, multiple imputation, matched case-control study...

Multiple cavernous malformations presenting in a patient with Poland syndrome: A case report

Directory of Open Access Journals (Sweden)

De Salles Antonio AF

2011-09-01

Full Text Available Abstract Introduction Poland syndrome is a congenital disorder related to chest and hand anomalies on one side of the body. Its etiology remains unclear, with an ipsilateral vascular alteration (of unknown origin to the subclavian artery in early embryogenesis being the currently accepted theory. Cavernous malformations are vascular hamartomas, which have been linked to a genetic etiology, particularly in familial cases, which commonly present with multiple lesions. Our case report is the first to describe multiple cavernous malformations associated with Poland syndrome, further supporting the vascular etiology theory, but pointing to a genetic rather than a mechanistic factor disrupting blood flow in the corresponding vessels. Case presentation A 41-year-old Caucasian man with Poland syndrome on the right side of his body presented to our hospital with a secondary generalized seizure and was found to have multiple cavernous malformations distributed in his brain, cerebellum, and brain stem, with a predominance of lesions in the left hemisphere. Conclusion The distribution of cavernous malformations in the left hemisphere and the right-sided Poland syndrome in our patient could not be explained by a mechanistic disruption of one of the subclavian arteries. A genetic alteration, as in familial cavernous malformations, would be a more appropriate etiologic diagnosis of Poland syndrome in our patient. Further genetic and pathological studies of the involved blood vessels in patients with Poland syndrome could lead to a better understanding of the disease.

Case Study Observational Research: A Framework for Conducting Case Study Research Where Observation Data Are the Focus.

Science.gov (United States)

Morgan, Sonya J; Pullon, Susan R H; Macdonald, Lindsay M; McKinlay, Eileen M; Gray, Ben V

2017-06-01

Case study research is a comprehensive method that incorporates multiple sources of data to provide detailed accounts of complex research phenomena in real-life contexts. However, current models of case study research do not particularly distinguish the unique contribution observation data can make. Observation methods have the potential to reach beyond other methods that rely largely or solely on self-report. This article describes the distinctive characteristics of case study observational research, a modified form of Yin's 2014 model of case study research the authors used in a study exploring interprofessional collaboration in primary care. In this approach, observation data are positioned as the central component of the research design. Case study observational research offers a promising approach for researchers in a wide range of health care settings seeking more complete understandings of complex topics, where contextual influences are of primary concern. Future research is needed to refine and evaluate the approach.

Developing and sustaining adolescent-friendly health services: A multiple case study from Ecuador and Peru.

Science.gov (United States)

Goicolea, Isabel; Coe, Anna-Britt; San Sebastián, Miguel; Hurtig, Anna-Karin

2017-08-01

Adolescent-Friendly Health Services (AFHSs) are those that are accessible, acceptable, equitable, appropriate and effective for different youth sub-populations. This study investigated the process through which four clinics in two countries - Peru and Ecuador - introduced, developed and sustained AFHSs. A multiple case study design was chosen, and data from each clinic were collected through document review, observations and informant interviews. National level data were also collected. Data were analysed following thematic analysis. The findings showed that the process of introducing, developing and sustaining AFHSs was long term, and required a creative team effort and collaboration between donors, public institutions and health providers. The motivation and external support was crucial to initiating and sustaining the implementation of AFHSs. Health facilities' transformation into AFHSs was linked to the broader organisation of country health systems, and the evolution of national adolescent health policies. In Peru, the centralised approach to AFHSs introduction facilitated the dissemination of a comprehensive national model to health facilities, but dependency on national directives made it more difficult to systemise them when ideological and organisational changes occurred. In Ecuador, a less centralised approach to introducing AFHSs made for easier integration of the AFHSs model.

Multiple Levels of Lumbar Spondylolysis - A Case Report -

Science.gov (United States)

Park, Kwang-Hwan; Ha, Joong-Won; Kim, Hak-Sun; Moon, Seong-Hwan; Lee, Hwan-Mo; Kim, Ho-Joong; Kim, Ju-Young

2009-01-01

We report here on an unusual case of multiple levels of asymmetric lumbar spondylolysis in a 19-year-old woman. The patient had severe low back pain of increasing intensity with lumbar instability, which was evident on the dynamic radiographs. MRI demonstrated the presence of abnormalities and the three dimensional CT scan revealed asymmetric complete spondylolysis at the left L2, L3 and L4 levels and the right L1, L2 and L3 levels. This case was treated surgically by posterior and posterolateral fusion at L2-3-4 with intersegmental fixation using pedicle screws and an auto iliac bone graft. The patient was relieved of her low back pain after the surgery. PMID:20404945

The application of microcatheter superselective catheterization in interventional chemoembolization for multiple hepatocarcinomas: an initial experience in 34 cases

International Nuclear Information System (INIS)

Xu Xiaolu; Chen Yongqiang; Wang Qing

2012-01-01

Objective: To assess the clinical value of superselective catheterization by using microcatheter in interventional chemoembolization for multiple hepatocarcinomas. Methods: A total of 68 patients with multiple hepatocarcinomas were enrolled in this study. The clinical data were retrospectively analyzed. Superselective catheterization by using a microcatheter was carried out in 34 cases (study group) and superselective catheterization by using a 4-5 F common catheter was performed in 34 cases (control group). The hepatic dysfunctions and the survival rate at 0.5, 1, 2 years were compared between the two groups. Results: The liver function of the patients in study group was much better than that of the patients in control group (P<0.05), and the survival time of the patients in study group was much longer than that of the patients in control group (P<0.05). Conclusion: For the treatment of multiple hepatocarcinomas, interventional chemoembolization by using microcatheter superselective catheterization technique is technically simple and clinically effective with high success rate and fewer complications. (authors)

Citation searching: a systematic review case study of multiple risk behaviour interventions.

Science.gov (United States)

Wright, Kath; Golder, Su; Rodriguez-Lopez, Rocio

2014-06-03

The value of citation searches as part of the systematic review process is currently unknown. While the major guides to conducting systematic reviews state that citation searching should be carried out in addition to searching bibliographic databases there are still few studies in the literature that support this view. Rather than using a predefined search strategy to retrieve studies, citation searching uses known relevant papers to identify further papers. We describe a case study about the effectiveness of using the citation sources Google Scholar, Scopus, Web of Science and OVIDSP MEDLINE to identify records for inclusion in a systematic review.We used the 40 included studies identified by traditional database searches from one systematic review of interventions for multiple risk behaviours. We searched for each of the included studies in the four citation sources to retrieve the details of all papers that have cited these studies.We carried out two analyses; the first was to examine the overlap between the four citation sources to identify which citation tool was the most useful; the second was to investigate whether the citation searches identified any relevant records in addition to those retrieved by the original database searches. The highest number of citations was retrieved from Google Scholar (1680), followed by Scopus (1173), then Web of Science (1095) and lastly OVIDSP (213). To retrieve all the records identified by the citation tracking searching all four resources was required. Google Scholar identified the highest number of unique citations.The citation tracking identified 9 studies that met the review's inclusion criteria. Eight of these had already been identified by the traditional databases searches and identified in the screening process while the ninth was not available in any of the databases when the original searches were carried out. It would, however, have been identified by two of the database search strategies if searches had been

Successful treatment of multiple bilateral impactions - a case report.

Science.gov (United States)

Schubert, Michael; Proff, Peter; Kirschneck, Christian

2016-07-25

Successful treatment of patients with multiple bilateral impactions can be an orthodontic challenge, but few reports on treatment planning and execution exist. In this case report, we describe the successful orthodontic treatment of a 16.3-year old female patient without systemic or genetic disease with initially nine persisting deciduous and nine impacted permanent teeth with complete root formation and closed apices in both jaws. After extraction of the deciduous and surgical exposure of the impacted permanent teeth, the Easy-Way-Coil™ system was used in conjunction with a skeletal anchorage (maxilla, BENEfit™ system) to guide the eruption of all impacted teeth. After a total treatment time of only 22.8 months all impacted teeth could be aligned successfully and a stable and functional class I occlusion was achieved. In addition, there were no adverse treatment effects such as anchorage loss, root resorptions or periodontal problems and an esthetic result could be achieved. The presented treatment approach thus proved to be highly effective in cases with multiple bilateral impactions with minimal side effects and considerably reduced treatment time.

Modified distal shoe appliance for premature loss of multiple deciduous molars: a case report.

Science.gov (United States)

Bhat, Prasanna Kumar; K, Navin H; Idris, Mohammed; Christopher, Pradeep; Rai, Niharika

2014-08-01

Preservation of the primary dentition until the normal time of exfoliation is one of the most important factor involved in preventive and interceptive dentistry. The premature loss of second primary molar before the eruption of permanent first molar can create a significant arch space/tooth size discrepancy. Distal shoe space maintainer is a valuable part of the Paediatric Dentist's armamentarium in those cases where the second primary molar is prematurely lost and it helps to guide the first permanent molar into place. Conventional design poses various limitations in cases of premature loss of multiple deciduous molars. Thus, it is required to modify the conventional designs according to the needs of the patient. This case report describes an innovative modification of distal shoe appliance in cases of premature loss of multiple deciduous molars. In the present case, modification of distal shoe space maintainer was advocated because of inadequate abutments caused due to multiple loss of deciduous molars. Bilateral design of distal shoe was planned for unilateral loss of deciduous molars.

Spontaneous regression of multiple pulmonary metastatic nodules of hepatocarcinoma: a case report

Energy Technology Data Exchange (ETDEWEB)

Bahk, Yong Whee; Park, Seog Hee; Kim, Sun Moo [St. Mary' s Hospital, Catholic Medical College, Seoul (Korea, Republic of)

1981-09-15

Although are spontaneous regression of either primary or metastatic malignant tumor in the absence of or inadequate therapy has been well documented. Since the earliest day of this century various malignant tumors have been reported to spontaneously disappear or to be arrested of their growth, but the cases of hepatocarcinoma has been very rare. From the literature, we were able to find out 5 previously reported cases of hepatocarcinoma which showed spontaneous regression at the primary site. Recently we have seen a case of multiple pulmonary metastatic nodules of hepatocarcinoma which completely regressed spontaneously and this forms the basis of the present case report. The patient was 55-year-old male admitted to St. Mary's Hospital, Catholic Medical College because of a hard palpable mass in the epigastrium on April 26, 1978. The admission PA chest roentgenogram revealed multiple small nodular densities scattered throughout both lung field especially in lower zones and toward the peripheral portion. A hepatoscintigram revealed a large cold area involving the left lobe and inermediate zone of the liver. Alfa-fetoprotein and hepatitis B serum antigen test were positive whereas many other standard liver function tests turned out to be negative. A needle biopsy of the tumor revealed well differentiated hepatocellular carcinoma. The patient was put under chemotherapy which consisted of 5 FU 500 mg intravenously for 6 days from April 28 to May 3, 1978. The patient was discharged after this single course of 5 FU treatment and was on a herb medicine, the nature and quantity of which obscure. No other specific treatment was given. The second admission took place on Dec. 3, 1980 because of irregularity in bowel habits and dyspepsia. A follow up PA chest roentgenogram obtained on the second admission revealed complete disappearance of previously noted multiple pulmonary nodular lesions (Fig. 3). Follow up liver scan revealed persistence of the cold area in the left lobe

Spontaneous regression of multiple pulmonary metastatic nodules of hepatocarcinoma: a case report

International Nuclear Information System (INIS)

Bahk, Yong Whee; Park, Seog Hee; Kim, Sun Moo

1981-01-01

Although are spontaneous regression of either primary or metastatic malignant tumor in the absence of or inadequate therapy has been well documented. Since the earliest day of this century various malignant tumors have been reported to spontaneously disappear or to be arrested of their growth, but the cases of hepatocarcinoma has been very rare. From the literature, we were able to find out 5 previously reported cases of hepatocarcinoma which showed spontaneous regression at the primary site. Recently we have seen a case of multiple pulmonary metastatic nodules of hepatocarcinoma which completely regressed spontaneously and this forms the basis of the present case report. The patient was 55-year-old male admitted to St. Mary's Hospital, Catholic Medical College because of a hard palpable mass in the epigastrium on April 26, 1978. The admission PA chest roentgenogram revealed multiple small nodular densities scattered throughout both lung field especially in lower zones and toward the peripheral portion. A hepatoscintigram revealed a large cold area involving the left lobe and inermediate zone of the liver. Alfa-fetoprotein and hepatitis B serum antigen test were positive whereas many other standard liver function tests turned out to be negative. A needle biopsy of the tumor revealed well differentiated hepatocellular carcinoma. The patient was put under chemotherapy which consisted of 5 FU 500 mg intravenously for 6 days from April 28 to May 3, 1978. The patient was discharged after this single course of 5 FU treatment and was on a herb medicine, the nature and quantity of which obscure. No other specific treatment was given. The second admission took place on Dec. 3, 1980 because of irregularity in bowel habits and dyspepsia. A follow up PA chest roentgenogram obtained on the second admission revealed complete disappearance of previously noted multiple pulmonary nodular lesions (Fig. 3). Follow up liver scan revealed persistence of the cold area in the left lobe

Twelve cases of multiple myeloma in Nagasaki (especially seven atomic bombing casualty cases). [In Japanese

Energy Technology Data Exchange (ETDEWEB)

Ichimaru, M; Yasuhi, S; Ouchuru, S

1963-12-01

Since 1958, there have been 12 cases of multiple myeloma in Nagasaki, and among them were 7 cases representing atomic bombing casualties, with 3 cases being with 2 km distance from the hypocenter. The age of onset was between 51 and 69 years, and the sex ratio was 8:4, it occurring mostly in males. Symptoms were predominantly low back pain and chest pain caused by the bone changes in 8 cases. Two cases complained of general malaise and palpitation which resulted from anemia. One developed persistent epistaris, and another complained of diplopia caused by the paralysis of the oculomotor nerve. Peripheral blood in all cases showed anemia, 9 with hyperchromic and 3 with normochromic or hypochromic anemia. Low platelet counts were seen in 3 cases. All showed leukopenia. All cases showed typical ..gamma..-globulin change with a myeloma peak, and in 4 cases showed an increase of ..beta..-globulin. Bence-Jones proteinuria was present in 5 cases. Average course was 1 year 4 months. Among complications, myeloma nephrosis, aplastic anemia, and pneumonia were the most important ones.

Twelve months of implementation of health care performance-based financing in Burkina Faso: A qualitative multiple case study.

Science.gov (United States)

Ridde, Valéry; Yaogo, Maurice; Zongo, Sylvie; Somé, Paul-André; Turcotte-Tremblay, Anne-Marie

2018-01-01

To improve health services' quantity and quality, African countries are increasingly engaging in performance-based financing (PBF) interventions. Studies to understand their implementation in francophone West Africa are rare. This study analysed PBF implementation in Burkina Faso 12 months post-launch in late 2014. The design was a multiple and contrasted case study involving 18 cases (health centres). Empirical data were collected from observations, informal (n = 224) and formal (n = 459) interviews, and documents. Outside the circle of persons trained in PBF, few in the community had knowledge of it. In some health centres, the fact that staff were receiving bonuses was intentionally not announced to populations and community leaders. Most local actors thought PBF was just another project, but the majority appreciated it. There were significant delays in setting up agencies for performance monitoring, auditing, and contracting, as well as in the payment. The first audits led rapidly to coping strategies among health workers and occasionally to some staging beforehand. No community-based audits had yet been done. Distribution of bonuses varied from one centre to another. This study shows the importance of understanding the implementation of public health interventions in Africa and of uncovering coping strategies. © 2017 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.

A Case of Mediastinal Extramedullary Plasmacytoma Associated with Multiple Myeloma

Energy Technology Data Exchange (ETDEWEB)

Min, Ji Hye; Kim, Tae Sung; Ko, Young Hyeh; Kim, Ki Hyun [Samsung Medical Center, Sungkyunkwan University, Seoul (Korea, Republic of)

2010-08-15

Extramedullary plasmacytoma is a rare manifestation of multiple myeloma, and involvement of the mediastinum by extramedullary plasmacytoma is very rare. We report here on a rare case of a large mediastinal extramedullary plasmacytoma and several pleural nodules with pleural effusions in a 45-year-old male patient with multiple myeloma that involved the thoracic spine and the calvarium. The mediastinal extramedullary plasmacytoma manifested on CT as an 11 x 4.5 cm-sized, relatively homogeneous, mildly enhancing, anterior mediastinal mass with several pleural nodules, and this simulated malignant lymphoma or malignant thymic epithelial tumor.

Maternal and perinatal outcomes in pregnancies with multiple sclerosis: a case-control study.

Science.gov (United States)

Yalcin, Serenat Eris; Yalcin, Yakup; Yavuz, And; Akkurt, Mehmet Ozgur; Sezik, Mekin

2017-05-24

To assess whether maternal multiple sclerosis (MS) is associated with adverse pregnancy outcomes by determining the clinical course of disease during pregnancy and postpartum throughout a 10-year-period in a single tertiary center. We conducted a case-control study that included pregnancies with a definitive diagnosis of MS (n=43), matched with 100 healthy pregnant women with similar characteristics. Maternal and perinatal data were retrieved from hospital files. Groups were compared with the Mann-Whitney and χ2 tests. Logistic regression models were constructed to determine independent effects. Maternal demographic and baseline laboratory data were similar across the groups. Rates of preterm delivery, fetal growth restriction, preeclampsia, gestational diabetes, stillbirth, cesarean delivery, congenital malformation, and 5-min Apgar score were comparable (P>0.05 for all). General anesthesia during cesarean delivery (96% vs. 39%, P=0.002), urinary tract infection (UTI) (12% vs. 3%, P=0.04), low 1-min Apgar score (21% vs. 9%, P=0.04), and nonbreastfeeding (33% vs. 2%, P=0.001) were more frequent in women with MS. The low 1-min Apgar score and breastfeeding rates were independent of general anesthesia and UTI in regression models. MS during pregnancy was not associated with adverse maternal and perinatal outcomes except UTI, low 1-min Apgar scores, and decreased breastfeeding rates.

A Case of Turner Syndrome with Multiple Embolic Infarcts

Directory of Open Access Journals (Sweden)

Cindy W. Yoon

2016-09-01

Full Text Available Only a few cases of Turner syndrome (TS with ischemic stroke have been reported. Various arteriopathies of the cerebral arteries, including fibromuscular dysplasia, congenital hypoplasia, moyamoya syndrome, and premature atherosclerosis have been assumed to be the cause of ischemic stroke in TS. There has been no case report of a TS patient presenting with an embolic stroke pattern without any cerebral arteriopathy. A 28-year-old woman with TS was referred to our hospital because of abnormal brain magnetic resonance imaging (MRI findings. She underwent brain MRI at the referring hospital because she experienced sudden-onset diffuse headache. Diffusion-weighted imaging revealed multiple acute embolic infarcts in different vascular territories. Intracranial and extracranial arterial disease was not detected on cerebral magnetic resonance angiography and carotid sonography. Embolic source workups, including transthoracic and transesophageal echocardiography, Holter monitoring, and transcranial Doppler shunt study, were all negative. Hypercoagulability and vasculitis panels were also negative. Our patient was diagnosed with cryptogenic embolic stroke. This is the first report of a TS patient with an embolic stroke pattern. Our case shows that ischemic stroke in TS could be due to embolism as well as the various cerebral arteriopathies documented in previous reports.

Nontesticular cancers in relatives of testicular germ cell tumor (TGCT) patients from multiple-case TGCT families

Science.gov (United States)

McMaster, Mary L; Heimdal, Ketil R; Loud, Jennifer T; Bracci, Janet S; Rosenberg, Philip S; Greene, Mark H

2015-01-01

Testicular germ cell tumors (TGCT) exhibit striking familial aggregation that remains incompletely explained. To improve the phenotypic definition of familial TGCT (FTGCT), we studied an international cohort of multiple-case TGCT families to determine whether first-degree relatives of FTGCT cases are at increased risk of other types of cancer. We identified 1041 first-degree relatives of TGCT cases in 66 multiple-case TGCT families from Norway and 64 from the United States (combined follow-up of 31,556 person-years). We collected data on all cancers (except nonmelanoma skin cancers) reported by the family informant in these relatives, and we attempted to verify all reported cancer diagnoses through medical or cancer registry records. We calculated observed-to-expected (O/E) standardized incidence ratios, together with 95% confidence intervals (CI), for invasive cancers other than TGCT. We found no increase in risk of cancer overall (Norway O/E = 0.8; 95% CI: 0.6–1.1 and United States O/E = 0.9; 95% CI: 0.7–1.3). Site-specific analyses pooled across the two countries revealed a leukemia excess (O/E = 6.5; 95% CI: 3.0–12.3), deficit of female breast cancer (O/E = 0.0; 95% CI: 0.0–0.6) and increased risk of soft tissue sarcoma (O/E = 7.2; 95% CI: 2.0–18.4); in all instances, these results were based on small case numbers and statistically significant only in Norway. While limited by sample size and potential issues relating to completeness of cancer reporting, this study in multiple-case TGCT families does not support the hypothesis that cancers other than testis cancer contribute to the FTGCT phenotype. PMID:25882629

Multiple Symmetric Lipomatosis: A Review of 3 Cases

Directory of Open Access Journals (Sweden)

Emilio Mevio

2012-01-01

Full Text Available Multiple symmetrical lipomatosis, or Madelung's disease, is a rare disease of unknown etiology. It is characterized by the presence of loose adipose tissue deposits localized in the cervical region and in the upper body. The neoformations grow slowly and their initial consequence is purely esthetic. They can, however, lead to compression of the laryngotacheal area and of the esophagus. This disease usually affects middle-aged males from the Mediterranean area with a history of alcohol abuse. Although most cases have been sporadic, a few authors have indicated that the disorder may be hereditary. It is thought that this pathology originates from an alteration in lipid metabolism. Since the patients were asymptomatic temperance and diet was proposed, surgical removal of the lipomatose mass is the treatment of choice in case of complications due to fat mass compression on upper aerodigestive tract. The authors present three cases of Madelung's disease with different and particular manifestations.

Student ownership of projects in an upper-division optics laboratory course: A multiple case study of successful experiences

Directory of Open Access Journals (Sweden)

Dimitri R. Dounas-Frazer

2017-12-01

Full Text Available We investigate students’ sense of ownership of multiweek final projects in an upper-division optics lab course. Using a multiple case study approach, we describe three student projects in detail. Within-case analyses focused on identifying key issues in each project, and constructing chronological descriptions of those events. Cross-case analysis focused on identifying emergent themes with respect to five dimensions of project ownership: student agency, instructor mentorship, peer collaboration, interest and value, and affective responses. Our within- and cross-case analyses yielded three major findings. First, coupling division of labor with collective brainstorming can help balance student agency, instructor mentorship, and peer collaboration. Second, students’ interest in the project and perceptions of its value can increase over time; initial student interest in the project topic is not a necessary condition for student ownership of the project. Third, student ownership is characterized by a wide range of emotions that fluctuate as students alternate between extended periods of struggle and moments of success while working on their projects. These findings not only extend the literature on student ownership into a new educational domain—namely, upper-division physics labs—they also have concrete implications for the design of experimental physics projects in courses for which student ownership is a desired learning outcome. We describe the course and projects in sufficient detail that others can adapt our results to their particular contexts.

Exploring barriers to remaining physically active: a case report of a person with multiple sclerosis.

Science.gov (United States)

Zalewski, Kathryn

2007-03-01

Physical therapy intervention for those with chronic disabling conditions typically follows an episode of care approach: therapists provide services when a decrement in functional performance occurs such that individuals require intervention to return to baseline performance. Attention to the psychosocial supports required for successful transition can be unintentionally minimized when the focus of an episode of care follows a change in physical function. The purpose of this case report is to present and discuss the challenges to successful community reintegration following physical therapy intervention with an emphasis on developing independent exercise habits in management of a person with multiple sclerosis. RW, presented in this case study, is a 52-year-old man diagnosed with progressive multiple sclerosis five years before self-referral to a pro bono physical therapy clinic.

Horseshoe lung with multiple congenital anomalies. Case report and review of the literature

Energy Technology Data Exchange (ETDEWEB)

Hawass, N.D.; Badawi, M.G.; Fatani, J.A.; Meshari, A.A.; Edrees, Y.B.

A detailed radiologic and anatomic study of a 20-week old fetus is presented. In addition to conventional radiography, various contrast medium injection techniques were used. The findings were followed up at autopsy. The fetus showed multiple congenital abnormalities comprising phocomelia, horseshoe lung, horseshoe kidney, urethral stenosis with megacystis, bilateral hydronephrosis, hydroureters, imperforate anus, and a single tracheo-esophageal tube (persistent esophago-trachea). The association of horseshoe lung with persistent esophago-trachea, microurethra, megacystis, bilateral hydroureters, hydronephrosis and phocomelia is, we believe, the first ever to have been recorded in the literature. Twenty-one cases of horseshoe lung have been reported in the literature. These cases were reviewed and a comparison with the present case is presented. The embryologic basis for these anomalies is also briefly discussed.

Multiple Brand Celebrity Endorsement: Případová studie David Beckham

OpenAIRE

Hiblerová, Adéla

2017-01-01

The Bachelor's Thesis on the topic of Multiple Brand Celebrity Endorsement: David Beckham Case Study focuses primarily on the issue of multiple endorsement of a number of brands by one celebrity. To be able to put this topic into perspective does this thesis begin with a description of celebrity endorsement as itself, defines 'celebrity', and also introduces various approaches towards cooperation of a celebrity and a brand in general. Consequently, reasons for and risks of such cooperation ar...

Multiple parameters anomalies for verifying the geosystem spheres coupling effect: a case study of the 2010 Ms7.1 Yushu earthquake in China

Directory of Open Access Journals (Sweden)

Shuo Zheng

2014-08-01

Full Text Available In the research of earthquake anomaly recognition, the coupling effect of multiple geosystem spheres can be expected to reasonably interpretating the correlation between various anomalous signals before strong earthquake. Specially, the development of the Lithosphere–Atmosphere–Ionosphere (LAI coupling model has been accepted as verified by some experimental, thermal and electromagnetic data. However, quasi-synchronous anomalies of the multiple parameters, including thermal, radon and electromagnetic data, have not been reported in a single event case for verifying the geosystem spheres coupling effect. In this paper, we firstly summarized the reported studies on the power spectrum density (PSD in the ELF/VLF band and radon data recorded from Guza seismic station. Then, historical surface latent heat flux (SLHF data from the NCEP/NCAR Reanalysis Project was employed for investigating anomalous change in a month before the April 14, 2010, Ms7.1 Yushu earthquake which is one of the typical intra-continental earthquakes in Tibet Plateau. The results from spatial and temporal analysis revealed that anomalous fields of PSD and SLHF data were located close to the epicenter and the ends of some active faults at Bayan Har Block and all anomalous dates converged between April 8 and 11 (6 to 3 days before the Yushu earthquake. Therefore, we suggest that the anomalies of multiple parameters before the main shock are related with the Yushu earthquake. This paper could give an ideal case study to verify the geosystem spheres coupling effect happened in a single event.

The integration of occupational therapy into primary care: a multiple case study design

Science.gov (United States)

2013-01-01

Background For over two decades occupational therapists have been encouraged to enhance their roles within primary care and focus on health promotion and prevention activities. While there is a clear fit between occupational therapy and primary care, there have been few practice examples, despite a growing body of evidence to support the role. In 2010, the province of Ontario, Canada provided funding to include occupational therapists as members of Family Health Teams, an interprofessional model of primary care. The integration of occupational therapists into this model of primary care is one of the first large scale initiatives of its kind in North America. The objective of the study was to examine how occupational therapy services are being integrated into primary care teams and understand the structures supporting the integration. Methods A multiple case study design was used to provide an in-depth description of the integration of occupational therapy. Four Family Health Teams with occupational therapists as part of the team were identified. Data collection included in-depth interviews, document analyses, and questionnaires. Results Each Family Health Team had a unique organizational structure that contributed to the integration of occupational therapy. Communication, trust and understanding of occupational therapy were key elements in the integration of occupational therapy into Family Health Teams, and were supported by a number of strategies including co-location, electronic medical records and team meetings. An understanding of occupational therapy was critical for integration into the team and physicians were less likely to understand the occupational therapy role than other health providers. Conclusion With an increased emphasis on interprofessional primary care, new professions will be integrated into primary healthcare teams. The study found that explicit strategies and structures are required to facilitate the integration of a new professional group

Important considerations for feasibility studies in physical activity research involving persons with multiple sclerosis: a scoping systematic review and case study.

Science.gov (United States)

Learmonth, Yvonne C; Motl, Robert W

2018-01-01

Much research has been undertaken to establish the important benefits of physical activity in persons with multiple sclerosis (MS). There is disagreement regarding the strength of this research, perhaps because the majority of studies on physical activity and its benefits have not undergone initial and systematic feasibility testing. We aim to address the feasibility processes that have been examined within the context of physical activity interventions in MS. A systematic scoping review was conducted based on a literature search of five databases to identify feasibility processes described in preliminary studies of physical activity in MS. We read and extracted methodology from each study based on the following feasibility metrics: process (e.g. recruitment), resource (e.g. monetary costs), management (e.g. personnel time requirements) and scientific outcomes (e.g. clinical/participant reported outcome measures). We illustrate the use of the four feasibility metrics within a randomised controlled trial of a home-based exercise intervention in persons with MS. Twenty-five studies were identified. Resource feasibility (e.g. time and resources) and scientific outcomes feasibility (e.g. clinical outcomes) methodologies were applied and described in many studies; however, these metrics have not been systematically addressed. Metrics related to process feasibility (e.g. recruitment) and management feasibility (e.g. human and data management) are not well described within the literature. Our case study successfully enabled us to address the four feasibility metrics, and we provide new information on management feasibility (i.e. estimate data completeness and estimate data entry) and scientific outcomes feasibility (i.e. determining data collection materials appropriateness). Our review highlights the existing research and provides a case study which assesses important metrics of study feasibility. This review serves as a clarion call for feasibility trials that will

Interference profiles with multiple spherical waves: general case

International Nuclear Information System (INIS)

Zerbino, L.M.; Torroba, R.; Rodriquez, N.; Garavaglia, M.

1984-01-01

Characteristics of multiple-beam interference fringes, as in a Fabry-Perot interferometer with monochromatic light, are analyzed. The optical path and the optical-path difference between interfering beams are calculated for the most general case. Different refractive indices in the inner and outer media, and arbitrary locations of the light source and the point of observation, are taken into account. An expression of the impulse response of the system is given. The results obtained from experimental tests confirm the theoretical predictions. 8 references

A Case of Multiple Sclerosis and Celiac Disease

Directory of Open Access Journals (Sweden)

H. Z. Batur-Caglayan

2013-01-01

Full Text Available Objectives. Multiple sclerosis (MS is an inflammatory autoimmune disorder of the central nervous system (CNS. Since a correlation between gluten intake and incidence of MS had been reported, the relationship of antigliadin antibodies and MS was debated. Case Report. We report the case of a 45-year-old female MS patient who is under interferon treatment. After seven years of monitoring, during her routine gastroenterological assessment, she was diagnosed with celiac disease. Conclusion. Beside the neurological manifestations that have been demonstrated in about 10% of celiac disease (CD patients, white-matter abnormalities in brain MRI are uncommon and controversial. But in the literature, MS seems to be associated with CD as in our patient. We suggest that MS patients with gastroenterological complaints should undergo an assessment for CD.

A study of the treatment of oral multiple primary cancers

International Nuclear Information System (INIS)

Sato, Takayuki; Kamata, Shin-etsu; Kawabata, Kazuyoshi

2003-01-01

The subjects were 30 multiple primary cancers (out of 2,169 oral squamous cell carcinoma including lip cancers), which were treated at the Division of Head and Neck, Cancer Institute Hospital. Seven synchronous carcinomas and 23 metachronous cases were seen. The most common site of the primary cancer was the tongue. Surgical treatment was performed for the first treatment in 5 cases of the 7 synchronous cancers. On the other hand, radical treatment was performed in 11 cases of the 23 metachronous cancers. Fourteen of the 18 cases were treated by surgical treatment and controlled. It is suggested that surgical treatment is the most effective for oral multiple primary cancers. (author)

Why do certain primary health care teams respond better to intimate partner violence than others? A multiple case study.

Science.gov (United States)

Goicolea, Isabel; Marchal, Bruno; Hurtig, Anna-Karin; Vives-Cases, Carmen; Briones-Vozmediano, Erica; San Sebastián, Miguel

2017-12-09

To analyse how team level conditions influenced health care professionals' responses to intimate partner violence. We used a multiple embedded case study. The cases were four primary health care teams located in a southern region of Spain; two of them considered "good" and two s "average". The two teams considered good had scored highest in practice issues for intimate partner violence, measured via a questionnaire (PREMIS - Physicians Readiness to Respond to Intimate Partner Violence Survey) applied to professionals working in the four primary health care teams. In each case quantitative and qualitative data were collected using a social network questionnaire, interviews and observations. The two "good" cases showed dynamics and structures that promoted team working and team learning on intimate partner violence, had committed social workers and an enabling environment for their work, and had put into practice explicit strategies to implement a women-centred approach. Better individual responses to intimate partner violence were implemented in the teams which: 1) had social workers who were knowledgeable and motivated to engage with others; 2) sustained a structure of regular meetings during which issues of violence were discussed; 3) encouraged a friendly team climate; and 4) implemented concrete actions towards women-centred care. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

A Diagnostic Study of Pre-Service Teachers' Competency in Multiple-Choice Item Development

Science.gov (United States)

Asim, Alice E.; Ekuri, Emmanuel E.; Eni, Eni I.

2013-01-01

Large class size is an issue in testing at all levels of Education. As a panacea to this, multiple choice test formats has become very popular. This case study was designed to diagnose pre-service teachers' competency in constructing questions (IQT); direct questions (DQT); and best answer (BAT) varieties of multiple choice items. Subjects were 88…

Management of multiple intrusive luxative injuries: A case report with 7-year follow-up

Directory of Open Access Journals (Sweden)

Seema Thakur

2014-01-01

Full Text Available This report presents a case of severe intrusive luxation of multiple anterior teeth in an 11-year-old girl. The teeth were repositioned successfully by endodontic and orthodontic management. The case was monitored for 7 years. Depending on the severity of the injury, different clinical approaches for treatment of intrusive luxation may be used. Despite the variety of treatment modalities, rehabilitation of intruded teeth is always a challenge and a multidisciplinary approach is important to achieve a successful result. In this case, intruded teeth were endodontically treated with multiple calcium hydroxide dressings and repositioned orthodontically. The follow-up of such cases is very important as the repair process after intrusion is complex. After 7 years, no clinical or radiographic pathology was detected.

An unusual case of idiopathic multiple invasive cervical resorption

Directory of Open Access Journals (Sweden)

Sathya Prakash Reddy Kesary

2014-01-01

Full Text Available Invasive cervical resorption is a rare form of root resorption, characterized by destruction of the cervical region of teeth resulting from the action of tooth resorbing cells. Being an asymptomatic condition, it is often discovered on routine radiographic examination. This multifactorial disease process can most commonly occur as a sequel to orthodontic treatment, dental trauma, bleaching procedures, and less commonly, as an outcome of segmental orthognathic surgery, periodontal root planning, tetracycline conditioning of the root canal, bruxism, transplantation of tooth, guided tissue regeneration, cementoenamel disjunction. In the absence of these predisposing factors, it can be labeled as ′idiopathic multiple cervical resorption′. This article describes the case of a medically fit Indian male, who displayed idiopathic invasive cervical resorption in multiple teeth.

Multiple case study analysis of young women's experiences in high school engineering

Science.gov (United States)

Pollock, Meagan C.

richly describe the diversity of experiences. A multiple case study analysis, this study answers the question: How do gender, class, race, and other components of intersectionality, influence high school females' experiences in engineering? Nine young women taking a high school engineering course in a suburban high school in Central Texas during the school year 2011-2012 volunteered to participate. The students were observed in their engineering classes for half of the spring 2012 semester, with bi-weekly interviews with the students, monthly interviews with the teacher, and a single interview with a parent of each volunteer. The nine rich case studies provide us with new stories that help prevent us from narrowing the experiences of women to a single incomplete stereotype, because these young women vary across race, socioeconomic backgrounds, and sexual orientation. Although each story is unique, there are commonalities among their experiences, including family, influence, classroom environment, biases, and beliefs. By drawing from their collective experiences in high school engineering, the findings direct us toward recommendations for educators, parents, engineering curriculum developers, designers of teacher professional development, and future research to improve equity and access for every student in engineering.

Analysis of Multidimensional Poverty: Theory and Case Studies ...

International Development Research Centre (IDRC) Digital Library (Canada)

2009-08-18

Aug 18, 2009 ... ... of applying a factorial technique, Multiple Correspondence Analysis, to poverty analysis. ... Analysis of Multidimensional Poverty: Theory and Case Studies ... agreement to support joint research projects in December 2017.

Spontaneous tumour lysis syndrome in a case of multiple myeloma – A rare occurrence

Directory of Open Access Journals (Sweden)

Kavitha Saravu

2013-03-01

Full Text Available We describe a case of a 40-year-old male patient who was found to have multiple myeloma with spontaneous tumour lysis syndrome (TLS, following a compression fracture of the L–2 vertebrae. Multiple myeloma was confirmed by bone marrow analysis and the M–band on serum protein electrophoresis. Hyperuricaemia (26.2 mg/dL, hyperkalaemia (> 7.0 mEq/L, hyperphosphatemia (16.2 mg of phosphorus/dL, normocalcemia and acute kidney injury, prior to anticancer treatment suggested spontaneous TLS. Inciting events for tumour lysis, such as chemotherapy, dehydration and exposure to steroids were absent. Patient received hydration, hypourecemic drugs and haemodialysis. This case report highlights the rare presentation of multiple myeloma with spontaneous TLS.

Ultrasonographic evaluation of cerebral arterial and venous haemodynamics in multiple sclerosis: a case-control study.

Directory of Open Access Journals (Sweden)

Pasquale Marchione

Full Text Available OBJECTIVE: Although recent studies excluded an association between Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis (MS, controversial results account for some cerebrovascular haemodynamic impairment suggesting a dysfunction of cerebral autoregulation mechanisms. The aim of this cross-sectional, case-control study is to evaluate cerebral arterial inflow and venous outflow by means of a non-invasive ultrasound procedure in Relapsing Remitting (RR, Primary Progressive (PP Multiple Sclerosis and age and sex-matched controls subjects. MATERIAL AND METHODS: All subjects underwent a complete extra-intracranial arterial and venous ultrasound assessment with a color-coded duplex sonography scanner and a transcranial doppler equipment, in both supine and sitting position by means of a tilting chair. Basal arterial and venous morphology and flow velocities, postural changes in mean flow velocities (MFV of middle cerebral arteries (MCA, differences between cerebral venous outflow (CVF in clinostatism and in the seated position (ΔCVF and non-invasive cerebral perfusion pressure (CPP were evaluated. RESULTS: 85 RR-MS, 83 PP-MS and 82 healthy controls were included. ΔCVF was negative in 45/85 (52.9% RR-MS, 63/83 (75.9% PP-MS (p = 0.01 and 11/82 (13.4% controls (p<0.001, while MFVs on both MCAs in sitting position were significantly reduced in RR-MS and PP-MS patients than in control, particularly in EDSS ≥ 5 subgroup (respectively, 42/50, 84% vs. 66/131, 50.3%, p<0.01 and 48.3 ± 2 cm/s vs. 54.6 ± 3 cm/s, p = 0.01. No significant differences in CPP were observed within and between groups. CONCLUSIONS: The quantitative evaluation of cerebral blood flow (CBF and CVF and their postural dependency may be related to a dysfunction of autonomic nervous system that seems to characterize more disabled MS patients. It's not clear whether the altered postural control of arterial inflow and venous outflow is a specific MS condition or simply an

A study of biorthogonal multiple vector-valued wavelets

International Nuclear Information System (INIS)

Han Jincang; Cheng Zhengxing; Chen Qingjiang

2009-01-01

The notion of vector-valued multiresolution analysis is introduced and the concept of biorthogonal multiple vector-valued wavelets which are wavelets for vector fields, is introduced. It is proved that, like in the scalar and multiwavelet case, the existence of a pair of biorthogonal multiple vector-valued scaling functions guarantees the existence of a pair of biorthogonal multiple vector-valued wavelet functions. An algorithm for constructing a class of compactly supported biorthogonal multiple vector-valued wavelets is presented. Their properties are investigated by means of operator theory and algebra theory and time-frequency analysis method. Several biorthogonality formulas regarding these wavelet packets are obtained.

A case of lung adenocarcinoma with multiple intracranial hemorrhages of brain metastases after whole-brain radiation therapy

International Nuclear Information System (INIS)

Nakamichi, Shinji; Hirano, Satoshi; Asao, Tetsuhiko; Takeda, Yuichiro; Sugiyama, Haruhito; Kobayashi, Nobuyuki

2011-01-01

Whole-brain radiation therapy (WBRT) is widely applied in cases of brain metastases of non-small cell lung cancer (NSCLC). However, there are few case reports on hemorrhages of brain metastases occurring after WBRT. A 63-year-old woman was given a diagnosis of stage IV (T4N0M1b) lung adenocarcinoma about 4 years previously, and received chemotherapy regimens and gamma knife radiosurgery. However, her brain metastases exacerbated and she received WBRT in November 2010 and docetaxel monotherapy in December 2010. Two weeks after completing WBRT, she experienced dysarthria and an MRI showed multiple hemorrhages within brain metastases. Over a period of careful observation, these hemorrhages repeatedly alternated between improvement and exacerbation. Radiotherapy for metastatic brain tumors is considered to suppress hemorrhagic events of brain metastases. However, multiple intracranial hemorrhages of brain metastases occurred after WBRT in the present case. The accumulation of further studies of similar cases is necessary to identify the exact mechanism of these hemorrhages. (author)

Case Study Research Methodology in Nursing Research.

Science.gov (United States)

Cope, Diane G

2015-11-01

Through data collection methods using a holistic approach that focuses on variables in a natural setting, qualitative research methods seek to understand participants' perceptions and interpretations. Common qualitative research methods include ethnography, phenomenology, grounded theory, and historic research. Another type of methodology that has a similar qualitative approach is case study research, which seeks to understand a phenomenon or case from multiple perspectives within a given real-world context.

Teaching Business Intelligence through Case Studies

Science.gov (United States)

Pomykalski, James J.

2015-01-01

In teaching business students about the application and implementation of technology, especially involving business intelligence, it is important to discover that project success in enterprise systems development efforts often depend on the non-technological problems or issues. The focus of this paper will be on the use of multiple case studies in…

Case report 554: Osteonecrosis at multiple sites as noted

Energy Technology Data Exchange (ETDEWEB)

Archer, A G; Nelson, M C [Georgetown Univ., Washington, DC (USA). Dept. of Radiology; Abbondanzo, S L [Georgetown Univ., Washington, DC (USA). Dept. of Pathology; Bogumill, G P [Georgetown Univ., Washington, DC (USA). Div. of Orthopaedics

1989-08-01

This is a case of a 31-year-old man who presented with persistent pain of the left knee and was found to have avascular necrosis at multiple sites. Plain film roentgenograms with tomography, bone scanning and magnetic resonance imaging were utilized in the diagnostic work-up. The history of treatment with steroids eight years previously was elicited only after the diagnosis was made radiographically and pathologically. (orig./GDG).

Rhabdomyolysis following interferon-beta treatment in a patient with multiple sclerosis - A case report.

Science.gov (United States)

Dalbjerg, Sara Maria; Tsakiri, Anna; Frederiksen, Jette Lautrup

2016-07-01

Multiple sclerosis is an inflammatory disease of the central nervous system for which there is currently no cure. Interferon-beta-1-alpha is worldwide one of the most widely used treatments in multiple sclerosis. To our knowledge there is one previous reported case of rhabdomyolysis associated with Interferon-beta treatment. We describe a 30 year old man with relapsing remitting multiple sclerosis who developed rhabdomyolysis and increased creatine kinase following Interferon-beta-1-alpha therapy. After the medication was discontinued, the patient rapidly improved. Clinicians should be aware of the possibility of rhabdomyolysis occurring during Interferon-beta-1-alpha therapy. In cases where patients complain of severe myalgia, and in particular if weakness is reported, creatine kinase activity should be measured to prevent irreversible rhabdomyolysis during Interferon-beta-1-alpha therapy in patients with multiple sclerosis. Copyright © 2016 Elsevier B.V. All rights reserved.

Case Report: Multiple Sclerosis in a Pregnant Afro-Caribbean Woman

African Journals Online (AJOL)

Case Report: Multiple Sclerosis in a Pregnant Afro-Caribbean Woman. Abiola I Balogun. Abstract. No Abstract Available Archives of Ibadan Medicine Vol.1(1) 2000: 21-22. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/aim.v1i1.34534.

Extraosseous Multiple Myeloma with Retroperitoneal Manifestation: A Case Report

International Nuclear Information System (INIS)

Berdugo, Juan Oswaldo; Nieto, Sonia Janeth; Garzon, Julian Gonzalo

2008-01-01

This paper presents a case of a 57 years old man (patient of Hospital Militar Central of Bogota, Colombia) with weight loss and a mass in the right clavicle. Plain film radiography shows a lytic lesion in the sternum side of the clavicle. biopsy reports a plasmacytomas, radiotherapy was performed. Three years later lesions of similar characteristics within ribs and a focal lesion in left testicle were detected. The diagnosis was multiple myeloma, Chemotherapy and orquidectomy were performed. One year after, patient complained of diffuse abdominal pain and loss weight, contrast abdominal CT was performed. Computed tomography showed a left heterogeneous mass with irregular contours that involved the retroperitoneal space occupying its three compartments. Biopsy was performed and reported pleomorphicplasmocytic proliferation with nuclear enlargement and hyperchromic nuclei consistent with multiple myeloma with abdominal involvement.

MULTIPLE PERSONALITY DISORDER FOLLOWING CONVERSION AND DISSOCIATIVE DISORDER NOS : A CASE REPORT

OpenAIRE

Jhingan, Harsh Prem; Aggarwal, Neeruj; Saxena, Shekhar; Gupta, Dhanesh K.

2000-01-01

A case progressing from symptoms of conversion disorder to dissociative disorder and then to multiple personality disorder as per DSM-III-R criteria is being reported. The clinical implications are discussed.

Multiple solid pilocytic astrocytomas in cerebleiium with neurofibromatosis type: A case report

International Nuclear Information System (INIS)

Choi, Seo Young; Kim, Myung Soon; Kim, Young Ju

2014-01-01

Pilocytic astrocytoma usually has a classic imaging manifestation of a solitary, cyst-like mass with a strong contrast-enhancing mural nodule. There is only one published report so far of multiple solid and cyst type pilocytic astrocytomas in the cerebellum in neurofibromatosis type 1 (NF1) patient from the United States in 2007. We report a case of pilocytic astrocytoma presenting with only solid, multiple pilocytic astrocytomas in the cerebellum in NF1 patient.

How teams use indicators for quality improvement - a multiple-case study on the use of multiple indicators in multidisciplinary breast cancer teams.

Science.gov (United States)

Gort, Marjan; Broekhuis, Manda; Regts, Gerdien

2013-11-01

A crucial issue in healthcare is how multidisciplinary teams can use indicators for quality improvement. Such teams have increasingly become the core component in both care delivery and in many quality improvement methods. This study aims to investigate the relationships between (1) team factors and the way multidisciplinary teams use indicators for quality improvement, and (2) both team and process factors and the intended results. An in-depth, multiple-case study was conducted in the Netherlands in 2008 involving four breast cancer teams using six structure, process and outcome indicators. The results indicated that the process of using indicators involves several stages and activities. Two teams applied a more intensive, active and interactive approach as they passed through these stages. These teams were perceived to have achieved good results through indicator use compared to the other two teams who applied a simple control approach. All teams experienced some difficulty in integrating the new formal control structure, i.e. measuring and managing performance, in their operational task, and in using their 'new' managerial task to decide as a team what and how to improve. Our findings indicate the presence of a network of relationships between team factors, the controllability and actionability of indicators, the indicator-use process, and the intended results. Copyright © 2013. Published by Elsevier Ltd.

Evaluating a Tacit Knowledge Sharing Initiative: A Case Study

Science.gov (United States)

Gubbins, Claire; Corrigan, Siobhan; Garavan, Thomas N.; O'Connor, Christy; Leahy, Damien; Long, David; Murphy, Eamonn

2012-01-01

Purpose: This paper aims to present a case study illustrating the issues involved in the tacit knowledge conversion process and to determine whether such conversion delivers value to the organisation in terms of business value and return on investment (ROI). Design/methodology/approach: A single-case multiple baseline participants experimental…

Motivating factors in hospital environmental management programs: a multiple case study in four private Brazilian hospitals

Directory of Open Access Journals (Sweden)

Jan Krüger

Full Text Available Abstract Environmental responsibility has been a widespread and relatively recent research theme in the healthcare sector. Considering that the greater life expectancy increases the need for healthcare services and that these services produce negative environmental externalities on human health, it is important to understand the relationship between environmental responsibility and the healthcare sector. This article aims to investigate what motivates hospital managers to adopt environmental responsibility programs and to identify the actions implemented by them. A multiple case study was conducted involving four Brazilian hospitals based in Rio de Janeiro and São Paulo. The results indicate that the main drivers are competitive, ethical and regulatory and that the competitive and regulatory motivators have the potential to establish a baseline for environmental performance that varies across ownership type (public or private. The results also indicate that the comprehensiveness of environmental actions is related to organizational resilience and to the motivators that drive hospitals to adopt those actions. Two conceptual models are proposed to illustrate these findings and offer bases for further research.

Multiple Sclerosis and Several Demographic Characteristics, Family History of MS, and Month of Birth: A Case-Control Study

Directory of Open Access Journals (Sweden)

Bagheri

2015-09-01

Full Text Available Background Several factors have been reported as risk factors for multiple sclerosis (MS; however, the main causes of the disease are still unknown. A geographical area with a low MS incidence is Ahvaz, Iran. Objectives The objective of this study was to evaluate the association of several demographic characteristics, family history, and birth month with MS in Ahvaz. Patients and Methods This was a case-control study including 155 MS cases and 155 controls matched for age, sex, and residential status. The participants were selected randomly, using a systematic method, from the MS patients referred to the MS Society of Khuzestan (Iran. The data collection tool was a standardized questionnaire designed by the authors to assess demographic characteristics. Data were analyzed using descriptive statistics including mean, frequency, and standard deviation and inferential statistical tests including χ2, Fisher’s exact test, and logistic regression using SPSS version 19. Results In both cases and controls, no significant associations were found between Arab ethnicity and incidence of MS, marital status and risk of MS in Ahvaz, or more than 15-year residency in Ahvaz, birth in Khuzestan, and month of birth and the risk of MS (P > 0.05. However, there was a marginally significant association between living from birth to age 15 years in Ahvaz and MS (P = 0.05. Furthermore, there was an association between a family history of MS and the risk of MS in Ahvaz (P = 0.02, which was significant in univariate logistic regression (P = 0.006. Conclusions The findings suggested that according to the ecological conditions of Ahvaz, a family history of MS may increase the risk of developing MS.

CUTANEOUS INVOLVEMENT IN MULTIPLE MYELOMA AT AN UNUSUAL SITE: A RARE CASE REPORT

Directory of Open Access Journals (Sweden)

Lohit Kumar

2015-05-01

Full Text Available Multiple myeloma is a rare cancer. According to the most recent data from the Surveillance, Epidemiology, and End Results (SEER program, multiple myeloma is the second most common haematological malignancy in the U.S. (after non - Hodgkin lymphoma, constitutes 1% of all cancers and constitutes 2% of all cancer deaths. Cutaneous involvement of multiple myeloma during treatment period is uncommon with fewer described in literature. Moreover, metastatic cutaneous involvement at the sole of the foot during treatment period of a IgA kappa type multiple myeloma patient followed by death has not encountered in literature. We have reported such a case

Leadership Analysis in K-12 Case Study: Superintendent's Hiring Dilemma

Science.gov (United States)

Alsobaie, Mohammed Fahad

2016-01-01

This paper will seek to analyze of the case "Superintendent's Hiring Dilemma" by Hoy and Tarter (2004) using multiple leadership perspectives. The last section of this analysis of the case study will provide the most effective leadership recommendations for the key players.

Methodology Series Module 2: Case-control Studies.

Science.gov (United States)

Setia, Maninder Singh

2016-01-01

Case-Control study design is a type of observational study. In this design, participants are selected for the study based on their outcome status. Thus, some participants have the outcome of interest (referred to as cases), whereas others do not have the outcome of interest (referred to as controls). The investigator then assesses the exposure in both these groups. The investigator should define the cases as specifically as possible. Sometimes, definition of a disease may be based on multiple criteria; thus, all these points should be explicitly stated in case definition. An important aspect of selecting a control is that they should be from the same 'study base' as that of the cases. We can select controls from a variety of groups. Some of them are: General population; relatives or friends; and hospital patients. Matching is often used in case-control control studies to ensure that the cases and controls are similar in certain characteristics, and it is a useful technique to increase the efficiency of the study. Case-Control studies can usually be conducted relatively faster and are inexpensive - particularly when compared with cohort studies (prospective). It is useful to study rare outcomes and outcomes with long latent periods. This design is not very useful to study rare exposures. Furthermore, they may also be prone to certain biases - selection bias and recall bias.

Exploring the use of storytelling in quantitative research fields using a multiple case study method

Science.gov (United States)

Matthews, Lori N. Hamlet

The purpose of this study was to explore the emerging use of storytelling in quantitative research fields. The focus was not on examining storytelling in research, but rather how stories are used in various ways within the social context of quantitative research environments. In-depth interviews were conducted with seven professionals who had experience using storytelling in their work and my personal experience with the subject matter was also used as a source of data according to the notion of researcher-as-instrument. This study is qualitative in nature and is guided by two supporting theoretical frameworks, the sociological perspective and narrative inquiry. A multiple case study methodology was used to gain insight about why participants decided to use stories or storytelling in a quantitative research environment that may not be traditionally open to such methods. This study also attempted to identify how storytelling can strengthen or supplement existing research, as well as what value stories can provide to the practice of research in general. Five thematic findings emerged from the data and were grouped under two headings, "Experiencing Research" and "Story Work." The themes were found to be consistent with four main theoretical functions of storytelling identified in existing scholarly literature: (a) sense-making; (b) meaning-making; (c) culture; and (d) communal function. The five thematic themes that emerged from this study and were consistent with the existing literature include: (a) social context; (b) quantitative versus qualitative; (c) we think and learn in terms of stories; (d) stories tie experiences together; and (e) making sense and meaning. Recommendations are offered in the form of implications for various social contexts and topics for further research are presented as well.

The expected and actual communication of health care workers during the management of intrapartum: An interpretive multiple case study

Directory of Open Access Journals (Sweden)

Doreen K.M. M'Rithaa

2015-12-01

Full Text Available Background: Daily activities within a health care organisation are mediated by information communication processes (ICP involving multiple health care professionals at different levels of care. Effective perinatal management requires critical information to be accurately communicated. If there is a breakdown in this communication patient safety is at risk for various reasons such as: inadequate critical information, misconception of information and uninformed decisions being made. The purpose of this study was to interpret the complexities around ICP in order to contribute to the effective management of the intrapartum period. Methods: Multi method, multiple case study approach was used to understand the ICP during the management of the intrapartum period. During the study, the expected ICP, the actual ICP, the challenges involved and the desired ICP were analysed. Twenty-four in-depth interviews with skilled birth attendants (SBAs employing observer-as-participant roles, field notes, and document review methods were utilised to gather the data. Thematic analysis was utilised to analyse the data using Atlas TI software. Results: The study revealed three subthemes which emerged from the expected ICP, whilst three others that emerged formed the theme actual ICP. The subthemes from the expected ICP included: accessibility of obstetric services, expected referral, recommended tools, expected communication and expected documentation. The theme actual ICP held threee merging subthemes: the handover processes, collaborative information seeking, information communicated and referral processes. Conclusion: This study showed that what was expected was not what was actually happening. The requirements of the policies and protocols need to be effectively implemented to improve practice building these into current biomedical guidelines.

Topological characteristics of brainstem lesions in clinically definite and clinically probable cases of multiple sclerosis: An MRI-study

International Nuclear Information System (INIS)

Brainin, M.; Omasits, M.; Reisner, T.; Neuhold, A.; Wicke, L.

1987-01-01

Disseminated lesions in the white matter of the cerebral hemispheres and confluent lesions at the borders of the lateral ventricles as seen on MRI are both considered acceptable paraclinical evidence for the diagnosis of multiple sclerosis. Similar changes are, however, also found in vascular diseases of the brain. We therefore aimed at identifying those additional traits in the infratentorial region, which in our experience are not frequently found in cerebrovascular pathology. We evaluated MR brain scans of 68 patients and found pontine lesions in 71% of cases with a clinically definite diagnosis (17 out of 24) and in 33% of cases with a probable diagnosis (14 out of 43). Lesions in the medulla oblongata were present in 50% and 16%, respectively, and in the midbrain in 25% and 7%, respectively. With rare exceptions all brainstem lesions were contiguous with the cisternal or ventricular cerebrospinal fluid spaces. In keeping with post-mortem reports the morphological spectrum ranged from large confluent patches to solitary, well delineated paramedian lesions or discrete linings of the cerebrospinal fluid border zones and were most clearly depicted from horizontal and sagittal T2 weighted SE-sequences. If there is a predilection for the outer or inner surfaces of the brainstem, such lesions can be considered an additional typical feature of multiple sclerosis and can be more reliably weighted as paraclinical evidence for a definite diagnosis. (orig.)

Practice Change in Community Pharmacy: A Case Study of Multiple Stakeholders' Perspectives

Directory of Open Access Journals (Sweden)

Shara Elrod

2012-01-01

Full Text Available Objective: To obtain a multi-stakeholder perspective of community pharmacy practice change. Design: Qualitative study. Setting: Community pharmacy in rural Mississippi. Participants: Fourteen key stakeholders of the patient care practice including pharmacists (n=4, support staff (n=2, collaborating providers (n=4, patients (n=3, and a payer (n=1. Intervention: Semi-structured interviews and participant-observation techniques were used. Main outcome measures: Description of the community pharmacy's practice and business model and identification of practice change facilitators. Results: Change facilitators for this practice included: a positive reputation in the community, forming solid relationships with providers, and convenience of patient services. Communication in and outside of the practice, adequate reimbursement, and resource allocation were identified as challenges. Conclusions: This case study is a multi-stakeholder examination of community pharmacy practice change and readers are provided with a real-world example of a community pharmacy's successful establishment of a patient care practice.   Type: Case Study

Methodology for Selecting Best Management Practices Integrating Multiple Stakeholders and Criteria. Part 2: Case Study

Directory of Open Access Journals (Sweden)

Mauricio Carvallo Aceves

2016-02-01

Full Text Available The selection of stormwater Best Management Practices (BMPs for mitigating the effects of urbanization on the hydrological cycle could be a complex process due to conflicting stakeholder views, and varying levels of performance of BMPs across a range of criteria (runoff reduction, erosion control, etc.. Part 1 of this article proposed a methodology based on the application of multi-criteria decision aid (MCDA methods, which was tested here on a residential stormwater network in the Montreal area. The case study considered green roofs, rain gardens, rain barrels and pervious pavement over a range of economic, social, and water quality and quantity criteria by applying 4 MCDA methods under three different stakeholder views. The results indicated Elimination et Choix Traduisant la Réalité (ELECTRE III to be the most appropriate method for the methodology, presenting flexibility concerning threshold values, criteria weights, and showing shared top choices across stakeholders (rain gardens, and rain gardens in combination with pervious pavement. The methodology shows potential for more formal applications and research opportunities. Future work may lie in the inclusion of multiple objective optimization, better stakeholder engagement, estimation of economic benefits, water quality modeling, long-term hydrological simulations, and estimating real BMP pollutant removal rates.

The Glioma International Case-Control Study

DEFF Research Database (Denmark)

Amirian, E. Susan; Armstrong, Georgina N; Zhou, Renke

2016-01-01

Decades of research have established only a few etiological factors for glioma, which is a rare and highly fatal brain cancer. Common methodological challenges among glioma studies include small sample sizes, heterogeneity of tumor subtypes, and retrospective exposure assessment. Here, we briefly...... describe the Glioma International Case-Control (GICC) Study (recruitment, 2010-2013), a study being conducted by the Genetic Epidemiology of Glioma International Consortium that integrates data from multiple data collection sites, uses a common protocol and questionnaire, and includes biospecimen...

The multiple brain abscesses associated with congenital pulmonary arteriovenous malformations: a case report.

OpenAIRE

Han, Seok; Lim, Dong-Jun; Chung, Yong-Gu; Cho, Tai-Hyoung; Lim, Seong-Jun; Kim, Woo-Jae; Park, Jung-Yul; Suh, Jung-Keun

2002-01-01

In this report, we describe a case of multiple brain abscesses associated with diffuse congenital pulmonary arteriovenous malformations (PAVM). Although the cases of brain abscesses associated with congenital PAVM are very rare, the brain abscess could be an initial clinical manifestation in asymptomatic PAVM as in the case presented in this report. PAVM may contribute to the development of a brain abscess by allowing easy bacterial access to systemic circulation through the right-to-left pul...

Professional practice of dietitians in the Brazilian School Feeding Program: A multiple case study

Directory of Open Access Journals (Sweden)

Patrícia Fernanda Ferreira PIRES

Full Text Available ABSTRACT Objective: To assess dietician’s numerical parameters for school feeding and discuss limitations and possibilities for professional practice in the municipalities of Vale do Ivaí, in Northern Paraná, Brazil. Methods: This is a multiple case study. A semi-structured interview was administered to dietitians working at the School Feeding Program in nine cities located in Vale do Ivaí, Paraná, Brazil. Resolution nº 465/2010, from the Brazilian Federal Board of Dietitians, was used to calculate the adequacy of working hours of dietitians. The legistation of the Brazilian School Feeding Program was applied to discuss professional practice. Results: All the cities had at least one dietitian responsible for the School Feeding Program. The percentage of adequate working hours was from 20 to 66%. Some dietitians were involved in management activities, administration, procurement, and accounting, in addition to dietitian assignments for the School Feeding Program. Most dietitians worked in other sectors of the municipalities such as the health system, social assistance, and at events. This practice could compromise compliance of technical activities that must be met by the dietitians of the School Feeding Program. Conclusion: The number of dietitians in most of cities working at School Feeding Program is not sufficient to meet the number of students. The insuficient workload and excessive activities could hinder the development of dietitian’s private activities. The hiring of nutrition and dietitian technicians and administrative assistants for bureaucratic activies is recommended.

Female entrepreneurship and challenges faced by women entrepreneurs to reconcile conflicts between work and family: multiple case study in travel agencies

Directory of Open Access Journals (Sweden)

Rivanda Meira Teixeira

2016-03-01

Full Text Available Women have gained more and more space in various professional areas and this development also occurs in the field of entrepreneurship. In Brazil GEM 2013 identified for the first time, that the number of new woman entrepreneurs was higher than male entrepreneurs. However, it is recognized that women entrepreneurs face many difficulties when trying to reconcile their companies with the family. The main objective of this research is to analyse the challenges faced by women entrepreneurs of travel agencies to reconcile the conflict between work and family. This study adopted the multiple cases research strategy and were selected seven women creators and managers of travel agencies in the cities of Aracaju and the Barra dos Coqueiros, in the state of Sergipe (east coast of Brazil. In an attempt to reconcile well the multiple roles these women often face the frustration and guilt. At this moment, it shows the importance of emotional contribution of husband and children. It is noticed that the search for balance between the conflicting demands generate emotional distress and / or physical.

Case-Based Instructional Practices: A Multiple-Case Study from Torts, Marketing, and Online Instructional Design Classes

Science.gov (United States)

Jung, Ji yoon

2017-01-01

The purpose of this study is to provide a comprehensive account on case-based instructional practices. Semester-long participant observation records in torts, marketing, and online instructional design classes, instructor interviews, course syllabi and teaching materials were used to describe the within-class complexity of the practices in terms…

Jejunal Gastric Heterotopia causing Multiple Strictures and Perforation Peritonitis- A Case Report with Review of Literature.

Science.gov (United States)

Vani, M; Nambiar, Ajit; Geetha, K; Kundil, Byju

2017-03-01

Gastric heterotopias beyond the ligament of Treitz though rare, should be thought of in the differential diagnosis of polypoid lesions presenting with gastrointestinal bleed or obstructive symptoms especially in children and in the young. Here is a 24-year-old male with multifocal jejunal gastric heterotopias causing multiple strictures and perforation peritonitis. Patient presented with acute abdomen pain and an emergency laparotomy was performed revealing jejunum with multiple strictures and perforation, followed by jejunal resection. On gross examination polypoid mucosa was noted at the stricture sites which showed heterotopic gastric mucosa on microscopy. Jejunal gastric heterotopias are extremely rare with less than ten reported cases and those presenting with multiple strictures are even rarer. To our knowledge this is the second case of jejunal gastric heterotopia presenting with multiple strictures.

An Examination of Fluoxetine for the Treatment of Selective Mutism Using a Nonconcurrent Multiple-Baseline Single-Case Design Across 5 Cases.

Science.gov (United States)

Barterian, Justin A; Sanchez, Joel M; Magen, Jed; Siroky, Allison K; Mash, Brittany L; Carlson, John S

2018-01-01

This study examined the utility of fluoxetine in the treatment of 5 children, aged 5 to 14 years, diagnosed with selective mutism who also demonstrated symptoms of social anxiety. A nonconcurrent, randomized, multiple-baseline, single-case design with a single-blind placebo-controlled procedure was used. Parents and the study psychiatrist completed multiple methods of assessment including Direct Behavior Ratings and questionnaires. Treatment outcomes were evaluated by calculating effect sizes for each participant as an individual and for the participants as a group. Information regarding adverse effects with an emphasis on behavioral disinhibition and ratings of parental acceptance of the intervention was gathered. All 5 children experienced improvement in social anxiety, responsive speech, and spontaneous speech with medium to large effect sizes; however, children still met criteria for selective mutism at the end of the study. Adverse events were minimal, with only 2 children experiencing brief occurrences of minor behavioral disinhibition. Parents found the treatment highly acceptable.

On using the Multiple Signal Classification algorithm to study microbaroms

Science.gov (United States)

Marcillo, O. E.; Blom, P. S.; Euler, G. G.

2016-12-01

Multiple Signal Classification (MUSIC) (Schmidt, 1986) is a well-known high-resolution algorithm used in array processing for parameter estimation. We report on the application of MUSIC to infrasonic array data in a study of the structure of microbaroms. Microbaroms can be globally observed and display energy centered around 0.2 Hz. Microbaroms are an infrasonic signal generated by the non-linear interaction of ocean surface waves that radiate into the ocean and atmosphere as well as the solid earth in the form of microseisms. Microbaroms sources are dynamic and, in many cases, distributed in space and moving in time. We assume that the microbarom energy detected by an infrasonic array is the result of multiple sources (with different back-azimuths) in the same bandwidth and apply the MUSIC algorithm accordingly to recover the back-azimuth and trace velocity of the individual components. Preliminary results show that the multiple component assumption in MUSIC allows one to resolve the fine structure in the microbarom band that can be related to multiple ocean surface phenomena.

The Initial Rise Method in the case of multiple trapping levels

International Nuclear Information System (INIS)

Furetta, C.; Guzman, S.; Cruz Z, E.

2009-10-01

The aim of the paper is to extent the well known Initial Rise Method (IR) to the case of multiple trapping levels. The IR method is applied to the minerals extracted from Nopal herb and Oregano spice because the thermoluminescent glow curves shape suggests a trap distribution instead of a single trapping level. (Author)

The Initial Rise Method in the case of multiple trapping levels

Energy Technology Data Exchange (ETDEWEB)

Furetta, C. [Centro de Investigacion en Ciencia Aplicada y Tecnologia Avanzada, IPN, Av. Legaria 694, Col. Irrigacion, 11500 Mexico D. F. (Mexico); Guzman, S.; Cruz Z, E. [Instituto de Ciencias Nucleares, UNAM, A. P. 70-543, 04510 Mexico D. F. (Mexico)

2009-10-15

The aim of the paper is to extent the well known Initial Rise Method (IR) to the case of multiple trapping levels. The IR method is applied to the minerals extracted from Nopal herb and Oregano spice because the thermoluminescent glow curves shape suggests a trap distribution instead of a single trapping level. (Author)

Case Study: Testing with Case Studies

Science.gov (United States)

Herreid, Clyde Freeman

2015-01-01

This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This month's issue discusses using case studies to test for knowledge or lessons learned.

Treatment of multiple unresectable basal cell carcinomas from Gorlin-Goltz syndrome: a case report.

Science.gov (United States)

Ojevwe, Fidelis O; Ojevwe, Cindy D; Zacny, James P; Dudek, Arkadiusz Z; Lin, Amy; Kohlitz, Patrick

2015-03-01

Nevoid basal cell carcinoma syndrome (NBCCS), which is also known by other names, including Gorlin-Goltz syndrome and multiple basal-cell carcinoma (BCC) syndrome, is a rare multi-systemic disease inherited in a dominant autosomal manner with complete penetrance and variable expressivity. The main clinical manifestations include multiple BCCs, odontogenic keratocysts of the jaw, hyperkeratosis of the palms and soles, skeletal abnormalities, intracranial calcifications and facial deformities. A 31-year-old male diagnosed with Gorlin-Goltz syndrome with multiple unresectable facial BCCs was treated with the Hedgehog inhibitor vismodegib. After one month of therapy on vismodegib, there were significant reductions in the size of multiple BCCs on the patient's face. The patient remains on this therapy. Hedgehog pathway inhibition is an effective strategy to treat unresectable BCCs from Gorlin-Goltz syndrome. Although vismodegib shows some promising clinical results in the early phase of its use, there are concerns of possible resistance developing within months. Duration of therapy, role of maintenance treatment and drug modification to reduce resistance need to be explored in future case studies. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Multiple Mucous Retention Cysts (Mucocele of the Oral Mucosa: A Case Report

Directory of Open Access Journals (Sweden)

Gholamreza Jahanshahi

2007-01-01

Full Text Available To our knowledge, the occurrence of multiple mucoceles is not very common. This case report presents a 62-year-old man with multiple nodules on the upper and lower labial mucosa as well as both buccal mucosae with unknown history. Histopathology evaluation showed minor salivary gland ducts dilated to the point of cyst formation. The cysts seemed to be formed either as a result of dilatation of salivary ducts due to altered secretion or because of an acquired or congenital weakness in the ductal structure. The physiopathology of these findings is discussed.

Airport Managers' Perspectives on Security and Safety Management Systems in Aviation Operations: A Multiple Case Study

Science.gov (United States)

Brown, Willie L., Jr.

Global terrorism continues to persist despite the great efforts of various countries to protect and safely secure their citizens. As airports form the entry and exit ports of a country, they are one of the most vulnerable locations to terror attacks. Managers of international airports constantly face similar challenges in developing and implementing airport security protocols. Consequently, the technological advances of today have brought both positive and negative impacts on security and terrorism of airports, which are mostly managed by the airport managers. The roles of the managers have greatly increased over the years due to technological advances. The developments in technology have had different roles in security, both in countering terrorism and, at the same time, increasing the communication methods of the terrorists. The purpose of this qualitative multiple case study was to investigate the perspectives of airport managers with regard to societal security and social interactions in the socio-technical systems of the National Terrorism Advisory System (NTAS). Through the data gained regarding managers' perception and experiences, the researcher hoped to enable the development of security measures and policies that are appropriate for airports as socio-technical systems. The researcher conducted interviews with airport managers to gather relevant data to fulfill the rationale of the study. Ten to twelve airport managers based in three commercial aviation airports in Maryland, United States participated in the study. The researcher used a qualitative thematic analysis procedure to analyze the data responses of participants in the interview sessions.

Epidemiology of multiple congenital anomalies in Europe: A EUROCAT population-based registry study

DEFF Research Database (Denmark)

Calzolari, Elisa; Barisic, Ingeborg; Loane, Maria

2014-01-01

BACKGROUND: This study describes the prevalence, associated anomalies, and demographic characteristics of cases of multiple congenital anomalies (MCA) in 19 population-based European registries (EUROCAT) covering 959,446 births in 2004 and 2010. METHODS: EUROCAT implemented a computer algorithm f...

A case of multiple sclerosis with multi-ring-like and butterfly-like enhancement on computerized tomography

International Nuclear Information System (INIS)

Morimoto, Takehiko; Nagao, Hideo; Sano, Nozomi; Habara, Shinji; Takahashi, Mitsugi; Matsuda, Hiroshi; Beppu, Keiko; Shoda, Takaaki

1985-01-01

We report a case of multiple sclerosis in which CT showed multiple ring-like enhancement and butterfly-like distribution of a low density area with marginal enhancement. The latter finding is found in other demyelinating disorders but is less common in tumors or abscesses. Therefore, it seems to have some diagnostic value in multiple sclerosis. (author)

Staff and students' perceptions and experiences of teaching and assessment in Clinical Skills Laboratories: interview findings from a multiple case study.

Science.gov (United States)

Houghton, Catherine E; Casey, Dympna; Shaw, David; Murphy, Kathy

2012-08-01

The Clinical Skills Laboratory has become an essential structure in nurse education and several benefits of its use have been identified. However, the literature identifies the need to examine the transferability of skills learned there into the reality of practice. This research explored the role of the Clinical Skills Laboratory in preparing nursing students for the real world of practice. This paper focuses specifically on the perceptions of the teaching and assessment strategies employed there. Qualitative multiple case study design. Five case study sites. Interviewees (n=58) included academic staff, clinical staff and nursing students. Semi-structured interviews. The Clinical Skills Laboratory can provide a pathway to practice and its authenticity is significant. Teaching strategies need to incorporate communication as well as psychomotor skills. Including audio-visual recording into assessment strategies is beneficial. Effective relationships between education institutions and clinical settings are needed to enhance the transferability of the skills learned. The Clinical Skills Laboratory should provide an authentic learning environment, with the appropriate use of teaching strategies. It is crucial that effective links between educators and clinical staff are established and maintained. Copyright © 2011 Elsevier Ltd. All rights reserved.

Studies of the Seasonal Pattern of Multiple Maternities.

Science.gov (United States)

Fellman, Johan

2017-06-01

The seasonality of population data has been of great interest in demographic studies. When seasonality is analyzed, the population at risk plays a central role. In a study of the monthly number of births and deaths, the population at risk is the product of the size of the population and the length of the month. Usually, the population can be assumed to be constant, and consequently, the population at risk is proportional to the length of the month. Hence, the number of cases per day has to be analyzed. If one studies the seasonal variation in twin or multiple maternities, the population at risk is the total number of monthly confinements, and the study should be based on the rates of the multiple maternities. Consequently, if one considers monthly twinning rates, the monthly number of birth data is eliminated and one obtains an unaffected seasonality measure of the twin maternities. The strength of the seasonality is measured by a chi-squared test or by the standard deviation. When seasonal models are applied, one must pay special attention to how well the model fits the data. If the goodness of fit is poor, it can erroneously result in a statement that the seasonality is slight, although the observed seasonal fluctuations are marked.

Multiple cerebral aneurysms of middle cerebral artery. Case report

Directory of Open Access Journals (Sweden)

D.A. Nica1, Tatiana Rosca1, A. Dinca2, M. Stroi3, Mirela Renta4, A.V. Ciurea5

2010-11-01

Full Text Available Multiple cerebral aneurysms present awide variation in incidence with averages of13% at angiographic studies and 22.7% atautopsy.High blood pressue, cigarette smoking,stress and possible also age and female sexseem to be risk factors for multipleintracranial aneurysms (MIAn in patientsof working age who have suffered asubarachnoid hemorrhage (SAH.Aneurysms were situated on the same sidein one-third of the patients with twoaneurysms and the most common site wasthe middle cerebral artery (MCA. Tomanage these challenging lesionsneurosurgeons must use all availableinnovations and advances, includingdiagnostic, technical and perioperativeadjuncts. The author presents a case ofmiddle age female, with two saccularaneurysms situated on the same side (rightMCA, who was operated in our clinic, 20days after first SAH episode, I grade onHunt/Hess scale. The angio MRI wasperformed before, and control DSangiography after operation. After pterionalapproach, the author used themagnification, microsurgical technics,temporal clip, and two permanent Yasargilcurved clips. A postoperative good recoveryenable the patient go to work and drive onemonth later.

Multiple homicides.

Science.gov (United States)

Copeland, A R

1989-09-01

A study of multiple homicides or multiple deaths involving a solitary incident of violence by another individual was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida, during 1983-1987. A total of 107 multiple homicides were studied: 88 double, 17 triple, one quadruple, and one quintuple. The 236 victims were analyzed regarding age, race, sex, cause of death, toxicologic data, perpetrator, locale of the incident, and reason for the incident. This article compares this type of slaying with other types of homicide including those perpetrated by serial killers. Suggestions for future research in this field are offered.

Childhood Trauma and Multiple Personality Disorder: The Case of a 9-Year-Old Girl.

Science.gov (United States)

LaPorta, Lauren D.

1992-01-01

This paper reports the case of a nine-year-old female victim of sexual abuse, evaluated and diagnosed with multiple personality disorder over a six-month period. Included is a description of the child's presentation with historical and developmental data. A discussion of the dynamic and predisposing features of the case follows, along with…

Mantle cell lymphoma of the gastrointestinal tract presenting with multiple intussusceptions – case report and review of literature

Directory of Open Access Journals (Sweden)

Abo Stephen M

2009-07-01

Full Text Available Abstract Background Mantle cell lymphoma (MCL is an aggressive type of B-cell non-Hodgkin's lymphoma that originates from small to medium sized lymphocytes located in the mantle zone of the lymph node. Extra nodal involvement is present in the majority of cases, with a peculiar tendency to invade the gastro-intestinal tract in the form of multiple lymphomatous polyposis. MCL can be accurately diagnosed with the use of the highly specific marker Cyclin D1. Few cases of mantle cell lymphoma presenting with intussuception have been reported. Here we present a rare case of multiple intussusceptions caused by mantle cell lymphoma and review the literature of this disease. Case presentation A 68-year-old male presented with pain, tenderness in the right lower abdomen, associated with nausea and non-bilious vomiting. CT scan of abdomen revealed ileo-colic intussusception. Laparoscopy confirmed multiple intussusceptions involving ileo-colic and ileo-ileal segments of gastrointestinal tract. A laparoscopically assisted right hemicolectomy and extended ileal resection was performed. Postoperative recovery was uneventful. The histology and immuno-histochemistry of the excised small and large bowel revealed mantle cell lymphoma with multiple lymphomatous polyposis and positivity to Cyclin D1 marker. The patient was successfully treated with Rituximab-CHOP chemotherapy and remains in complete remission at one-year follow-up. Conclusion This is a rare case of intestinal lymphomatous polyposis due to mantle cell lymphoma presenting with multiple small bowel intussusceptions. Our case highlights laparoscopic-assisted bowel resection as a potential and feasible option in the multi-disciplinary treatment of mantle cell lymphoma.

Systemic amyloidosis due to unknown multiple myeloma in small bowel pseudo-obstruction: case report

Directory of Open Access Journals (Sweden)

Giuseppe Caparrotti

2016-03-01

Full Text Available Amyloidosis is a pathologic diagnosis characterized by extracellular deposition of insoluble protein fibrils in various organs and tissues. There are two main forms of amyloidosis, primary amyloidosis, and secondary amyloidosis. Gastrointestinal involvement is common in both amyloidosis forms. We describe the case of a 78-year-old woman taken to the operating room for small bowel obstruction, found to have pseudo-obstruction and enteritis. Exploratory laparotomy revealed gastric mass and histological examen showed extensive amyloid deposition consistent with amyloidosis. Hematological evaluation revealed unknown multiple myeloma. This case report and literature data suggest to perform a hematological examination in patients with amyloidosis diagnosis to exclude a multiple myeloma or other plasma cell disorders

Peripheral (Seventh Nerve Palsy and Multiple Sclerosis: A Diagnostic Dilemma - A Case Report

Directory of Open Access Journals (Sweden)

Christian Saleh

2016-01-01

Full Text Available During the last decades, only a few cases on the association between peripheral demyelinating diseases and multiple sclerosis (MS have been reported. We describe the case of a young man who was initially diagnosed with Bell's palsy, and only after performing a brain MRI was the diagnosis of MS made. We review the literature and discuss some pitfalls which may lead to missing the diagnosis of MS.

Feasibility study for remote assessment of cognitive function in multiple sclerosis.

Science.gov (United States)

George, Michaela F; Holingue, Calliope B; Briggs, Farren B S; Shao, Xiaorong; Bellesis, Kalliope H; Whitmer, Rachel A; Schaefer, Catherine; Benedict, Ralph Hb; Barcellos, Lisa F

2016-01-01

Cognitive impairment is common in multiple sclerosis (MS), and affects employment and quality of life. Large studies are needed to identify risk factors for cognitive decline. Currently, a MS-validated remote assessment for cognitive function does not exist. Studies to determine feasibility of large remote cognitive function investigations in MS have not been published. To determine whether MS patients would participate in remote cognitive studies. We utilized the Modified Telephone Interview for Cognitive Status (TICS-M), a previously validated phone assessment for cognitive function in healthy elderly populations to detect mild cognitive impairment. We identified factors that influenced participation rates. We investigated the relationship between MS risk factors and TICS-M score in cases, and score differences between cases and control individuals. The TICS-M was administered to MS cases and controls. Linear and logistic regression models were utilized. 11.5% of eligible study participants did not participate in cognitive testing. MS cases, females and individuals with lower educational status were more likely to refuse (pTICS-M score among cases (pTICS-M score was significantly lower in cases compared to controls (p=0.007). Our results demonstrate convincingly that a remotely administered cognitive assessment is quite feasible for conducting large epidemiologic studies in MS, and lay the much needed foundation for future work that will utilize MS-validated cognitive measures.

Multiple primary cancer

International Nuclear Information System (INIS)

Jung, Gyu Sik; Lee, Ouk; Kim, So Sun; Kim, Ho Joon; Chun, Byung Hee; Joh, Young Duck

1989-01-01

It is rare for one human being to be afflicted with more than one cancer. However with further advances in therapeutic regimens, histopathologic observation, diagnostic modalities, and increased curiosity, there are increasing number of case reports of multiple primary cancer. The present study evaluates 25 histologically confirmed cases of multiple primary cancer from 1974 to 1988 at Kosin Medical Center. The most frequent site of the first primary cancer in male was stomach and in female, uterine cervix. The first primary cancer in female occurred in endocrine-related organs (breast, uterus and thyroid) in 63.6 percent. Synchronous cancers are diagnosed simultaneously or within an interval of about six months and synchronous cancers were 16 out of 25 cases. Metachronous cancers are diagnosed at interval of more than six months. There were 9 metachronous cancers and average interval between the first and second primary cancer was 22.8 months. The incidence of multiple primary cancer was 0.11 percent. The average age was 51.9 years at the time of the first primary cancer (53.1 years in male and 50.3 years in female). CT scan was most helpful in early detection of multiple primary cancers facilitating biopsy and surgery. Multiple primary cancers are beyond the medical curiosity. Early diagnosis of the disease and careful follow-up study, based on an awareness of the possibility of second cancers, will substantially increase the survival of these patients

Acute gouty arthritis and rapidly progressive renal failure as manifestation of multiple myeloma: clinical case description

Directory of Open Access Journals (Sweden)

O.V. Gudym

2017-08-01

Full Text Available The article describes a clinical case of multiple myeloma in 78-year-old man, its clinical onset was as an acute attack of gout. The patient was admitted to hospital due to the development of the first acute attack of gout. The attack was characterized by polyarthricular joint lesion of the upper and lower extremities, pronounced inflammatory reaction, insufficient response to the use of non-steroidal anti-inflammatory drugs, and a high level of hyperuricemia. The serum uric acid concentration ranged from 636 to 712 μmol/l. The study of the synovial fluid of the inflamed knee joint made it possible to reveal uric acid crystals and to confirm the diagnosis of acute gouty arthritis. Simultaneously, the patient had significant renal impairment: creatinine was 574 μmol/l, urea — 39.9 mmol/l, glomerular filtration rate according to CKD-EPI — 8 ml/min. The daily proteinuria was 1.8 g. A retrospective assessment of laboratory parameters allowed to reveal completely normal indicators of renal function 6 months ago. Considering the development of acute gouty arthritis, its polyarticular nature, persistent course, rapid involvement of new joints, high uric acid levels during an acute attack exceeding 600 μmol/l (10 mg/dL, rapid development of renal failure within 6 months until the terminal stage, it was suggested the secondary nature of gout on the background of kidney damage by another pathological process. Further clinical, laboratory and instrumental studies allowed verifying multiple myeloma with renal damage. Bence Jones protein in the urine was not detected, there was also no evidence of hyperproteinemia. However, pain in the spine, ribs and chest was the basis for carrying out an X-ray study of the bones of the skeleton. Changes in the skeleton typical for multiple myeloma have been identified. Myelogram showed a high content of plasma cells (21.1 %, electrophoresis of blood proteins showed a high M-gradient (30.42 %, and a cytochemical

Coding Response to a Case-Mix Measurement System Based on Multiple Diagnoses

Science.gov (United States)

Preyra, Colin

2004-01-01

Objective To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Data Sources Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Study Design Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Principal Findings Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Conclusions Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post. PMID:15230940

Walker devices and microswitch technology to enhance assisted indoor ambulation by persons with multiple disabilities: three single-case studies.

Science.gov (United States)

Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Oliva, Doretta; Campodonico, Francesca; Buono, Serafino

2013-07-01

These three single-case studies assessed the use of walker devices and microswitch technology for promoting ambulation behavior among persons with multiple disabilities. The walker devices were equipped with support and weight lifting features. The microswitch technology ensured that brief stimulation followed the participants' ambulation responses. The participants were two children (i.e., Study I and Study II) and one man (i.e., Study III) with poor ambulation performance. The ambulation efforts of the child in Study I involved regular steps, while those of the child in Study II involved pushing responses (i.e., he pushed himself forward with both feet while sitting on the walker's saddle). The man involved in Study III combined his poor ambulation performance with problem behavior, such as shouting or slapping his face. The results were positive for all three participants. The first two participants had a large increase in the number of steps/pushes performed during the ambulation events provided and in the percentages of those events that they completed independently. The third participant improved his ambulation performance as well as his general behavior (i.e., had a decline in problem behavior and an increase in indices of happiness). The wide-ranging implications of the results are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.

Breast Cancer and Modifiable Lifestyle Factors in Argentinean Women: Addressing Missing Data in a Case-Control Study

Science.gov (United States)

Coquet, Julia Becaria; Tumas, Natalia; Osella, Alberto Ruben; Tanzi, Matteo; Franco, Isabella; Diaz, Maria Del Pilar

2016-01-01

A number of studies have evidenced the effect of modifiable lifestyle factors such as diet, breastfeeding and nutritional status on breast cancer risk. However, none have addressed the missing data problem in nutritional epidemiologic research in South America. Missing data is a frequent problem in breast cancer studies and epidemiological settings in general. Estimates of effect obtained from these studies may be biased, if no appropriate method for handling missing data is applied. We performed Multiple Imputation for missing values on covariates in a breast cancer case-control study of Córdoba (Argentina) to optimize risk estimates. Data was obtained from a breast cancer case control study from 2008 to 2015 (318 cases, 526 controls). Complete case analysis and multiple imputation using chained equations were the methods applied to estimate the effects of a Traditional dietary pattern and other recognized factors associated with breast cancer. Physical activity and socioeconomic status were imputed. Logistic regression models were performed. When complete case analysis was performed only 31% of women were considered. Although a positive association of Traditional dietary pattern and breast cancer was observed from both approaches (complete case analysis OR=1.3, 95%CI=1.0-1.7; multiple imputation OR=1.4, 95%CI=1.2-1.7), effects of other covariates, like BMI and breastfeeding, were only identified when multiple imputation was considered. A Traditional dietary pattern, BMI and breastfeeding are associated with the occurrence of breast cancer in this Argentinean population when multiple imputation is appropriately performed. Multiple Imputation is suggested in Latin America’s epidemiologic studies to optimize effect estimates in the future. PMID:27892664

Social influences on adolescents' dietary behavior in Catalonia, Spain: A qualitative multiple-cases study from the perspective of social capital.

Science.gov (United States)

Carrillo-Álvarez, Elena; Riera-Romaní, Jordi; Canet-Vélez, Olga

2018-04-01

Adolescence has been referred to as the last best chance to prevent adult non-communicable diseases. Gaining further evidence on the psychosocial determinants of health behaviors, particularly the impact of peers, social networks and media on diet, is necessary to develop appropriate preventive strategies. Based on a multiple-cases study, our aim was to discuss the social influences on adolescents' dietary behavior from a social capital perspective. Participants were reached through four high-schools in different Catalan rural-urban and socioeconomic contexts. Our results confirm the different layout of social capital in the community, school, peers and family. In our sample, family and peers are the most influent sources of social capital in relation to dietary behaviors, inducing both protective and damaging effects. Copyright © 2018 Elsevier Ltd. All rights reserved.

Finding the Little 'c' in Physics: A Multiple Case Study Examining the Development of Creative Activities in the Physics Classroom

Science.gov (United States)

Wheeler, Christopher

This study focused on how physics teachers develop and implement activities that promote creative thinking strategies in the standards based physics classroom. A particular focus was placed on every day or little "c", creativity, which can be taught in the high school classroom. The study utilized a multiple case study design, which allows for in-depth study in a variety of settings. Four participants from various high schools were identified utilizing administrator recommendations. Data were then collected via interviews, observations, and documents. The data were coded and analyzed for emerging themes. The themes were then merged to determine findings to the stated research questions. The research demonstrated the importance of modifying activities for student interest and understanding through effective use of scientific inquiry. The past experiences and professional development of the participants served as a vital piece to the development of their educational pedagogy especially concerning inquiry and questioning strategies. It was also established that an unstructured, positive classroom environment is a vital aspect of teaching while supporting creative thinking skills.

Prevalence of multiple sclerosis in Verona, Italy: an epidemiological and genetic study.

Science.gov (United States)

Gajofatto, A; Stefani, A; Turatti, M; Bianchi, M R; Lira, M G; Moretto, G; Salviati, A; Benedetti, M D

2013-04-01

Recent multiple sclerosis (MS) prevalence studies classify Italy as a high-risk area without intra-regional latitude effect. To determine MS prevalence in Verona, Italy, and frequency of myelin oligodendrocyte glycoprotein (MOG) gene G511C polymorphism and HLA-DRB1*15 locus in a sample of cases and healthy controls. The study area population on the prevalence date (31 December 2001) was 253208 (133508 women, 119700 men). Multiple case sources were examined. Patients fulfilling McDonald's criteria (2001) were included. Crude, age- and sex-specific prevalence rates were computed. MOG G511C polymorphism and HLA-DRB1*15 were determined by standard methods. We identified 270 cases of MS yielding a crude prevalence rate of 106.6/100000 (95% CI: 94-120). Prevalence was higher in women (140.8/100000) than in men (68.5/100000). The age-adjusted prevalence rate standardized to the European population was 96.0/100000. MOG G511C polymorphism did not differ between cases and controls. HLA-DRB1*15 frequency was 58/155 (37%) in cases and 24/157 (15%) in controls (P<0.001). There was no HLA-DRB1*15 influence on susceptibility to other autoimmune disorders. The high MS prevalence in Verona confirms Italy as a high-risk area with a homogenous distribution across the country. HLA-DRB1*15 is a relevant MS susceptibility locus in the Italian population, possibly with little influence on the occurrence of concomitant autoimmune disorders. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

A Case Study of Learning, Motivation, and Performance Strategies for Teaching and Coaching CDE Teams

Science.gov (United States)

Ball, Anna; Bowling, Amanda; Bird, Will

2016-01-01

This intrinsic case study examined the case of students on CDE (Career Development Event) teams preparing for state competitive events and the teacher preparing them in a school with a previous exemplary track record of winning multiple state and national career development events. The students were interviewed multiple times during the 16-week…

Sociocultural and Demographic Risk Factors for the Development of Multiple Sclerosis in Kuwait: A Case - Control Study.

Directory of Open Access Journals (Sweden)

Suhail N Al-Shammri

Full Text Available Immunological, genetic and environmental factors are believed to play important roles in the pathogenesis of Multiple Sclerosis (MS. There have been many studies on risk factors for MS but these have been mainly in Caucasian populations; robust studies in Arab populations remain relatively uncommon. This study therefore aimed to identify behavioral, socio-cultural, and demographic factors associated with development of MS in Kuwait, a high income Arab country, currently undergoing a demographic transition.In this case- control study, 195 Kuwaiti MS patients and 146 healthy age and sex-matched controls were recruited. Both groups of subjects were interviewed using a structured questionnaire, in relation to anthropometric, socio-cultural and demographic data, residence during the 1990/91 Gulf War and current and past medical history, including medications. We also clinically evaluated, and retrospectively reviewed medical records of patients to derive appropriate clinical information, including associated chronic medical illness requiring long-term treatment.On multiple logistic regression analysis after adjustment for potential confounders including age, gender and BMI, in all the subjects, a positive associations prevail with presence of MS and some sociocultural and demographic factors, which included non-Bedouin ethnicity (AOR 2, 95% CI 1.0-3.9, p 0.049, positive family history of MS (AOR 10.6, 95% CI 3.0-36.9, p < 0.001, and low daily sunlight exposure of < 15min/day (AOR 5.3, 95% CI 2.7-10.5 p < 0.001. In addition, while 41.8% of MS patients indicated at least one comorbidity, only 26.8% of the controls reported any associated physical illness, with the suggestion that presence of certain comorbidities might increase MS risk (AOR 2.4, 95% CI 1.3-4.7, p < 0.001. Other risk variables such as smoking status and mode of routine outdoor dressing were not significant in all the MS subjects taken as a whole, but demonstrated variably positive

Multiple sclerosis in the Faroe Islands. 7. Results of a case control questionnaire with multiple controls

DEFF Research Database (Denmark)

Kurtzke, J F; Hyllested, K; Arbuckle, J D

1997-01-01

Detailed questionnaires were completed in 1978-79 by 23 of the 28 then known resident Faroese multiple sclerosis (MS) patients and 127 controls. These controls were divided into 69 Group A (patient sibs and other relatives), 37 Group B (matched neighbor controls, their spouses and sibs, plus...... facilities, and nature of house construction or heating. Detailed dietary histories, available for half the subjects, revealed no differences, cases versus controls, for four age periods between age 0 and 30 years, and for 16 specified foodstuffs. Animal exposures showed overall no consistent differences...

Connections Between Future Time Perspectives and Self-Regulated Learning for Mid-Year Engineering Students: A Multiple Case Study

Science.gov (United States)

Chasmar, Justine

This dissertation presents multiple studies with the purpose of understanding the connections between undergraduate engineering students' motivations, specifically students' Future Time Perspectives (FTPs) and Self-Regulated Learning (SRL). FTP refers to the views students hold about the future and how their perceptions of current tasks are affected by these views. SRL connects the behaviors, metacognition, and motivation of students in their learning. The goals of this research project were to 1) qualitatively describe and document engineering students' SRL strategies, 2) examine interactions between engineering students' FTPs and SRL strategy use, and 3) explore goal-setting as a bridge between FTP and SRL. In an exploratory qualitative study with mid-year industrial engineering students to examine the SRL strategies used before and after an SRL intervention, results showed that students intended to use more SRL strategies than they attempted. However, students self-reported using new SRL strategies from the intervention. Students in this population also completed a survey and a single interview about FTP and SRL. Results showed perceptions of instrumentality of coursework and skills as motivation for using SRL strategies, and a varied use of SRL strategies for students with different FTPs. Overall, three types of student FTP were seen: students with a single realistic view of the future, conflicting ideal and realistic future views, or open views of the future. A sequential explanatory mixed methods study was conducted with mid-year students from multiple engineering majors. First a cluster analysis of survey results of FTP items compared to FTP interview responses was used for participant selection. Then a multiple case study was conducted with data collected through surveys, journal entries, course performance, and two interviews. Results showed that students with a well-defined FTP self-regulated in the present based on their varied perceptions of

Multiplicity distribution and multiplicity moment of black and grey particles in high energy nucleus–nucleus interactions

International Nuclear Information System (INIS)

Ghosh, Dipak; Deb, Argha; Datta, Utpal; Bhattacharyya, S.

2011-01-01

In this paper we have studied the multiplicity distribution of black and grey particles emitted from 16 O–AgBr interactions at 2.1 AGeV and 60 AGeV. We have also calculated the multiplicity moment up to the fifth order for both the interactions and for both kinds of emitted particles. The variation of multiplicity moment with the order number has been investigated. It is seen that in the case of black particles multiplicity moment up to fourth order remains almost constant as energy increases from 2.1 AGeV to 60 AGeV. Fifth order multiplicity moment increases insignificantly with energy. However in the case of grey particles no such constancy of multiplicity moment with energy of the projectile beam is obtained. Later we have extended our study on the basis of Regge–Mueller approach to find the existence of second order correlation during the emission of black as well as the grey particles. The second Mueller moment is found to be positive and it increases as energy increases in the case of black particles. On the contrary in the case of grey particles the second Mueller moment decreases with energy. It can be concluded that as energy increases correlation among the black particles increases. On the other hand with the increase of energy correlation among the grey particles is found to diminish. (author)

A case of multiple intracranial tuberculoma followed by serial computerized tomography

International Nuclear Information System (INIS)

Kummer, R. von; Storch, B.; Krause, K.H.; Rauch, H.

1981-01-01

This is the case report of an Indian living in Europe who suffered from multiple cerebral tuberculomes in connexion with extrapulmonal tuberculosis. The retrogression of the inflammatory granulomes and the surrounding cerebral edema by treatment with tuberculostatics and Dexamethasone was observed by means of computerized tomography (CT) over a period of 8 months. The value of CT in the diagnosis and treatment of cerebral tuberculomes is discussed. The diagnosis of cerebral tuberculomes is difficult as neither the clinical picture nor additional neuroradiological tests ensure safe delimitation against other intracranial growths. In how far this situation has changed by the introduction of CT into diagnostics is discussed by the example of serial computerized tomography on a patient with multiple cerebral tuberculomes. (orig.) [de

First-episode psychosis as the initial presentation of multiple sclerosis: a case report

Directory of Open Access Journals (Sweden)

Enderami A

2018-04-01

Full Text Available Athena Enderami,1 Rose Fouladi,2 Seyed Hamzeh Hosseini3 1Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Sari, Iran; 2Sport Injuries and Corrective Exercise, University of Mazandaran, Mazandaran, Babolsar, Iran; 3Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran Background: Multiple sclerosis (MS is an inflammatory disease that affects the central nervous system (CNS. MS with episode of psychosis is a rare entity, and to the best of our knowledge, no case has been reported from Iran till date. Case presentation: We report a case of MS with first-episode psychosis in a 27-year-old single man with no history of psychiatric disorder or drug abuse. The patient developed neurological symptoms after 3 months and was finally diagnosed as a case of MS. His symptoms started with behavioral dysfunctions and progressively resulted in depression. Subsequently, treatment was performed with citalopram 20 mg daily, risperidone 2 mg three times a day, and biperiden 2 mg three times a day; however, no improvements in the symptoms were observed. T2-weighted magnetic resonance imaging has demonstrated periventricular and white matter multiple sclerotic plugs with lesions. Eventually, MS was diagnosed after the appearance of paresthesia, upper and lower limb muscle weakness, ataxia, and urinary incontinency as typical signs. Then, the medications were changed to methylprednisolone and interferon therapy, which resulted in improvements in the clinical conditions of the patient. Conclusion: Based on the fact that organic disorders such as MS may sometimes appear with initial pure psychiatric symptoms without any neurological signs and symptoms, examinations for symptoms linked to CNS dysfunction, cognitive changes, atypical symptoms, detailed neurological examination, and limited response to conventional antipsychotic drugs are highly

Organisational culture and learning: a case study.

Science.gov (United States)

Bell, Elaine

2013-11-01

To explore the impact organisational cultures have on the learning experience of student nurses and identify the influencing factors. A case study approach was used. The single case being a Defence School of Health Care Studies (DSHCS) and the multiple units of analysis: student nurses, the lecturers and Student Standing Orders. An in depth three dimensional picture was achieved using multiple data collection methods: interview, survey, observation and document analysis. The findings suggest that the DSHCS is perceived to be a sub-culture within a dominant civilian learning culture. Generally, the students and staff believed that the DSHCS is an excellent learning environment and that the defence students overall are high achievers. The common themes that appeared from the data were image, ethos, environment, discipline, support, welfare and a civilian versus military way of thinking. The learning experience of defence student nurses is very positive and enhanced by the positive learning culture of the civilian Higher Educational Institution. The factors influencing a positive learning experience that can be impacted by the overarching culture are discipline, image, ethos of adult learning, support and welfare. Copyright © 2013 Elsevier Ltd. All rights reserved.

The performance of integrated health care networks in continuity of care: a qualitative multiple case study of COPD patients

Directory of Open Access Journals (Sweden)

Sina Waibel

2015-07-01

Full Text Available Background: Integrated health care networks (IHN are promoted in numerous countries as a response to fragmented care delivery by providing a coordinated continuum of services to a defined population. However, evidence on their effectiveness and outcome is scarce, particularly considering continuity across levels of care; that is the patient's experience of connected and coherent care received from professionals of the different care levels over time. The objective was to analyse the chronic obstructive pulmonary disease (COPD patients’ perceptions of continuity of clinical management and information across care levels and continuity of relation in IHN of the public health care system of Catalonia.Methods: A qualitative multiple case study was conducted, where the cases are COPD patients. A theoretical sample was selected in two stages: (1 study contexts: IHN and (2 study cases consisting of COPD patients. Data were collected by means of individual, semi-structured interviews to the patients, their general practitioners and pulmonologists and review of records. A thematic content analysis segmented by IHN and cases with a triangulation of sources and analysists was carried out.Results: COPD patients of all networks perceived that continuity of clinical management was existent due to clear distribution of roles for COPD care across levels, rapid access to care during exacerbations and referrals to secondary care when needed; nevertheless, patients of some networks highlighted too long waiting times to non-urgent secondary care. Physicians generally agreed with patients, however, also indicated unclear distribution of roles, some inadequate referrals and long waiting times to primary care in some networks. Concerning continuity of information, patients across networks considered that their clinical information was transferred across levels via computer and that physicians also used informal communication mechanisms (e-mail, telephone; whereas

Mixed multiplicities for arbitrary ideals and generalized Buchsbaum-Rim multiplicities

International Nuclear Information System (INIS)

Callejas-Bedregal, R.; Jorge Perez, V.H.

2005-12-01

We introduce first the notion of mixed multiplicities for arbitrary ideals in a local d-dimensional noetherian ring (A, m) which, in some sense, generalizes the concept of mixed multiplicities for m-primary ideals. We also generalize Teissier's Product Formula for a set of arbitrary ideals. We also extend the notion of the Buchsbaum-Rim multiplicity (in short, we write BR-multiplicity) of a submodule of a free module to the case where the submodule no longer has finite colength. For a submodule M of A p we introduce a sequence e BR k (M), k = 0,...,d + p - 1 which in the ideal case coincides with the multiplicity sequence c 0 (I, A),...,c d (I, A) defined for an arbitrary ideal I of A by Achilles and Manaresi in [AM]. In case that M has finite colength in A p and it is totally decomposable we prove that our BR-multiplicity sequence essentially falls into the standard BR-multiplicity of M. (author)

Familial atypical multiple mole melanoma syndrome in an adult Indian male-case report and literature review

Directory of Open Access Journals (Sweden)

Radhika C G Raj

2015-01-01

Full Text Available Familial atypical multiple mole melanoma syndrome (FAMMMS is an autosomal dominant genodermatosis characterized by multiple melanocytic nevi, usually more than 50, and a family history of melanoma. It is known to be associated with carcinoma of pancreas and other malignancies involving gastrointestinal tract, breast, lung, larynx, and skin in the kindred. There is no published report of FAMMMS in dark-skinned individuals. We report a case of FAMMMS in a dark-skinned adult Indian male, who had multiple extensive nevi all over the body and oral mucosa; associated with malignant melanoma, squamous cell carcinoma (Marjolin′s ulcer, and carcinoma of pancreas. His father had died of carcinoma of lung and his sister had a partial phenotypic expression. The clinical presentation of the case is discussed with review of literature.

Antithyroid drugs induced agranulocytosis and multiple myeloma: case report and general considerations.

Science.gov (United States)

Dănciulescu Miulescu, R; Carşote, M; Trifănescu, R; Ferechide, D; Poiană, C

2013-09-15

Antithyroid drugs as thionamides are largely used in the treatment of the thyrotoxicosis. Side effects were reported in less than 10% of the cases, especially hematological, hepatic or skin allergies. One of the most severe manifestations is agranulocytosis, probably based on an immune mechanism that is exacerbated by the presence of the thyroid autoimmune disease itself. If the presence of the severe leucopenia is actually an epiphenomenon of a preexisting hematological disturbance as multiple myeloma is debated. The myeloma may also be correlated with an autoimmune predisposition. We present the case of a 56 years old female patient diagnosed with Graves' disease, who developed agranulocytosis after 8 months of therapy with thiamazole. Two months after antithyroid drug's withdrawal, the granulocytes number increased and she received therapy with radioiodine. Two years later she came back for diffuse bone pain that turned out to be caused by a multiple myeloma, confirmed by bone marrow biopsy. It might be a connection between the severe form of leucopenia that the patient developed and the medullar malignancy.

Can dentists detect multiple myeloma through oral manifestations?

Directory of Open Access Journals (Sweden)

Thaís Miranda Xavier de Almeida

2018-01-01

Full Text Available Objective: To review published data on oral manifestations of multiple myeloma. Methods: An electronic database search was performed of articles published from 1971 to November 2016 in order to identify studies that reported oral manifestations of patients with multiple myeloma. Case reports and case series with oral manifestations of multiple myeloma in English were included in the study. An additional search was performed of the references of the selected articles. Results: Thirty-seven articles that reported 81 patients with oral manifestations of multiple myeloma were selected: 30 case reports (82% and seven case series (18%. The most common clinical features in the dental cavity were swelling (65.4%, bone pain (33.3%, paresthesia (27.1% and amyloidosis lesions (11.1%. Osteolytic lesions detected on imaging exams were reported in the majority of the patients (90.1% as plasmacytomas or ‘punched-out’ lesions. Conclusions: Swelling and osteolytic lesions represent the most common clinical and radiographic signs of the jaws relating to multiple myeloma, respectively. Keywords: Multiple Myeloma, Oral Manifestations, Mouth, Jaws

Beyond the City Lights: A Multiple-Case Study of Successful, Experienced Secondary Science Teachers in Rural Schools

Science.gov (United States)

DeVore-Wedding, Beverly R.

Recruitment and retention concerns for teachers, particularly in rural school districts and in science, fill the daily news and research literature. The shortage of STEM workers is also another concern as well. Then why do nationally recognized secondary science teachers remain in rural schools with lower salaries, increased responsibilities beyond teaching content, and multi-preparations, stay in those schools? How do they overcome challenges in their schools? This multiple case study focuses on Presidential Award for Excellence in Mathematics and Science Teaching (PAEMST) awardees who have taught secondary science in rural school districts 10 years or more. Eight rural PAEMST high school science teachers were identified in Nebraska and the six contiguous states; four consented to participate in this study. Interviews of these teachers and a colleague, principal, and or students were conducted to answer the research questions. Using a lens of resiliency, similarities were identified that show how these teachers overcome adversity and thrived in their rural school and communities. Resilient themes that emerged from this study are adaptability, autonomy, collaborative, competency, connectedness, problem-solvers, and resourcefulness. Common themes of success for teaching in rural schools for the four teachers were autonomy and relationships. Common themes of challenges for teaching in rural schools were diversity, funding, professional isolation, and teaching assignments. These characteristics and strategies may help schools with their recruitment and retention of teachers as well as teachers themselves benefiting from hearing other teachers' stories of success and longevity.

Abnormal radiological features in a multiple myeloma patient: a case report and radiological review of myelomas

DEFF Research Database (Denmark)

Ghosh, Sujoy; Wadhwa, P; A, Kumar

2011-01-01

and porotic changes. Primary sclerotic manifestations are rare and occur in only 3% of cases. Although exceptional, multiple myeloma must be borne in mind in the presence of bone sclerosis. This report presents a patient with multiple myeloma with a sunburst/hair-on-end pattern on the radiograph and sclerotic...

Season of infectious mononucleosis as a risk factor for multiple sclerosis: A UK primary care case-control study.

Science.gov (United States)

Downham, Christina; Visser, Elizabeth; Vickers, Mark; Counsell, Carl

2017-10-01

Infectious mononucleosis (IM) and vitamin D deficiency are both risk factors for multiple sclerosis (MS). We wished to establish if IM in the winter months when vitamin D levels are low may be a greater risk factor for MS than IM in the summer months. We identified all patients with MS diagnosed aged 16-60 in a large primary care database in the United Kingdom and matched each by age, sex, general practice and observation period with up to six controls. We identified a coded diagnosis of IM prior to the index date (date of diagnosis). Logistic regression was used to calculate the odds ratio for prior IM exposure in cases versus controls and for winter versus summer exposure in cases and controls with prior IM exposure. Based on 9247 cases and 55,033 matched controls (246 and 846 with prior IM respectively), IM was associated with the development of MS (OR 1.77, 95%CI 1.53-2.05) but there was no evidence that IM in the winter as opposed to summer was associated with developing MS (OR 1.09, 95%CI 0.72-1.66). We found no evidence that the season of IM influences the risk of subsequent MS. Copyright © 2017 Elsevier B.V. All rights reserved.

The headache to subjects with multiple sclerosis: clinical and imaging study

International Nuclear Information System (INIS)

Moldovanu, Ion; Voiticovschi-Iosob, Cristina

2011-01-01

The present study showed clinical and imaging particularities of primary headache to subjects with multiple sclerosis. From the total number of 28 patients included in this study 22 (78,57%) had headache accuses (3 men and 19 women). Was observed a high prevalence of tension type headache, present to 10 of the 22 patients (45.45%). Migraine was diagnosed to 8 respondents (36.36 %). In 4 cases was found a combination of migraine and tension type headache (8.1%). Headache was more common to women with multiple sclerosis (MS) than to men. Neuroimaging of MS patients indicates the fact that the presence of demyelinating disease in the brainstem, midbrain, periaqueductal gray substance is associated with an increased risk of headache, migraine characteristics (migraine-like). Psychometric test have revealed a high level of depression and anxiety in patients with MS and chronic headache. (authors)

Integrated Markov-neural reliability computation method: A case for multiple automated guided vehicle system

International Nuclear Information System (INIS)

Fazlollahtabar, Hamed; Saidi-Mehrabad, Mohammad; Balakrishnan, Jaydeep

2015-01-01

This paper proposes an integrated Markovian and back propagation neural network approaches to compute reliability of a system. While states of failure occurrences are significant elements for accurate reliability computation, Markovian based reliability assessment method is designed. Due to drawbacks shown by Markovian model for steady state reliability computations and neural network for initial training pattern, integration being called Markov-neural is developed and evaluated. To show efficiency of the proposed approach comparative analyses are performed. Also, for managerial implication purpose an application case for multiple automated guided vehicles (AGVs) in manufacturing networks is conducted. - Highlights: • Integrated Markovian and back propagation neural network approach to compute reliability. • Markovian based reliability assessment method. • Managerial implication is shown in an application case for multiple automated guided vehicles (AGVs) in manufacturing networks

High-output cardiac failure secondary to multiple vascular malformations in the liver: case report

International Nuclear Information System (INIS)

Spaner, S.; Demeter, S.; Lien, D.; Shapiro, J.; McCarthy, M.; Raymond, G.

2001-01-01

High-output cardiac failure is associated with several systemic illnesses, including hyperthyroidism, thiamine deficiency, severe anemia, multiple myeloma, Paget's disease of bone and Osler-Weber-Rendu syndrome. We present an unusual case of a woman with high-output cardiac failure as a result of multiple arteriovenous fistulas in the liver, most likely representing an unusual variant of Osler-Weber-Rendu syndrome (i.e., no other telangiectasias or a family history of vascular malformations was demonstrated). (author)

MRI study of degenerative process in multiple system atrophy

International Nuclear Information System (INIS)

Yagishita, Toshiyuki; Kojima, Shigeyuki; Hirayama, Keizo

1995-01-01

The characteristic morphological changes of the brainstem and cerebellar regions of multiple system atrophy (MSA) were studied by MRI in varing subtypes, that is olivoponto cerebellar atrophy (OPCA: 23 cases), striatonigral degeneration (SND: 7 cases) and Shy-Drager's syndrome (SDS: 9 cases). OPCA was characterized by atrophy of the entire regions of the brainstem and the cerebellum. SND and SDS tended to show atrophy similar in type but lessin extent to OPCA. The common lesions in MSA were atrophy of the pontine base and cerebellum, and dilation of the fourth ventricle. Atrophy of the pontine base was more dominant in the inferior part than in the superior part, and cerebellar atrophy was more dominant in the superior part than in the inferior part, indicating that degeneration of the pontocerebellar pathway proceeds principally along fibers connecting the inferior part of the pons and the superior part of the cerebellum. Dilation of the fourth ventricle indicated atrophy of the middle cerebellar peduncle. In almost all the cases of OPCA and about a half the cases of SND and SDS, the pontine base and the middle cerebellar peduncle appeared as high signal intensity on T 2 weighted image and as low intensity on T 1 , suggesting degeneration and demyelination. In a few cases of OPCA, the dorsolateral part of the putamen were demonstrated as low signal intensity on T 2 weighted image. (author)

Multiple Synchronous Central Giant Cell Granulomas of the Maxillofacial Region: A Case Report

International Nuclear Information System (INIS)

Kang, Min Seok; Kim, Hak Jin

2010-01-01

Multifocal central giant cell granulomas (CGCG) in the maxillofacial region are suggestive of systemic disease such as hyperparathyroidism or an inherited syndrome such as Noonan-like multiple giant cell lesion syndrome. Only 5 cases of multifocal CGCGs in the maxillofacial region without any concomitant systemic disease have currently been reported. We report here on an unusual case of 17-year-old man who presented with multifocal CGCGs of the bilateral posterior mandible and right maxilla and he was without any concomitant systemic disease

Multiple Synchronous Central Giant Cell Granulomas of the Maxillofacial Region: A Case Report

Energy Technology Data Exchange (ETDEWEB)

Kang, Min Seok; Kim, Hak Jin [Pusan National University Hospital, Busan (Korea, Republic of)

2010-01-15

Multifocal central giant cell granulomas (CGCG) in the maxillofacial region are suggestive of systemic disease such as hyperparathyroidism or an inherited syndrome such as Noonan-like multiple giant cell lesion syndrome. Only 5 cases of multifocal CGCGs in the maxillofacial region without any concomitant systemic disease have currently been reported. We report here on an unusual case of 17-year-old man who presented with multifocal CGCGs of the bilateral posterior mandible and right maxilla and he was without any concomitant systemic disease

Evaluation of Hemodynamic Properties of Cerebral Venous Drainage in Patients with Multiple Sclerosis: A Case-Control Study

International Nuclear Information System (INIS)

Jandaghi, Ali Babaei; Amanian, Dayan; Roudbari, Seyed Ali; Kanafi, Alireza Rajabzadeh; Pourghorban, Ramin

2014-01-01

The purpose of this study was to compare patients with multiple sclerosis and healthy control subjects as regards hemodynamics of cerebral venous drainage. Between December 2012 and May 2013, 44 consecutive patients with multiple sclerosis and 44 age- and sex-matched healthy subjects underwent the B-mode, color Doppler, and duplex Doppler evaluations of the internal jugular vein (IJV) and vertebral vein. The following four parameters were investigated: IJV stenosis, reversal of postural control of the cerebral venous outflow pathways, absence of detectable blood flow in the IJVs and/or vertebral veins, and reflux in the IJVs and/or vertebral veins in the sitting or supine position. In the study group, IJV stenosis, postural control reversal of the cerebral venous outflow pathways, and absence of flow in the IJVs and/or vertebral veins were found in 3 (6.8%), 2 (4.5%), and 3 (6.8%) patients, respectively. In the control group, IJV stenosis (P=0.12), postural control reversal of the cerebral venous outflow pathways (P=0.50), and absence of flow (P=0.12) were not detected. Abnormal reflux was found neither in multiple sclerosis patients nor in healthy subjects. No significant difference in the cerebral venous drainage through the IJV or vertebral vein was found between patients with multiple sclerosis and healthy subjects within any of the investigated ultrasonographic parameters

VGC analyzer: a software for statistical analysis of fully crossed multiple-reader multiple-case visual grading characteristics studies

International Nuclear Information System (INIS)

Baath, Magnus; Hansson, Jonny

2016-01-01

Visual grading characteristics (VGC) analysis is a non-parametric rank-invariant method for analysis of visual grading data. In VGC analysis, image quality ratings for two different conditions are compared by producing a VGC curve, similar to how the ratings for normal and abnormal cases in receiver operating characteristic (ROC) analysis are used to create an ROC curve. The use of established ROC software for the analysis of VGC data has therefore previously been proposed. However, the ROC analysis is based on the assumption of independence between normal and abnormal cases. In VGC analysis, this independence cannot always be assumed, e.g. if the ratings are based on the same patients imaged under both conditions. A dedicated software intended for analysis of VGC studies, which takes possible dependencies between ratings into account in the statistical analysis of a VGC study, has therefore been developed. The software-VGC Analyzer-determines the area under the VGC curve and its uncertainty using non-parametric re-sampling techniques. This article gives an introduction to VGC Analyzer, describes the types of analyses that can be performed and instructs the user about the input and output data. (authors)

Case Report: GcMAF Treatment in a Patient with Multiple Sclerosis.

Science.gov (United States)

Inui, Toshio; Katsuura, Goro; Kubo, Kentaro; Kuchiike, Daisuke; Chenery, Leslye; Uto, Yoshihiro; Nishikata, Takahito; Mette, Martin

2016-07-01

Gc protein-derived macrophage-activating factor (GcMAF) has various functions as an immune modulator, such as macrophage activation, anti-angiogenic activity and anti-tumor activity. Clinical trials of second-generation GcMAF demonstrated remarkable clinical effects in several types of cancers. Thus, GcMAF-based immunotherapy has a wide application for use in the treatment of many diseases via macrophage activation that can be used as a supportive therapy. Multiple sclerosis (MS) is considered to be an autoimmune disorder that affects the myelinated axons in the central nervous system (CNS). This study was undertaken to examine the effects of second-generation GcMAF in a patient with MS. This case study demonstrated that treatments of GcMAF in a patient with MS have potent therapeutic actions with early beneficial responses, especially improvement of motor dysfunction. GcMAF shows therapeutic potency in the treatment of MS. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Case of possible multiple system atrophy with a characteristic imaging finding of open bladder neck during storage phase as an initial sign.

Science.gov (United States)

Zhang, Lu; Haga, Nobuhiro; Ogawa, Soichiro; Matsuoka, Kanako; Koguchi, Tomoyuki; Akaihata, Hidenori; Hata, Junya; Kataoka, Masao; Ishibashi, Kei; Kojima, Yoshiyuki

2017-11-01

Multiple system atrophy is a neurodegenerative disease that affects autonomic and motor systems. Patients with multiple system atrophy usually experience lower urinary tract symptoms, which sometimes appear as an initial symptom before the emergence of the generalized symptoms. An open bladder neck during the filling phase on video urodynamic study is one characteristic imaging finding after the diagnosis of multiple system atrophy, but has not previously been reported at an early phase of the disease. We report a case in which an open bladder neck was observed on several imaging modalities before generalized symptoms emerged. Because occult neurogenic bladder might exist in patients whose lower urinary tract symptoms are resistant to pharmacotherapy, we report this case to raise awareness of the importance of sufficient imaging evaluations. An open bladder neck might be an important imaging finding for diagnosing multiple system atrophy, irrespective of the presence of generalized symptoms. This finding could help avoid false diagnosis and unnecessary treatment. © 2017 The Japanese Urological Association.

Tolerance to multiple climate stressors: a case study of Douglas-fir drought and cold hardiness

Science.gov (United States)

Sheel Bansal; Connie Harrington; Brad St. Clair

2016-01-01

1. Drought and freeze events are two of the most common forms of climate extremes which result in tree damage or death, and the frequency and intensity of both stressors may increase with climate change. Few studies have examined natural covariation in stress tolerance traits to cope with multiple stressors among wild plant populations. 2. We assessed the...

Barriers to the adoption of low carbon production: A multiple-case study of Chinese industrial firms

International Nuclear Information System (INIS)

Liu, Yong

2014-01-01

This study employs a multiple-case study method, identifies barriers to the adoption of low carbon production, and categorizes these barriers into four domains: structural, regulatory, cultural, and contextual. The two most frequently mentioned barriers were “lack of financial incentives to stimulate low carbon innovation” and “lack of a common definition of low carbon production”. The two least frequently mentioned barriers were “silos exist between planning and production” and “operational staff are often physically separated from planning staff, which isolates them from planning decisions”. Furthermore, contextual barriers were significantly related to structural and regulatory barriers, while regulatory barriers were significantly related to structural barriers. Larger firms tend to have a more structured organization and lower perceptions of the employment term barrier. However, larger structured organizations have been affected by a long history of a planning-oriented economy and hence tend to have inflexible hierarchical systems. In contrast, small firms have hierarchical systems with less effect on low carbon production than those of large enterprises. Another interesting trend is the direct size effect on cultural barriers, which is evident in a culture of risk aversion, as well as the lack of low carbon technology and the existence of silos between planning and production. - Highlights: • Barriers were categorized as structural, regulatory, cultural and contextual. • Contextual barriers were significantly related to structural and regulatory barriers. • Regulatory barriers were significantly related to structural barriers. • Firm size directly affected firm hierarchical systems and cultural barriers

Multiple Myeloma of the Central Nervous System: 13 Cases and Review of the Literature

Directory of Open Access Journals (Sweden)

Gergely Varga

2018-01-01

Full Text Available Central nervous system involvement is a rare complication of multiple myeloma with extremely poor prognosis as it usually fails to respond to therapy. We present 13 cases diagnosed at two centers in Budapest and review the current literature. The majority of our cases presented with high-risk features initially; two had plasma cell leukemia. Repeated genetic tests showed clonal evolution in 3 cases. Treatments varied according to the era, and efficacy was poor as generally reported in the literature. Only one patient is currently alive, with 3-month follow-up, and the patient responded to daratumumab-based treatment. Recent case reports show promising effectivity of pomalidomide and marizomib.

Vascular comorbidities in multiple sclerosis

DEFF Research Database (Denmark)

Thormann, Anja; Magyari, Melinda; Koch-Henriksen, Nils

2016-01-01

To investigate the occurrence of vascular comorbidities before and after the clinical onset of multiple sclerosis. In this combined case-control and cohort study, all Danish born citizens with onset of multiple sclerosis 1980-2005 were identified from the Danish Multiple Sclerosis Registry...... and randomly matched with controls regarding year of birth, gender, and municipality on January 1st in the year of multiple sclerosis (MS) onset (index date). Individual-level information on comorbidities was obtained from several independent nationwide registries and linked to the study population by unique...

Adopting and implementing nutrition guidelines in recreational facilities: Public and private sector roles. A multiple case study

Directory of Open Access Journals (Sweden)

Olstad Dana

2012-05-01

Full Text Available Abstract Background Recreational facilities are an important community resource for health promotion because they provide access to affordable physical activities. However, despite their health mandate, many have unhealthy food environments that may paradoxically increase the risk of childhood obesity. The Alberta Nutrition Guidelines for Children and Youth (ANGCY are government-initiated, voluntary guidelines intended to facilitate children’s access to healthy food and beverage choices in schools, childcare and recreational facilities, however few recreational facilities are using them. Methods We used mixed methods within an exploratory multiple case study to examine factors that influenced adoption and implementation of the ANGCY and the nature of the food environment within three cases: an adopter, a semi-adopter and a non-adopter of the ANGCY. Diffusion of Innovations theory provided the theoretical platform for the study. Qualitative data were generated through interviews, observations, and document reviews, and were analysed using directed content analysis. Set theoretic logic was used to identify factors that differentiated adopters from the non-adopter. Quantitative sales data were also collected, and the quality of the food environment was scored using four complementary tools. Results The keys to adoption and implementation of nutrition guidelines in recreational facilities related to the managers’ nutrition-related knowledge, beliefs and perceptions, as these shaped his decisions and actions. The manager, however, could not accomplish adoption and implementation alone. Intersectoral linkages with schools and formal, health promoting partnerships with industry were also important for adoption and implementation to occur. The food environment in facilities that had adopted the ANGCY did not appear to be superior to the food environment in facilities that had not adopted the ANGCY. Conclusions ANGCY uptake may continue to falter

Familial multiple lipomatosis: a case report

NARCIS (Netherlands)

Veger, H. T. C.; Ravensbergen, N. J. C.; Ottenhof, A.; da Costa, S. A.

2010-01-01

Lipoma is the most common type of soft tissue tumour. Multiple lipomas localised in different areas of the body are rare and can occur in specific hereditary syndromes. Familial multiple lipomatosis is a rare benign hereditary syndrome with a proposed autosomal-dominant inheritance. We present the

On a Diagnosed Case of Multiple Personality Disorder -A Supplementary Report with Special Reference to Psychotherapy-

OpenAIRE

藤田, 裕司

2000-01-01

As a supplement of the study on a dignosed case of MPD (Multiple Personality Disorder), the effect of the psychotherapy was discussed. The patient was a twenty-four-year-old woman suspected of an attempted murder. In this article, continued from the previous one reporting the process of a series of ten psychotherapeutic interviews with her, the general comment on that was made, and the merits and demerits of the psychotherapy were clarified.

Surgically treated cases of lumbar spondylolysis and isthmic spondylolisthesis: a multicenter study.

Science.gov (United States)

Hirano, Kenichi; Imagama, Shiro; Matsuyama, Yukihiro; Kawakami, Noriaki; Yukawa, Yasutsugu; Kato, Fumihiko; Hachiya, Yudo; Kanemura, Tokumi; Kamiya, Mitsuhiro; Deguchi, Masao; Ito, Zenya; Wakao, Norimitsu; Ando, Kei; Tauchi, Ryoji; Muramoto, Akio; Ishiguro, Naoki

2015-06-01

Prospective database study. To grasp the characteristics of surgically treated cases with lumbar spondylolysis or isthmic spondylolisthesis. A detailed analysis of surgically treated cases with spondylolysis or isthmic spondylolisthesis has never been reported. An epidemiological study in Japan conducted on 2000 subjects found the incidence of lumbar spondylolysis in the Japanese general population (population-based study) to be 5.9% (males: 7.9%, females: 3.9%). Among 124 vertebrae with spondylolysis, there were 0.8% L2 lesions, 3.2% L3 lesions, 5.6% L4 lesions, and 90.3% L5 lesions, including 5 cases (4.3%) with multiple-level lesions. We have been registering surgically treated spine cases in our database since 2000. From this database, we prospectively collected cases with lumbar spondylolysis or isthmic spondylolisthesis that were treated surgically between January 2000 and December 2009. We determined the age at surgery, sex, and vertebral level of spondylolysis. Of the 564 spondylolysis patients treated surgically, 66.8% were male and 33.2% were female. The mean age at surgery was 52.5 years (range, 13-84 y). There were 585 vertebrae with spondylolysis including 21 cases (3.7%) with multiple-level lesions. L5 spondylolysis affected 432 vertebrae and was the most common location (73.8%), followed by 125 L4 lesions (21.4%), 24 L3 lesions (4.1%), and 2 L2 lesions (0.7%). The percentage of L4 lesions in our study was significantly higher and of L5 lesions was significantly lower than those lesions' percentages in the population-based study. L4 spondylolysis may be more unstable or cause clinical symptoms more frequently leading to more surgical intervention. The percentage of multiple-level spondylolysis was similar between the 2 studies, suggesting these patients respond relatively well to conservative treatment. The male/female ratio was 2:1 in both studies, indicating that males and females require surgery at a similar frequency.

Guidelines for Conducting Positivist Case Study Research in Information Systems

Directory of Open Access Journals (Sweden)

Graeme Shanks

2002-11-01

Full Text Available The case study research approach is widely used in a number of different ways within the information systems community. This paper focuses on positivist, deductive case study research in information systems. It provides clear definitions of important concepts in positivist case study research and illustrates these with an example research study. A critical analysis of the conduct and outcomes of two recently published positivist case studies is reported. One is a multiple case study that validated concepts in a framework for viewpoint development in requirements definition. The other is a single case study that examined the role of social enablers in enterprise resource planning systems implementation. A number of guidelines for successfully undertaking positivist case study research are identified including developing a clear understanding of key concepts and assumptions within the positivist paradigm; providing clear and unambiguous definitions of the units and interactions when using any theory; carefully defining the boundary of the theory used in the case study; using hypotheses rather than propositions in the empirical testing of theory; using fuzzy or probabilistic propositions in recognising that reality can never be perfectly known; selecting case studies carefully, particularly single case studies; and recognising that generalisation from positivist, single case studies is inherently different from generalisation from single experiments. When properly undertaken, positivist, deductive case study research is a valuable research approach for information systems researchers, particularly when used within pluralist research programs that use a number of different research approaches from different paradigms.

An access technology delivery protocol for children with severe and multiple disabilities: a case demonstration.

Science.gov (United States)

Mumford, Leslie; Lam, Rachel; Wright, Virginia; Chau, Tom

2014-08-01

This study applied response efficiency theory to create the Access Technology Delivery Protocol (ATDP), a child and family-centred collaborative approach to the implementation of access technologies. We conducted a descriptive, mixed methods case study to demonstrate the ATDP method with a 12-year-old boy with no reliable means of access to an external device. Evaluations of response efficiency, satisfaction, goal attainment, technology use and participation were made after 8 and 16 weeks of training with a custom smile-based access technology. At the 16 week mark, the new access technology offered better response quality; teacher satisfaction was high; average technology usage was 3-4 times per week for up to 1 h each time; switch sensitivity and specificity reached 78% and 64%, respectively, and participation scores increased by 38%. This case supports further development and testing of the ATDP with additional children with multiple or severe disabilities.

Vitiligo: A study of 120 cases

Directory of Open Access Journals (Sweden)

Kar P

2001-11-01

Full Text Available Vitiligo is a common pignientary disorder and of major social and cosmetic concern in India. Purpose of the study was to find out age at onset and sex incidence in vitiligo, role of hereditary factors and associations with other diseases. 120 self reporting vitiligo patients attending out patient department of a service hospital were selected for the study and this data was analysed. In the present series out of 120 cases 62 (51.6% were males and 58(48.35%were females. There was practically no difference in sex incidence. The lowest age of onset was two years and the oldest was 65 years. In the majority of patients,52(43.2%, disease started before twenty years of age.8 (6.6% cases gave definite family history of vitiligo. Exposed areas of the body were commonly affected in majority (66.6% of cases. The legs were commonest site of involvement in 60(50% cases. Circunicript type of vitiligo (46.6% was heading the list. Majority of patients (56.6% had multiple lesions. Diabetes mellitus was found in 2 (2.6% patients. Cause of vitiligo is still idiopathic. Hereditary factors hardly play any role in manifestation of vitiligo

Classifying Multiple Types of Hand Motions Using Electrocorticography During Intraoperative Awake Craniotomy & Seizure Monitoring Processes - Case Studies

Directory of Open Access Journals (Sweden)

Tao eXie

2015-10-01

Full Text Available In this work, some case studies were conducted toclassify several kinds of hand motions from electrocorticography(ECoG signals during intraoperative awake craniotomy &extraoperative seizure monitoring processes. Four subjects (P1,P2 with intractable epilepsy during seizure monitoring and P3,P4 with brain tumor during awake craniotomy participatedin the experiments. Subjects performed three types of handmotions (Grasp, Thumb-finger motion and Index-finger motioncontralateral to the motor cortex covered with ECoG electrodes.Two methods were used for signal processing. Method I:autoregressive (AR model with burg method was applied toextract features, and additional waveform length (WL featurehas been considered, finally the linear discriminative analysis(LDA was used as the classifier. Method II: stationary subspaceanalysis (SSA was applied for data preprocessing, and thecommon spatial pattern (CSP was used for feature extractionbefore LDA decoding process. Applying method I, the threeclassaccuracy of P1□P4 were 90.17%, 96.00%, 91.77% and92.95% respectively. For method II, the three-class accuracy ofP1□P4 were 72.00%, 93.17%, 95.22% and 90.36% respectively.This study verified the possibility of decoding multiple handmotion types during an awake craniotomy, which is the firststep towards dexterous neuroprosthetic control during surgicalimplantation, in order to verify the optimal placement of electrodes.The accuracy during awake craniotomy was comparableto results during seizure monitoring. This study also indicatedthat ECoG was a promising approach for precise identificationof eloquent cortex during awake craniotomy, and might forma promising BCI system that could benefit both patients andneurosurgeons.

Nonsyndromic Bilateral Multiple Impacted Supernumerary Mandibular Third Molars: A Rare and Unusual Case Report

Directory of Open Access Journals (Sweden)

G. Siva Prasad Reddy

2013-01-01

Full Text Available A supernumerary tooth is that which is present additionally to the normal series and can be found in any region of the dental arch. An impacted tooth is defined as the one which is embedded in the alveolus, so that its eruption is prevented, or the tooth is locked in position by bone or the adjacent teeth. The occurrence of multiple supernumerary teeth in only one patient in the absence of an associated systemic condition or syndrome is considered as a rare phenomenon. The occurrence of supernumerary teeth in the lower molar region is rare. A prevalence of less than 2% of cases occurring in this region has been estimated. Their occurrence presents a clinical problem for orthodontists and oral surgeons. The cause, frequency, complications, and surgical operation of impacted teeth are always interesting subjects for study and research. An impacted tooth can result in caries, pulp disease, periapical and periodontal disease, temporomandibular joint disorder, infection of the fascial space, root resorption of the adjacent tooth, and even oral and maxillofacial tumours. The management of impacted wisdom teeth has changed over the past 20 years from removal of nonsymptomatic third molars to simple observation. The aim of this paper is to present a rare case of bilateral multiple impacted supernumerary mandibular third molars.

Effects of Business Model Development Projects on Organizational Culture: A Multiple Case Study of SMEs

Directory of Open Access Journals (Sweden)

Ulla Santti

2017-08-01

Full Text Available Previous research has shown that links between organizational culture and innovativeness/performance may act as a “social glue” that helps a company develop organizational culture as a competitive advantage. In this study of three case companies, the organizational culture change due business model development projects is studied using the Competing Values Framework (CVF tool and interviews with respondents about discovered changes. To reveal intervention and implied effects between business model development project and organizational culture changes, we used CIMO logic (context, intervention, mechanism, and outcome to bridge practice and theory by explanatory, backward-looking research. Our case studies of companies in relatively short-duration business model development projects indicate that organizational culture may have some dynamic characteristics, for example, an increase of the adhocracy organizational type in all case companies or an increase in the hierarchical leadership type in one case company. Thus, the development of an organizational culture type can be partly controlled. Our results also indicated business model development projects do have a minor effect on organizational culture, even when development activities have not been put fully into practice. However, the more comprehensively business model development project activities have been put into practice, the larger the effect on organizational culture.

MRI study of degenerative process in multiple system atrophy

Energy Technology Data Exchange (ETDEWEB)

Yagishita, Toshiyuki; Kojima, Shigeyuki; Hirayama, Keizo [Chiba Univ. (Japan). School of Medicine

1995-02-01

The characteristic morphological changes of the brainstem and cerebellar regions of multiple system atrophy (MSA) were studied by MRI in varing subtypes, that is olivoponto cerebellar atrophy (OPCA: 23 cases), striatonigral degeneration (SND: 7 cases) and Shy-Drager`s syndrome (SDS: 9 cases). OPCA was characterized by atrophy of the entire regions of the brainstem and the cerebellum. SND and SDS tended to show atrophy similar in type but lessin extent to OPCA. The common lesions in MSA were atrophy of the pontine base and cerebellum, and dilation of the fourth ventricle. Atrophy of the pontine base was more dominant in the inferior part than in the superior part, and cerebellar atrophy was more dominant in the superior part than in the inferior part, indicating that degeneration of the pontocerebellar pathway proceeds principally along fibers connecting the inferior part of the pons and the superior part of the cerebellum. Dilation of the fourth ventricle indicated atrophy of the middle cerebellar peduncle. In almost all the cases of OPCA and about a half the cases of SND and SDS, the pontine base and the middle cerebellar peduncle appeared as high signal intensity on T{sub 2} weighted image and as low intensity on T{sub 1}, suggesting degeneration and demyelination. In a few cases of OPCA, the dorsolateral part of the putamen were demonstrated as low signal intensity on T{sub 2} weighted image. (author).

Study of the α and β phases of quartz by neutron multiple diffraction

International Nuclear Information System (INIS)

Mazzocchi, V.L.

1984-01-01

Crystal structures of α and β phases of quartz are studied, employing neutron multiple diffraction as a method of analysis. Theoretical multiple diffraction patterns in a many-beam case were determined by a computer program which calculates intensities of beams as sums of Taylor's series expansions, retaining terms up to a order n. Experimental 'umweg' and transmitted beam patterns were obtained for the 00.1 primary reflection of α and β phases of quartz. To calculate α - quartz multiple diffraction intensities it was necessary to determine the Dauphine twinning fraction for the crystal after having passed by the β-phase. For the two models of β-quartz a better agreement between experimental and calculated integrated intensities was found for the disordered structure model based on split-half-oxigen positions. (Author) [pt

Coexistence of systemic lupus erythematosus and multiple sclerosis. A case report and literature review.

Science.gov (United States)

Jácome Sánchez, Elisa Carolina; García Castillo, María Ariana; González, Victor Paredes; Guillén López, Fernando; Correa Díaz, Edgar Patricio

2018-01-01

Multiple sclerosis (MS) and systemic lupus erythematous (SLE) are autoimmune diseases, the coexistence of which is uncommon in patients. Owing to the rarity of this condition, the distinction between MS and SLE is a diagnostic challenge for neurologists. We present a case report in which MS and SLE were present in the same patient. There are few case reports in the world on the association between MS and SLE. The following case report is the first of its kind in which both MS and SLE are present in a patient from a country with low prevalence of MS such as Ecuador.

Evolving Curricular Models in Culinary Arts: An Instrumental Case Study of a Technical Field

Science.gov (United States)

Cossio, Allison

2016-01-01

The purpose of this research study was to examine how chefs and other individuals in the food industry understood the field of culinary arts. This study used an instrumental case study with purposeful sampling of multiple cases. Through a series of open-ended interviews using snowball-sampling strategy that concluded with 45 participants sharing…

Integrating evidence-based practices for increasing cancer screenings in safety net health systems: a multiple case study using the Consolidated Framework for Implementation Research.

Science.gov (United States)

Liang, Shuting; Kegler, Michelle C; Cotter, Megan; Emily, Phillips; Beasley, Derrick; Hermstad, April; Morton, Rentonia; Martinez, Jeremy; Riehman, Kara

2016-08-02

Implementing evidence-based practices (EBPs) to increase cancer screenings in safety net primary care systems has great potential for reducing cancer disparities. Yet there is a gap in understanding the factors and mechanisms that influence EBP implementation within these high-priority systems. Guided by the Consolidated Framework for Implementation Research (CFIR), our study aims to fill this gap with a multiple case study of health care safety net systems that were funded by an American Cancer Society (ACS) grants program to increase breast and colorectal cancer screening rates. The initiative funded 68 safety net systems to increase cancer screening through implementation of evidence-based provider and client-oriented strategies. Data are from a mixed-methods evaluation with nine purposively selected safety net systems. Fifty-two interviews were conducted with project leaders, implementers, and ACS staff. Funded safety net systems were categorized into high-, medium-, and low-performing cases based on the level of EBP implementation. Within- and cross-case analyses were performed to identify CFIR constructs that influenced level of EBP implementation. Of 39 CFIR constructs examined, six distinguished levels of implementation. Two constructs were from the intervention characteristics domain: adaptability and trialability. Three were from the inner setting domain: leadership engagement, tension for change, and access to information and knowledge. Engaging formally appointed internal implementation leaders, from the process domain, also distinguished level of implementation. No constructs from the outer setting or individual characteristics domain differentiated systems by level of implementation. Our study identified a number of influential CFIR constructs and illustrated how they impacted EBP implementation across a variety of safety net systems. Findings may inform future dissemination efforts of EBPs for increasing cancer screening in similar settings. Moreover

Developing the DESCARTE Model: The Design of Case Study Research in Health Care.

Science.gov (United States)

Carolan, Clare M; Forbat, Liz; Smith, Annetta

2016-04-01

Case study is a long-established research tradition which predates the recent surge in mixed-methods research. Although a myriad of nuanced definitions of case study exist, seminal case study authors agree that the use of multiple data sources typify this research approach. The expansive case study literature demonstrates a lack of clarity and guidance in designing and reporting this approach to research. Informed by two reviews of the current health care literature, we posit that methodological description in case studies principally focuses on description of case study typology, which impedes the construction of methodologically clear and rigorous case studies. We draw from the case study and mixed-methods literature to develop the DESCARTE model as an innovative approach to the design, conduct, and reporting of case studies in health care. We examine how case study fits within the overall enterprise of qualitatively driven mixed-methods research, and the potential strengths of the model are considered. © The Author(s) 2015.

A case matched study examining the reliability of using ImPACT to assess effects of multiple concussions.

Science.gov (United States)

Barker, Trevor; Russo, Stephen A; Barker, Gaytri; Rice, Mark A; Jeffrey, Mary G; Broderick, Gordon; Craddock, Travis J A

2017-04-28

Approximately 3.8 million sport and recreational concussions occur per year, creating a need for accurate diagnosis and management of concussions. Researchers and clinicians are exploring the potential dose-response cumulative effects of concussive injuries using computerized neuropsychological exams, however, results have been mixed and/or contradictory. This study starts with a large adolescent population and applies strict inclusion criteria to examine how previous mild traumatic brain injuries affect symptom reports and neurocognitive performance on the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) computerized tool. After applying exclusion criteria and case matching, 204 male and 99 female participants remained. These participants were grouped according to sex and the number of previous self-reported concussions and examined for overall differences on symptoms reported and scores obtained on the ImPACT neurocognitive battery composites. In an effort to further reduce confounding factors due to the varying group sizes, participants were then case matched on age, sex, and body mass index and analyzed for differences on symptoms reported and scores obtained on the ImPACT neurocognitive battery composites. Case matched analysis demonstrated males with concussions experience significantly higher rates of dizziness (p = .027, η 2  = .035), fogginess (p = .038, η 2  = .032), memory problems (p = .003, η 2  = .055), and concentration problems (p = .009, η 2  = .046) than males with no reported previous concussions. No significant effects were found for females, although females reporting two concussions demonstrated a slight trend for experiencing higher numbers of symptoms than females reporting no previous concussions. The results suggest that male adolescent athletes reporting multiple concussions have lingering concussive symptoms well after the last concussive event; however, these symptoms were found to

Case Studies of Multilingual/Multicultural Asian Deaf Adults: Strategies for Success.

Science.gov (United States)

Wang, Qiuying; Andrews, Jean; Liu, Hsiu Tan; Liu, Chun Jung

2016-01-01

Case studies of adult d/Deaf or Hard of Hearing Multilingual Learners (DMLs) are few, especially studies of DMLs who learn more than one sign language and read logographic and alphabetic scripts. To reduce this paucity, two descriptive case studies are presented. Written questionnaires, face-to-face interviews, and self-appraisals of language-use rubrics were used to explore (a) the language and literacy histories of two adult Asian DMLs who had learned multiple languages: Chinese (spoken/written), English (written), Chinese Sign Language, and American Sign Language; and (b) how each language was used in different cultural communities with diverse conversational partners. Home literacy environment, family support, visual access to languages, peer and sibling support, role models, encouragement, perseverance, and Deaf identity all played vital roles in the participants' academic success. The findings provide insights into the acquisition of multiple languages and bi-literacy through social communication and academic content.

Use of multiple sensor technologies for quality control of in situ biogeochemical measurements: A SeaCycler case study

Science.gov (United States)

Atamanchuk, Dariia; Koelling, Jannes; Lai, Jeremy; Send, Uwe; Wallace, Douglas

2017-04-01

Over the last two decades observing capacity for the global ocean has increased dramatically. Emerging sensor technologies for dissolved gases, nutrients and bio-optical properties in seawater are allowing extension of in situ observations beyond the traditionally measured salinity, temperature and pressure (CTD). However the effort to extend observations using autonomous instruments and platforms carries the risk of losing the level of data quality achievable through conventional water sampling techniques. We will present results from a case study with the SeaCycler profiling winch focusing on quality control of the in-situ measurements. A total of 13 sensors were deployed from May 2016 to early 2017 on SeaCycler's profiling sensor float, including CTD, dissolved oxygen (O2, 3 sensors), carbon dioxide (pCO2, 2 sensors), nutrients, velocity sensors, fluorometer, transmissometer, single channel PAR sensor, and others. We will highlight how multiple measurement technologies (e.g. for O2 and CO2) complement each other and result in a high quality data product. We will also present an initial assessment of the bio-optical data, their implications for seasonal phytoplankton dynamics and comparisons to climatologies and ocean-color data products obtained from the MODIS satellite.

Coexistence of multiple sclerosis and ankylosing spondylitis: Report of four cases from Russia and review of the literature.

Science.gov (United States)

Fominykh, Vera; Shevtsova, Tatyana; Arzumanian, Narine; Brylev, Lev

2017-10-01

Multiple sclerosis is a chronic demyelinating disorder of the central nervous system. There are many cases of multiple sclerosis - like syndrome and demyelinating disorders in systemic lupus erythematosus, Sjogren disease, Behcet disease and other autoimmune conditions. Coexistence of ankylosing spondylitis and multiple sclerosis usually is rare but in this article we report 4 Russian patients with concomitant multiple sclerosis and ankylosing spondylitis diseases. None of these patients received anti-tumor necrosis factor alpha therapy prior to diagnosis of multiple sclerosis. Pathogenesis, diagnostic and treatment challenges are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

Optimising case detection within UK electronic health records : use of multiple linked databases for detecting liver injury

NARCIS (Netherlands)

Wing, Kevin; Bhaskaran, Krishnan; Smeeth, Liam; van Staa, Tjeerd P|info:eu-repo/dai/nl/304827762; Klungel, Olaf H|info:eu-repo/dai/nl/181447649; Reynolds, Robert F; Douglas, Ian

2016-01-01

OBJECTIVES: We aimed to create a 'multidatabase' algorithm for identification of cholestatic liver injury using multiple linked UK databases, before (1) assessing the improvement in case ascertainment compared to using a single database and (2) developing a new single-database case-definition

Multiple x-ray diffraction applied to the study of crystal impurities

International Nuclear Information System (INIS)

Cardoso, L.P.

1983-06-01

The x-ray multiple diffraction technique is used in the study of impurities concentration and localization in the crystal lattice, implemented with the fundamental observation that the impurities cannot be distributed with the same spatial group symmetry of the crystal. This fact could introduce scattered intensity in the crystal reciprocal lattice forbidden nodes. This effect was effectively observed in multiple diffraction diagrams, where a reinforcement of the scattered intensity in the pure crystal is produced, when choosing conveniently the involved reflections. The reflectivity theory was developed in the kinematic case, which take into account the scattering by the impurities atoms, and the analysis showed that, in the first approximation, the impurities can influence both in the allowed and forbidden positions for the pure crystal. (L.C.J.A.)

Multiproteinopathy, neurodegeneration and old age: a case study.

Science.gov (United States)

Rojas, Julio C; Stephens, Melanie L; Rabinovici, Gil D; Kramer, Joel H; Miller, Bruce L; Seeley, William W

2018-02-01

A complex spectrum of mixed brain pathologies is common in older people. This clinical pathologic conference case study illustrates the challenges of formulating clinicopathologic correlations in late-onset neurodegenerative diseases featuring cognitive-behavioral syndromes with underlying multiple proteinopathy. Studies on the co-existence and interactions of Alzheimer's disease (AD) with neurodegenerative non-AD pathologies in the aging brain are needed to understand the pathogenesis of neurodegeneration and to support the development of diagnostic biomarkers and therapies.

The Multiple Use of Tropical Forests by Indigenous Peoples in Mexico: a Case of Adaptive Management

Directory of Open Access Journals (Sweden)

Víctor M. Toledo

2003-12-01

Full Text Available The quest for an appropriate system of management for tropical ecosystems necessitates that ecologists consider the accumulated experiences of indigenous peoples in their long-term management of local resources, a subject of current ethnoecology. This paper provides data and empirical evidence of an indigenous multiple-use strategy (MUS of tropical forest management existing in Mexico, that can be considered a case of adaptive management. This conclusion is based on the observation that some indigenous communities avoid common modernization routes toward specialized, unsustainable, and ecologically disruptive systems of production, and yet probably achieve the most successful tropical forest utilization design, in terms of biodiversity conservation, resilience, and sustainability. This analysis relies on an exhaustive review of the literature and the authors' field research. Apparently, this MUS represents an endogenous reaction of indigenous communities to the intensification of natural resource use, responding to technological, demographic, cultural, and economic changes in the contemporary world. This transforms traditional shifting cultivators into multiple-use strategists. Based on a case study, three main features (biodiversity, resilience, and permanence considered relevant to achieving adaptive and sustainable management of tropical ecosystems are discussed.

Multiple intracranial hydatid cysts: MR findings

International Nuclear Information System (INIS)

Pumar, J.; Alvarez, M.; Leira, R.; Prieto, J.M.; Arrojo, L.; Pereira, J.; Vidal, J.

1992-01-01

Multiple intracranial hydatid cysts are uncommon and usually localized in the supratentorial compartment. We report a case studied by CT and MR of multiple intracranial hydatid cysts scattered in various anatomic sites: supratentorial, infratentorial and also intraventricular. (orig.)

Gigantism in sibling unrelated to multiple endocrine neoplasia: case report.

Science.gov (United States)

Matsuno, A; Teramoto, A; Yamada, S; Kitanaka, S; Tanaka, T; Sanno, N; Osamura, R Y; Kirino, T

1994-11-01

The cases of gigantism sisters with somatotroph adenomas unrelated to multiple endocrine neoplasia (MEN) Type 1 are reported. The sisters grew rapidly since they were 5 or 6 years old and were diagnosed to have gigantism with pituitary adenoma by computed tomographic scan and magnetic resonance imaging. A serum endocrinological examination showed the elevated growth hormone values. After thyroxine-releasing hormone stimulation, growth hormone values exhibited a paradoxical rise. They were supposed to be unrelated to MEN Type 1, because analysis of the 11th chromosomes and the other endocrine functions were normal. They were operated on by the transphenoidal method. Immunohistochemical staining of both tumor specimens confirmed somatotroph adenomas. Pituitary adenoma associated with MEN Type 1 is a well-recognized entity. However, the sporadic occurrence of pituitary adenoma unrelated to MEN Type 1, especially in siblings, is extremely rare. Fifteen cases of pituitary adenomas in siblings were described in the literature. As for gigantism, only two brothers were reported. Our case of gigantism sisters is the second sporadic case. In our review of the isolated cases of pituitary adenoma in siblings described in the literature, 12 (70%) of 17 cases including ours are acromegaly or gigantism. This incidence is much higher than that of MEN Type 1 patients with pituitary adenomas. The cause of the familial occurrence of pituitary adenomas is still unclear, although autosomal recessive inheritance has been suggested. It has been stated that point mutations in codon 201 or 227 of the Gs alpha gene located in chromosome 20 were found in about 35 to 40% of somatotroph adenomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Satellite observed impacts of wildfires on regional atmosphere composition and shortwave radiative forcing: multiple cases study

Science.gov (United States)

Fu, Y.; Li, R.; Huang, J.; Bergeron, Y.; Fu, Y.

2017-12-01

Emissions of aerosols and trace gases from wildfires and the direct shortwave radiative forcing were studied using multi-satellite/sensor observations from Aqua Moderate-Resolution Imaging Spectroradiometer (MODIS), Aqua Atmospheric Infrared Sounder (AIRS), Aura Ozone Monitoring Instrument (OMI), and Aqua Cloud's and the Earth's Radiant Energy System (CERES). The selected cases occurred in Northeast of China (NEC), Siberia of Russia, California of America have dominant fuel types of cropland, mixed forest and needleleaf forest, respectively. The Fire radiative power (FRP) based emission coefficients (Ce) of aerosol, NOx (NO2+NO), formaldehyde (HCHO), and carbon monoxide (CO) showed significant differences from case to case. 1) the FRP of the cropland case in NEC is strongest, however, the Ce of aerosol is the lowest (20.51 ± 2.55 g MJ-1). The highest Ce of aerosol is 71.34 ± 13.24 g MJ-1 in the needleleaf fire case in California. 2) For NOx, the highest Ce existed in the cropland case in NEC (2.76 ± 0.25 g MJ-1), which is more than three times of those in the forest fires in Siberia and California. 3) The Ce of CO is 70.21±10.97 and 88.38±46.16 g MJ-1 in the forest fires in Western Siberia and California, which are about four times of that in cropland fire. 4) The variation of Ce of HCHO are relatively small among cases. Strong spatial correlations are found among aerosol optical depth (AOD), NOx, HCHO, and CO. The ratios of NOx to AOD, HCHO, and CO in the cropland case in NEC show much higher values than those in other cases. Although huge differences of emissions and composition ratios exist among cases, the direct shortwave (SW) radiative forcing efficiency (SWARFE) of smoke at the top of the atmosphere (TOA) are in good agreement, with the shortwave radiative forcing efficiencies values of 20.09 to 22.93 per unit AOD. Results in this study reveal noteworthy variations of the FRP-based emissions coefficient and relative chemical composition in the smoke

Case Study on the Meaning of Citizen Formation and its Relationship to Multiple Intelligences from the Standpoint of Families and Educational Facilities in Barranquilla, Colombia

Directory of Open Access Journals (Sweden)

Marco antonio turbay*

2009-12-01

Full Text Available Socialization of the individual is one of the main challenges in regional development, just as important as politics, economics and ecology; and a key component of this process is Citizen Formation, which provides people with knowledge and coexistence principles that lead them to recognize themselves as social beings, with rights and obligations in society. This mixed-model study aims to describe meanings attached to Citizen Formation by a father, his daughter, and a teacher. This case studies let actors developnarratives which they use to build the meaning of Citizen Formation. Bruner’s narrative technique is privileged, with its foundational concept of “meaning”. The search is complemented by the idea of “multiple intelligences” by Gardner.

Medium dependence of multiplicity distributions in MLLA

International Nuclear Information System (INIS)

Armesto, Nestor; Pajares, Carlos; Quiroga-Arias, Paloma

2009-01-01

We study the modification of the multiplicity distributions in MLLA due to the presence of a QCD medium. The medium is introduced through a multiplicative constant (f med ) in the soft infrared parts of the kernels of the QCD evolution equations. Using the asymptotic ansatz for mean multiplicities of the quark and gluons, left angle n G right angle =e γy and left angle n Q right angle =r -1 e γy , respectively, we study two cases: fixed γ as previously considered in the literature, and fixed α s . We find opposite behaviors of the dispersion of the multiplicity distributions with increasing f med in both cases. For fixed γ the dispersion decreases, while for fixed α s it increases. (orig.)

Computer Assisted Instruction in Special Education Three Case Studies

OpenAIRE

İbrahim DOĞAN; Ömür AKDEMİR

2015-01-01

The purpose of this study is to investigate the computer use of three students attending the special education center. Students have mental retardation, hearing problem and physical handicap respectively. The maximum variation sampling is used to select the type of handicap while the convenience sampling is used to select the participants. Three widely encountered handicap types in special education are chosen to select the study participants. The multiple holistic case study design is used i...

Cost comparison between private and public collection of residual household waste: multiple case studies in the Flemish region of Belgium.

Science.gov (United States)

Jacobsen, R; Buysse, J; Gellynck, X

2013-01-01

The rising pressure in terms of cost efficiency on public services pushes governments to transfer part of those services to the private sector. A trend towards more privatizing can be noticed in the collection of municipal household waste. This paper reports the findings of a research project aiming to compare the cost between the service of private and public collection of residual household waste. Multiple case studies of municipalities about the Flemish region of Belgium were conducted. Data concerning the year 2009 were gathered through in-depth interviews in 2010. In total 12 municipalities were investigated, divided into three mutual comparable pairs with a weekly and three mutual comparable pairs with a fortnightly residual waste collection. The results give a rough indication that in all cases the cost of private service is lower than public service in the collection of household waste. Albeit that there is an interest in establishing whether there are differences in the costs and service levels between public and private waste collection services, there are clear difficulties in establishing comparisons that can be made without having to rely on a large number of assumptions and corrections. However, given the cost difference, it remains the responsibility of the municipalities to decide upon the service they offer their citizens, regardless the cost efficiency: public or private. Copyright © 2012 Elsevier Ltd. All rights reserved.

Non-syndromic multiple odontogenic keratocysts associated with dental anomalies: A report of unusual case and its management

Directory of Open Access Journals (Sweden)

Sulabha A Narsapur

2015-01-01

Full Text Available Odontogenic keratocyst (OKC, now known as keratocystic odontogenic tumor (KCOT, is the most common cystic lesion occurring in the maxillofacial region. Multiple occurrence of these cysts is less frequent and is usually associated with syndromes, the most common being the Gorlin Goltz syndrome or the nevoid basal cell carcinoma syndrome (NBCCS. We hereby report an unusual case of multiple OKCs in a healthy adult, associated with other dental anomalies. Management approach consisted of enucleation with curettage of the smaller lesions and decortication of buccal cortex in the large lesion. The condition in the present case may be because of the multifocal nature of OKC rather than its association with any syndrome. Concomitant occurrence of multiple OKCs with other dental anomalies may be coincidental. Impacted teeth or missing teeth must be radiographed to rule out the lesions associated with them.

Student Self-Perceptions of Leadership in Two Missouri FFA Chapters: A Collective Case Study

Science.gov (United States)

Kagay, Rachel Bartholomew; Marx, Adam A.; Simonsen, Jon C.

2015-01-01

The focus of this study is the self-perceptions of leadership engagement of FFA members in two FFA chapters in Missouri. This multiple case study used documentation of student self-perceptions, researcher observations, and focus groups. The two cases included 24 high school students comprised of FFA officers and members, who provided their…

Creating Multiple Pathways in the Arts: A New York City Case Study

Science.gov (United States)

Maguire, Cindy; Mishook, Jacob; Garcia, Ivonne; de Gaillande, Genevieve

2013-01-01

Increasingly, education policy makers understand the importance of students and families having access to a range of high quality educational opportunities inside and outside of school, 365 days a year. This paper explores the concept of multiple pathways in arts education to further conceptualize and build upon such opportunities, inside and…

Multiple hereditary exostoses and ischiofemoral impingement: a case-control study

International Nuclear Information System (INIS)

Yoong, Philip; Mansour, Ramy; Teh, James L.

2014-01-01

To assess whether there is a significant difference in the ischiofemoral space in patients with multiple hereditary exostoses affecting the proximal femora compared to normal patients. Ischiofemoral impingement is an increasingly recognized cause of hip and buttock pain. This causes narrowing of the ischiofemoral space resulting in an abnormal quadratus femoris muscle. We performed a retrospective search for individuals with MHE with proximal femoral involvement on pelvic MRI over a 7-year period (2006-2013). Suitable patients were age- and sex-matched with a control group. The minimum ischiofemoral space (MIFS) was recorded in each hip, as was the presence of edema and atrophy of quadratus femoris and concomitant hip osteoarthrosis. MRI features suggestive of ischiofemoral impingement were defined as MIFS less than 10 mm or an abnormal quadratus femoris muscle. Twenty-one hips in 11 individuals with MHE were included in the study. A total of 42 hips were analyzed. The mean age was 37 years (range, 13-72 years) and 55 % were male. There was a significant difference (p < 0.05) in the MIHS in individuals with MHE (mean, 10.7 mm, range, 0-21 mm) compared to a control group (mean, 18.1 mm, range, 10.5-26.5 mm). MRI features suggestive of ischiofemoral impingement were seen in 13/21 (62 %) hips in the MHE group and 0/21 (0 %) in the control group. The reduced ischiofemoral space and associated quadratus femoris abnormalities in patients with MHE involving the proximal femora may account for hip/buttock symptoms in the absence of significant degenerative change. (orig.)

Multiple hereditary exostoses and ischiofemoral impingement: a case-control study

Energy Technology Data Exchange (ETDEWEB)

Yoong, Philip; Mansour, Ramy; Teh, James L. [Nuffield Orthopaedic Centre, Department of Radiology, Oxford (United Kingdom)

2014-09-15

To assess whether there is a significant difference in the ischiofemoral space in patients with multiple hereditary exostoses affecting the proximal femora compared to normal patients. Ischiofemoral impingement is an increasingly recognized cause of hip and buttock pain. This causes narrowing of the ischiofemoral space resulting in an abnormal quadratus femoris muscle. We performed a retrospective search for individuals with MHE with proximal femoral involvement on pelvic MRI over a 7-year period (2006-2013). Suitable patients were age- and sex-matched with a control group. The minimum ischiofemoral space (MIFS) was recorded in each hip, as was the presence of edema and atrophy of quadratus femoris and concomitant hip osteoarthrosis. MRI features suggestive of ischiofemoral impingement were defined as MIFS less than 10 mm or an abnormal quadratus femoris muscle. Twenty-one hips in 11 individuals with MHE were included in the study. A total of 42 hips were analyzed. The mean age was 37 years (range, 13-72 years) and 55 % were male. There was a significant difference (p < 0.05) in the MIHS in individuals with MHE (mean, 10.7 mm, range, 0-21 mm) compared to a control group (mean, 18.1 mm, range, 10.5-26.5 mm). MRI features suggestive of ischiofemoral impingement were seen in 13/21 (62 %) hips in the MHE group and 0/21 (0 %) in the control group. The reduced ischiofemoral space and associated quadratus femoris abnormalities in patients with MHE involving the proximal femora may account for hip/buttock symptoms in the absence of significant degenerative change. (orig.)

The impact of the cycle counting in the inventory accuracy: multiple cases in industries of Paraná

Directory of Open Access Journals (Sweden)

Everton Drohomeretski

2013-05-01

Full Text Available This article aims to identify the impact of cycle counting on inventory accuracy. Multiple case studies were used as research method; these include seven case studies of companies in Paraná. A research protocol was used as the basis for collecting the data. For the data analysis, the content analysis method was used with the triangulation of collected data. For the main results, the study demonstrates the relationship between cycle counting, the level of importance attributed by the organization, the number of items and the rate of accuracy obtained. The high level of control of inventory processes, together with the use of cycle counting made it possible to eliminate the main cause of failure in inventory accuracy – errors in recording the movement of material – and with this, improve the operational efficiency of the companies.

Urea cycle disorder misdiagnosed as multiple sclerosis: a case report and review of the literature.

Science.gov (United States)

Algahtani, Hussein; Alameer, Seham; Marzouk, Yousef; Shirah, Bader

2018-04-01

Urea cycle disorders are a group of inborn errors of metabolism caused by dysfunction of any of the six enzymes or two transport proteins involved in urea biosynthesis. In this paper, we report a patient who presented with neurological dysfunction and coma in the immediate postpartum period. She was misdiagnosed for many years as a case of multiple sclerosis. The importance of reporting this case is to illustrate that the wrong diagnosis of patients as being affected with multiple sclerosis for many years due to magnetic resonance imaging abnormalities rather than the classic relapsing-remitting nature of the disease may lead to catastrophic consequences. The patient was treated with intravenous steroids several times, which is contraindicated in patients with urea cycle disorders as it may precipitate acute hyperammonemic attacks. In addition, the management of urea cycle disorder could have started earlier and avoided multiple admissions to the intensive care unit. We believe that the presence of symmetric hyperintense insular cortical changes are seen in multiple hyperammonemic processes, and in the context of the clinical presentation and high ammonia levels can be suggestive of a urea cycle disorder. For any patient presenting with atypical clinical features, images should be reviewed and discussed in detail with an experienced neuroradiologist. In addition, the ammonia levels should be checked if a urea cycle disorder is suspected.

MULTIPLE SPINAL CANAL MENINGIOMAS

Directory of Open Access Journals (Sweden)

Nandigama Pratap Kumar

2016-10-01

Full Text Available BACKGROUND Meningiomas of the spinal canal are common tumours with the incidence of 25 percent of all spinal cord tumours. But multiple spinal canal meningiomas are rare in compare to solitary lesions and account for 2 to 3.5% of all spinal meningiomas. Most of the reported cases are both intra cranial and spinal. Exclusive involvement of the spinal canal by multiple meningiomas are very rare. We could find only sixteen cases in the literature to the best of our knowledge. Exclusive multiple spinal canal meningiomas occurring in the first two decades of life are seldom reported in the literature. We are presenting a case of multiple spinal canal meningiomas in a young patient of 17 years, who was earlier operated for single lesion. We analysed the literature, with illustration of our case. MATERIALS AND METHODS In September 2016, we performed a literature search for multiple spinal canal meningiomas involving exclusively the spinal canal with no limitation for language and publication date. The search was conducted through http://pubmed.com, a wellknown worldwide internet medical address. To the best of our knowledge, we could find only sixteen cases of multiple meningiomas exclusively confined to the spinal canal. Exclusive multiple spinal canal meningiomas occurring in the first two decades of life are seldom reported in the literature. We are presenting a case of multiple spinal canal meningiomas in a young patient of 17 years, who was earlier operated for solitary intradural extra medullary spinal canal meningioma at D4-D6 level, again presented with spastic quadriparesis of two years duration and MRI whole spine demonstrated multiple intradural extra medullary lesions, which were excised completely and the histopathological diagnosis was transitional meningioma. RESULTS Patient recovered from his weakness and sensory symptoms gradually and bladder and bowel symptoms improved gradually over a period of two to three weeks. CONCLUSION Multiple

Conjunctival Aspergilloma with Multiple Mulberry Nodules: A Case Report

Directory of Open Access Journals (Sweden)

Jiunn-Liang Chen

2005-06-01

Full Text Available A 30-year-old healthy female presented with a 1-year history of chronic mucous discharge, tearing, and irritation in the left eye. Slit-lamp examination revealed severe papillary and follicular reaction surrounding a movable subconjunctival mass on the left upper tarsal conjunctiva. Incision and curettage were performed to establish the diagnosis. Multiple peculiar black mulberry nodules were obtained. The clumps of septate hyphae seen with periodic acid-Schiff stain were characteristic of fungus ball (aspergilloma. The patient's symptoms improved significantly after surgery without any antifungal therapy. Although rarely reported, aspergillus is a common fungus in the conjunctiva that may seed into the subconjunctiva. We present this case to remind ophthalmologists of such a rare cause of recalcitrant conjunctival inflammation in immunocompetent patients.

Clinical Use of the Marital Satisfaction Inventory: Two Case Studies.

Science.gov (United States)

Wills, Robert M.; Snyder, Douglas K.

1982-01-01

Describes the clinical use of the Marital Satisfaction Inventory (MSI), a multidimensional self-report measure of marital interaction. Two case studies of couples in marital therapy are presented. The MSI is presented as a cost-efficient procedure, permitting objective assessment across multiple areas of a couple's relationship. (Author/JAC)

A Complex Facial Trauma Case with Multiple Mandibular Fractures and Dentoalveolar Injuries

Directory of Open Access Journals (Sweden)

Yeliz Guven

2015-01-01

Full Text Available The principles of management of mandibular fractures differ in children when compared to adults and depend on the specific age-related status of the growing mandible and the developing dentition. This paper presents a case report with a complex facial trauma affecting the mandibular body and condyle region and dentoalveolar complex. Clinical examination revealed soft tissue injuries, limited mouth opening, lateral deviation of the mandible, an avulsed incisor, a subluxated incisor, and a fractured crown. CBCT examination revealed a nondisplaced fracture and an oblique greenstick fracture of the mandibular body and unilateral fracture of the condyle. Closed reduction technique was chosen to manage fractures of the mandible. Favorable healing outcomes on multiple fractures of the mandible throughout the 6-year follow-up period proved the success of the conservative treatment. This case report is important since it presents a variety of pathological sequelae to trauma within one case.

Networks in Argentine agriculture: a multiple-case study approach

Directory of Open Access Journals (Sweden)

Sebastián Senesi

2013-06-01

Full Text Available Argentina is among the four largest producers of soybeans, sunflower, corn, and wheat, among other agricultural products. Institutional and policy changes during the 1990s fostered the development of Argentine agriculture and the introduction of innovative process and product technologies (no-till, agrochemicals, GMO, GPS and new investments in modern, large-scale sunflower and soybean processing plants. In addition to technological changes, a "quiet revolution" occurred in the way agricultural production was carried out and organized: from self-production or ownership agriculture to a contract-based agriculture. The objective of this paper is to explore and describe the emergence of networks in the Argentine crop production sector. The paper presents and describes four cases that currently represent about 50% of total grain and oilseed production in Argentina: "informal hybrid form", "agricultural trust fund", "investor-oriented corporate structure", and "network of networks". In all cases, hybrid forms involve a group of actors linked by common objectives, mainly to gain scale, share resources, and improve the profitability of the business. Informal contracts seem to be the most common way of organizing the agriculture process, but using short-term contracts and sequential interfirm collaboration. Networks of networks involve long-term relationships and social development, and reciprocal interfirm collaboration. Agricultural trust fund and investor-oriented corporate structures have combined interfirm collaboration and medium-term relationships. These organizational forms are highly flexible and show a great capacity to adapt to challenges; they are competitive because they enjoy aligned incentives, flexibility, and adaptability.

A Case Study of Resources Management Planning with Multiple Objectives and Projects

Science.gov (United States)

David L. Peterson; David G. Silsbee; Daniel L. Schmoldt

1995-01-01

Each National Park Service unit in the United States produces a resources management plan (RMP) every four years or less. The plans commit budgets and personnel to specific projects for four years, but they are prepared with little quantitative and analytical rigor and without formal decisionmaking tools. We have previously described a multiple objective planning...

Multiple Site Action Research Case Studies: Practical and Theoretical Benefits and Challenges

Science.gov (United States)

Pereira, Mary Delfin; Vallance, Roger

2006-01-01

A curriculum initiative project was implemented in four schools in Singapore over a span of five to six weeks during 2004. The project employed a number of different schools: girls only, boys only and co-educational schools; different levels of performance in a graded situation; multiple teachers and classes within each site; and control and…

Intestinal volvulus and perforation caused by multiple magnet ingestion: report of a case.

Science.gov (United States)

Ilçe, Zekeriya; Samsum, Hakan; Mammadov, Emil; Celayir, Sinan

2007-01-01

Ingested magnets can cause intestinal fistulas, perforation, and obstruction. There have been reports of magnet ingestion causing intestinal volvulus, but multiple magnet ingestion causing perforation and intestinal volvulus in a child is very unusual. We report the case of a 4-year-old girl, who ingested four magnets she acquired as toys, which caused intestinal volvulus and perforation as a result of pressure necrosis, several days after ingestion. At surgery we repaired two perforations, but additional bowel resection was not required. The patient was discharged on postoperative day 10. If multiple magnet ingestion is suspected in a child, the child must be monitored carefully. If there are signs of obstruction, emergency surgery is mandatory.

Optimization of carrier multiplication for more effcient solar cells: the case of Sn quantum dots.

Science.gov (United States)

Allan, Guy; Delerue, Christophe

2011-09-27

We present calculations of impact ionization rates, carrier multiplication yields, and solar-power conversion efficiencies in solar cells based on quantum dots (QDs) of a semimetal, α-Sn. Using these results and previous ones on PbSe and PbS QDs, we discuss a strategy to select QDs with the highest carrier multiplication rate for more efficient solar cells. We suggest using QDs of materials with a close to zero band gap and a high multiplicity of the bands in order to favor the relaxation of photoexcited carriers by impact ionization. Even in that case, the improvement of the maximum solar-power conversion efficiency appears to be a challenging task. © 2011 American Chemical Society

CASE STUDY CRITIQUE; UPPER CLINCH CASE STUDY

Science.gov (United States)

Case study critique: Upper Clinch case study (from Research on Methods for Integrating Ecological Economics and Ecological Risk Assessment: A Trade-off Weighted Index Approach to Integrating Economics and Ecological Risk Assessment). This critique answers the questions: 1) does ...

Bilateral Video-Assisted Thoracoscopic Surgery Resection for Multiple Mediastinal Myelolipoma: Report of a Case

Science.gov (United States)

Kohno, Tadasu; Mun, Mingyon; Yoshiya, Tomoharu

2014-01-01

Myelolipoma in the mediastinum is an extremely rare entity. In this report, we present the case of a 79-year-old asymptomatic man who had three bilateral paravertebral mediastinal tumors. The three tumors were resected simultaneously using bilateral three-port video-assisted thoracoscopic surgery (VATS). There has been no evidence of recurrence within four years after the operation. Multiple bilateral mediastinal myelolipomas are extremely rare. There are no reports in the English literature of multiple bilateral thoracic myelolipomas that were resected simultaneously using bilateral VATS. We also present characteristic features of myelolipomas, which are helpful for diagnosis. PMID:24782978

Proteomic Analysis of Cerebrospinal Fluid in a Fulminant Case of Multiple Sclerosis

Directory of Open Access Journals (Sweden)

Jonas Bergquist

2012-06-01

Full Text Available Multiple Sclerosis (MS is a chronic disease, but in rare fulminant cases rapid progression may lead to death shortly after diagnosis. Currently there is no diagnostic test to predict disease course. The aim of this study was to identify potential biomarkers/proteins related to rapid progression. We present the case history of a 15-year-old male MS patient. Cerebrospinal fluid (CSF was taken at diagnosis and at the time of rapid progression leading to the patient’s death. Using isobaric tag labeling and nanoflow liquid chromatography in conjunction with matrix assisted laser desorption/ionization time of flight tandem mass spectrometry we quantitatively analyzed the protein content of two CSF samples from the patient with fulminant MS as well as one relapsing-remitting (RR MS patient and one control headache patient, whose CSF analysis was normal. Seventy-eight proteins were identified and seven proteins were found to be more abundant in both fulminant MS samples but not in the RR MS sample compared to the control. These proteins are involved in the immune response, blood coagulation, cell proliferation and cell adhesion. In conclusion, in this pilot study we were able to show differences in the CSF proteome of a rapidly progressing MS patient compared to a more typical clinical form of MS and a control subject.

Proteomic Analysis of Cerebrospinal Fluid in a Fulminant Case of Multiple Sclerosis

Science.gov (United States)

Füvesi, Judit; Hanrieder, Jörg; Bencsik, Krisztina; Rajda, Cecilia; Kovács, S. Krisztián; Kaizer, László; Beniczky, Sándor; Vécsei, László; Bergquist, Jonas

2012-01-01

Multiple Sclerosis (MS) is a chronic disease, but in rare fulminant cases rapid progression may lead to death shortly after diagnosis. Currently there is no diagnostic test to predict disease course. The aim of this study was to identify potential biomarkers/proteins related to rapid progression. We present the case history of a 15-year-old male MS patient. Cerebrospinal fluid (CSF) was taken at diagnosis and at the time of rapid progression leading to the patient’s death. Using isobaric tag labeling and nanoflow liquid chromatography in conjunction with matrix assisted laser desorption/ionization time of flight tandem mass spectrometry we quantitatively analyzed the protein content of two CSF samples from the patient with fulminant MS as well as one relapsing-remitting (RR) MS patient and one control headache patient, whose CSF analysis was normal. Seventy-eight proteins were identified and seven proteins were found to be more abundant in both fulminant MS samples but not in the RR MS sample compared to the control. These proteins are involved in the immune response, blood coagulation, cell proliferation and cell adhesion. In conclusion, in this pilot study we were able to show differences in the CSF proteome of a rapidly progressing MS patient compared to a more typical clinical form of MS and a control subject. PMID:22837721

Reliability of assessing the sensory perception of children with profound intellectual and multiple disabilities : a case study

NARCIS (Netherlands)

Vlaskamp, C.; Cuppen-Fonteine, H.

Background This study describes preliminary stages of developing a checklist to enable practitioners to determine the behavioural responses of children with profound intellectual and multiple disabilities to sensory stimuli. Reliability of currently used checklists is low, with a focus on the

Medium dependence of multiplicity distributions in MLLA

Energy Technology Data Exchange (ETDEWEB)

Armesto, Nestor; Pajares, Carlos; Quiroga-Arias, Paloma [Universidade de Santiago de Compostela, Departamento de Fisica de Particulas and IGFAE, Santiago de Compostela (Spain)

2009-06-15

We study the modification of the multiplicity distributions in MLLA due to the presence of a QCD medium. The medium is introduced through a multiplicative constant (f{sub med}) in the soft infrared parts of the kernels of the QCD evolution equations. Using the asymptotic ansatz for mean multiplicities of the quark and gluons, left angle n{sub G} right angle =e{sup {gamma}}{sup y} and left angle n{sub Q} right angle =r {sup -1}e{sup {gamma}}{sup y}, respectively, we study two cases: fixed {gamma} as previously considered in the literature, and fixed {alpha}{sub s}. We find opposite behaviors of the dispersion of the multiplicity distributions with increasing f{sub med} in both cases. For fixed {gamma} the dispersion decreases, while for fixed {alpha}{sub s} it increases. (orig.)

Free Surface Downgoing VSP Multiple Imaging

Science.gov (United States)

Maula, Fahdi; Dac, Nguyen

2018-03-01

The common usage of a vertical seismic profile is to capture the reflection wavefield (upgoing wavefield) so that it can be used for further well tie or other interpretations. Borehole Seismic (VSP) receivers capture the reflection from below the well trajectory, traditionally no seismic image information above trajectory. The non-traditional way of processing the VSP multiple can be used to expand the imaging above the well trajectory. This paper presents the case study of using VSP downgoing multiples for further non-traditional imaging applications. In general, VSP processing, upgoing and downgoing arrivals are separated during processing. The up-going wavefield is used for subsurface illumination, whereas the downgoing wavefield and multiples are normally excluded from the processing. In a situation where the downgoing wavefield passes the reflectors several times (multiple), the downgoing wavefield carries reflection information. Its benefit is that it can be used for seismic tie up to seabed, and possibility for shallow hazards identifications. One of the concepts of downgoing imaging is widely known as mirror-imaging technique. This paper presents a case study from deep water offshore Vietnam. The case study is presented to demonstrate the robustness of the technique, and the limitations encountered during its processing.

[The life as a caregiver of a person affected by Chorea Huntington: multiple case study].

Science.gov (United States)

Winkler, Evi; Ausserhofer, Dietmar; Mantovan, Franco

2012-10-01

Chorea Huntington is an autosomal dominantly inherited, neurodegenerative brain disorder that leads to involuntary hyperkinesia, psychotic symptoms and dementia. The illness not only changes the life of the person itself but also the world of the caregivers. The challenges in the care of a person which is affected by Chorea Huntington have an effect on the daily living as an assemblage of natural and social conditions. a multiple case study was conducted. It included semi-structured interviews with three caregivers of people with Chorea Huntington in South Tyrol. The qualitative data was analyzed using the qualitative structured analysis of Mayring (2007). The objective of this study was to describe the phenomenon of change of life from family members that care people affected by Chorea Huntington in a specific cultural setting (South Tyrol, Italy). The caregivers reported that the diagnosis of Chorea Huntington leads to negative changes in "relationship and family". Particularly, frustration, aggression, impatience and apathy were perceived as stressful. At the same time they highlight the positive changes through home care. They report that the relationship became more intimate and integral and it was characterized by more cohesion. Family caregivers get valuable support from the home care service, however, they complain that there is no facility in South Tyrol, which is specialized to care people with Chorea Huntington. Therefore, the caregivers have to "give up a lot" and don't have any personal desires, dreams and expectations for the future. The caregivers have learned independently to deal with their changed life step by step, and to see also the positive effects of the caring role. The life of family caregivers of a person which is affected by Chorea Huntington is characterized by abandonment. A continuous and professional care would be important for the affected and his caregiver. A continuous and professional care is important for both, addressing the

Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis.

Science.gov (United States)

Broggi, G; Ferroli, P; Franzini, A; Servello, D; Dones, I

2000-01-01

To examine surgical findings and results of microvascular decompression (MVD) for trigeminal neuralgia (TN), including patients with multiple sclerosis, to bring new insight about the role of microvascular compression in the pathogenesis of the disorder and the role of MVD in its treatment. Between 1990 and 1998, 250 patients affected by trigeminal neuralgia underwent MVD in the Department of Neurosurgery of the "Istituto Nazionale Neurologico C Besta" in Milan. Limiting the review to the period 1991-6, to exclude the "learning period" (the first 50 cases) and patients with less than 1 year follow up, surgical findings and results were critically analysed in 148 consecutive cases, including 10 patients with multiple sclerosis. Vascular compression of the trigeminal nerve was found in all cases. The recurrence rate was 15.3% (follow up 1-7 years, mean 38 months). In five of 10 patients with multiple sclerosis an excellent result was achieved (follow up 12-39 months, mean 24 months). Patients with TN for more than 84 months did significantly worse than those with a shorter history (p<0.05). There was no mortality and most complications occurred in the learning period. Surgical complications were not related to age of the patients. Aetiopathogenesis of trigeminal neuralgia remains a mystery. These findings suggest a common neuromodulatory role of microvascular compression in both patients with or without multiple sclerosis rather than a direct causal role. MVD was found to be a safe and effective procedure to relieve typical TN in patients of all ages. It should be proposed as first choice surgery to all patients affected by TN, even in selected cases with multiple sclerosis, to give them the opportunity of pain relief without sensory deficits.

Lessons for Co-Innovation in Agricultural Innovation Systems: A Multiple Case Study Analysis and a Conceptual Model

Science.gov (United States)

Fielke, Simon J.; Botha, Neels; Reid, Janet; Gray, David; Blackett, Paula; Park, Nicola; Williams, Tracy

2018-01-01

Purpose: This paper highlights important lessons for co-innovation drawn from three ex-post case study innovation projects implemented within three sub-sectors of the primary industry sector in New Zealand. Design/methodology/approach: The characteristics that fostered co-innovation in each innovation project case study were identified from…

Erector spinae plane block may aid weaning from mechanical ventilation in patients with multiple rib fractures: Case report of two cases

Directory of Open Access Journals (Sweden)

Amar Nandhakumar

2018-01-01

Full Text Available Uncontrolled pain in patients with rib fracture leads to atelectasis and impaired cough which can progress to pneumonia and respiratory failure necessitating mechanical ventilation. Of the various pain modalities, regional anaesthesia (epidural and paravertebral is better than systemic and oral analgesics. The erector spinae plane block (ESPB is a new modality in the armamentarium for the management of pain in multiple rib fractures, which is simple to perform and without major complications. We report a case series where ESPB helped in weaning the patients from mechanical ventilation. Further randomised controlled studies are warranted in comparing their efficacy in relation to other regional anaesthetic techniques.

Multiple keratocystic odontogenic tumors in a non-syndromic minor patient: Report of an unusual case

Directory of Open Access Journals (Sweden)

Shalu Rai

2013-01-01

Full Text Available Keratocystic odontogenic tumor (KCOT is developmental odontogenic cysts of epithelial origin known for their potentially aggressive behavior and significant rate of recurrences. Single odontogenic cysts are very well documented in the literature. Multiple (KCOT are principle features of nevoid basal cell carcinoma syndrome (naevoid basal cell carcinoma syndrome; Gorlin-Goltz syndrome. We report an intriguing case of multiple KCOT in a non-syndromic patient simultaneously occurring in maxilla as well as in mandible with brief highlight on molecular data and the treatment modality.

Trichoepithelioma And Multiple Basal Cell Epithelioma

Directory of Open Access Journals (Sweden)

Dey S.K

1996-01-01

Full Text Available A combination of multiple trichoepithelioma and basal cell epithelioma is reported. Although malignant degeneration of trichoepithelioma is debated, clinical and histopathological studies, in our case, hint at that. The case is reported for its rarity.

Robust Tests for Additive Gene-Environment Interaction in Case-Control Studies Using Gene-Environment Independence

DEFF Research Database (Denmark)

Liu, Gang; Lee, Seunggeun; Lee, Alice W

2018-01-01

test with case-control data. Our simulation studies suggest that the EB approach uses the gene-environment independence assumption in a data-adaptive way and provides power gain compared to the standard logistic regression analysis and better control of Type I error when compared to the analysis......There have been recent proposals advocating the use of additive gene-environment interaction instead of the widely used multiplicative scale, as a more relevant public health measure. Using gene-environment independence enhances the power for testing multiplicative interaction in case......-control studies. However, under departure from this assumption, substantial bias in the estimates and inflated Type I error in the corresponding tests can occur. This paper extends the empirical Bayes (EB) approach previously developed for multiplicative interaction that trades off between bias and efficiency...

Air MEDEVAC in case of multiple casualties – The experience of civilian-military cooperation in RoAF

Directory of Open Access Journals (Sweden)

Dragoș C. Tudose

2016-07-01

Full Text Available Introduction: Starting September 2010 in Romania was created the Military Emergency Medical Service (SMMU by the Ministry of National Defense, which has as main mission to provide first aid and save the lives of military personnel during military operations using special equipped MEDEAVC aircraft. Nationwide exist the national emergency system which operates thru 112- SMURD acting in support of the civilian population. In case of accidents with multiple victims the experience has shown the need for collaboration between the two systems, in order to save lives. In the last 5 years there has been an increasing Airlift missions (MEDEVAC with multiple victims executed by joint civil-military medical teams using military aircraft. Material and methods. This paper provides a review of the most important aspects of particularities, advantages and disadvantages of this type of medical transport using the MEDEVAC missions based study carried out by the Air Force in recent years. Results and conclusions. Performing these tasks presents challenges to mission planning, use of medical equipment and procedures, command-control system, exercise programs jointly joint medical teams and, of course, managing a large number of patients in flight. The large number of patients transported safely and in the shortest time, regardless of weather conditions recommends this type of medical intervention. Given the Romanian military presence in various theaters and that NATO strategic medical evacuation is a national responsibility, the capacity of air transport in case multiple casualties is a priority.

Teaching Ambition: A Case Study of High School Music Students

Science.gov (United States)

Draves, Tami

2012-01-01

Music teacher socialisation (MTS) has received increased attention in music education research, but few researchers have explored MTS with students during their primary socialisation, or pre-college, years. The purpose of this qualitative multiple case study was to examine the perspectives of high school music students who plan to pursue a music…

Case of multiple hepatic abscesses detected by CT scan in the patient with acute lymphoblastic leukemia

Energy Technology Data Exchange (ETDEWEB)

Saburi, Yoshio; Shuto, Ryusuke; Mizutani, Ryoko; Hosokawa, Takafumi; Itoga, Takashi (Medical Coll. of Oita (Japan))

1983-12-01

A 34 year old man admitted to a hospital on 21 Feb. 1983 was diagnosed acute lymphoblastic leukemia. A hematological complete remission was achieved by combination therapy of vincristine, prednisolone and L-asparaginase. However, he had been complaining of high fever and right hypochondralgia since early in Apr. 1983, and it was revealed that elevation of right diaphragm on chest X-ray. Therefore, he was also given several antibiotics (CPZ, TOB, LMOX, PIPC, LCM, AMK, MINO and GM) for complication of probable liver abscess. Remittent fever persisted in spite of as mentioned above various antibiotics. The multiple hepatic abscesses were found by CT scan of the mid-abdomen as the low density lesions, but bacterial cultures detected no pathogens. His complaining of remittent fever and right hypochondralgia were improved by treatment with Miconazole during about one month, and decreasing in size and number of multiple hepatic abscesses were found by CT scan. Though we could not determine clearly, but suspected that multiple hepatic abscesses were due to fungus infection, by reason of therapeutic result. Regarding the complication of hepatic abscesses with leukemia, 5 cases have been reported in Japan, and one case out of 5 cases were detected by CT scan. We thought that CT scans were useful procedures for early diagnosis of hepatic abscesses. Recently, the patient has continued complete remission hematologically.

Young Adult and Usual Adult Body Mass Index and Multiple Myeloma Risk: A Pooled Analysis in the International Multiple Myeloma Consortium (IMMC).

Science.gov (United States)

Birmann, Brenda M; Andreotti, Gabriella; De Roos, Anneclaire J; Camp, Nicola J; Chiu, Brian C H; Spinelli, John J; Becker, Nikolaus; Benhaim-Luzon, Véronique; Bhatti, Parveen; Boffetta, Paolo; Brennan, Paul; Brown, Elizabeth E; Cocco, Pierluigi; Costas, Laura; Cozen, Wendy; de Sanjosé, Silvia; Foretová, Lenka; Giles, Graham G; Maynadié, Marc; Moysich, Kirsten; Nieters, Alexandra; Staines, Anthony; Tricot, Guido; Weisenburger, Dennis; Zhang, Yawei; Baris, Dalsu; Purdue, Mark P

2017-06-01

Background: Multiple myeloma risk increases with higher adult body mass index (BMI). Emerging evidence also supports an association of young adult BMI with multiple myeloma. We undertook a pooled analysis of eight case-control studies to further evaluate anthropometric multiple myeloma risk factors, including young adult BMI. Methods: We conducted multivariable logistic regression analysis of usual adult anthropometric measures of 2,318 multiple myeloma cases and 9,609 controls, and of young adult BMI (age 25 or 30 years) for 1,164 cases and 3,629 controls. Results: In the pooled sample, multiple myeloma risk was positively associated with usual adult BMI; risk increased 9% per 5-kg/m 2 increase in BMI [OR, 1.09; 95% confidence interval (CI), 1.04-1.14; P = 0.007]. We observed significant heterogeneity by study design ( P = 0.04), noting the BMI-multiple myeloma association only for population-based studies ( P trend = 0.0003). Young adult BMI was also positively associated with multiple myeloma (per 5-kg/m 2 ; OR, 1.2; 95% CI, 1.1-1.3; P = 0.0002). Furthermore, we observed strong evidence of interaction between younger and usual adult BMI ( P interaction adult BMI may increase multiple myeloma risk and suggest that healthy BMI maintenance throughout life may confer an added benefit of multiple myeloma prevention. Cancer Epidemiol Biomarkers Prev; 26(6); 876-85. ©2017 AACR . ©2017 American Association for Cancer Research.

Paper 5: Surveillance of multiple congenital anomalies: implementation of a computer algorithm in European registers for classification of cases

DEFF Research Database (Denmark)

Garne, Ester; Dolk, Helen; Loane, Maria

2011-01-01

Surveillance of multiple congenital anomalies is considered to be more sensitive for the detection of new teratogens than surveillance of all or isolated congenital anomalies. Current literature proposes the manual review of all cases for classification into isolated or multiple congenital anomal...

An Unusual Radiologic Manifestation of Pulmonary Tuberculosis with Bilateral Multiple Lung Nodules and Diffuse Alveolar Hemorrhage: A Case Report

Energy Technology Data Exchange (ETDEWEB)

Jeong, Seo In; Seon, Hyun Ju; Kim, Yun Hyeon [Dept. of Radiology, Chunnam National University Hospital, Gwangju (Korea, Republic of); Choi, Sung [Dept. of Radiology, Chunnam National University Hwasun Hospital, Hwasun(Korea, Republic of)

2011-12-15

Pulmonary tuberculosis presenting as bilateral multiple lung nodules or diffuse alveolar hemorrhage is very rare. Here, we report a case of pulmonary tuberculosis presenting as bilateral multiple lung nodules and diffuse alveolar hemorrhage mimicking granulomatous vasculitis, such as Wegener's granulomatosis.

Cost comparison between private and public collection of residual household waste: Multiple case studies in the Flemish region of Belgium

International Nuclear Information System (INIS)

Jacobsen, R.; Buysse, J.; Gellynck, X.

2013-01-01

Highlights: ► The goal is to compare collection costs for residual household waste. ► We have clustered all municipalities in order to find mutual comparable pairs. ► Each pair consists of one private and one public operating waste collection program. ► All cases show that private service has lower costs than public service. ► Municipalities were contacted to identify the deeper causes for the waste management program. - Abstract: The rising pressure in terms of cost efficiency on public services pushes governments to transfer part of those services to the private sector. A trend towards more privatizing can be noticed in the collection of municipal household waste. This paper reports the findings of a research project aiming to compare the cost between the service of private and public collection of residual household waste. Multiple case studies of municipalities about the Flemish region of Belgium were conducted. Data concerning the year 2009 were gathered through in-depth interviews in 2010. In total 12 municipalities were investigated, divided into three mutual comparable pairs with a weekly and three mutual comparable pairs with a fortnightly residual waste collection. The results give a rough indication that in all cases the cost of private service is lower than public service in the collection of household waste. Albeit that there is an interest in establishing whether there are differences in the costs and service levels between public and private waste collection services, there are clear difficulties in establishing comparisons that can be made without having to rely on a large number of assumptions and corrections. However, given the cost difference, it remains the responsibility of the municipalities to decide upon the service they offer their citizens, regardless the cost efficiency: public or private.

Cost comparison between private and public collection of residual household waste: Multiple case studies in the Flemish region of Belgium

Energy Technology Data Exchange (ETDEWEB)

Jacobsen, R., E-mail: ray.jacobsen@ugent.be [Department of Agricultural Economics, Ghent University, Coupure Links 653, B-9000 Ghent (Belgium); Buysse, J., E-mail: j.buysse@ugent.be [Department of Agricultural Economics, Ghent University, Coupure Links 653, B-9000 Ghent (Belgium); Gellynck, X., E-mail: xavier.gellynck@ugent.be [Department of Agricultural Economics, Ghent University, Coupure Links 653, B-9000 Ghent (Belgium)

2013-01-15

Highlights: Black-Right-Pointing-Pointer The goal is to compare collection costs for residual household waste. Black-Right-Pointing-Pointer We have clustered all municipalities in order to find mutual comparable pairs. Black-Right-Pointing-Pointer Each pair consists of one private and one public operating waste collection program. Black-Right-Pointing-Pointer All cases show that private service has lower costs than public service. Black-Right-Pointing-Pointer Municipalities were contacted to identify the deeper causes for the waste management program. - Abstract: The rising pressure in terms of cost efficiency on public services pushes governments to transfer part of those services to the private sector. A trend towards more privatizing can be noticed in the collection of municipal household waste. This paper reports the findings of a research project aiming to compare the cost between the service of private and public collection of residual household waste. Multiple case studies of municipalities about the Flemish region of Belgium were conducted. Data concerning the year 2009 were gathered through in-depth interviews in 2010. In total 12 municipalities were investigated, divided into three mutual comparable pairs with a weekly and three mutual comparable pairs with a fortnightly residual waste collection. The results give a rough indication that in all cases the cost of private service is lower than public service in the collection of household waste. Albeit that there is an interest in establishing whether there are differences in the costs and service levels between public and private waste collection services, there are clear difficulties in establishing comparisons that can be made without having to rely on a large number of assumptions and corrections. However, given the cost difference, it remains the responsibility of the municipalities to decide upon the service they offer their citizens, regardless the cost efficiency: public or private.

The Danish Multiple Sclerosis Registry. History, data collection and validity

DEFF Research Database (Denmark)

Koch-Henriksen, N; Rasmussen, S; Stenager, E

2001-01-01

The Danish Multiple Sclerosis Registry was formally established in 1956 but started operating in 1949 with a nationwide prevalence survey. Since then, the Registry has continued collecting data on new and old cases of multiple sclerosis (MS) or suspected MS from multiple sources. The Registry...... instrument for monitoring incidence and prevalence, analysing survival, performing genetic analysis, providing unselected patient samples for clinical analyses, performing case-control studies and prospective studies and estimating the need for treatment and care....

Exploring interprofessional, interagency multimorbidity care: case study based observational research

Science.gov (United States)

McKinlay, Eileen M.; Morgan, Sonya J.; Gray, Ben V.; Macdonald, Lindsay M.; Pullon, Susan R.H.

2017-01-01

Background The increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care. Objective To explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care. Design Using a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration. Results The two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals. Conclusion Cases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them. PMID

A real case study on transportation scenario comparison

Directory of Open Access Journals (Sweden)

Tsoukiás A.

2002-01-01

Full Text Available This paper presents a real case study dealing with the comparison of transport scenarios. The study is conducted within a larger project concerning the establishment of the maritime traffic policy in Greece. The paper presents the problem situation and an appropriate problem formulation. Moreover a detailed version of the evaluation model is presented in the paper. The model consists of a complex hierarchy of evaluation models enabling us to take into account the multiple dimensions and points of view of the actors involved in the evaluations.

Tuberous sclerosis: Ultrasound, CT and MRI features of two cases with multiple organ involvement

International Nuclear Information System (INIS)

Arslan, A.; Ciftci, E.; Cetin, A.; Selcuk, H.; Demirci, A.

1998-01-01

The cases of two patients with tuberous sclerosis with multiple sites of involvement are presented. Both patients had characteristic cerebral lesions of tuberous sclerosis associated with bilateral renal angiomyolipomas and hepatic hamartomas. Additionally there were diffuse pulmonary cystic changes in one patient and cardiac rhabdomyoma in the other. Copyright (1998) Blackwell Science Pty Ltd

Multiple small hemorrhagic infarcts in cerebral air embolism: a case report.

Science.gov (United States)

Togo, Masaya; Hoshi, Taku; Matsuoka, Ryosuke; Imai, Yukihiro; Kohara, Nobuo

2017-11-16

Cerebral air embolism is a rare cause of cerebral infarction. In cerebral air embolism, T2 star-weighted imaging shows numerous spotty hypointense signals. Previous reports have suggested that these signals represent air in the brain and are gradually diminished and absorbed. We experienced two cases of cerebral air embolism, and in one of them, we conducted an autopsy. Case 1 was a 76-year-old Japanese man with lung cancer and emphysema. A spasmodic cough induced massive cerebral and cardiac air embolisms and the patient died because of cerebral herniation. T2 star-weighted imaging of brain magnetic resonance imaging showed multiple spotty low signals. Brain autopsy showed numerous spotty hemorrhagic infarcts in the area of T2 star-weighted imaging signals. Case 2 was an 85-year-old Japanese man with emphysema who suffered from acute stroke. Similar spotty T2 star-weighted imaging signals were observed and remained unchanged 2 months after the onset. These findings indicate that T2 star-weighted imaging in cerebral air embolism partially represents micro-hemorrhagic infarction caused by air bubbles that have migrated into the brain.

Maltreatment in multiple-birth children.

Science.gov (United States)

Lang, Cathleen A; Cox, Matthew J; Flores, Glenn

2013-12-01

The rate of multiple births has increased over the last two decades. In 1982, an increased frequency of injuries among this patient population was noted, but few studies have evaluated the increased incidence of maltreatment in twins. The study aim was to evaluate the features of all multiple-birth children with substantiated physical abuse and/or neglect over a four-year period at a major children's hospital. A Retrospective chart review was conducted of multiple-gestation children in which at least one child in the multiple set experienced child maltreatment from January 2006 to December 2009. Data regarding the child, injuries, family, and perpetrators were abstracted. We evaluated whether family and child characteristics were associated with maltreatment, and whether types of injuries were similar within multiple sets. For comparison, data from the same time period for single-birth maltreated children also were abstracted, including child age, gestational age at birth, and injury type. There were 19 sets of multiple births in which at least one child had abusive injuries and/or neglect. In 10 of 19 sets (53%), all multiples were found to have a form of maltreatment, and all children in these multiple sets shared at least one injury type. Parents lived together in 63% of cases. Fathers and mothers were the alleged perpetrator in 42% of the cases. Multiple-gestation-birth maltreated children were significantly more likely than single-birth maltreated children to have abdominal trauma (13% vs. 1%, respectively; pchildren often, but not always, were abused. In sets with two maltreated children, children usually shared the same modes of maltreatment. Multiples are significantly more likely than singletons to be younger and experience fractures and abdominal trauma. The findings support the current standard practice of evaluating all children in a multiple set when one is found to be abused or neglected. Copyright © 2013 Elsevier Ltd. All rights reserved.

Prayer Healing: A Case Study Research Protocol.

Science.gov (United States)

Kruijthoff, Dirk J; van der Kooi, Cornelis; Glas, Gerrit; Abma, Tineke A

2017-01-01

Context • Prayer healing is a common practice in many religious communities around the world. Even in the highly secularized Dutch society, cases of prayer healing are occasionally reported in the media, often generating public attention. There is an ongoing debate regarding whether such miraculous cures do actually occur and how to interpret them. Objective • The aim of the article was to present a research protocol for the investigation of reported cases of remarkable and/or unexplained healing after prayer. Design • The research team developed a method to perform a retrospective, case-based study of prayer healing. Reported prayer healings can be investigated systematically in accordance with a step-by-step methodology. The focus is on understanding the healing by studying it from multiple perspectives, using both medical judgment and patients' narratives collected by qualitative methods Setting • The study occurred at Vrije Universiteit (VU) and VU Medical Center (Amsterdam, Netherlands) as well as the general medical practice of the first author. Participants • Potential participants could be any individuals in the Netherlands or neighboring countries who claim to have been healed through prayer. The reports of healing came from multiple sources, including the research team's medical practices and their direct vicinities, newspaper articles, prayer healers, and medical colleagues. Outcome Measures • Medical data were obtained before and after prayer. Subsequently, a member of a research team and of a medical assessment committee made a standardized judgment that evaluated whether a cure was clinically remarkable or scientifically unexplained. The participants' experiences and insider perspectives were studied, using in-depth interviews in accordance with a qualitative research methodology, to gain insight into the perceptions and explanations of the cures that were offered by participants and by the members of the medical assessment committee. The

Ischemic Stroke Following Multiple Traumas in a Child: A Case Report

Directory of Open Access Journals (Sweden)

Pei-Jung Lin

2006-04-01

Full Text Available Stroke is an uncommon disorder in children but an increasingly recognized cause of disability. Acute stroke may be attributable to trauma, but this topic is seldom discussed. In limited reports, most ischemic strokes following trauma were detected after a considerable delay. Early recognition of stroke following trauma might reduce secondary neurologic complications. We report a case of posterior cerebral artery area infarct following multiple traumas in a child. A comprehensive etiologic survey was undertaken and discussed. Although the definite pathogenesis is still unclear, adequate, individualized, and uncomplicated management can significantly affect the outcome.

The state of case study approach in mergers and acquisitions literature: A bibliometric analysis

Directory of Open Access Journals (Sweden)

K.S. Reddy

2015-12-01

Full Text Available The purpose of this paper is to survey the state of case study research in mergers and acquisitions (M&A literature. Thus, it is an original attempt at presenting the current state and review of the case method in M&A research, provided no earlier study claims this. The stylized review reveals that 93 journal articles adopted the case method of which 66 (27 articles examined developed (emerging markets, and single (multiple case based studies were 44 (46 and remaining three adopted survey and interview method during survey period 1991–2015. Albeit, very few studies accomplished the purpose of case study research in business management, that is, testing extant theory and building new theory. Lastly, we recall various methodological guidelines to establish the sound research environment in the qualitative case method.

Cancer risk among patients with multiple sclerosis: A cohort study in Isfahan, Iran.

Science.gov (United States)

Etemadifar, Masoud; Jahanbani-Ardakani, Hamidreza; Ghaffari, Sara; Fereidan-Esfahani, Maboobeh; Changaei, Hossein; Aghadoost, Nazila; Jahanbani Ardakani, Ameneh; Moradkhani, Negin

2017-01-01

Multiple sclerosis (MS), a central nervous system (CNS) autoimmune disorder, affects 2.3 million people around the world. Cancer kills around 7.5 million people annually. Both diseases have similar risks and intertwining molecular causes. Most studies focusing on MS and cancer have found an insignificant difference or reduction in the amount of cancer found in the MS community. We performed a cohort study using data from Isfahan Multiple Sclerosis Society (IMSS) and Isfahan cancer society and followed-up for 8 years on average (2006-2014). All of the 1718 MS patients were diagnosed according to McDonald's criteria, then standardized incidence ratio and the numbers of expected cancer case were calculated. While patients had an insignificant change in cancer prevalence, men had fewer cancer cases and women showed an increased prevalence of cancer. Certain types of cancer proved statistically significant. Breast cancer, nervous system cancers, and lymphoma were elevated in the cohort. Our results support the hypothesis that MS significantly affects certain cancers in a protective or associative manner. All cancer rates, except breast cancer, cancers located in the nervous system, and lymphomas were reduced in cohort, suggesting that unregulated immune function may provide protective effects to MS patients against cancer.

Radiological Findings in a Case of Multiple Focal Nodular Hyperplasia Associated with Portal Vein Atresia and Portopulmonary Hypertension

Energy Technology Data Exchange (ETDEWEB)

Lee, In Joon; Jeong, Sook Hyang; Choi, Jin Woo; Park, Hee Sun; Lee, Kyoung Ho; Kim, Hae Ryoung [Seoul National University Bundang Hospital, Seoul (Korea, Republic of)

2008-08-15

We present here the radiological findings of a rare case of multiple focal nodular hyperplasia that was associated with portal vein atresia and portopulmonary hypertension in a young woman. This case illustrates and supports the pathophysiological hypotheses that were previously proposed for the coexistence of these three abnormalities

Unusual CT findings of a benign metastasizing leiomyoma presenting with multiple cavitary nodules: a case report

International Nuclear Information System (INIS)

Ahn, Ji Eun; Do, Kyung Hyun; Chae, Eun Jin; Seo, Joon Beom; Lee, Jin Seong; Song, Koun Sik; Song, Jae Wo; Kim, Kyu Rae; Lim, Tae Hwan

2007-01-01

A benign metastasizing leiomyoma is a rare condition that affects women with a history of uterine leiomyoma, usually after a myomectomy or hysterectomy. Typical radiographic findings include well-circumscribed solitary or multiple pulmonary nodules ranging from a few millimeters to several centimeters in diameter and scattered among the normal interstitium. We report a case of a benign metastasizing leiomyoma that manifested with multiple cavitary nodules in a 46-year-old woman with no previous history of a myomectomy or hysterectomy

Unusual CT findings of a benign metastasizing leiomyoma presenting with multiple cavitary nodules: a case report

Energy Technology Data Exchange (ETDEWEB)

Ahn, Ji Eun; Do, Kyung Hyun; Chae, Eun Jin; Seo, Joon Beom; Lee, Jin Seong; Song, Koun Sik; Song, Jae Wo; Kim, Kyu Rae; Lim, Tae Hwan [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

2007-09-15

A benign metastasizing leiomyoma is a rare condition that affects women with a history of uterine leiomyoma, usually after a myomectomy or hysterectomy. Typical radiographic findings include well-circumscribed solitary or multiple pulmonary nodules ranging from a few millimeters to several centimeters in diameter and scattered among the normal interstitium. We report a case of a benign metastasizing leiomyoma that manifested with multiple cavitary nodules in a 46-year-old woman with no previous history of a myomectomy or hysterectomy.

Evaluation of the role of Care Sport Connectors in connecting primary care, sport, and physical activity, and residents' participation in the Netherlands: study protocol for a longitudinal multiple case study design.

Science.gov (United States)

Smit, E; Leenaars, K E F; Wagemakers, M A E; Molleman, G R M; Koelen, M A; van der Velden, J

2015-11-23

The number of people with one or more chronic diseases is increasing, but this trend could be reduced by promoting physical activity. Therefore, in 2012, the Dutch Ministry of Health, Welfare, and Sport introduced Care Sport Connectors (CSCs), to whom a broker role has been ascribed. The defined outcome of CSCs role is an increased number of residents participating in local sports facilities and being physically active in their own neighbourhood. To realize this, primary care and sports professionals need to collaborate, and local sports facilities and neighbourhoods need to offer accessible physical activities for people in the locality, including people with one or more chronic diseases or at increased risk of chronic disease(s). Adequate scientific research is needed to assess CSCs' impact on: 1) connecting primary care, sport, and physical activity and 2) increasing the number of residents who engage in physical activity to promote their health. To study the role and the impact of CSCs, a longitudinal multiple case study will be conducted, in nine municipalities spread over the Netherlands, from 2014 until 2017. A mixed methodology will be used to perform action research and process evaluation. Study I focuses on the expected alliances of CSCs and the preconditions that facilitate or hinder CSCs in the formation of these alliances. The study population will consist of intermediary target groups. A literature review, interviews, focus groups, and document analysis will be undertaken. Study II will concentrate on lifestyle program participants to identify health and physical activity behavior changes. For this purpose, interviews, literature studies, a Delphi study, fitness tests, and questionnaires will be used. Linking and integrating results gained by multiple methods, at different levels, will provide a validated assessment of CSCs' impact on connecting the primary care and sports sectors. This will reveal changes in residents' physical activity behavior, and

Tumefactive multiple sclerosis requiring emergency craniotomy: case report and literature review.

Science.gov (United States)

Munarriz, Pablo M; Castaño-Leon, Ana M; Martinez-Perez, Rafael; Hernandez-Lain, Aurelio; Ramos, Ana; Lagares, Alfonso

2013-01-01

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, characterized by focal neurological dysfunction with a relapsing and remitting course. Tumor-like presentation of MS (or "tumefactive"/"pseudotumoral" presentation) has been described before with a certain frequency; it consists of a large single plaque (>2cm) with presence of edema and mass effect and it is hard to distinguish from a brain tumor. However, we present a very rare case of a 53-year-old woman with a right temporal mass that turned out to be a MS plaque, who deteriorated within hours (brain herniation with loss of consciousness and unilateral mydriasis) and required an emergency craniotomy. We also present a review of the literature. It appears that only 4 cases of emergency craniotomy/craniectomy required in a patient with a tumor-like MS plaque have been reported before. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

[A case of leptomeningeal melanomatosis with acute paraplegia and multiple cranial nerve palsies].

Science.gov (United States)

Hattori, Kasumi; Matsuda, Nozomu; Murakami, Takenobu; Ito, Eiichi; Ugawa, Yoshikazu

2017-12-27

A 62-year-old man with acute paraplegia was transferred to our hospital. He had flaccid paraplegia and multiple cranial nerve palsies, such as mydriasis of the left pupil, abduction palsy of the left eye, hoarseness and dysphagia, but no meningeal irritation signs. MRI of the spinal canal showed swellings of the conus medullaris and the cauda equine, and also contrast enhancement of the spinal meninges. The cerebrospinal fluid (CSF) showed pleocytosis and protein increment. The lymph node was swollen in his right axilla. The biopsy specimen from the right axillary lymph node revealed metastasis of malignant melanoma histologically. Careful check-up of his whole body found a malignant melanoma in the subungual region of the right ring finger. Repeated cytological examination revealed melanoma cells in the CSF, confirming the diagnosis of leptomeningeal melanomatosis. His consciousness was gradually deteriorated. His family members chose supportive care instead of chemotherapy or surgical therapy after full information about his conditions. Finally, he died 60 days after transfer to our hospital. This is a rare case of leptomenigeal melanomatosis presenting with acute paraplegia and multiple cranial nerve palsies. Careful follow-up and repeated studies are vital for the early diagnosis of leptomenigeal melanomatosis in spite of atypical clinical presentation.

Social and Emotional Dynamics of College Students with Musical Intelligence and Musical Training: A Multiple Case Study

Science.gov (United States)

Pelayo, Jose Maria G., III; Galang, Edgar

2013-01-01

Music has been in its formal existence for so many years now and it has also been utilized to enhance, relax and help man's meditation. This study focused on how music can or may influence an individual. The researchers investigated and described the influence of Howard Gardner's theory on Multiple Intelligence (specifically, musical…

Classifying multiple types of hand motions using electrocorticography during intraoperative awake craniotomy and seizure monitoring processes—case studies

Science.gov (United States)

Xie, Tao; Zhang, Dingguo; Wu, Zehan; Chen, Liang; Zhu, Xiangyang

2015-01-01

In this work, some case studies were conducted to classify several kinds of hand motions from electrocorticography (ECoG) signals during intraoperative awake craniotomy & extraoperative seizure monitoring processes. Four subjects (P1, P2 with intractable epilepsy during seizure monitoring and P3, P4 with brain tumor during awake craniotomy) participated in the experiments. Subjects performed three types of hand motions (Grasp, Thumb-finger motion and Index-finger motion) contralateral to the motor cortex covered with ECoG electrodes. Two methods were used for signal processing. Method I: autoregressive (AR) model with burg method was applied to extract features, and additional waveform length (WL) feature has been considered, finally the linear discriminative analysis (LDA) was used as the classifier. Method II: stationary subspace analysis (SSA) was applied for data preprocessing, and the common spatial pattern (CSP) was used for feature extraction before LDA decoding process. Applying method I, the three-class accuracy of P1~P4 were 90.17, 96.00, 91.77, and 92.95% respectively. For method II, the three-class accuracy of P1~P4 were 72.00, 93.17, 95.22, and 90.36% respectively. This study verified the possibility of decoding multiple hand motion types during an awake craniotomy, which is the first step toward dexterous neuroprosthetic control during surgical implantation, in order to verify the optimal placement of electrodes. The accuracy during awake craniotomy was comparable to results during seizure monitoring. This study also indicated that ECoG was a promising approach for precise identification of eloquent cortex during awake craniotomy, and might form a promising BCI system that could benefit both patients and neurosurgeons. PMID:26483627

First-episode psychosis as the initial presentation of multiple sclerosis: a case report.

Science.gov (United States)

Enderami, Athena; Fouladi, Rose; Hosseini, Seyed Hamzeh

2018-01-01

Multiple sclerosis (MS) is an inflammatory disease that affects the central nervous system (CNS). MS with episode of psychosis is a rare entity, and to the best of our knowledge, no case has been reported from Iran till date. We report a case of MS with first-episode psychosis in a 27-year-old single man with no history of psychiatric disorder or drug abuse. The patient developed neurological symptoms after 3 months and was finally diagnosed as a case of MS. His symptoms started with behavioral dysfunctions and progressively resulted in depression. Subsequently, treatment was performed with citalopram 20 mg daily, risperidone 2 mg three times a day, and biperiden 2 mg three times a day; however, no improvements in the symptoms were observed. T2-weighted magnetic resonance imaging has demonstrated periventricular and white matter multiple sclerotic plugs with lesions. Eventually, MS was diagnosed after the appearance of paresthesia, upper and lower limb muscle weakness, ataxia, and urinary incontinency as typical signs. Then, the medications were changed to methylprednisolone and interferon therapy, which resulted in improvements in the clinical conditions of the patient. Based on the fact that organic disorders such as MS may sometimes appear with initial pure psychiatric symptoms without any neurological signs and symptoms, examinations for symptoms linked to CNS dysfunction, cognitive changes, atypical symptoms, detailed neurological examination, and limited response to conventional antipsychotic drugs are highly recommended to be carried out for patients with first-episode psychosis and even in the followup period.

Modeling transport pricing with multiple stakeholders. Working paper : Methodology and a case study

NARCIS (Netherlands)

Smits, E.

2012-01-01

Pricing measures (e.g., a kilometre charge or cordon toll) are used to improve the external effects of transportation (e.g., congestion or emissions). This working paper presents a planning model for pricing while taking the preferences and interactions of multiple stakeholders (e.g., governments or

The role of economic evaluation in the decision-making process of family physicians: design and methods of a qualitative embedded multiple-case study

Science.gov (United States)

Lessard, Chantale; Contandriopoulos, André-Pierre; Beaulieu, Marie-Dominique

2009-01-01

Background A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs). The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory. Methods/design A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis) and field of family medicine (macro-level of analysis). The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original framework and new themes

The role of economic evaluation in the decision-making process of family physicians: design and methods of a qualitative embedded multiple-case study

Directory of Open Access Journals (Sweden)

Beaulieu Marie-Dominique

2009-02-01

Full Text Available Abstract Background A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs. The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory. Methods/design A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis and field of family medicine (macro-level of analysis. The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original

ePRISM: A case study in multiple proxy and mixed temporal resolution integration

Science.gov (United States)

Robinson, Marci M.; Dowsett, Harry J.

2010-01-01

As part of the Pliocene Research, Interpretation and Synoptic Mapping (PRISM) Project, we present the ePRISM experiment designed I) to provide climate modelers with a reconstruction of an early Pliocene warm period that was warmer than the PRISM interval (similar to 3.3 to 3.0 Ma), yet still similar in many ways to modern conditions and 2) to provide an example of how best to integrate multiple-proxy sea surface temperature (SST) data from time series with varying degrees of temporal resolution and age control as we begin to build the next generation of PRISM, the PRISM4 reconstruction, spanning a constricted time interval. While it is possible to tie individual SST estimates to a single light (warm) oxygen isotope event, we find that the warm peak average of SST estimates over a narrowed time interval is preferential for paleoclimate reconstruction as it allows for the inclusion of more records of multiple paleotemperature proxies.

Existence and Multiplicity Results for Nonlinear Differential Equations Depending on a Parameter in Semipositone Case

Directory of Open Access Journals (Sweden)

Hailong Zhu

2012-01-01

Full Text Available The existence and multiplicity of solutions for second-order differential equations with a parameter are discussed in this paper. We are mainly concerned with the semipositone case. The analysis relies on the nonlinear alternative principle of Leray-Schauder and Krasnosel'skii's fixed point theorem in cones.

Combining evidence from multiple electronic health care databases: performances of one-stage and two-stage meta-analysis in matched case-control studies.

Science.gov (United States)

La Gamba, Fabiola; Corrao, Giovanni; Romio, Silvana; Sturkenboom, Miriam; Trifirò, Gianluca; Schink, Tania; de Ridder, Maria

2017-10-01

Clustering of patients in databases is usually ignored in one-stage meta-analysis of multi-database studies using matched case-control data. The aim of this study was to compare bias and efficiency of such a one-stage meta-analysis with a two-stage meta-analysis. First, we compared the approaches by generating matched case-control data under 5 simulated scenarios, built by varying: (1) the exposure-outcome association; (2) its variability among databases; (3) the confounding strength of one covariate on this association; (4) its variability; and (5) the (heterogeneous) confounding strength of two covariates. Second, we made the same comparison using empirical data from the ARITMO project, a multiple database study investigating the risk of ventricular arrhythmia following the use of medications with arrhythmogenic potential. In our study, we specifically investigated the effect of current use of promethazine. Bias increased for one-stage meta-analysis with increasing (1) between-database variance of exposure effect and (2) heterogeneous confounding generated by two covariates. The efficiency of one-stage meta-analysis was slightly lower than that of two-stage meta-analysis for the majority of investigated scenarios. Based on ARITMO data, there were no evident differences between one-stage (OR = 1.50, CI = [1.08; 2.08]) and two-stage (OR = 1.55, CI = [1.12; 2.16]) approaches. When the effect of interest is heterogeneous, a one-stage meta-analysis ignoring clustering gives biased estimates. Two-stage meta-analysis generates estimates at least as accurate and precise as one-stage meta-analysis. However, in a study using small databases and rare exposures and/or outcomes, a correct one-stage meta-analysis becomes essential. Copyright © 2017 John Wiley & Sons, Ltd.

Acute respiratory infection case definitions for young children: a systematic review of community-based epidemiologic studies in South Asia.

Science.gov (United States)

Roth, Daniel E; Gaffey, Michelle F; Smith-Romero, Evelyn; Fitzpatrick, Tiffany; Morris, Shaun K

2015-12-01

To explore the variability in childhood acute respiratory infection case definitions for research in low-income settings where there is limited access to laboratory or radiologic investigations. We conducted a systematic review of community-based, longitudinal studies in South Asia published from January 1990 to August 2013, in which childhood acute respiratory infection outcomes were reported. Case definitions were classified by their label (e.g. pneumonia, acute lower respiratory infection) and clinical content 'signatures' (array of clinical features that would be always present, conditionally present or always absent among cases). Case definition heterogeneity was primarily assessed by the number of unique case definitions overall and by label. We also compared case definition-specific acute respiratory infection incidence rates for studies reporting incidence rates for multiple case definitions. In 56 eligible studies, we found 124 acute respiratory infection case definitions. Of 90 case definitions for which clinical content was explicitly defined, 66 (73%) were unique. There was a high degree of content heterogeneity among case definitions with the same label, and some content signatures were assigned multiple labels. Within studies for which incidence rates were reported for multiple case definitions, variation in content was always associated with a change in incidence rate, even when the content differed by a single clinical feature. There has been a wide variability in case definition label and content combinations to define acute upper and lower respiratory infections in children in community-based studies in South Asia over the past two decades. These inconsistencies have important implications for the synthesis and translation of knowledge regarding the prevention and treatment of childhood acute respiratory infection. © 2015 John Wiley & Sons Ltd.

Accounting for control mislabeling in case-control biomarker studies.

Science.gov (United States)

Rantalainen, Mattias; Holmes, Chris C

2011-12-02

In biomarker discovery studies, uncertainty associated with case and control labels is often overlooked. By omitting to take into account label uncertainty, model parameters and the predictive risk can become biased, sometimes severely. The most common situation is when the control set contains an unknown number of undiagnosed, or future, cases. This has a marked impact in situations where the model needs to be well-calibrated, e.g., when the prediction performance of a biomarker panel is evaluated. Failing to account for class label uncertainty may lead to underestimation of classification performance and bias in parameter estimates. This can further impact on meta-analysis for combining evidence from multiple studies. Using a simulation study, we outline how conventional statistical models can be modified to address class label uncertainty leading to well-calibrated prediction performance estimates and reduced bias in meta-analysis. We focus on the problem of mislabeled control subjects in case-control studies, i.e., when some of the control subjects are undiagnosed cases, although the procedures we report are generic. The uncertainty in control status is a particular situation common in biomarker discovery studies in the context of genomic and molecular epidemiology, where control subjects are commonly sampled from the general population with an established expected disease incidence rate.

Linking biomedical engineering ethics case study approach and policy.

Science.gov (United States)

Dibrell, William; Dobie, Elizabeth Ann

2007-01-01

In this paper we link bioengineering case study methods to the development of policy. The case study approach to ethics is an excellent way to show the complex nature of practical/moral reasoning. This approach can, however, lead to a kind of overwhelming complexity. The individual nature of each case makes it difficult to identify the most important information and difficult to see what moral considerations are most relevant. In order to make the overwhelming complexity less debilitating, we present a framework for moral decision making derived from suggestions made by W.D. Ross and Virginia Held. Ross articulates the multiple sources of morality and Held deepens the discussion by reminding us of the foundational importance of care and sympathy to our moral natures. We show how to use the notion of prima facie duty and discuss moral conflict. In doing this, we show how the framework, applied to cases, can be of assistance in helping us develop policies and codes of ethics with sufficient plasticity to be useful in the complex world of the bioengineer.

Coding response to a case-mix measurement system based on multiple diagnoses.

Science.gov (United States)

Preyra, Colin

2004-08-01

To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post.

The Use of Management and Marketing Textbook Multiple-Choice Questions: A Case Study.

Science.gov (United States)

Hampton, David R.; And Others

1993-01-01

Four management and four marketing professors classified multiple-choice questions in four widely adopted introductory textbooks according to the two levels of Bloom's taxonomy of educational objectives: knowledge and intellectual ability and skill. Inaccuracies may cause instructors to select questions that require less thinking than they intend.…

Er det kvalitative multiple casestudie anvendeligt i sundhedstjenesteforskning?

DEFF Research Database (Denmark)

Ledderer, Loni

2008-01-01

multiple case study as an alternative research strategy. Drawing on empirical examples from an accomplished case study, where the introduction of the concept "Motivational Interviewing" into preventive consultations in ten clinics was investigated, the paper emphasizes three dimensions in the research...

Vaccines and multiple sclerosis

DEFF Research Database (Denmark)

Frederiksen, J. L.; Topsøe Mailand, M.

2017-01-01

An association between certain vaccinations and onset or relapse of multiple sclerosis (MS) has been debated. Based on PubMed, we made a thorough literature review and included all relevant studies, 51 on MS and 15 on optic neuritis (ON). Case studies were excluded. With the exception of a live...

Multicriterial analysis in operation strategy: case study with rice purchasers of six retailer firms

Directory of Open Access Journals (Sweden)

Marcelo Fernandes Pacheco Dias

2011-09-01

Full Text Available This article aims at presenting a multiple case study in which we measured the prioritization given to competitive factors by six companies that buy rice products for retailing. The multiple case study took place in six large self-service food agents that operate in Santa Catarina and Rio Grande do Sul. The competition in the industry was described by a tree-like structure, which first layer includes: price, quality, variety, image, deliver and services as competitive factors. For prioritizing, we distributed relative importance between factors, with the aid of the AHP method of multicriteria decision support. Quality was prioritized in five companies. The other one prioritized variety. Internal comparisons were made with the results from second layer of the structure.

Isolated Multiple Fragmented Cricoid Fracture Associated with External Blunt Neck Trauma: A Case Report

International Nuclear Information System (INIS)

Lee, Byung Hoon; Hwang, Yoon Joon; Kim, Yong Hoon; Seo, Jung Wook; Cho, Hyeon Je; Kim, Yeon Soo

2010-01-01

Blunt laryngeal trauma is a relatively uncommon but possibly life-threatening injury. An isolated cricoid fracture associated with blunt trauma is rare. We report a case of an isolated multiple fragmented cricoid cartilage fracture that developed in a 20-year-old man after a blunt neck trauma that occurred during a baseball game and was diagnosed by 64-slice multidetector computed tomography (MDCT)

Genome-wide association study identifies multiple susceptibility loci for multiple myeloma

DEFF Research Database (Denmark)

Mitchell, Jonathan S; Li, Ni; Weinhold, Niels

2016-01-01

Multiple myeloma (MM) is a plasma cell malignancy with a significant heritable basis. Genome-wide association studies have transformed our understanding of MM predisposition, but individual studies have had limited power to discover risk loci. Here we perform a meta-analysis of these GWAS, add a ...

Multiple Bony Injuries on Bone Scan in a Case of Unsuspected Child Abuse

Directory of Open Access Journals (Sweden)

Ya-Wen Chuang

2017-01-01

Full Text Available This case is described of an eleven-month-old infant with lower limbs swelling and the left elbow skeletal malformation following a fall. The radionuclide bone scan was performed to exclude bone infection or congenital skeletal anomaly. The images unexpectedly showed multiple increased radioactive foci throughout the whole body. It was a strong probability of child abuse. All lesions are readily apparent on the following plain film radiographs and MRI.

Extraskeletal multiple myeloma presenting with an atrial mass: a case report and a review of the literature

Directory of Open Access Journals (Sweden)

Vigo Federica

2012-08-01

Full Text Available Abstract Introduction Extraskeletal presentation at diagnosis or during the course of multiple myeloma is a rare event. The prognosis is usually very poor. At the moment there is no agreed gold standard for the treatment of this presentation. Case presentation A 79-year-old Caucasian woman was treated at our hospital for right atrial myeloma localization. Our patient showed the following signs and symptoms of congestive heart failure: dyspnea, hypotension, cyanosis and facial edema. Surgery was not considered feasible due to the extent of the disease. Our patient underwent external-beam radiation therapy using an intensity modulated technique, thus obtaining a persistent complete remission. Our patient has been in continuous complete local remission for 25 months since the end of radiotherapy. Conclusion The role of radiotherapy is not defined in multiple myeloma with extraskeletal presentation. Our regimen seems to be effective in controlling the disease in this patient. This case report adds to the existing literature as it describes an unusual presentation of the disease and a new therapeutic approach to this rare presentation of multiple myeloma.

The Comparison Study of Contralateral Transient Evoked Otoacoustic Emission (TEOAE Suppression in Normal Hearing Subjects and Multiple Sclerosis Patients

Directory of Open Access Journals (Sweden)

KH Mohamadkhani

2007-01-01

Full Text Available ABSTRACT: Introduction & Objective: A common auditory complaint of multiple sclerosis patients, is misunderstanding speech in the presence of background noise. Evidence from animal and human studies has suggested that the medial olivocochlear bundle may play an important role in hearing noise. The medial olivocochlear bundle function can be evaluated by the suppression effect of transient otoacoustic emission in response to contralateral acoustic stimulation. The present study was conducted to investigate the suppression effect of transient otoacoustic emission in multiple sclerosis patients. Materials & Methods: This analytical case-control study was conducted on 34 multiple sclerosis patients (24 female, 10 male, aged 20-50 years and 34 controls matched for age and gender in Faculty of Rehabilitation, Tehran University of Medical Sciences in 2006. All cases were selected in simple random manner. The suppression effect of transient otoacoustic emission was evaluated by comparing the transient otoacoustic emission levels with and without contralateral acoustic stimulation. Data were analyzed using SPSS software and independent T- test. Results:There was no significant difference in transient otoacoustic emission levels of two groups, but a significantly reduced suppression effect of transient otoacoustic emission was found in multiple sclerosis patients, in compare with the controls. Conclusion: Outer hair cells activity in multiple sclerosis patients was normal but these patients presented low activity of the medial olivocochlear bundle system which could affect their ability to hear in the presence of background noise.

Prevalence of multiple birth in Isfahan, Iran

Directory of Open Access Journals (Sweden)

Ahmad Yazdekhasti

2018-01-01

Full Text Available Background: According to increasing rate of using assisted reproductive technology (ART which result in higher rates of multiple birth and natal difficulties, we aimed to determine the prevalence rate of multiple birth pregnancies. Materials and Methods: A descriptive cross-sectional study evaluating birth files in 2009–2010 of main hospitals of Isfahan, Iran. Results: Among 31640 files' studies, 614 cases of multiple birth pregnancies were investigated. The product of these pregnancies were 1286 (50.2% females infants including 557 twins (17.6/1000, 56 triplets (1.8/1000, and one case of quadruple (0.03/1000. Infants weigh <2500 g were 84.9% of all. Mothers had a mean age of 27.9 ± 4.9 which 30.4% of them had a positive history of using ART. Conclusion: The prevalence of multiple birth pregnancies is growing. The need for more mother and child care is important. Using ART world wide is leading more multiple birth which could be a cause for more complicated pregnancies.

Multiple Thymoma with Myasthenia Gravis

Directory of Open Access Journals (Sweden)

Dong Hyun Seo

2017-02-01

Full Text Available The actual incidence of multiple thymoma is unknown and rarely reported because it remains controversial whether the cases represent a disease of multicentric origin or a disease resulting from intrathymic metastasis. In this case, a patient underwent total thymectomy for multiple thymoma with myasthenia gravis via bilateral video-assisted thoracic surgery. A well-encapsulated multinodular cystic mass, measuring 57 mm×50 mm×22 mm in the right lobe of the thymus, and a well-encapsulated mass, measuring 32 mm×15 mm×14 mm in the left lobe, were found. Both tumors were type B2 thymoma. Few cases of multiple thymoma with myasthenia gravis have ever been reported in the literature. We report a case of synchronous multiple thymoma associated with myasthenia gravis.

Study on multiple-hops performance of MOOC sequences-based optical labels for OPS networks

Science.gov (United States)

Zhang, Chongfu; Qiu, Kun; Ma, Chunli

2009-11-01

In this paper, we utilize a new study method that is under independent case of multiple optical orthogonal codes to derive the probability function of MOOCS-OPS networks, discuss the performance characteristics for a variety of parameters, and compare some characteristics of the system employed by single optical orthogonal code or multiple optical orthogonal codes sequences-based optical labels. The performance of the system is also calculated, and our results verify that the method is effective. Additionally it is found that performance of MOOCS-OPS networks would, negatively, be worsened, compared with single optical orthogonal code-based optical label for optical packet switching (SOOC-OPS); however, MOOCS-OPS networks can greatly enlarge the scalability of optical packet switching networks.

A case of multiple hepatic abscesses detected by CT scan in the patient with acute lymphoblastic leukemia

International Nuclear Information System (INIS)

Saburi, Yoshio; Shuto, Ryusuke; Mizutani, Ryoko; Hosokawa, Takafumi; Itoga, Takashi

1983-01-01

A 34 years old man admitted to a hospital on 21 Feb. 1983 and was diagnosed acute lymphoblastic leukemia. A hematological complete remission was achieved by combination therapy of vincristine, prednisolone and L-asparaginase. However, he had complaining of high fever and right hypochondralgia since early in Apr. 1983, and it was revealed that elevation of right diaphragm on chest X-ray. Therefore, he was also given several antibiotics (CPZ, TOB, LMOX, PIPC, LCM, AMK, MINO and GM) for complication of probable liver abscess. Remittent fever was persisted in spite of as mentioned above various antibiotics. The multiple hepatic abscesses were found by CT scan of the mid-abdomen as the low density lesions, but bacterial cultures detected no any pathogens. His complaining of remittent fever and right hypochondralgia were improved by treated with Miconazole during about one month, and decreasing in size and number of multiple hepatic abscesses were found by CT scan. Though we could not determined clearly, but suspected that, multiple hepatic abscesses were due to fungus infection, by reason of therapeutic result. Regarding the complication of hepatic abscesses with leukemia, 5 cases have been reported in Japan, and one case out of 5 cases were detected by CT scan. We thought that CT scan were useful procedure for a early diagnosis of hepatic abscesses. In recently, the patient has continued of complete remission hematologically. (author)

Epidemiological investigations into multiple sclerosis in southern Hesse. II. The distribution of cases in relation to exogenous features.

Science.gov (United States)

Lauer, K; Firnhaber, W

1984-10-01

In order to discover possible exogenous variables associated with a higher multiple sclerosis risk, the distribution of cases with definite and probable multiple sclerosis ascertained in the course of a micro-epidemiologic study in Southern Hesse was evaluated and compared with some environmental factors. The prevalence in 1980, the prevalence of cases with disease-onset within the region according to locality of onset and the rate of native Southern Hesse patients according to childhood residence all showed a similar geographical distribution, with the highest values in the south-eastern, mountainous part of the region. This district has a lower annual mean temperature, more annual snow-days and a higher annual precipitation compared to the remaining area. A statistical comparison revealed no association with industrial or agricultural activities, with a particular type of land use, with cattle, pig- or horse-breeding, or with sanitary or housing standards. On the other hand, a slight association with the soil type could be demonstrated, with higher rates on loam and clay subsoils when compared to predominantly sandy regions. Whether this finding has any significance or not remains to be clarified.

Multiple magnet ingestion: is there a role for early surgical intervention?

Science.gov (United States)

Salimi, Amrollah; Kooraki, Soheil; Esfahani, Shadi Abdar; Mehdizadeh, Mehrzad

2012-01-01

Children often swallow foreign bodies. Multiple magnet ingestion is rare, but can result in serious complications. This study presents three unique cases of multiple magnet ingestion: one case an 8-year-old boy with multiple magnet ingestion resulting in gastric obstruction and the other two cases with intestinal perforations due to multiple magnet intake. History and physical examination are unreliable in children who swallow multiple magnets. Sometimes radiological findings are not conclusive, whether one magnet is swallowed or more. If magnets are not moved in sequential radiology images, we recommend early surgical intervention before gastrointestinal complications develop. Toy companies, parents, physicians, and radiologists should be warned about the potential complications of such toys.

A typical MR imaging of multiple sclerosis

International Nuclear Information System (INIS)

Katagiri, Shinako; Kan, Shinichi; Ikeda, Toshiaki; Nishiyama, Syougo; Nishimaki, Hiroshi; Matsubayashi, Takashi; Hata, Takashi

1995-01-01

MR imaging is very useful in detecting the intracranial lesion of multiple sclerosis (MS). We present six patients of MS with atypical MR imaging findings. Six patients aged 27-56 years (mean 36 years), and sexuality of six patients were 2 men and 4 females. Three patient's clinical course had episodes of optic neuritis. The plaque's size of the predominant lesion of the patients ranged from 3.0 to 9.0 cm in diameter. The plaques were oval, elliptically and other shaped. At acute stage, MR imaging detected perfocal edema and focal mass effect in three cases of our study. Two out of six cases showed multiple irregularly enhancing lesion with Gadolinium-DTPA. Plaques of all cases did not disappear completely in final MR imaging study. (author)

A prevalence-based association test for case-control studies.

Science.gov (United States)

Ryckman, Kelli K; Jiang, Lan; Li, Chun; Bartlett, Jacquelaine; Haines, Jonathan L; Williams, Scott M

2008-11-01

Genetic association is often determined in case-control studies by the differential distribution of alleles or genotypes. Recent work has demonstrated that association can also be assessed by deviations from the expected distributions of alleles or genotypes. Specifically, multiple methods motivated by the principles of Hardy-Weinberg equilibrium (HWE) have been developed. However, these methods do not take into account many of the assumptions of HWE. Therefore, we have developed a prevalence-based association test (PRAT) as an alternative method for detecting association in case-control studies. This method, also motivated by the principles of HWE, uses an estimated population allele frequency to generate expected genotype frequencies instead of using the case and control frequencies separately. Our method often has greater power, under a wide variety of genetic models, to detect association than genotypic, allelic or Cochran-Armitage trend association tests. Therefore, we propose PRAT as a powerful alternative method of testing for association.

A Case Study Examination of Best Practices of Professional Learning Communities

Science.gov (United States)

Akopoff, Tanya M.

2010-01-01

A current trend in education is that small teacher groups, called professional learning communities (PLC), are being advocated as a tool to help teachers reach struggling students. Educators planning to use PLC as an intervention strategy can benefit from research-based information about PLC best practices. This multiple case study addressed the…

A Case of Multiple Splenic Lymph angiomas Diagnosed by Percutaneous Needle Biopsy

Energy Technology Data Exchange (ETDEWEB)

Ki, Seung Seog; Jeong, Sook Hyang; Yoon, Chang Jin; Chang, Se Jung; Choi, Joon Hyuk; Ha, Ji Su; Kim, Soon Je [KEPCO Medical foundation Hanil General Hospital, Seoul (Korea, Republic of); Lee, Hye Seung [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

2007-06-15

Lymphangioma of the spleen is an extremely rare disease in adults, and performing splenectomy has been considered necessary for its diagnosis and treatment, but the diagnosis of an isolated splenic mass lesion without performing splenectomy is a challenging problem. Herein, we report on a case of multiple splenic lymphangiomas that were found incidentally in a 56-year-old female; these lesions were diagnosed by percutaneous splenic biopsy without splenectomy. We suggest that this approach is a reasonable option for benign looking-appearing splenic tumors because splenectomy and its postsplenectomy complications can be avoided

A Case of Multiple Splenic Lymph angiomas Diagnosed by Percutaneous Needle Biopsy

International Nuclear Information System (INIS)

Ki, Seung Seog; Jeong, Sook Hyang; Yoon, Chang Jin; Chang, Se Jung; Choi, Joon Hyuk; Ha, Ji Su; Kim, Soon Je; Lee, Hye Seung

2007-01-01

Lymphangioma of the spleen is an extremely rare disease in adults, and performing splenectomy has been considered necessary for its diagnosis and treatment, but the diagnosis of an isolated splenic mass lesion without performing splenectomy is a challenging problem. Herein, we report on a case of multiple splenic lymphangiomas that were found incidentally in a 56-year-old female; these lesions were diagnosed by percutaneous splenic biopsy without splenectomy. We suggest that this approach is a reasonable option for benign looking-appearing splenic tumors because splenectomy and its postsplenectomy complications can be avoided

Merkel cell carcinoma with fingolimod treatment for multiple sclerosis: A case report.

Science.gov (United States)

Mahajan, Kedar R; Ko, Jennifer S; Tetzlaff, Michael T; Hudgens, Courtney W; Billings, Steven D; Cohen, Jeffrey A

2017-10-01

Neoplasms and reactivation of latent viruses have been observed in individuals taking fingolimod. Merkel cell carcinoma (MCC), a rare neuroendocrine skin cancer, is associated with immunosuppression and can be triggered by the oncogenic Merkel cell polyoma virus (MCPyV). We report a case of a 61-year-old man with multiple sclerosis who developed MCPyV-positive MCC 4 years after starting fingolimod. This is the second report of MCC associated with MCPyV in an individual on fingolimod. Copyright © 2017 Elsevier B.V. All rights reserved.

The nature of embedded purchasing activities in SMEs : results from a Dutch multiple case study

NARCIS (Netherlands)

Hagelaar, Geoffrey; Staal, Anne; Holman, Richard; Walhof, Gert

2015-01-01

Aims: identify and explain purchasing-oriented patterns in Small and Medium Sized Enterprises (SMEs) via case study research. Scope: Using a conceptual framework and empirical research this article proposes a series of purchasing-oriented patterns in SMEs. These patterns align activities to achieve

Dedifferentiated chondrosarcoma in patients with multiple osteochondromatosis: report of a case and review of the literature

International Nuclear Information System (INIS)

Kilpatrick, S.E.; Pike, E.J.; Ward, W.G.; Pope, T.L.

1997-01-01

Multiple osteochondromatosis (MOS) is a familial disorder of autosomal dominant transmission characterized by the development of multiple exostoses and often derangements of epiphyseal cartilage, sometimes resulting in long bone growth retardation. Patients with the disorder appear to be at increased risk for developing secondary chondrosarcomas. Rarely, dedifferentiated chondrosarcomas may also occur. We report a single case of a 27-year-old man with multiple osteochondromatosis who developed a fatal dedifferentiated chondrosarcoma. Radiographically, the neoplasm arose from the pelvis completely destroying the left pubic ramus. Subsequently, the patient underwent preoperative chemotherapy followed by a left external hemipelvectomy. On pathologic examination, the tumor was characterized by high-grade pleomorphic sarcoma sharply juxtaposed to a low-grade chondrosarcoma. The patient ultimately died of widespread metastatic sarcoma. (orig.). With 7 figs

Dedifferentiated chondrosarcoma in patients with multiple osteochondromatosis: report of a case and review of the literature

Energy Technology Data Exchange (ETDEWEB)

Kilpatrick, S.E. [Department of Pathology, North Carolina Baptist Hospitals, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC (United States); Pike, E.J. [Department of Radiology, North Carolina Baptist Hospitals, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC (United States); Ward, W.G. [Department of Orthopaedics, North Carolina Baptist Hospitals, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC (United States); Pope, T.L. [Department of Radiology, North Carolina Baptist Hospitals, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC (United States)

1997-06-01

Multiple osteochondromatosis (MOS) is a familial disorder of autosomal dominant transmission characterized by the development of multiple exostoses and often derangements of epiphyseal cartilage, sometimes resulting in long bone growth retardation. Patients with the disorder appear to be at increased risk for developing secondary chondrosarcomas. Rarely, dedifferentiated chondrosarcomas may also occur. We report a single case of a 27-year-old man with multiple osteochondromatosis who developed a fatal dedifferentiated chondrosarcoma. Radiographically, the neoplasm arose from the pelvis completely destroying the left pubic ramus. Subsequently, the patient underwent preoperative chemotherapy followed by a left external hemipelvectomy. On pathologic examination, the tumor was characterized by high-grade pleomorphic sarcoma sharply juxtaposed to a low-grade chondrosarcoma. The patient ultimately died of widespread metastatic sarcoma. (orig.). With 7 figs.

Management of a rare case of idiopathic multiple unerupted impacted permanent teeth in an adult female patient

Directory of Open Access Journals (Sweden)

Karunakar Shetty

2016-01-01

Full Text Available This clinical case report describes the multi-disciplinary approach in the management of an unusual presentation of idiopathic multiple unerupted impacted permanent teeth in a 20-year-old female patient. The case was unique in that, not only were there multiple missing permanent teeth, but also over retained deciduous teeth and attrited existing permanent teeth with loss of vertical dimension of occlusion. Since the patient was young, it was decided to retain all the erupted permanent teeth and extract the infected deciduous teeth with the objective of fabricating overlay complete dentures. This is a simple, reversible and an economical treatment modality, which satisfies both the esthetic and functional demands where the extraction of teeth is not generally indicated and, in addition, provides a stable occlusion.

Pathological study of multiple myeloma in atomic bomb survivors

Energy Technology Data Exchange (ETDEWEB)

Takaki, Y.; Kishikawa, M.; Bundo, K. (Nagasaki Univ. (Japan). School of Medicine)

1980-11-01

Pathological records of autopsies carried out in Nagasaki from '46 to '77 were reviewed. Of 9331 autopsies, 5787 were unexposed cases and were used as a control. 9.2% of the deaths were due to hematologic disorders. There was no evidence that the incidence of multiple myeloma among a-bomb survivors increased compared with the control. The incidences of leukemia, lymphoma and aplastic anemia were also listed.

Multiple endocrine diseases in cats: 15 cases (1997-2008).

Science.gov (United States)

Blois, Shauna L; Dickie, Erica L; Kruth, Stephen A; Allen, Dana G

2010-08-01

The objective of this retrospective study was to characterize a population of cats from a tertiary care center diagnosed with multiple endocrine disorders, including the specific disorders and time intervals between diagnosis of each disorder. Medical records of 15 cats diagnosed with more than one endocrine disorder were reviewed. The majority of cats were domestic shorthairs, and the mean age at the time of diagnosis of the first disorder was 10.3 years. The most common combination of disorders was diabetes mellitus and hyperthyroidism. Two cats had concurrent diabetes mellitus and hyperadrenocorticism, one cat had concurrent central diabetes insipidus and diabetes mellitus. A mean of 25.7 months elapsed between diagnoses of the first and second endocrine disorder, but this was variable. This study suggests the occurrence of multiple endocrine disorders is uncommon in cats. Copyright 2010 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

Dose-dependent transitions in mechanisms of toxicity: case studies

International Nuclear Information System (INIS)

Slikker, William; Andersen, Melvin E.; Bogdanffy, Matthew S.; Bus, James S.; Cohen, Steven D.; Conolly, Rory B.; David, Raymond M.; Doerrer, Nancy G.; Dorman, David C.; Gaylor, David W.; Hattis, Dale; Rogers, John M.; Setzer, R. Woodrow; Swenberg, James A.; Wallace, Kendall

2004-01-01

Experience with dose response and mechanisms of toxicity has shown that multiple mechanisms may exist for a single agent along the continuum of the full dose-response curve. It is highly likely that critical, limiting steps in any given mechanistic pathway may become overwhelmed with increasing exposures, signaling the emergence of new modalities of toxic tissue injury at these higher doses. Therefore, dose-dependent transitions in principal mechanisms of toxicity may occur, and could have significant impact on the interpretation of reference data sets for risk assessment. To illustrate the existence of dose-dependent transitions in mechanisms of toxicity, a group of academic, government, and industry scientists, formed under the leadership of the ILSI Health and Environmental Sciences Institute (HESI), developed a series of case studies. These case studies included acetaminophen, butadiene, ethylene glycol, formaldehyde, manganese, methylene chloride, peroxisome proliferator-activated receptor (PPAR), progesterone/hydroxyflutamide, propylene oxide, vinyl acetate, vinyl chloride, vinylidene chloride, and zinc. The case studies formed the basis for technical discourse at two scientific workshops in 2003

Applying voting theory in natural resource management: a case of multiple-criteria group decision support.

Science.gov (United States)

Laukkanen, Sanna; Kangas, Annika; Kangas, Jyrki

2002-02-01

Voting theory has a lot in common with utility theory, and especially with group decision-making. An expected-utility-maximising strategy exists in voting situations, as well as in decision-making situations. Therefore, it is natural to utilise the achievements of voting theory also in group decision-making. Most voting systems are based on a single criterion or holistic preference information on decision alternatives. However, a voting scheme called multicriteria approval is specially developed for decision-making situations with multiple criteria. This study considers the voting theory from the group decision support point of view and compares it with some other methods applied to similar purposes in natural resource management. A case study is presented, where the approval voting approach is introduced to natural resources planning and tested in a forestry group decision-making process. Applying multicriteria approval method was found to be a potential approach for handling some challenges typical for forestry group decision support. These challenges include (i) utilising ordinal information in the evaluation of decision alternatives, (ii) being readily understandable for and treating equally all the stakeholders in possession of different levels of knowledge on the subject considered, (iii) fast and cheap acquisition of preference information from several stakeholders, and (iv) dealing with multiple criteria.

The validity of the negative binomial multiplicity distribution in the case of the relativistic nucleus-nucleus interaction

International Nuclear Information System (INIS)

Ghosh, D.; Mukhopadhyay, A.; Ghosh, A.; Roy, J.

1989-01-01

This letter presents new data on the multiplicity distribution of charged secondaries in 24 Mg interactions with AgBr at 4.5 GeV/c per nucleon. The validity of the negative binomial distribution (NBD) is studied. It is observed that the data can be well parametrized in terms of the NBD law for the whole phase space and also for different pseudo-rapidity bins. A comparison of different parameters with those in the case of h-h interactions reveals some interesting results, the implications of which are discussed. (orig.)

eHealth in Denmark: a case study.

Science.gov (United States)

Kierkegaard, Patrick

2013-12-01

Denmark is widely regarded as a leading country in terms of eHealth integration and healthcare delivery services. The push for eHealth adoption over that past 20 years in the Danish health sector has led to the deployment of multiple eHealth technologies. However, in reality the Danish healthcare suffers from eHealth system fragmentation which has led to eHealth's inability to reach full potential in delivering quality healthcare service. This paper will presents a case study of the current state of eHealth in the Danish healthcare system and discuss the current challenges the country is facing today.

Nature and Specificity of Gestural Disorder in Children with Developmental Coordination Disorder: A Multiple Case Study

Directory of Open Access Journals (Sweden)

Orianne Costini

2017-07-01

Full Text Available Aim: Praxis assessment in children with developmental coordination disorder (DCD is usually based on tests of adult apraxia, by comparing across types of gestures and input modalities. However, the cognitive models of adult praxis processing are rarely used in a comprehensive and critical interpretation. These models generally involve two systems: a conceptual system and a production system. Heterogeneity of deficits is consistently reported in DCD, involving other cognitive skills such as executive or visual-perceptual and visuospatial functions. Surprisingly, few researches examined the impact of these functions in gestural production. Our study aimed at discussing the nature and specificity of the gestural deficit in DCD using a multiple case study approach.Method: Tasks were selected and adapted from protocols proposed in adult apraxia, in order to enable a comprehensive assessment of gestures. This included conceptual tasks (knowledge about tool functions and actions; recognition of gestures, representational (transitive, intransitive, and non-representational gestures (imitation of meaningless postures. We realized an additional assessment of constructional abilities and other cognitive domains (executive functions, visual-perceptual and visuospatial functions. Data from 27 patients diagnosed with DCD were collected. Neuropsychological profiles were classified using an inferential clinical analysis based on the modified t-test, by comparison with 100 typically developing children divided into five age groups (from 7 to 13 years old.Results: Among the 27 DCD patients, we first classified profiles that are characterized by impairment in tasks assessing perceptual visual or visuospatial skills (n = 8. Patients with a weakness in executive functions (n = 6 were then identified, followed by those with an impaired performance in conceptual knowledge tasks (n = 4. Among the nine remaining patients, six could be classified as having a visual

Approach to a case of multiple irregular red cell antibodies in a liver transplant recipient: Need for developing competence.

Science.gov (United States)

Dara, Ravi C; Tiwari, Aseem K; Pandey, Prashant; Arora, Dinesh

2015-01-01

Liver transplant procedure acts as a challenge for transfusion services in terms of specialized blood components, serologic problems, and immunologic effects of transfusion. Red cell alloimmunization in patients awaiting a liver transplant complicate the process by undue delay or unavailability of compatible red blood cell units. Compatible blood units can be provided by well-equipped immunohematology laboratory, which has expertise in resolving these serological problems. This report illustrates resolution of a case with multiple alloantibodies using standard techniques, particularly rare antisera. Our case re-emphasizes the need for universal antibody screening in all patients as part of pretransfusion testing, which helps to identify atypical antibodies and plan for appropriate transfusion support well in time. We recommend that the centers, especially the ones that perform complex procedures like solid organ transplants and hematological transplants should have the necessary immunohematological reagents including rare antisera to resolve complex cases of multiple antibodies as illustrated in this case.

Approach to a case of multiple irregular red cell antibodies in a liver transplant recipient: Need for developing competence

Directory of Open Access Journals (Sweden)

Ravi C Dara

2015-01-01

Full Text Available Liver transplant procedure acts as a challenge for transfusion services in terms of specialized blood components, serologic problems, and immunologic effects of transfusion. Red cell alloimmunization in patients awaiting a liver transplant complicate the process by undue delay or unavailability of compatible red blood cell units. Compatible blood units can be provided by well-equipped immunohematology laboratory, which has expertise in resolving these serological problems. This report illustrates resolution of a case with multiple alloantibodies using standard techniques, particularly rare antisera. Our case re-emphasizes the need for universal antibody screening in all patients as part of pretransfusion testing, which helps to identify atypical antibodies and plan for appropriate transfusion support well in time. We recommend that the centers, especially the ones that perform complex procedures like solid organ transplants and hematological transplants should have the necessary immunohematological reagents including rare antisera to resolve complex cases of multiple antibodies as illustrated in this case.

MULTIPLE MALIGNANT TUMORS IN 8-YEARS OLD BOY WITH XERODERMA PIGMENTOSUM: A CASE REPORT

Directory of Open Access Journals (Sweden)

V. I. Al’banova

2014-01-01

Full Text Available This case report describes xeroderma pigmentosum in an 8-year old boy. At the age of 4 he was diagnosed with aggressive keratinizing squamous cell carcinoma. Surgical treatment, close-focus radiotherapy, isotretinoin and cyclosporine were ineffective. At the age of 8 he had multiple tumors on the face and concha of the ear, with destruction of adjacent bone and cartilage and regional nodal metastasing.

Committed to Differentiation and Engagement: A Case Study of Two American Secondary Social Studies Teachers

Directory of Open Access Journals (Sweden)

Derek Anderson

2014-05-01

Full Text Available This case study examines two 10th-grade US History teachers who collaborated to create and implement an integrated, thematic eight-week unit on war with an emphasis differentiated instruction. Drawing on the National Council for the Social Studies (2010 framework for powerful and purposeful social studies instruction, the case study uses multiple sources of data, including 38 lesson observations, analyses of the teachers’ lesson plans and student work, and interviews of teachers. Initially, the teachers were successful at engaging students in simulations, small-group discussions, and higher-order thinking. As the unit progressed, however, the teachers reverted to transmission-style teaching with an emphasis on breadth over depth. Changing teaching practice requires overcoming barriers associated with prior experiences and deeply-held beliefs about teaching and learning.

A CASE REPORT OF MULTIPLE PRIMARY SQUAMOUS CELL CARCINOMAS OF THE OVARY AND SIGMOID COLON

Directory of Open Access Journals (Sweden)

A. B. Villert

2016-01-01

Full Text Available Squamous cell ovarian and sigmoid colon carcinomas are extremely rare malignancies. Because of their rarity, it is difficult to investigate the clinical characteristics and prognosis of patients with theses malignancies, and therefore, the increased interest in each clinical case report is highly relevant. Multiple primary squamous cell ovarian and sigmoid colon carcinomas are the subject of discussion and differential diagnosis of sigmoid colon cancer with secondary ovarian cancer. Histopathological and clinical characteristics of the tumors were present and evidences in favor of the multiple primary malignancies were given. The association of squamous cell ovarian and sigmoid colon carcinomas with human papilloma virus type 16 was shown.

Hypothermia in Multiple Sclerosis: Beyond the Hypothalamus? A Case Report and Review of the Literature

Directory of Open Access Journals (Sweden)

Francesco Berti

2018-01-01

Full Text Available Hypothermia is a rare and poorly understood complication of Multiple Sclerosis (MS. We report on a 66-year-old patient currently with Secondary Progressive MS (SP-MS who developed unexplained hypothermia associated with multiple hospitalisations and we review the literature on this topic. In our case, magnetic resonance imaging (MRI of the brain failed to highlight hypothalamic disease, but spinal MRI identified a number of spinal cord lesions. Given the incidence and clinical significance of spinal involvement in MS and the hypothermic disturbances observed in high Spinal Cord Injury (SCI, we hypothesise that upper spinal cord pathology, along with hypothalamic and brainstem dysfunctions, can contribute to hypothermia.

Transformational change in healthcare: an examination of four case studies.

Science.gov (United States)

Charlesworth, Kate; Jamieson, Maggie; Davey, Rachel; Butler, Colin D

2016-04-01

Objectives Healthcare leaders around the world are calling for radical, transformational change of our health and care systems. This will be a difficult and complex task. In this article, we examine case studies in which transformational change has been achieved, and seek to learn from these experiences. Methods We used the case study method to investigate examples of transformational change in healthcare. The case studies were identified from preliminary doctoral research into the transition towards future sustainable health and social care systems. Evidence was collected from multiple sources, key features of each case study were displayed in a matrix and thematic analysis was conducted. The results are presented in narrative form. Results Four case studies were selected: two from the US, one from Australia and one from the UK. The notable features are discussed for each case study. There were many common factors: a well communicated vision, innovative redesign, extensive consultation and engagement with staff and patients, performance management, automated information management and high-quality leadership. Conclusions Although there were some notable differences between the case studies, overall the characteristics of success were similar and collectively provide a blueprint for transformational change in healthcare. What is known about the topic? Healthcare leaders around the world are calling for radical redesign of our systems in order to meet the challenges of modern society. What does this paper add? There are some remarkable examples of transformational change in healthcare. The key factors in success are similar across the case studies. What are the implications for practitioners? Collectively, these key factors can guide future attempts at transformational change in healthcare.

A Monte Carlo Study on Multiple Output Stochastic Frontiers

DEFF Research Database (Denmark)

Henningsen, Géraldine; Henningsen, Arne; Jensen, Uwe

, dividing all other output quantities by the selected output quantity, and using these ratios as regressors (OD). Another approach is the stochastic ray production frontier (SR) which transforms the output quantities into their Euclidean distance as the dependent variable and their polar coordinates......In the estimation of multiple output technologies in a primal approach, the main question is how to handle the multiple outputs. Often an output distance function is used, where the classical approach is to exploit its homogeneity property by selecting one output quantity as the dependent variable...... of both specifications for the case of a Translog output distance function with respect to different common statistical problems as well as problems arising as a consequence of zero values in the output quantities. Although, our results partly show clear reactions to statistical misspecifications...

Coupling the effect of mental practice and Pilates on ambulation of individuals with multiple sclerosis: Five case studies

Directory of Open Access Journals (Sweden)

Darshpreet Kaur

2016-01-01

Full Text Available Pilates, a popular form of exercise, greatly emphasizes on the strengthening of the core muscles; however, the efficacy of exercise program can be impaired in patients with cognitive impairments. To bridge this gap, mental practice of a desired task can help to mentally simulate a given action and retain many properties of the corresponding real action. This study tries to gain preliminary understanding on the effectiveness of the combination of mental practice and core-strengthening Pilates exercises. To explore the effectiveness of mental practice and Pilates-based training on core strength, balance and mobility in multiple sclerosis (MS patients. This study highlights a single center case series describing the outcomes in ambulant patients with MS treated with mental practice and Pilates. Five volunteer ambulant individuals with stable relapsing-remitting MS participated in 20 individualized sessions, spread over 10-week duration. Pilates with mental practice session was delivered by a physiotherapist. Each session comprised 20 min of mental practice followed by 40 min of core-strengthening Pilates exercises. All the included patients were screened with Movement Imagery Questionnaire-Revised Second Version to determine if they are were able to effectively engage in imagery practice. A range of outcomes were measured: Timed up and go, chair stand test, curl-ups, the abdominal angle through leg raises, and the Activities-specific Balance Confidence Scale before and after the intervention. Group data analysis indicated significant improvement between baseline and post-intervention phases for all the tested parameters. This study provides preliminary insight into this novel combination technique to improve balance and mobility in ambulant people with MS. Mental practice played an important role in keeping the patient's compliance, which was analyzed through structured interviews. Variations in response to the intervention are evident.

Multiple-source multiple-harmonic active vibration control of variable section cylindrical structures: A numerical study

Science.gov (United States)

Liu, Jinxin; Chen, Xuefeng; Gao, Jiawei; Zhang, Xingwu

2016-12-01

Air vehicles, space vehicles and underwater vehicles, the cabins of which can be viewed as variable section cylindrical structures, have multiple rotational vibration sources (e.g., engines, propellers, compressors and motors), making the spectrum of noise multiple-harmonic. The suppression of such noise has been a focus of interests in the field of active vibration control (AVC). In this paper, a multiple-source multiple-harmonic (MSMH) active vibration suppression algorithm with feed-forward structure is proposed based on reference amplitude rectification and conjugate gradient method (CGM). An AVC simulation scheme called finite element model in-loop simulation (FEMILS) is also proposed for rapid algorithm verification. Numerical studies of AVC are conducted on a variable section cylindrical structure based on the proposed MSMH algorithm and FEMILS scheme. It can be seen from the numerical studies that: (1) the proposed MSMH algorithm can individually suppress each component of the multiple-harmonic noise with an unified and improved convergence rate; (2) the FEMILS scheme is convenient and straightforward for multiple-source simulations with an acceptable loop time. Moreover, the simulations have similar procedure to real-life control and can be easily extended to physical model platform.

Connections between Future Time Perspectives and Self-Regulated Learning for Mid-Year Engineering Students: A Multiple Case Study

Science.gov (United States)

Chasmar, Justine

2017-01-01

This dissertation presents multiple studies with the purpose of understanding the connections between undergraduate engineering students' motivations, specifically students' Future Time Perspectives (FTPs) and Self-Regulated Learning (SRL). FTP refers to the views students hold about the future and how their perceptions of current tasks are…

Synchronous GISTs associated with multiple sporadic tumors: a case report

Directory of Open Access Journals (Sweden)

Danila Comandini

2017-08-01

Full Text Available Gastrointestinal stromal tumors (GISTs are rare neoplasms, but they also represent the most common mesenchymal tumors of the gastrointestinal tract originating from the cell of Cajal. GIST incidence ranges around 1% of all gastrointestinal malignancies. Approximately 5% of all GISTs have a hereditary etiology. The remaining 95% of GISTs are considered sporadic events, with up to 75% of cases driven by a constitutional activation of the c-KIT proto-oncogene. GISTs are generally solitary lesions. Nonetheless, multiple sporadic GISTs can occur and present as synchronous or metachronous tumors, usually associated with familial GIST. Here, we report a case of primary prostate and lung tumors associated with gastric and small bowel GISTs, unrelated to any known hereditary syndrome. Also, in the case we describe, the prostatic tumor came before the GISTs, while the lung tumor occurred later in time and led to pulmonary lobectomy plus lymphoadenectomy, with a diagnosis of nonsmall cell lung cancer. With the exception of a slight difference in lymphoid infiltration, the abdominal and gastric GIST nodules shared the same proliferative MIB1 index and mitotic count. However, the genetic analysis revealed that the gastric GIST and abdominal tumors were characterized by two different c-KIT mutations. This molecular heterogeneity supported the hypothesis of two different synchronous GISTs arising from stomach and ileum. At present, the patient is disease free and has already completed the third year of adjuvant therapy with imatinib. This case supports the importance of the analysis of c-KIT mutational status to distinguish metastases from synchronous multicentric GISTs, with relevant implications in therapeutic decisions, as well as the importance of a dedicated multidisciplinary team and of a radiological follow-up after the diagnosis of a primary GIST, to discover a relapse of the GIST or, possibly, additional malignancies.

Structural characterization and discrimination of Chinese medicinal materials with multiple botanical origins based on metabolite profiling and chemometrics analysis: Clematidis Radix et Rhizoma as a case study.

Science.gov (United States)

Guo, Lin-Xiu; Li, Rui; Liu, Ke; Yang, Jie; Li, Hui-Jun; Li, Song-Lin; Liu, Jian-Qun; Liu, Li-Fang; Xin, Gui-Zhong

2015-12-18

Traditional Chinese medicines (TCMs)-based products are becoming more and more popular over the world. To ensure the safety and efficacy, authentication of Chinese medicinal materials has been an important issue, especially for that with multiple botanical origins (one-to-multiple). Taking Clematidis Radix et Rhizoma (CRR) as a case study, we herein developed an integrated platform based on metabolite profiling and chemometrics analysis to characterize, classify, and predict the "one-to-multiple" herbs. Firstly, the predominant constituents, triterpenoid saponins, in three Clematis CRR were rapid characterized by a novel UPLC-QTOF/MS-based strategy, and a total of 49 triterpenoid saponins were identified. Secondly, metabolite profiling was performed by UPLC-QTOF/MS, and 4623 variables were extracted and aligned as dataset. Thirdly, by using pattern recognition analysis, a clear separation of the three Clematis CRR was achieved as well as a total number of 28 variables were screened as the valuable variables for discrimination. By matching with identified saponins, these 28 variables were corresponding to 10 saponins which were identified as marker compounds. Fourthly, based on the relative intensity of the marker compounds-related variables, genetic algorithm optimized support vector machines (GA-SVM) was employed to predict the species of CRR samples. The obtained model showed excellent prediction performance with a prediction accuracy of 100%. Finally, a heatmap visualization was employed for clarifying the distribution of identified saponins, which could be useful for phytochemotaxonomy study of Clematis herbs. These results indicated that our proposed platform was a powerful tool for chemical profiling and discrimination of herbs with multiple botanical origins, providing promising perspectives in tracking the formulation processes of TCMs products. Copyright © 2015 Elsevier B.V. All rights reserved.