Left Supraclavicular Spindle Cell Lipoma

Background. Spindle cell lipoma (SCL) is a benign lipomatous tumour, typically occurring in the posterior neck, shoulder or upper back of elderly males. They compose of fat, CD34 positive spindle cells, and ropey collagen on a myxoid matrix. This case highlights a rare presentation of SCL and the need for pre-operative diagnosis. Case Report. A 63-year-old gentleman presented with a pre-existing left supraclavicular mass that had recently increased in size. FNA and CT Scans were performed and results discussed in the mutidisciplinary team meeting. Excisional biopsy was recommended. Radiology. CT neck showed a left supraclavicular mass of fatty density with fine internal septations. A low-grade liposarcoma could not be excluded. Histopathology. FNA was indeterminate. Histology of specimen showed bland spindle cells with no evidence of malignancy. Immuno-histochemistry showed SCL with CD34 positivity and negative staining on CDK4 and p16. Management. Excision biopsy of the mass was performed which was technically difficult as the mass invaginated around the brachial plexus. The patient recovered well post-operatively with no neurological deficits. Conclusion. Spindle cell lipoma is a rare benign tumour and a pre-operative diagnosis based on the clinical context, imaging and immuno-histochemistry is crucial to management

Aula invertida : una estrategia para la enseñanza de funciones básicas

1 recurso en línea (75 páginas) : gráficasLa presente investigación buscó identificar los beneficios de implementar la estrategia didáctica de “aula invertida” en el proceso de aprendizaje del concepto función. Para el desarrollo de ésta se llevó a cabo la revisión de la literatura acerca de esta metodología y las investigaciones previamente realizadas implementando dicho modelo. Como el aula invertida no presenta un esquema riguroso ni una serie de actividades que presenten obligatoriedad, se decidió trabajar mediante la presentación de videos escogidos por el investigador y los cuales fueron observados por los estudiantes; posteriormente cada grupo de estudiantes debió presentar ante sus compañeros una exposición en la que presentaron lo que habían entendido del tema; luego de las exposiciones se evaluó el conocimiento adquirido por ellos, además se realizaron algunas actividades grupales con la asesoría del profesor, punto en el cual se realizó la formalización del concepto en estudio, para finalmente ser evaluado por última vez en este proceso de aprendizaje. El proceso muestra buenos resultados, y deja ver así el aula invertida como una oportunidad de aprendizaje de dicho concepto en la población en la que se realizó la investigación.Bibliografía y webgrafía: páginas 61-64MaestríaMagíster en Educación Matemátic

An analysis of the development and implementation of a smartphone application for the delivery of antimicrobial prescribing policy: lessons learnt

Objectives: Smartphone usage amongst clinicians is widespread. Yet smartphones are not widely used for the dissemination of policy or as clinical decision support systems. We report here on the development, adoption and implementation process of the Imperial Antimicrobial Prescribing Application across five teaching hospitals in London. Methods: Doctors and clinical pharmacists were recruited to this study, which employed a mixed methods indepth case-study design with focus groups, structured pre- and post-intervention survey questionnaires and live data on application uptake. The primary outcome measure was uptake of the application by doctors and its acceptability. The development and implementation processes were also mapped. Results: The application was downloaded by 40% (376) of junior doctors with smartphones (primary target user group) within the first month and by 100% within 12 months. There was an average of 1900 individual access sessions per month, compared with 221 hits on the Intranet version of the policy. Clinicians (71%) reported that using the application improved their antibiotic knowledge. Conclusions: Clinicians rapidly adopted the mobile application for antimicrobial prescribing at the point of care, enabling the policy to reach a much wider audience in comparison with paper- and desktop-based versions of the policy. Organizations seeking to optimize antimicrobial prescribing should consider utilizing mobile technology to deliver point-of-care decision support. The process revealed a series of barriers, which will need to be addressed at individual and organizational levels to ensure safe and high-quality delivery of local policy at the point of care

Deriving mesoscopic models of collective behaviour for finite populations

Animal groups exhibit emergent properties that are a consequence of local interactions. Linking individual-level behaviour to coarse-grained descriptions of animal groups has been a question of fundamental interest. Here, we present two complementary approaches to deriving coarse-grained descriptions of collective behaviour at so-called mesoscopic scales, which account for the stochasticity arising from the finite sizes of animal groups. We construct stochastic differential equations (SDEs) for a coarse-grained variable that describes the order/consensus within a group. The first method of construction is based on van Kampen's system-size expansion of transition rates. The second method employs Gillespie's chemical Langevin equations. We apply these two methods to two microscopic models from the literature, in which organisms stochastically interact and choose between two directions/choices of foraging. These `binary-choice' models differ only in the types of interactions between individuals, with one assuming simple pair-wise interactions, and the other incorporating higher-order effects. In both cases, the derived mesoscopic SDEs have multiplicative, or state-dependent, noise. However, the different models demonstrate the contrasting effects of noise: increasing order in the pair-wise interaction model, whilst reducing order in the higher-order interaction model. Although both methods yield identical SDEs for such binary-choice, or one-dimensional, systems, the relative tractability of the chemical Langevin approach is beneficial in generalizations to higher-dimensions. In summary, this book chapter provides a pedagogical review of two complementary methods to construct mesoscopic descriptions from microscopic rules and demonstrates how resultant multiplicative noise can have counter-intuitive effects on shaping collective behaviour.Comment: Second version, 4 figures, 2 appendice

On the relationships between applied force, photography technique, and the quantification of bruise appearance

Bruising is an injury commonly observed within suspect cases of assault or abuse, yet how a blunt impact initiates bruising and influences its severity is not fully understood. Furthermore, the standard method of documenting a bruise with colour photography is known to have limitations which influence the already subjective analysis of a bruise. This research investigated bruising using a standardised blunt impact, delivered to 18 volunteers. The resulting bruise was imaged using colour, cross polarised (CP) and infrared photography. Timelines of the L*a*b* colour space were determined from both colour and CP images for up to 3 weeks. Overall, no single photographic technique out-performed the others, however CP did provide greater contrast than colour photography. L*a*b* colour space timelines were not attributable any physiological characteristics. Whilst impact force negatively correlated with BMI (R2 = 0.321), neither were associated with any measure of bruise appearance. Due to the inter-subject variability in the bruise response to a controlled infliction, none of the methods in the current study could be used to reliably predict the age of a bruise or the severity of force used in creating a bruise. A more comprehensive approach combining impact characteristics, tissue mechanics, enhanced localised physiological measures and improvements in quantifying bruise appearance is likely to be essential in removing subjectivity from their interpretation

The role of environmental reservoirs in human campylobacteriosis

Campylobacteriosis is infection caused by the bacteria Campylobacter spp. and is considered a major public health concern. Campylobacter spp. have been identified as one of the most common causative agents of bacterial gastroenteritis. They are typically considered a foodborne pathogen and have been shown to colonise the intestinal mucosa of all food-producing animals. Much emphasis has been placed on controlling the foodborne pathway of exposure, particularly within the poultry industry, however, other environmental sources have been identified as important contributors to human infection. This paper aims to review the current literature on the sources of human exposure to Campylobacter spp. and will cover contaminated poultry, red meat, unpasteurised milk, unwashed fruit and vegetables, compost, wild bird faeces, sewage, surface water, ground water and drinking water. A comparison of current Campylobacter spp. identification methods from environmental samples is also presented. The review of literature suggests that there are multiple and diverse sources for Campylobacter infection. Many environmental sources result in direct human exposure but also in contamination of the food processing industry. This review provides useful information for risk assessment.Harriet Whiley, Ben van den Akker, Steven Giglio and Richard Bentha

Linking NHS data for pediatric pharmacovigilance: Results of a Delphi survey

Background: Adverse drug events are a major cause of patient safety incidents. Current systems of pharmacovigilance under-report adverse drug reactions (ADRs), especially in children, leading to delays in their identification. This is of particular concern, as children especially have an increased vulnerability toADRs. Objectives: The objective was to seek consensus among healthcare professionals (HCPs) about barriers and facilitators to the linkage of routinely collected health data for pediatric pharmacovigilance in Scotland. Methods: A Delphi survey was conducted with a random sample of HCPs including nurses, pharmacists and doctors, working in primary or secondary care, in Scotland. Participants were identified from sampling frames of the target professionals such as an NHS workforce list for general practitioners and recruited by postal invitation. A total of 819 HCPs were invited to take part. Those agreeing to participate were given the option of completing the questionnaires online or as hard copy. Reminders were sent twice at a fortnightly interval. Questions content included description of professional role as well as testing for the willingness to support the proposed project and was informed by the Theoretical Domains Framework of Behavior Change (TDF) and earlier qualitative work. Three Delphi rounds were administered, including a first round for item generation. Results: 121 of those invited agreed to take part (15%). The first round of the Delphi study included 21 open questions and generated over a 1000 individual statements from 61 participants that returned the questionnaires (50.4%). These were rationalized to 149 items for the second round in which participants rated their views on the importance (or not) of each item on a 9-point Likert scale (strongly disagree - strongly agree). After the third round, there was consensus on items that focused on professional standards, and practical requirements, overall there was support for data linkage and a multi-professional approach. Conclusions: It would be acceptable to stakeholders to introduce a data linkage system for pharmacovigilance as long as identified concerns are addressed. Concerns included adherence to current professional, legal and ethical standards, as well resolving practical issues

Is it harder to know or to reason? Analyzing two-tier science assessment items using the Rasch measurement model

Two-tier multiple-choice (TTMC) items are used to assess students’ knowledge of a scientific concept for tier 1 and their reasoning about this concept for tier 2. But are the knowledge and reasoning involved in these tiers really distinguishable? Are the tiers equally challenging for students? The answers to these questions influence how we use and interpret TTMC instruments. We apply the Rasch measurement model on TTMC items to see if the items are distinguishable according to different traits (represented by the tier), or according to different content sub-topics within the instrument, or to both content and tier. Two TTMC data sets are analyzed: data from Singapore and Korea on the Light Propagation Diagnostic Instrument (LPDI), data from the United States on the Classroom Test of Scientific Reasoning (CTSR). Findings for LPDI show that tier-2 reasoning items are more difficult than tier-1 knowledge items, across content sub-topics. Findings for CTSR do not show a consistent pattern by tier or by content sub-topic. We conclude that TTMC items cannot be assumed to have a consistent pattern of difficulty by tier—and that assessment developers and users need to consider how the tiers operate when administering TTMC items and interpreting results. Researchers must check the tiers’ difficulties empirically during validation and use. Though findings from data in Asian contexts were more consistent, further study is needed to rule out differences between the LPDI and CTSR instruments

Did BP Atone for its Transgressions? Expanding Theory on 'Ethical Apology' in Crisis Communication

© 2016 John Wiley & Sons Ltd. Ethical communication during crisis response is often assessed by external perceptions of the organization's intentions, rather than an assessment of the organization's communicative behaviors. This can easily lead researchers to draw editorial conclusions about an organization's ethics in crisis response rather than accurately describing its communicative behaviors. The case of BP's 2010 oil spill in the Gulf of Mexico provides a prime example for the importance of accurately assessing the ethical content of an organization's crisis response because the ethics of BP's response have been discussed in news and academic sources; yet little direct examination of the ethical content in BP's response has occurred. The findings have implications for communication ethics, social media engagement, and crisis communication more generally

First Neutrino Observations from the Sudbury Neutrino Observatory

The first neutrino observations from the Sudbury Neutrino Observatory are presented from preliminary analyses. Based on energy, direction and location, the data in the region of interest appear to be dominated by 8B solar neutrinos, detected by the charged current reaction on deuterium and elastic scattering from electrons, with very little background. Measurements of radioactive backgrounds indicate that the measurement of all active neutrino types via the neutral current reaction on deuterium will be possible with small systematic uncertainties. Quantitative results for the fluxes observed with these reactions will be provided when further calibrations have been completed.Comment: Latex, 7 pages, 10 figures, Invited paper at Neutrino 2000 Conference, Sudbury, Canada, June 16-21, 2000 to be published in the Proceeding