Hope

no abstrac

Determining factors behind the PageRank log-log plot

We study the relation between PageRank and other parameters of information networks such as in-degree, out-degree, and the fraction of dangling nodes. We model this relation through a stochastic equation inspired by the original definition of PageRank. Further, we use the theory of regular variation to prove that PageRank and in-degree follow power laws with the same exponent. The difference between these two power laws is in a multiple coefficient, which depends mainly on the fraction of dangling nodes, average in-degree, the power law exponent, and damping factor. The out-degree distribution has a minor effect, which we explicitly quantify. Our theoretical predictions show a good agreement with experimental data on three different samples of the Web

Hoffmann Sign

The Hoffmann sign or reflex is commonly taught as part of the physical examination to detect abstract upper motor neuron pathology. We present a case of a patient with congenital spinal stenosis and a fall who had a positive Hoffmann sign as the result of a central cord syndrome. The materials contain a video of this physical exam finding and briefly review its history, reliability and clinical utility

Recurrent autoimmune hemolytic anemia in splenic marginal zone lymphoma.

Autoimmune hemolytic anemia (AIHA) is a condition associated with an extensive differential diagnosis that includes lymphoid malignancies. Although AIHA occurs in about 10-25% of patients with chronic lymphocytic leukemia, it is also reported to occur in all of the other lymphoid subtypes. In this article, we report a case of recurrent AIHA in a 67-year-old woman with two acute episodes of hemolysis separated by 3 years of hematologic remission. Both episodes were severe enough to require blood transfusion, oral steroids, and rituximab. Bone marrow biopsy and immunophenotyping using flow cytometry done during both admissions confirmed the presence of splenic marginal zone lymphoma

The Management of Newly Diagnosed Probable Creutzfeldt-Jakob Disease In Acute Rehabilitation Setting: A Case Report

Abstract Creutzfeldt-Jakob disease is a rare and fatal neurodegenerative disease. The purpose of this report is to demonstrate the role of inpatient rehabilitation for a patient recently diagnosed with probable Creutzfeldt-Jakob disease. A 62-year-old male was readmitted to an acute care hospital after a recent mechanical fall. For several weeks, he had a constellation of symptoms, including cognitive impairment and progressive memory loss, gait and postural instability, 20 pounds of unintentional weight loss, visual hallucinations, myoclonus, and hypophonia. After an extensive workup, a diagnosis of probable Creutzfeldt-Jakob disease was made, and he was transferred to an acute inpatient rehabilitation hospital. The patient underwent therapeutic exercise, gait training, neuromuscular reeducation, cognitive behavioral therapy, and voice therapy during his 14-day rehabilitation stay. The patient progressed from moderate assistance to minimal assistance with most activities of daily living, bed mobility, and transfers at the final assessment. He was provided with a rolling walker, home health services, and coordinated care with physicians at discharge. This case report highlights the unique challenges of individuals and their families who suffer from prion disease and reviews ways to manage these barriers through non-pharmacological and pharmacological treatment options at an inpatient rehabilitation facility. When a diagnosis of probable CJD is made, an inpatient rehabilitation facility can assist in decreasing the caregiver burden and support the psychosocial needs of CJD patients while improving physical functioning

Effectiveness of iterative interventions to increase research productivity in one residency program.

BACKGROUND: The Accreditation Council for Graduate Medical Education requires residency programs to expose residents to research opportunities. OBJECTIVE: The purpose of this study was to assess the impact of a series of iterative interventions to increase scholarly activity in one internal medicine residency. METHODS: Retrospective analysis of the effectiveness of a series of interventions to increase resident and faculty scholarly productivity over a 14-year period was performed using quality improvement methodology. Outcomes measured were accepted regional and national abstracts and PubMed indexed manuscripts of residents and faculty. RESULTS: Initially, regional meeting abstracts increased and then were supplanted by national meeting abstracts. Sustained gains in manuscript productivity occurred in the eighth year of interventions, increasing from a baseline of 0.01 publications/FTE/year to 1.57 publications/FTE/year in the final year measured. Run chart analysis indicated special cause variation associated with the interventions performed. CONCLUSIONS: Programs attempting to stimulate research production among faculty and residents can choose among many interventions cited in the literature. Since success of any group of interventions is likely additive and may take years to show benefit, measuring outcomes using quality improvement methodology may be an effective way to determine success

Design of a clinical competency committee to maximize formative feedback.

BACKGROUND: As the next phase in the roll-out of Next Accreditation System, US residency programs are to develop Clinical Competency Committees (CCCs) to formally implement outcome-based medical education objectives in the resident assessment process. However, any changes to an assessment system must consider balancing formative and summative tensions, flexibility and standardization tensions, fairness and transparency to learners, and administrative burden for faculty. OBJECTIVES/METHODS: In this article, one program discusses the approach one internal medicine residency took to create a developmental model CCC. In this model, a learner\u27s mentor presents the argument for competence to the CCC, while a second reviewer presents challenges to that argument to the rest of the committee members. The CCC members provide other insights and make recommendations. The mentor presents the final committee recommendations to that resident, who then works with the mentor to develop a plan for future action. RESULTS: CCC second reviewers spent an average of 30.4 min (SD: 11.4) preparing for each resident\u27s discussion, a duty performed 5-7 times every 6 months. Faculty development was associated with an increase in the number of action-oriented comments in the meeting minutes (3.2-4.1 comments per resident, CONCLUSION: Developmental model CCCs may be feasible for residency programs, but faculty development may be necessary

Primary Cutaneous Peripheral T-Cell Lymphoma Not Otherwise Specified: A Rapidly Progressive Variant of Cutaneous T-Cell Lymphoma.

Primary Cutaneous Peripheral T-Cell Lymphoma NOS (PTL-NOS) is a rare, progressive, fatal dermatologic disease that presents with features similar to many common benign plaque-like skin conditions, making recognition of its distinguishing features critical for early diagnosis and treatment (Bolognia et al., 2008). A 78-year-old woman presented to ambulatory care with a single 5 cm nodule on her shoulder that had developed rapidly over 1-2 weeks. Examination was suspicious for malignancy and a biopsy was performed. Biopsy results demonstrated CD4 positivity, consistent with Mycosis Fungoides with coexpression of CD5, CD47, and CD7. Within three months her cancer had progressed into diffuse lesions spanning her entire body. As rapid progression is usually uncharacteristic of Mycosis Fungoides, her diagnosis was amended to PTL-NOS. Cutaneous T-Cell Lymphoma (CTCL) should be suspected in patients with patches, plaques, erythroderma, or papules that persist or multiply despite conservative treatment. Singular biopsies are often nondiagnostic, requiring a high degree of suspicion if there is deviation from the anticipated clinical course. Multiple biopsies are often necessary to make the diagnosis. Physicians caring for patients with rapidly progressive, nonspecific dermatoses with features described above should keep more uncommon forms of CTCL in mind and refer for early biopsy

Agranulocytosis Associated with Topiramate: A Case Report and Review of Published Cases.

A 41-year-old female presented to the hospital with sore throat and shortness of breath. She was hypoxic with an oxygen saturation of 87% in room air. Physical examination revealed swollen uvula with exudates. She had been started on topiramate for treatment of migraine few months ago. The dose of topiramate was increased to 100 mg twice daily 2 weeks ago. Complete blood count revealed an absolute neutrophil count (ANC) of 8 c/m

Rater Perceptions of Bias Using the Multiple Mini-interview Format: a Qualitative Study

Introduction The Multiple Mini-Interview (MMI) format appears to mitigate individual rater biases. However, the format itself may introduce structural systematic bias, favoring extroverted personality types.  This study aimed to gain a better understanding of these biases from the perspective of the interviewer. Methods A sample of MMI interviewers participated in a series of primary and follow-up one-on-one semi-structured interviews.   Interviews pursued subjects of perception of biases (including norming; applicant personality, appearance and behavior; and interviewer personality) associated with the MMI process.  Emergent qualitative data analysis was performed using the constant-comparative method. Results A number of perceived biases were identified by subjects, sub-grouped into cultural factors, personality factors, perception of prior preparation, concerns with norming, and biases associated with specific applicant characteristics. Discussion While the MMI appears to help mitigate individual rater biases, our analysis suggests that raters perceive structural systematic biases may be introduced by the question type and format of the MMI itself.  Whether rater awareness of these biases mitigates them, and whether these herald other unconscious biases is unknown