A giant mystery in giant cell myocarditis: navigating diagnosis, immunosuppression, and mechanical circulatory support.

Giant cell myocarditis is a rare but often devastating diagnosis. Advances in cardiac imaging and mechanical circulatory support have led to earlier and more frequent diagnoses and successful management. This disease state has wide variation in acuity of presentation, and consequently, optimal treatment ranging from intensity and type of immunosuppression to mechanical circulatory support is not well defined. The following case describes the management of a patient with an unusual presentation of giant cell myocarditis over a 10 year course of advanced heart failure therapies and immunomodulatory support. This case highlights emerging concepts in the management of giant cell myocarditis including sub-acute presentations, challenges in diagnosis, and treatment modalities in the modern era

Justice for All: American Muslims, Sharia Law, and Maintaining Comity with American Jurisprudence

The U.S. Muslim population, although currently only comprising one percent of all Americans, is on the rise. Muslim Americans are largely assimilated, happy with their lives, moderate with respect to divisive issues, and opposed to violence. Nonetheless, in recent years, a growing misunderstanding and fear of Muslims has led some activists to seek to ban the application of Islamic law, or Sharia, in American courts, de-spite the lack of evidence of an increase in the use of Sharia in U.S. courts. These attempted bans have seen varying degrees of success. This Note argues that these bans violate the voluntary, but longstanding, principle of comity and are unnecessary. When properly applied, comity prevents Sharia from pre-empting the Constitution while encouraging mutual acceptance and understanding between Muslim and non-Muslim Americans

Direct Training to Increase Inter-rater Agreement between an Observer’s and Teachers’ Self-Report Ratings of Treatment Integrity

Measuring an implementer’s treatment integrity, specifically an implementer’s adherence to steps of an intervention, can be done via direct (e.g., observation) or indirect (e.g., self-report) methods of assessment. Direct observation is a widely used and accepted method of data collection in research due to its technical adequacy. However, direct observation is resource intensive, often making it impractical outside of research. Self-report measures of adherence can be less resource intensive and are commonly used in school settings, yet results from previous research indicate that implementers frequently overestimate their adherence when using self-report measures. To address this issue, results from research that build support for teacher self-report as a reliable method of treatment integrity assessment are needed. As such, the objective of the current study was to improve inter-rater agreement (IRA) between teachers’ adherence self-report ratings and ratings provided by an observer. The student investigator (i.e., primary observer) observed instructional practice during baseline. Then, after a brief indirect training on the intervention, the primary observer and teachers rated teacher adherence to an explicit instruction intervention. When it was determined that the teachers’ adherence ratings did not adequately agree with the observer’s, teachers were staggered into a phase in which they received direct training on the intervention steps to assess if a change in IRA occurred. Results indicate that after direct intervention training, IRA between the primary observer and teachers improved