Seasonal relapsing minimal change disease: a novel strategy for avoiding long-term immunosuppression.

BACKGROUND: We describe the case of a young woman with seasonal allergic rhinitis who presented with signs of a lower respiratory tract infection, acute renal impairment and the nephrotic syndrome, demonstrated on biopsy to be due to minimal change disease (MCD) with acute tubular injury. Following initiation of high-dose corticosteroids, her respiratory symptoms and renal impairment improved, and the nephrotic syndrome went rapidly into remission, but relapsed, off treatment, in a seasonal fashion. MANAGEMENT: In view of significant side effects related to corticosteroids, relapses were treated with the calcineurin inhibitor tacrolimus with excellent effect, but the patient was keen to avoid the complications of medium-term immunosuppression and so the drug was weaned early. She relapsed for the second time, whilst off tacrolimus, at the same time of year as at her initial presentation. In subsequent years we have successfully managed this patient with seasonal relapsing MCD with seasonal prophylactic tacrolimus therapy. DISCUSSION: We discuss the natural history of MCD and treatment options and demonstrate the utility of a clear understanding of the natural history of the condition in order to predict disease relapse and tailor therapy to the individual patient

Becoming Canadian: Folk Literary Innovation in the Memoirs of Yiddish-Speaking Immigrants to Canada

This article considers the ways Yiddish-speaking immigrants to Canada creatively adapted folklore that they learned in “the old home” in order to make it fit their new Canadian contexts, and in doing so created new hybrid folklore and identities. To do this, I discuss the autobiographical texts of three people who migrated between 1900 and 1930, J.J. Goodman’s Gezamelte Shriften (Collected Writings) (Winnipeg: 1919), Michael Usiskin’s Oksn un Motorn (Oxen and Tractors) (Toronto: 1945), and Falek Zolf ’s Oyf Fremder Erd (On Foreign Soil) (Winnipeg: 1945). I argue that these personal narratives offer important insights into how the first major wave of Eastern European Jewish immigrants to Canada formed and expressed Canadian-Eastern European Jewish culture.Dans le présent article, nous explorerons la créativité avec laquelle les immigrants yiddishophones ont adapté au contexte canadien le folklore qu’ils ont appris dans l’« ancien monde », créant, de ce fait, un folklore hybride, ainsi que de nouvelles identités. À cette fin, nous examinerons les textes autobiographiques de trois individus qui ont immigré au pays entre 1900 et 1930, à savoir les Gezamelte Shriften (OEuvres complètes) de J. J. Goodman (Winnipeg, 1919), Oksn un Motorn (Les boeufs et les tracteurs) de Michael Usiskin (Toronto, 1945) et Oyf Fremder Erd (En sol étranger) de Falek Zolf (Winnipeg, 1945). Nous défendrons la thèse suivant laquelle ces récits offrent d’importantes pistes pour comprendre la contribution de la première vague d’immigrants juifs d’Europe orientale à la création et l’expression de la culture judéo-canadienne est-européenne

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Student Choice between Computer and Traditional Paper-and-Pencil University Tests: What Predicts Preference and Performance?

Two studies were conducted to assess meta-cognitive and individual difference influences on students’ choice of writing tests in paper-and-pencil or computer-administered format. In Study 1, university students chose the test format for an accounting exam (paper-and-pencil or computer). In Study 2, students disclosed their reasons for their choice of test format, predicted their scores on the first test and provided confidence ratings for their predictions. The results of both studies show that the reasons for choosing a computer vs. a paper-and-pencil test format differ, and that both choice and performance can be explained to some extent by individual difference and meta-cognitive factors.Deux enquêtes ont été menées afin de mesurer l’apport des différences métacognitives et des différences individuelles dans une tâche où un étudiant doit choisir de compléter un examen en format papier ou administré par ordinateur. Dans la première enquête, des étudiants universitaires ont choisi le format d’un examen de comptabilité (format papier ou administré par ordinateur). Dans la deuxième enquête, on a demandé aux étudiants d’expliquer leur choix, de prédire les résultats de leurs examens, et de fournir leur niveau de confiance quant à l’exactitude de leurs prédictions. Les résultats des deux enquêtes ont montré que le choix d’un exam en format papier est associé à un raisonnement différent que celui associé au choix d’un examen administré par ordinateur. De plus, les résultats ont montré que le choix du format de l’examen et la performance aux examens peuvent être, en partie, expliqués par des facteurs individuels et métacognitifs

Lupus nephritis management guidelines compared

In the past years, many (randomized) trials have been performed comparing the treatment strategies for lupus nephritis. In 2012, these data were incorporated in six different guidelines for treating lupus nephritis. These guidelines are European, American and internationally based, with one separate guideline for children. They offer information on different aspects of the management of lupus nephritis including induction and maintenance treatment of the different histological classes, adjunctive treatment, monitoring of the patient, definitions of response and relapse, indications for (repeat) renal biopsy, and additional challenges such as the presence of vascular complications, the pregnant SLE patient, treatment in children and adolescents and considerations about end-stage renal disease and transplantation. In this review, we summarize the guidelines, determine the common ground between them, highlight the differences and discuss recent literature

Why I Fear Water

Twenty-year-old Crystal Levinson, the granddaughter of Holocaust survivors, is searching for her Father; her paternal father, but also the figurative Father, God. When Crystal was a child, her mother was a practicing Jew, while her father, who later abandoned her family, denied God. Having been caught in the middle of extremes, Crystal grows up haunted by a sense of absence. As Crystal searches for her missing father she also searches for her lost faith, and does so by narrating her connection to the divine through the symbol of water. To Crystal, the meaning of water fluctuates between God, nature, life, memory, history, heritage, faith, art, love, intimacy, connection and creation, all of which she glimpses through personal relationships and by sculpting. Crystal’s narrative draws upon religious symbolism while borrowing from spiritualist nature writing such as Barry Lopez’s "Desert Notes" and Annie Dillard’s "Pilgrim at Tinker’s Creek." Elizabeth Smart’s "By Grand Central Station I Sat Down and Wept" and Virginia Woolf’s "The Waves" are strong influences due to the interiority and lyricism of their narratives, and their investigations into the connection between intimacy and spirituality