Designing Dialogues for Complexities with Marginalised Youth: Processes and Tools

Culture, lifestyles, resources and conditions offered by complex realities create challenges, but also ignite opportunities for a meaningful dialogue between the facilitators and marginalised youth that enable empathy, learning and empowerment. We propose a dialogue model that has helped to identify opportunities to motivate and potentially empower the youth to be/become involved in the service innovation and local dialogue with the stakeholders. Through a case study, we demonstrate how we apply this model while working with indigenous San youth in vocational training or higher education courses in Windhoek, Namibia. By taking into account the complexities, tools adapted and developed for enhancing dialogue are introduced. Reflections are made on both the outcomes and the ways that designers restructure their roles as facilitators to enable peer-to-peer exchanges, ongoing dialogues with the youth, and potentially catalyse a transformative process in unlocking situated knowledge, developing skills and capacities of the youth who are part of the fabric of change

A practical algorithmic approach to mature aggressive B cell lymphoma diagnosis in the double/triple hit era. Selecting cases, matching clinical benefit. A position paper from the Italian Group of Haematopathology (G.I.E.)

An accurate diagnosis of clinically distinct subgroups of aggressive mature B cell lymphomas is crucial for the choice of proper treatment. Presently, precise recognition of these disorders relies on the combination of morphological, immunophenotypical, and cytogenetic/molecular features. The diagnostic workup in such situations implies the application of costly and time-consuming analyses, which are not always required, since an intensified treatment option is reasonably reserved to fit patients. The Italian Group of Haematopathology proposes herein a practical algorithm for the diagnosis of aggressive mature B cell lymphomas based on a stepwise approach, aimed to select cases deserving molecular analysis, in order to optimize time and resources still assuring the optimal management for any patient

Lupus anticoagulant in patients without thrombotic or obstetric complications

El inhibidor lúpico (IL) es un criterio de laboratorio para síndrome antifosfolipídico (SAF); sin embargo, puede detectarse en individuos asintomáticos o estar asociado a otras situaciones clínicas. Presentamos un análisis retrospectivo de 2000 exámenes consecutivos para IL (TTPA, DRVVT), de los cuales 499 casos no presentaban criterios clínicos de SAF (trombosis o complicaciones obstétricas). Aplicando los criterios SSC-ISTH, hallamos IL+ en 27,3% (410/1501) y 43,3% (216/499) de los casos con y sin clínica de SAF respectivamente, analizándose en los casos no-SAF las características clínicas y de laboratorio. Contexto clínico de casos IL+ no-SAF: 18,0% asintomáticos, 34,3% sangrado (epistaxis, gingivorragia, equimosis, hematomas espontáneos) y 47,7% otras manifestaciones (infertilidad, insuficiencia renal crónica, desórdenes autoinmunes, cardiopatía isquémica, trombocitopenia inmune, entre otras). Otras alteraciones de laboratorio en casos IL+ no- SAF, con síntomas de sangrado: alteraciones plaquetarias, descenso de VWF:RCo y/o VWF:Ag, disthrombocytopeminución de FVIII, FII, FV, FVII, FXI o fibrinógeno (sólo o sumado a disminución de plaquetas o FX), inhibidor a-FV o hiperfibrinolisis fueron detectadas en el 55,4% de los casos. El análisis mostró IL+ en un número importante de estudios (216/2000) sin criterios de SAF (1,95% en individuos asintomáticos, 3,70% en pacientes con síntomas de sangrado y 5,15% en casos con otro contexto clínico). Los casos con IL+ y sangrado representan un desafío particular, al requerir evaluar otros posibles defectos subyacentes, que pudiesen justificar el comportamiento clínico. La detección e identificación de defectos combinados requiere de un análisis minucioso, a fin de alcanzar un diagnóstico correcto, esencial para tomar decisiones terapéuticas adecuadas.Despite lupus anticoagulant (LA) is a laboratory criterion for antiphospholipid syndrome (APS), it can be present in asymptomatic subjects or it can be associated with other clinical settings. We present a retrospective analysis of 2000 consecutive LA assays (APTT, DRVVT), 499 of them were performed in patients without APS clinical criteria (thrombosis or obstetric complications). According to SSC-ISTH criteria, LA+ was found in 27.3% (410/1501) and 43.3% (216/499) of cases with or without APS criteria respectively; in no-APS group, the analysis of clinical background and laboratory features was done. Clinical background of LA+ cases no-APS: 18.0% asymptomatic, 34.3% bleeding symptoms (epistaxis, gingivorrhagia, bruising, spontaneous hematomas) and 47.7% other clinical settings (infertility, chronic kidney disease, autoimmune disorders, ischemic heart disease, idiopathic thrombocytopenic purpura, among others). Other abnormal laboratory tests in LA+ cases no- APS with bleeding symptoms: platelet dysfunction; low VWF:RCo and/or VWF:Ag; decrease of FVIII, FII, FV, FVII, FXI or fibrinogen (alone or with low platelet count or low FX), a-FV inhibitor and hyperfibrinolysis were found in the 55.4% of the cases. The analysis showed LA+ in an important number of cases (216/2000) without APS criteria (1.95% in asymptomatic cases, 3.70% in patients with bleeding symptoms and 5.15% in cases with other clinical settings). Those LA+ cases with bleeding symptoms represent a particular challenge because other possible underlying defects have to be analysed in order to explain the clinical behaviour. The detection and identifications of combined defects required a careful analysis in order to achieve an accurate diagnosis, essential for therapeutic decisions.Fil: Remotti, L.. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas ; ArgentinaFil: Grosso, S. H.. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas ; ArgentinaFil: Ingratti, M. F.. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas ; ArgentinaFil: Vera Morandini, Maria Paula. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas ; ArgentinaFil: Woods, Adriana Inés. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Bermejo, E. I.. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas ; ArgentinaFil: Sánchez Luceros, Analía Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentina. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas ; ArgentinaFil: Meschengieser, S. S.. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas ; ArgentinaFil: Lazzari, María Ángela. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Blanco, A. N.. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas ; Argentin

A practical algorithmic approach to mature aggressive B cell lymphoma diagnosis in the double/triple hit era: selecting cases, matching clinical benefit : A position paper from the Italian Group of Haematopathology (G.I.E.).

An accurate diagnosis of clinically distinct subgroups of aggressive mature B cell lymphomas is crucial for the choice of proper treatment. Presently, precise recognition of these disorders relies on the combination of morphological, immunophenotypical, and cytogenetic/molecular features. The diagnostic workup in such situations implies the application of costly and time-consuming analyses, which are not always required, since an intensified treatment option is reasonably reserved to fit patients. The Italian Group of Haematopathology proposes herein a practical algorithm for the diagnosis of aggressive mature B cell lymphomas based on a stepwise approach, aimed to select cases deserving molecular analysis, in order to optimize time and resources still assuring the optimal management for any patient. © 2019, The Author(s)

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