Wrap It Up – Sexually Transmitted Primary Cytologmegalovirus Proctitis In Immunocompetent Host: A Case Report

Background: In persons who presents with fever, rectal pain and bleeding, CMV proctitis should be considered if other workup is negative, especially if recent unprotected anal receptive intercourse. Case Presentation: A 26-year-old bisexual man presented with chief complaints of fever, malaise, rectal pain, and rectal bleeding after anal insertion of foreign body. He initially denied any unprotected sexual intercourse. CBC, CMP, stool pathogen, rectal gonorrhea, and rectal chlamydia were unremarkable. He returned after 1 week with the similar complaints, however admitted to unprotected anal receptive intercourse a month prior. His vitals were notable for temperature of 102 with tachycardia to 108. Labs were significant for WBC 6.6, atypical lymphocytes 22%, ALP 173, AST 72, and ALT 146. CT AP with contrast showed perirectal fat stranding, rectal wall thickening, and several perirectal lymph nodes. Syphilis and HIV testing were negative. Given concern for viral proctitis from HSV, he was treated with valacyclovir. Flexible sigmoidoscopy showed diffuse severe inflammation with deep ulcerations consistent with severe ulcerative proctitis extending 15cm into the rectum. Biopsies were positive for CMV on immunohistochemical staining and viral culture. CMV serology was positive for IgM, IgG, and viral DNA. The patient was treated with ganciclovir for primary CMV proctitis for a 14-day course. Conclusion: Proctitis typically presents with rectal bleeding, rectal pain, anorectal itching, cramps/tenesmus, or discharge from the anal canal. Common sexually transmitted infectious causes include chlamydia, gonorrhea, syphilis, HSV. CMV has also been shown to be a cause of procto-colitis in immunocompromised patients with HIV. Though rare, primary CMV in an immunocompetent host can cause proctitis and has been reported in persons who engage in unprotected anal intercourse, especially MSM. Diagnosis of primary CMV proctitis requires multiple diagnostic tests in the right clinical setting. Detection of CMV IgM, a four-fold increase in CMV IgG done 2-4 weeks apart, and sigmoidoscopy showing rectal mucositis or ulceration are suggestive of CMV proctitis. In our patient, his atypical lymphocytes and elevated liver function tests were also suggestive of CMV. Biopsy showing presence of inclusion bodies or basophilic intranuclear inclusions and immunohistochemical staining that is positive for CMV are confirmatory. Treatment for primary CMV proctitis has not been well defined and is typically conservative management though we chose to treat with ganciclovir given severity of symptoms. In conclusion, a mononucleosis-like illness with rectal bleeding and/or pain after unprotected anal intercourse can suggest a diagnosis of CMV proctitis.https://digitalcommons.psjhealth.org/ppmc_internal/1007/thumbnail.jp

Networks, technology and regional development: small tourism enterprises in Western Southland, New Zealand

Tourism is increasingly being used as a tool to stimulate regional development in rural areas. Small tourism enterprises (STE) lie at the heart of the industry and form a major part of the tourism sector. Characterised by flexible organisational structures and small size, STE are well positioned to respond to a growing demand for unique personalised visitor experiences. Information and communications technologies (ICT) enhance access to information, improve the efficiency of business activities and promote networking between businesses, community and travellers at the local, regional and international level.Western Southland is a predominantly rural region in the far south of New Zealand. Promoting the development of a cohesive tourism industry in the Western Southland region will benefit individual operators, their communities and the region as a whole. Using the case of Western Southland, this study explores the profile and characteristics of STE; their perceptions of the value of networking and collaboration, and their attitudes towards and use of ICT. Also considered are the implications of STE attitudes and behaviour in relation to the New Zealand Tourism Strategy and the New Zealand Digital Strategy goals in shaping regional development. A variety of business and community stakeholders are part of the broader case study contributing a rich understanding of the dynamics of the region. A mixed method approach is used to collect data through a series of semi-structured interviews and a survey. Key findings show that limited planned networking is occurring and there is a need to increase STE awareness of the benefits of collaborative activities in order to promote active engagement with other STE. Existing networks are found to be largely informal and embedded in the social and cultural context of communities. The level of ICT use by STE varies, and considerable support is required to encourage operators to upskill. National development goals promote ideals of sustainable communities and businesses, and are aligned with what operators envisage for their region

Thinking with Paint: Troubling Settler Colonialisms Through Early Childhood Art Pedagogies

In this paper we think with the specificities of paint to tell stories about entanglements of settler colonialism and paint and painting in early childhood art education. We see to become implicated (Razack, 1998) within settler colonialism in the context we now call Canada. We paint a messy non-linear picture of our work with children through a process of storytelling. Through complex pictures of how we are attempting (even if partially and imperfectly) to respond and stay with the trouble our stories bring forward, we gesture toward hope and decolonizing strategies. Our work takes inspiration from contemporary artists and from anti-racist and Indigenous scholars

Gender-biased behavior at work: what can surveys tell us about the link between sexual harassment and gender discrimination?

This paper examines the links between survey-based reports of sexual harassment and gender discrimination. In particular, we are interested in assessing whether these concepts measure similar forms of gender-biased behavior and whether they have the same effect on workers' job satisfaction and intentions to leave their jobs. Our results provide little support for the notion that survey-based measures of sexual harassment and gender discrimination capture the same underlying behavior. Respondents do appear to differentiate between incidents of sexual harassment and incidents of gender discrimination in the workplace. Both gender discrimination and sexual harassment are associated with a substantially higher degree of job dissatisfaction, particularly amongst men. While women who experience gender discrimination are somewhat more likely to intend to change jobs, amongst men it is sexual harassment that leads to an increased propensity to quit. We find no significant interactions between our two measures of gender bias, perhaps implying that the intensity of gender bias is relatively unimportant for understanding job dissatisfaction and the intention to quit. At the same time, this may reflect the lack of precision with which we estimate this interaction, especially for me

Supporting Live Development of SOAP and CORBA Clients

We present middleware for a Client Development Environment that facilitates live development of client applications for SOAP or CORBA servers. We use JPie, a tightly integrated programming environment for live software construction in Java, as the target platform for our design. JPie provides dynamic classes whose signature and implementation can be modified at run time, with changes taking effect immediately upon existing instances of the class. We extend this model to automate addition, mutation, and deletion of dynamic server methods within dynamic clients. Our implementation simplifies distributed application development by masking technical differences between local and remote method invocations. Moreover, the live development model allows server-side changes to be dynamically integrated into a running client to support simultaneous live development of both the client and server

Investigating the Effectiveness and Efficiency of Simulation-Based EHR Training: Media Naturalness Theory Perspective

Increased use of Electronic Health Records (EHRs) systems has resulted in the need to provide quality EHR training to healthcare professionals. In this paper, we investigate the role of computer-based simulation training (Lateef, 2010; Bell et al., 2008). In simulation-based training (SBT), typical instruction is replaced with tasks that are designed to replicate real-world events or settings and manage an individual\u27s experience in an “artificial” environment (Lateef, 2010; Salas et al., 2009; Bell et al., 2008). SBT can provide students with an improved learning experience that reduces perceived stress and improves EHR task efficiency and performance. This study uses media naturalness and compensatory adaptation theories to explain why, although computer-based training may be considered less natural, it is expected to have a positive effect on performance. While participants may struggle with less natural media at the beginning of a task, they can adapt and compensate for the missing naturalness, resulting in similar or improved performance (Kock, 2005; Kock & DeLuca, 2007). We develop a research model that describes how simulation-based EHR training can mitigate perceived participant stress and augment task efficiency by reducing time to complete EHR tasks, which, in turn, has a positive effect on task-based performance. We will empirically test the model with a unique dataset created from an EHR lab assessment and questionnaires completed by two third-year cohorts of medical students. The measurement instrument was developed based on previously validated instruments and demonstrated appropriate validity and reliability in this study (Kock et al., 2018). To test our research model, we will use partial least squares (PLS), a second-generation variance-based structural equation modeling technique (Chin 1998; Haenlein and Kaplan 2004; Kock 2010). We expect the results to show that simulation-based EHR training enables healthcare providers to reduce perceived stress and complete EHR tasks more efficiently, both of which would have a positive effect on task performance. The findings of this study will help to enhance our understanding of the positive role of simulation-based training, which stimulates individuals to achieve higher levels of efficiency, less stress, and increased levels of performance through the lens of the media naturalness and compensatory adaptation theories. The findings of this study will not only help academics explain theoretical relationships between simulation-based training and performance but also assist practitioners in achieving higher efficiency and effective performance, which are critical for better healthcare outcomes. This study also will enhance our understanding of the role of EHR use experience in modifying the relationship between simulation-based training and performance. This research will make several key contributions. First, the study in this research emphasizes the EHR-enabled performance-related benefits of simulation-based training. Second, this study identifies how (e.g., mediation of stress and efficiency) simulation-based training impacts performance. Third, to the best of our knowledge, this research presents the first study to incorporate the context (i.e., the moderating role of EHR use experience) under which simulation-based EHR training impacts performance. In summary, this study contributes important practical implications by demonstrating an improved method of training health care professionals in the use of EHRs, which will allow them to experience reduced levels of stress, and in turn, provide better care to patients. Keywords electronic health records, simulation, stress, efficiency, time, EHR task performance, healthcare provider

Unraveling the Link between Simulation EHR Training and Task Performance: The Mediation Role of Stress

Past research has explored the link between computer-mediated communication (CMC) and task performance, but it remains unclear how (i.e., under what mechanisms) CMC impacts task performance. Drawing on media naturalness theory and the stimulus-organism-response model as our theoretical framework, we develop a research model and describe how simulation-based EHR training (a type of CMC) can improve EHR-based task performance by mitigating stress. We empirically test the model with a unique experimental dataset from EHR lab assessment and questionnaires that 225 participants completed. The structural equation modeling analysis results show that simulation EHR training helped improve EHR-based task performance (both effectiveness and efficiency) by reducing perceived stress. We discuss theoretical and practical implications, limitations, and future research

Unraveling the Link between Simulation EHR Training and Task Performance: The Mediation Role of Stress

Past research has explored the link between computer-mediated communication (CMC) and task performance, but it remains unclear how (i.e., under what mechanisms) CMC impacts task performance. Drawing on media naturalness theory and the stimulus-organism-response model as our theoretical framework, we develop a research model and describe how simulation-based EHR training (a type of CMC) can improve EHR-based task performance by mitigating stress. We empirically test the model with a unique experimental dataset from EHR lab assessment and questionnaires that 225 participants completed. The structural equation modeling analysis results show that simulation EHR training helped improve EHR-based task performance (both effectiveness and efficiency) by reducing perceived stress. We discuss theoretical and practical implications, limitations, and future research

ARE DANCERS SYMMETRICAL DURING SINGLE LEG AND DOUBLE LEGGED LANDINGS?

The effect of limb preference on lower extremity function and performance was examined in young healthy dancers. Fifteen elite adolescent dancers performed 15 consecutive single leg hops on each leg and 3 rebound jumps onto two triaxial force platforms. To identify limb preference the Waterloo Footedness Questionnaire was administered. Functional symmetry indices (SI) were calculated for the peak landing forces, and limb dominance was identified as the limb producing the greatest take-off power during the rebound jumps. Significant asymmetry was identified in the landing performance of the dancers. However no relationship was found between limb preference and limb dominance of the dancers. In conclusion, dance teachers should aim to achieve safer landing strategies by developing ambidextrous movement in young dancers

Research as Inquiry: A Discipline Specific Approach to Information Literacy

https://aquila.usm.edu/textbooks/1003/thumbnail.jp