Extramedullary plasmacytoma of the uterine cervix arising in an asymptomatic 46-year-old female

An extramedullary plasmacytoma is a rare type of plasma cell tumour that can be found in soft tissues throughout the body. The most common location for an extramedullary plasmacytoma is in the head and neck region. Few case reports have previously documented patients with an extramedullary plasmacytoma within the female genital tract. We report a case of a healthy and asymptomatic 46-year-old female who presented to Colposcopy Clinic with a finding of low-grade squamous intraepithelial lesion seen on a routine Pap smear. She was found to have a cervical polyp that was excised. Pathology revealed diffuse sheets of atypical plasma cells with lambda light chain restriction. She was referred to Hematology for extensive work-up as the pathology finding was concerning for a plasma cell neoplasm. Staging investigations, including bone marrow biopsy, skeletal survey, whole body PET-CT scan, serum protein electrophoresis, and serum free light chain testing, were all negative. Surgical resection with a hysterectomy was recommended as the most appropriate course of management. The treatment approach is consistent with guidelines outlined in the literature, whereby extramedullary plasmacytomas, which arise outside of the head and neck region and have clear margins, should undergo surgical resection. Extramedullary plasmacytomas carry a risk of progressing to systemic disease, such as multiple myeloma, making it crucial that these patients be followed with routine surveillance to achieve the most optimal long term survival outcome

“Everything new is happening all at once”: a qualitative study of early career obstetrician and gynaecologists’ preparedness for independent practice

Background: The transition from residency training into practice is associated with increasing risks of litigation, burnout, and stress. Yet, we know very little about how best to prepare graduates for the full scope of independent practice, beyond ensuring clinical competence. Thus, we explored the transition to independent practice (TTP) experiences of recent Obstetrics and Gynaecology graduates to understand potential gaps in their perceived readiness for practice. Methods: Using constructivist grounded theory, we conducted semi-structured interviews with 20 Obstetricians/Gynaecologists who graduated from nine Canadian residency programs within the last five years. Iterative data collection and analysis led to the development of key themes. Results: Five key themes encompassed different practice gaps experienced by participants throughout their transition. These practice gaps fit into five competency domains: providing clinical care, such as managing unfamiliar low-risk ambulatory presentations; navigating logistics, such as triaging referrals; managing administration, such as hiring or firing support staff; reclaiming personhood, such as boundary-setting between work and home; and bearing ultimate responsibility, such as navigating patient complaints. Mitigating factors were found to widen or narrow the extent to which new graduates experienced a practice gap. There was a shared sense among participants that some practice gaps were impossible to resolve during training. Conclusions: Existing practice gaps are multi-dimensional and perhaps not realistically addressed during residency. Instead, TTP mentorship and training opportunities must extend beyond residency to ensure that new graduates are equipped for the full breadth of independent practice

Whose research is it anyway? Academic social networks versus institutional repositories

Open access article. Creative Commons Attribution 4.0 License (CC-BY) appliesINTRODUCTION Looking for ways to increase deposits into their institutional repository (IR), researchers at one institution started to mine academic social networks (ASNs) (namely, ResearchGate and Academia.edu) to discover which researchers might already be predisposed to providing open access to their work. METHODS Researchers compared the numbers of institutionally affiliated faculty members appearing in the ASNs to those appearing in their institutional repositories. They also looked at how these numbers compared to overall faculty numbers. RESULTS Faculty were much more likely to have deposited their work in an ASN than in the IR. However, the number of researchers who deposited in both the IR and at least one ASN exceeded that of those who deposited their research solely in an ASN. Unexpected findings occurred as well, such as numerous false or unverified accounts claiming affiliation with the institution. ResearchGate was found to be the favored ASN at this particular institution. DISCUSSION The results of this study confirm earlier studies’ findings indicating that those researchers who are willing to make their research open access are more disposed to do so over multiple channels, showing that those who already self-archive elsewhere are prime targets for inclusion in the IR. CONCLUSION Rather than seeing ASNs as a threat to IRs, they may be seen as a potential site of identifying likely contributors to the IR.Ye

Youth\u27s Strategies for Staying Safe and Coping With the Stress of Living in Violent Communities.

Youth living in urban environments of pervasive violence are exposed to a variety of violence-related stressors. This qualitative descriptive study sought to ascertain how community-dwelling youth perceived exposure to violence and how these youth identified and used available resources. The intent of this community-based participatory research study was to help inform the design of a youth violence prevention center intervention. Semi-structured interviews were conducted with a purposive sample of 18 youth ages 10-16. Youth reported high levels of exposure to neighborhood violence. A theme of identifying and navigating safe and unsafe places emerged. Other stressors were more proximal and included interpersonal issues and conflicts. Youth used neighborhood and individual resources to cope with stressors. Youth maintained a high level of vigilance and developed clear strategies to safely navigate violent neighborhoods. Implications for youth due to the constant vigilance and exquisite sensitivity to stressors of chronic neighborhood violence are discussed

Sensitization in transplantation: Assessment of risk (STAR) 2019 Working Group Meeting Report.

The purpose of the STAR 2019 Working Group was to build on findings from the initial STAR report to further clarify the expectations, limitations, perceptions, and utility of alloimmune assays that are currently in use or in development for risk assessment in the setting of organ transplantation. The goal was to determine the precision and clinical feasibility/utility of such assays in evaluating both memory and primary alloimmune risks. The process included a critical review of biologically driven, state-of-the-art, clinical diagnostics literature by experts in the field and an open public forum in a face-to-face meeting to promote broader engagement of the American Society of Transplantation and American Society of Histocompatibility and Immunogenetics membership. This report summarizes the literature review and the workshop discussions. Specifically, it highlights (1) available assays to evaluate the attributes of HLA antibodies and their utility both as clinical diagnostics and as research tools to evaluate the effector mechanisms driving rejection; (2) potential assays to assess the presence of alloimmune T and B cell memory; and (3) progress in the development of HLA molecular mismatch computational scores as a potential prognostic biomarker for primary alloimmunity and its application in research trial design

Validation of two generic patient-reported outcome measures in patients with type 2 diabetes

<p>Abstract</p> <p>Background</p> <p>Prior to using a generic patient-reported outcome measure (PRO), the measure should be validated within the target population. The purpose of the current study was to validate two generic measures in patients with type 2 diabetes.</p> <p>Methods</p> <p>Patients with type 2 diabetes in Scotland and England completed two generic measures: EQ-5D and Psychological General Well-Being Index (PGWB). Two diabetes-specific measures were administered: ADS and DSC-R. Analyses assessed reliability and validity.</p> <p>Results</p> <p>There were 130 participants (53 Scotland; 77 England; 64% male; mean age = 55.7 years). Responses on the EQ-5D and PGWB reflected moderate impairment consistent with previous diabetes samples: mean EQ-5D Index score, 0.75; EQ-5D VAS, 68.8; PGWB global score, 67.9. All scales of the PGWB demonstrated good internal consistency reliability (Cronbach's alpha = 0.77 to 0.97). The EQ-5D and PGWB demonstrated convergent validity through significant correlations with the ADS (r = 0.48 to 0.61), DSC-R scales (r = 0.33 to 0.81 except ophthalmology subscale), and Body Mass Index (r = 0.15 to 0.38). The EQ-5D and PGWB discriminated between groups of patients known to differ in diabetes-related characteristics (e.g., history of hypoglycemia).</p> <p>Conclusion</p> <p>Results support the use of the EQ-5D and PGWB among patients with type 2 diabetes, possibly in combination with condition-specific measures.</p

Isolated small bowel disease and multiple lung nodules: an unusual initial presentation of pediatric Crohn’s disease

Crohn’s disease (CD) is a chronic idiopathic inflammatory disorder of the gastrointestinal tract characterized by transmural inflammation, skip lesions, and architectural changes. Isolated small bowel involvement is seen in approximately 1% of patients with CD at diagnosis. Extraintestinal manifestations can occur, with pulmonary involvement seen in &lt;1% of all CD. We report an unusual case of a previously healthy 12-year old male who presented to hospital with acute abdominal pain, emesis, and fever. He had microcytic anemia, thrombocytosis, elevated C-reactive protein, hypoalbuminemia, digital clubbing, and poor growth. Interestingly, initial upper endoscopy and ileocolonoscopy were unremarkable. Pathology revealed colonic nonnecrotizing granulomas without inflammation. He incidentally was found to have multiple lung nodules despite the absence of respiratory symptoms, and MRE revealed five small bowel strictures. This prompted work-up for alternative etiologies including infectious and rheumatologic, which were negative. Ultimately, five months later, double balloon enteroscopy revealed ileal ulcerations at the strictures and several small aphthous ulcers in the transverse and sigmoid colon. Biopsies showed active ileitis and chronic active colitis with nonnecrotizing granulomas. He developed perianal disease, confirmed on MR pelvis, and a diagnosis of CD was made. The patient started infliximab therapy and is clinically in remission. This is a rare and unique phenotype of CD with initial presentation of multiple lung nodules and isolated small bowel disease. This case highlights the importance of recognizing that pulmonary manifestations should be considered in the absence of respiratory symptoms and that a normal first endoscopy does not preclude a diagnosis of CD

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POLICY The International Food Policy Research Institute&apos;s (IFPRI&apos;s) mission is to identify and analyze policies that meet the food needs of the developing world in a sustainabl e way. Research at IFPRI concentrates on economic growth and poverty alleviation in low-income countries, improvement in the well-being of poor people, and sound management of the natural resource base that supports agriculture. This book was produced by IFPRI&apos;s 2020 Vision for Food, Agriculture, and the Environment, an initiative to develop a shared vision and a consensus for action on how to meet future world food needs while reducing poverty and protecting the environment. The Economi c Research Service (ERS) is the main source of economic information and research in the U.S. Department of Agriculture. The mission of ERS is to inform and enhance public and private decisionmaking on economic and policy issues related to agriculture, food, natural resources, and rural development. The American Agricultural Economics Association (AAEA) supports the professiona l development of economist s who help society to solve problems related to agriculture, food, resources, and economic development.Who Will Be Fed i

Women's experiences of their preabortion ultrasound image printout

OBJECTIVES:We know little about women's interest in and experiences with a printout of their preabortion ultrasound image. METHODS:We conducted a mixed-methods study at a large-volume abortion-providing facility where patients are offered the opportunity to receive their ultrasound printout, using 2 years of abstracted medical chart data on demographics and printout acceptance and interviews with patients about whether they took a printout and, if they did, why and what they did with it. We analyzed chart data using multivariable logistic regression to examine predictors of printout acceptance and interviews using elaborative coding and modified grounded theory. RESULTS:We abstracted data from 5342 charts and interviewed 23 women. Thirty-eight percent of all patients and 61% of interviewees accepted the printout. Predictors of accepting the printout included being younger, being nonwhite, having a partner who is a boyfriend or friend, and not having a support person at the visit. Interviewees reported that they accepted the printout simply because it was offered, out of curiosity and as part of confirming their abortion decision. They described various uses for the printout, including sharing with others, consulting before their abortion appointment, retaining as a keepsake and nothing at all. CONCLUSIONS:Some abortion patients are interested in receiving a printout of their ultrasound image and find it useful. Women accept a printout for a range of reasons and use it in various ways; there is no singular experience or use of the printout. IMPLICATIONS:We find no evidence that taking a printout of the preabortion ultrasound image causes emotional distress, nor did we find that it was expressly important for any patient's experience. Providers should consider providing interested patients with a printout, if they have the capability to do so, when they request one