Acute Kawasaki Disease: Not Just for Kids

Kawasaki Disease is a small-to-medium-vessel vasculitis that preferentially affects children. Kawasaki Disease can occur in adults, but the presentation may differ from that observed in children. Typical findings in both adults and children include fever, conjunctivitis, pharyngitis, and skin erythema progressing to a desquamating rash on the palms and soles. Adults more frequently present with cervical adenopathy (93% of adults vs. 15% of children), hepatitis (65% vs. 10%), and arthralgia (61% vs. 24–38%). In contrast, adults are less frequently affected by meningitis (10% vs. 34%), thrombocytosis (55% vs. 100%), and coronary artery aneurysms (5% vs. 18–25%). We report a case of acute Kawasaki Disease in a 24-year-old man who presented with rash, fever, and arthritis. He was successfully treated with high-dose aspirin and intravenous immunoglobulin (IVIG). Our case highlights the importance of considering Kawasaki Disease in adults presenting with symptoms commonly encountered in a general medical practice

Relational agency: Relational sociology, agency and interaction

yesThis article explores how the concept of agency in social theory changes when it is conceptualised as a relational rather than an individual phenomenon. I begin with a critique of the structure/agency debate, particularly of how this emerges in the critical realist approach to agency typified by Margaret Archer. It is argued that this approach, and the critical realist version of relational sociology that has grown from it, reifies social relations as a third entity to which agents have a cognitive, reflexive relation, playing down the importance of interaction. This upholds the Western moral and political view of agents as autonomous, independent, and reflexive individuals. Instead of this I consider agency from a different theoretical tradition in relational sociology in which agents are always located in manifold social relations. From this I create an understanding of agents as interactants, ones who are interdependent, vulnerable, intermittently reflexive, possessors of capacities that can only be practiced in joint actions, and capable of sensitive responses to others and to the situations of interaction. Instead of agency resting on the reflexive monitoring of action or the reflexive deliberation on structurally defined choices, agency emerges from our emotional relatedness to others as social relations unfold across time and space

Assimilation of passive microwave AMSR-2 satellite observations in a snowpack evolution model over northeastern Canada

Over northeastern Canada, the amount of water stored in a snowpack, estimated by its snow water equivalent (SWE) amount, is a key variable for hydrological applications. The limited number of weather stations driving snowpack models over large and remote northern areas generates great uncertainty in SWE evolution. A data assimilation (DA) scheme was developed to improve SWE estimates by updating meteorological forcing data and snowpack states with passive microwave (PMW) satellite observations and without using any surface-based data. In this DA experiment, a particle filter with a Sequential Importance Resampling algorithm (SIR) was applied and an inflation technique of the observation error matrix was developed to avoid ensemble degeneracy. Advanced Microwave Scanning Radiometer 2 (AMSR-2) brightness temperature (TB) observations were assimilated into a chain of models composed of the Crocus multilayer snowpack model and radiative transfer models. The microwave snow emission model (Dense Media Radiative Transfer – Multi-Layer model, DMRT-ML), the vegetation transmissivity model (ω-τopt), and atmospheric and soil radiative transfer models were calibrated to simulate the contributions from the snowpack, the vegetation, and the soil, respectively, at the top of the atmosphere. DA experiments were performed for 12 stations where daily continuous SWE measurements were acquired over 4 winters (2012–2016). Best SWE estimates are obtained with the assimilation of the TBs at 11, 19, and 37&thinsp;GHz in vertical polarizations. The overall SWE bias is reduced by 68&thinsp;% compared to the original SWE simulations, from 23.7&thinsp;kg&thinsp;m−2 without assimilation to 7.5&thinsp;kg&thinsp;m−2 with the assimilation of the three frequencies. The overall SWE relative percentage of error (RPE) is 14.1&thinsp;% (19&thinsp;% without assimilation) for sites with a fraction of forest cover below 75&thinsp;%, which is in the range of accuracy needed for hydrological applications. This research opens the way for global applications to improve SWE estimates over large and remote areas, even when vegetation contributions are up to 50&thinsp;% of the PMW signal.</p

Development and Validation of a Bedside Score to Predict Early Death in Cancer of Unknown Primary Patients

BACKGROUND: We have investigated predictors of 90-day-mortality in a large cohort of non-specific cancer of unknown primary patients. METHODS: Predictors have been identified by univariate and then logistic regression analysis in a single-center cohort comprising 429 patients (development cohort). We identified four predictors that produced a predictive score that has been applied to an independent multi-institutional cohort of 409 patients (validation cohort). The score was the sum of predictors for each patient (0 to 4). RESULTS: The 90-day-mortality-rate was 33 and 26% in both cohorts. Multivariate analysis has identified 4 predictors for 90-day-mortality: performance status>1 (OR = 3.03, p = 0.001), at least one co-morbidity requiring treatment (OR = 2.68, p = 0.004), LDH>1.5 x the upper limit of normal (OR = 2.88, p = 0.007) and low albumin or protein levels (OR = 3.05, p = 0.007). In the development cohort, 90-day-mortality-rates were 12.5%, 32% and 64% when the score was [0-1], 2 and [3]-[4], respectively. In the validation cohort, risks were 13%, 25% and 62% according to the same score values. CONCLUSIONS: We have validated a score that is easily calculated at the beside that estimates the 90-days mortality rate in non-specific CUP patients. This could be helpful to identify patients who would be better served with palliative care rather than aggressive chemotherapy

Activity theory, complexity and sports coaching: An epistemology for a discipline

The aim of this article is two-fold. Firstly, it is to advance the case for Activity Theory (AT) as a credible and alternative lens to view and research sports coaching. Secondly, it is to position this assertion within the wider debate about the epistemology of coaching. Following a framing introduction, a more comprehensive review of the development and current conceptualisation of AT is given. Here, AT’s evolution through three distinct phases and related theorists, namely Vygotsky, Leont’ev and Engeström, is initially traced. This gives way to a more detailed explanation of AT’s principal conceptual components, including ‘object’, ‘subject’, ‘tools’ (mediating artefacts), ‘rules’, a ‘community’ and a ‘division of labour’. An example is then presented from empirical work illustrating how AT can be used as a means to research sports coaching. The penultimate section locates such thinking within coaching’s current ‘epistemological debate; arguing that the coaching ‘self’ is not an autonomous individual, but a relative part of social and cultural arrangements. Finally, a conclusion summarises the main points made, particularly in terms in presenting the grounding constructivist epistemology of AT as a potential way forward for sports coaching

Neurobiological degeneracy and affordance perception support functional intra-individual variability of inter-limb coordination during ice climbing

This study investigated the functional intra-individual movement variability of ice climbers differing in skill level to understand how icefall properties were used by participants as affordances to adapt inter-limb coordination patterns during performance. Seven expert climbers and seven beginners were observed as they climbed a 30 m icefall. Movement and positioning of the left and right hand ice tools, crampons and the climber's pelvis over the first 20 m of the climb were recorded and digitized using video footage from a camera (25 Hz) located perpendicular to the plane of the icefall. Inter-limb coordination, frequency and types of action and vertical axis pelvis displacement exhibited by each climber were analysed for the first five minutes of ascent. Participant perception of climbing affordances was assessed through: (i) calculating the ratio between exploratory movements and performed actions, and (ii), identifying, by self-confrontation interviews, the perceptual variables of environmental properties, which were significant to climbers for their actions. Data revealed that experts used a wider range of upper and lower limb coordination patterns, resulting in the emergence of different types of action and fewer exploratory movements, suggesting that effective holes in the icefall provided affordances to regulate performance. In contrast, beginners displayed lower levels of functional intra-individual variability of motor organization, due to repetitive swinging of ice tools and kicking of crampons to achieve and maintain a deep anchorage, suggesting lack of perceptual attunement and calibration to environmental properties to support climbing performanc

Combined FDG-PET/CT for the detection of unknown primary tumors: systematic review and meta-analysis

The aim of this study was to systematically review and meta-analyze published data on the diagnostic performance of combined 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the detection of primary tumors in patients with cancer of unknown primary (CUP). A systematic search for relevant studies was performed of the PubMed/MEDLINE and Embase databases. Methodological quality of the included studies was assessed. Reported detection rates, sensitivities and specificities were meta-analyzed. Subgroup analyses were performed if results of individual studies were heterogeneous. The 11 included studies, comprising a total sample size of 433 patients with CUP, had moderate methodological quality. Overall primary tumor detection rate, pooled sensitivity and specificity of FDG-PET/CT were 37%, 84% (95% CI 78–88%) and 84% (95% CI 78–89%), respectively. Sensitivity was heterogeneous across studies (P = 0.0001), whereas specificity was homogeneous across studies (P = 0.2114). Completeness of diagnostic workup before FDG-PET/CT, location of metastases of unknown primary, administration of CT contrast agents, type of FDG-PET/CT images evaluated and way of FDG-PET/CT review did not significantly influence diagnostic performance. In conclusion, FDG-PET/CT can be a useful method for unknown primary tumor detection. Future studies are required to prove the assumed advantage of FDG-PET/CT over FDG-PET alone and to further explore causes of heterogeneity

FDG PET/CT in carcinoma of unknown primary

Carcinoma of unknown primary (CUP) is a heterogeneous group of metastatic malignancies in which a primary tumor could not be detected despite thorough diagnostic evaluation. Because of its high sensitivity for the detection of lesions, combined 18F-fluoro-2-deoxyglucose positron emission tomography (FDG PET)/computed tomography (CT) may be an excellent alternative to CT alone and conventional magnetic resonance imaging in detecting the unknown primary tumor. This article will review the use, diagnostic performance, and utility of FDG PET/CT in CUP and will discuss challenges and future considerations in the diagnostic management of CUP