Narrative Case Research Articles

Hegemony in medical pluralism: articulations and relationships in care, a case study

This study aims to describe and analyze the medical pluralism and the type of hegemony-subordination relation between forms of care or knowledge in the treatment of a patient with glaucoma to show the articulatory and transactional process between several therapeutic resources and understand which structural elements shaped the treatment itinerary and option. This is a qualitative research that used a narrative case study. To reconstruct the narrative, a semi-structured interview was conducted based on a thematic script previously established by a set of a priori categories to later transcribe the data and perform hermeneutic triangulation. Results showed that the hegemony in medical pluralism was based on equivalence relations, so that the patient replaced the use of pharmacological drugs with alternative medicine treatments. However, the relational process of equivalence developed itself in a context of biomedical significance, in which the treatment or control of intraocular pressure configured the substitution premise. Thus, the processes that triggered the hegemonic relations were constituted by various social, cultural, and economic factors such as unemployment, social security, and gender, which played a fundamental role during the search for care.

Reconceptualising Intracareer Transitions as Coach-Becomings: A Rhizomatic Narrative Case Study of an American Basketball Coach

This paper offers a poststructuralist exploration of the career transitions of an American basketball coach into and within collegiate basketball. We draw on the theory of Deleuze and Guattari to reconceptualise coaching transitions as coach-becomings contrasted with humanist conceptions of outcome-centred, staged processes. Our nomadic analysis is based on longitudinal interviews and ethnographic data collected over a 4-year period. We adopt narrative rhizomatics and ventriloquism to examine the coaching and institutional assemblages engaged in the production of coaching beliefs and behaviours in specific transition contexts. We also attend to the dialogical and performative aspects of analysis in relation to the role of researchers. Our findings suggest that collegiate environments are conducive to disciplinary coaching practices framed within discourses of masculine militarism and dualist representationalism, thus adversely impacting learning, development, and adaptability in transition. We argue that an alternative conceptualisation of transitions as coach-becomings shifts the focus away from arborescent unitary logic to more creative, nonlinear pedagogies that embrace multiplicity and fluidity. Engaging with the Deleuzian ontology of difference also implies raising awareness of coaching as a social and political practice.

Identity negotiations of a Mexican transnational in the Rio Grande Valley: Crossing the border daily

This narrative case study examines the cultural affiliations of one transnational US-born Mexican American college student, and her various intersecting veins of identity. The aim was to capture the bordered existence in the many criteria of her being. Her linguistic identity, pop culture identity, spiritual identity, as well as her general cultural affiliations are examined as intersecting rays of influence. Utilizing Anzaldúa’s (2012) bordered identity as theoretical grounding for her partitioned selves, along with Bakhtin’s (1986) notion of cultural and linguistic dialogue, we analyzed the complexities in this one bicultural, bilingual young woman venturing into adulthood. This study sheds light on the experiences and identifications of transnational young people living on the US-Mexico border. In particular, the participant seemed to continuously challenge fixed notions of identity, which contest current academic labels and frameworks that scholars have used to examine the identity of transnational students.

A Study on the Narrative Case of Counseling for Middle-Aged Couples Using Transactional Analysis Theory

A Study on the Narrative Case of Counseling for Middle-Aged Couples Using Transactional Analysis Theory

XYZ Biotech: A Fictional Business Development Case Utilizing Quantitative Tools to Evaluate a New Antibody-Drug-Conjugate Opportunity for Metastatic Breast Cancer

Multiple considerations must be evaluated with a new acquisition or license in biopharmaceutical business development. This case utilizes a fictional company, XYZ Biotech, to illustrate the quantitative considerations in evaluating an antibody-drug combination product in the metastatic breast cancer (mBC) space. The steps shown in this case also include the development of a market model to define the potential size of the market opportunity, a weighted benefit pricing model to evaluate the present price, and a net present value model to estimate projections from the product. The case also engages multiple qualitative considerations as part of the discussion section. It concludes by offering several nuanced questions at the end to stimulate discussion around the analysis, probe additional considerations needed for a business case, and analyze what other elements or issues would drive a decision. In the appendix is a short case summary of key facts for participants to develop solutions and share in class before reviewing the case narrative.

Using a functional multilingualism framework and online learning to develop professional repertoires and racial literacy for trainee mathematics teachers in London, England

ABSTRACT This article is a narrative case study of language provision for trainee mathematics teachers on a one-year initial teacher training course: a Postgraduate Certificate in Education in London, England. It draws on Heugh’s (2018) (Conclusion: Multilingualism, Diversity and Equitable Learning: Towards crossing the ‘Abyss’. in The Multilingual Edge of Education 2018 (pp 341-367) Palgrave MacMillan) description of Functional Multilingualism; Muscovitch’s (2015) Academic Literacy in Mathematics for English learners in The Journal of Mathematical Behaviour, 40, 43-62) to intertwine the development of professional language repertoires with the praxis of school mathematics pedagogy; and digital multimodal literacies to promote writing, professional language repertoires and critical language awareness. It models practices and tasks designed to improve outcomes in the Postgraduate Certificate in Education course and address the lack of confidence felt by trainee teachers when teaching multilingual classes. These develop safe spaces that allow for sharing of school practicum experiences and is a context for discussion of race literacy and other aspects of diversity and inclusion referred to in the Equalities Act (2010). Drawing on innovation over a four-year period (2017–2021) the case study provides a variety of starting points to develop consistency within the many initial teacher training routes leading to Qualified Teacher Status and for collaboration between schools and Higher Education Institutes during further two years of school-based training required in England before final recognition as a fully qualified teacher.

Identifying Key Issues in Climate Change Litigation: A Machine Learning Text Analytic Approach

As climate change, environmental, social, and governance (ESG), along with sustainability, become increasingly crucial for businesses and society, there is a noticeable scarcity of information and transparency regarding corporate practices. Often, government agency enforcement actions lead to litigation and are ultimately resolved by court decisions. Moreover, in instances when there is perceived inadequacy in government enforcement, citizens frequently turn to the courts for preventive judgments against businesses or agencies. In an effort to shed light on the multifaceted aspects of climate change, we adopted a novel, exploratory approach to analyze climate change-related litigation cases. Utilizing a blend of machine learning-based text analytics, we have extracted key insights from individual case narratives. Our analysis encompassed over four hundred cases from the Westlaw database through various keyword searches. The emergent topics from our case dataset revolved around four critical environmental themes: forest, land, water, and air emissions. Our findings provide insight into the nature and dimensions of climate change and also carry significant policy implications, laying the groundwork for future research in this domain.

Research on Service Design of Garbage Classification Driven by Artificial Intelligence

This paper proposes a framework for AI-driven municipal solid waste classification service design and management, with an emphasis on advancing sustainable urban development. This study uses narrative research and case study methods to delve into the benefits of AI technology in waste classification systems. The framework includes intelligent recognition, management strategies, AI-based waste classification technologies, service reforms, and AI-powered customer involvement and education. Our research indicates that AI technology can improve accuracy, efficiency, and cost-effectiveness in waste classification, contributing to environmental sustainability and public health. However, the effectiveness of AI applications in diverse city contexts requires further verification. The framework holds theoretical and practical significance, offering insights for future service designs of waste management and promoting broader goals of sustainable urban development.

Factors influencing community-facility linkage forcase management ofpossible serious bacterial infections among young infants inKenya.

Despite evidence showing the feasibility and acceptability of implementing the World Health Organization's guidelines on managing possible serious bacterial infection (PSBI) in Kenya, the initial implementation revealed sub-optimal community-facility referrals and follow-up of PSBI cases. This study explores facilitators and barriers of community-facility linkages in implementing PSBI guidelines in Busia and Migori counties, Kenya. We used an exploratory qualitative study design drawing on endline evaluation data from the 'COVID-19: Mitigating Neonatal Mortality' project collected between June and July 2022. Data include case narratives with caregivers of sick young infants (0-59 days old) (18), focus group discussions with community health volunteers (CHVs) (6), and in-depth interviews with facility-based providers (18). Data were analysed using an inductive thematic analysis framework. Between August 2021 and July 2022, CHVs assessed 10 187 newborns, with 1176 (12%) identified with PSBI danger signs and referred to the nearest facility, of which 820 (70%) accepted referral. Analysis revealed several factors facilitating community-facility linkage for PSBI treatment, including CHVs' relationship with community members and facilities, availability of a CHV desk and tools, use of mobile app, training and supportive supervision. However, challenges such as health system-related factors (inadequate providers, stockout of essential commodities and supplies, and lack of transport/ambulance) and individual-related factors (caregivers' refusal to take referrals) hindered community-facility linkage. Addressing common barriers and fostering positive relationships between community health workers and facilities can enhance acceptance and access to PSBI services at the community level. Combining community health workers' efforts with a mobile digital strategy can improve the efficiency of the identification, referral and tracking of PSBI cases in the community and facilitate linkage with primary healthcare facilities.

Mining the past: The case for historical narratives in global justice theorizing

Debates on global justice, it is claimed, can be enriched in important ways by more explicitly historicizing our approach and using historical narratives, stories and debates to expand our conceptual vocabulary and theoretical purview. The claim is illustrated through a specific analysis of Paul Robeson’s relationship with the Welsh Miners. It is argued such a historical turn, grounded in a wider interdisciplinary engagement with subjects such as cultural studies may see at least three key benefits accrue in terms of our understanding of the field. Firstly, it can uncover philosophical and theoretical ideas and alternatives so far unconsidered; secondly, it can generate a shift in the empirical frame that accounts for and seeks to identify means for “real world” political change; lastly, it should encourage us to question the in/out dichotomy at the heart of the western debate, which projects global injustice as being “out there.”

Martin’s Lounge: From Valuation Engagement to Fraud Examination

ABSTRACT This case utilizes a fictional bar to engage students in using accounting information to detect and monitor for asset misappropriation by employees. Students are given background information about Martin’s Lounge and a task of identifying asset misappropriation and estimating losses due to asset misappropriation. All information necessary to solve the case is provided in the case narrative and the six Excel files supplied with the case. Students can use generalized audit software (e.g., IDEA), Microsoft Excel, or data analytic/visualization software to solve the case. The case challenges students to consider how accounting data can be used to detect instances of asset misappropriation and the possible perpetrator of a fraud. The case can be assigned as an individual assignment or a small group assignment.

Like Water, We Re-Member: A Conceptual Model of Identity (Re)formation through Cultural Reclamation for Indigenous Peoples of Mexico in the United States

Background: Diasporic Indigenous peoples of Mexico living in the United States continue to survive and reclaim their cultures despite multiple disruptions to identity formation resulting from systematic violence and cultural silencing enacted through white settler colonialism in the United States and Mexico. Honoring Indigenous survivance, the authors present a conceptual model of Indigenous identity healing and reformation that mirrors the dynamic qualities of water for Indigenous Mexican peoples living in the United States. Methods: The conceptual model arose from a ceremony-based, participatory, digital archiving project documenting Indigenous oral histories. The model is illustrated through case analysis of three Indigenous Mexican individuals living in the United States whose stories holistically represent the model’s components. Results: The case narratives illustrate how Indigenous Mexican identities are (re)formed by moving through the model components of Rift (disconnection from land, culture, and community), Longing (yearning to find what was lost), Reconnecting (reclaiming cultural practices), and Affirmation (strengthening of identity through community), via Reflection (memory work which propels movement through each stage). Conclusions: Findings suggest that identities can be (re)formed through reclaiming cultural practices and reconnecting with the community. This conceptual model may be useful for further understanding Indigenous Latinx identity development and healing.

Music teacher mothers’ career navigation during the COVID-19 pandemic

The purpose of this narrative case study was to re-present and re-story the experiences, particularly related to career navigation, of music teacher mothers in the United States during the COVID-19 pandemic. We explored how music teacher mothers had to adjust the balance between work, family, and personal life during the pandemic, in what ways the pandemic may have changed the way music teacher mothers parent, and how the pandemic may have affected, or already changed, music teacher mothers’ long-term career goals. Three participants, selected based on the diversity of their family structures, teaching backgrounds, and locations, shared their stories through a series of two interviews conducted via Zoom. Participants’ stories illuminated the relational, vocational, financial, and health-related struggles brought about by the nexus of teaching music during the pandemic. We explore resonances between their stories related to priorities, boundaries, career decisions, and financial considerations.

Backstage at the Barristers’ Case Conference: A Dramaturgical Analysis

Socio-legal ethnographies have focused largely on the dramaturgical themes present in the competing performances seen in adversarial trials. Drawing on ethnographic observations of British homicide investigations, we illuminate the hidden “backstage” space of prosecution barristers’ case conferences. Using Goffman’s dramaturgical framework, we analyze the interactions, deliberations, and negotiations that are enacted between barristers, homicide detectives, forensic scientists, and other specialists. To our knowledge, the work that happens in these conferences has never been documented. Our findings reveal how prosecution narratives evolve and are tested behind the scenes before being performed in court. We pay particular attention to the role of anticipatory work in guiding how criminal justice actors choreograph the prosecution case. The findings add to our understanding of narrative case building and elaborate Goffman’s dramaturgical framework. We discuss the implications of our findings for due process.

Treatment of cerebral ventriculitis with a new self-irrigating catheter system: narrative review and case series

Cerebral ventriculitis is a life-threatening condition that requires prompt and effective pharmacological intervention. The continuous irrigation of the cerebral ventricles with fluid and its drainage is a system to remove toxic substances and infectious residues in the ventricles; this system is called IRRAflow®. We used this kind of ventricular irrigation/drainage system to treat two patients with post-surgical cerebral ventriculitis and a patient with bacterial meningitis complicated with ventriculitis. In this case series, we discuss the management of these three cases of cerebral ventriculitis: we monitored cytochemical parameters and cultures of the cerebrospinal fluid of patients during their ICU stay and we observed a marked improvement after irrigation and drainage with IRRAflow® system. Irrigation/drainage catheter stay, mode settings, and antibiotic therapies were different among these three patients, and neurological outcomes were variable, according to their underlying pathologies. IRRAflow® system can be applied also in other types of brain injury, such as intraventricular hemorrhage, intracranial abscess, subdural hematomas, and intracerebral hemorrhage, with the aim to remove the hematic residues and enhance the functional recovery of the patients. IRRAflow® seems a promising and useful tool to treat infectious and hemorrhagic diseases in neuro-intensive care unit.

Complete transverse transection of the normal-sized non-pregnant uterus associated with wearing a safety belt in abdominal blunt trauma: Narrative review and case study.

This review and case study illustrates a patient with a complete transverse transection of a non-pregnant uterus caused by blunt trauma associated with wearing a safety belt. The 31-year-old patient, who had a previous cesarean section, presented with impending hypovolemic shock caused by intra-abdominal hemorrhage secondary to blunt trauma while wearing a safety belt. On physical examination, a transverse straight line of ecchymosis along the line of a fastened safety belt was noted without any other external injury. The operative findings revealed a complete transverse transection which had cut through the lower part of the non-pathological, normal-sized uterus with active bleeding and mild injury to the small bowel without active bleeding. Total hysterectomy and simple closure of the small bowel were performed with successful outcomes. We hypothesize that transection was caused by the enormous pressure produced by blunt trauma transmitted through the abdomen by the fastened safety belt and the weakness of the uterine wall caused by the previous low transverse cesarean section which facilitated the separation and extension to the entire wall. In conclusion, this case study provides the following learning points: (1) Enormous forces produced by a fixed fastened safety belt during a car accident can cause complete transverse transection of a normal-sized, non-pathological uterus, leading to life-threatening intra-abdominal hemorrhage. (2) A previous cesarean section may potentiate the transection, especially when the uterus is repositioned above the pelvic brim. (3) The gynecologic condition should also be included in the differential diagnoses in cases of intra-abdominal hemorrhage. If highly suspected, gynecologists should be notified for early recognition and avoidance of delayed actions.

Preparing for Death While Investing in Life: A Narrative Inquiry and Case Report of Home-Based Paediatric Palliative, End-of-Life, and After-Death Care.

Paediatric palliative care is pivotal for addressing the complex needs of children with incurable diseases and their families. While home-based care offers a familiar and supportive environment, delivering comprehensive services in this context is challenging. The existing literature on home-based palliative care lacks detailed guidance for its organization and implementation. This qualitative narrative inquiry explores the organization and provision of home-based paediatric palliative care. Data were collected from healthcare practitioners using conversations, storytelling, and reflective journaling. Schwind's Narrative Reflective Process was applied to synthesize the data, resulting in an in-depth case description. The narrative approach illuminates the complexities of home-based paediatric palliative, end-of-life, and after-death care. Key findings encompass the importance of early-care coordination, interprofessional collaboration, effective symptom management, emotional and psychosocial support, and comprehensive end-of-life planning. Through the case study of the child patient, the challenges and strategies for providing holistic, family-centred care within the home environment are described. Practical insights gained from this report can inform the development and improvement of home-based palliative care programs, benefiting researchers, practitioners, and policymakers seeking to optimize care for children and families in similar contexts.

Equity M&M - Adaptation of the Morbidity and Mortality Conference to Analyze and Confront Structural Inequity in Internal Medicine.

At morbidity and mortality (M&M) conferences, medical teams review cases for medical education and system improvement. Adverse outcomes are often driven by social inequity, but processes to analyze such outcomes are lacking. Adapt quality improvement and patient safety (QIPS) tools in the M&M format to systematically analyze adverse patient outcomes rooted in social and structural determinants of health (SSDH). One-hour conferences conducted in health systems in Seattle, WA, and Dallas, TX. Equity M&M conferences were held 11 times, each with approximately 45 participants comprised of internal medicine trainees, faculty, and non-medical staff. Conferences included a case narrative and counternarrative highlighting SSDH, an equity-framed root cause analysis, and potential interventions. Conferences were received well across both institutions. Following conferences, most respondents reported increased identification of opportunities for action towards equity (88.5%) and confidence in discussing equity issues with colleagues (92.3%). Equity M&M conferences are a structured tool for deconstructing and confronting structural inequity that leads to adverse patient outcomes. Evaluations demonstrate educational impact on participants. Anecdotal examples suggest institutional impact. Other health systems could adopt this model for similar advocacy and system improvement.

Acute cholecystitis as a complication of diverting loop ileostomy: A case series and narrative review

Introduction: Diverting ileostomy is increasingly utilized in modern colorectal surgery for the management of colorectal cancer and inflammatory bowel disease (IBD) among other bowel pathologies. Cholelithiasis has known associations with ileostomy and IBD, potentially caused by changes to enterohepatic circulation and cholesterol absorption in the gallbladder. However, cases of cholecystitis following ileostomy have not been reported across the literature. Case Series: We present three cases of cholecystitis following diverting loop ileostomy in a 56-year-old female, 74-year-old female, and 73-year-old female. A digital literature search was conducted on databases PubMed and EMBASE in February 2023 covering literature from 1974 to 2023 to identify any further cases; however, none were identified. To our knowledge, these are the first reported cases of cholecystitis following ileostomy. Conclusion: We believe these three cases highlight that developing symptomatic gallstones following diverting ileostomy occurs, and patients should be carefully counseled of the risks preoperatively, and be educated of gallstone-related symptoms to enable early engagement of upper gastrointestinal surgeons for treatment. Additionally, we recommend preoperative gallbladder imaging and close monitoring prior to and after ileostomy formation for development of gallstone complications. Ultimately, this case series and narrative review lay the groundwork for further research investigating any causality between diverting loop ileostomy formation and development of complications of gallstone disease.

The cultural and religious complexities of Amish-focused mental health conditions research: insights from an exhaustive narrative review and case study of counseling controversies

ABSTRACT This exhaustive review of Amish mental health conditions research suggests that studies are well-executed by methodological protocols but that (1) findings are inconsistent or limited in generalizability, (2) instrument validity remains contested, and (3) study investigation into Amish cultural-religious dynamics is limited. We present a case study from a sizeable Amish settlement finds that documents how competing ideologies – notably old Amish religious theology, the scientific-psychological, and the Evangelical Protestant – have generated Amish-internal controversies over defining and treating mental health conditions, suggesting that Amish mental health conditions research may produce inconsistent findings if not accounting for internal cultural-religious dynamics. Future research should include pre-study investigations into the targeted population's cultural and religious dynamics, consist of more nuanced case reports from therapists and psychiatrists, and include replication studies at different times and places, with deliberate attention to contextual factors.