Narrative Case Research Articles

SMARCA4 deficiency in small cell lung cancer: A case report and narrative review of the literature

SWItch/Sucrose Non-Fermentable (SWI/SNF) is a large protein complex with a central role in chromatin remodeling and genome transcription. The catalytic subunits of the SWI/SNF related BAF chromatin remodeling complex subunit ATPase 2 (SWI/SNF SMARCA2; also called BRM) and SWI/SNF related BAF chromatin remodeling complex subunit ATPase 4 (SMARCA4; also called BRG1) are encoded by the SMARCA2 and SMARCA4 genes, respectively, and are mutually exclusive. Loss of either SMARCA2 and/or SMARCA4 has been previously reported in several types of malignant solid tumors of the gastrointestinal and genitourinary tract. So far, their absence in non-small cell lung cancer has been observed in a series of studies involving primary tumors and cell lines, where it is associated with loss of differentiation and heightened tumorigenic potential leading to an unfavorable prognosis. SMARCA2 and SMARCA4 deficiency is frequent in solid predominant adenocarcinomas and tumors with low levels of bronchial epithelial markers, including thyroid transcription factor 1. A rare case of SMARCA4 deficiency in small cell lung cancer is described. A 57-year-old male patient, with no medical history of past illness, was admitted to our center for the investigation and management of a space-occupying lesion in the right upper lung lobe with tracheal and mediastinal infiltration. Biopsy of a lymph node in the right supraclavicular region was diagnostic for small cell lung cancer with regional loss of SMARCA4. The patient demonstrated progressive respiratory failure and clinical deterioration and eventually deceased despite intubation and transfer to the intensive care unit. This case indicates that SMARCA4-deficient small cell lung cancer may present with an aggressively deteriorating phenotype with poor outcomes for the patie

Samirah X’s Sense of Audience: A Case Study on Black Teen Activism on Social Media

This article presents a critical account of one teen’s sense of audience as she enacted literacies on social media platforms and provides strategies that can inform the teaching of audience and purpose in ways responsive to teens’ digital literacies. Informed by case-study research and insights gained from interviewing, observing, and collecting digital artifacts, I discuss how Samirah X, a self-described teen actress and social justice advocate, engaged in writing practices on social media for three different main perceived audiences: cultural and racial community audience, socially conscious audience, and parental audience. Other sub-audiences from Samirah X’s case narrative are presented: audience as Black people, culture, and identity; audience as Black women and girls; and audience as Blacks who experience injustice and acts of violence. At the conclusion of this article, I provide implications for teaching English Language Arts focused on how social media work can fulfill state standards.

Acase of atopic dermatitis-the biopsychosocial view

Atopic dermatitis is perhaps the most comprehensively studied skin disease in psychosomatic medicine and psychoneuroimmunology. Its biopsychosocial conceptualization incorporates psychodynamic as well as behavioral and systemic considerations. At the same time, there is also extensive biological knowledge of the neuroendocrine-immune control of barrier and immune function, characterized through animal experiments and translational clinical studies. Integrating this knowledge into clinical routine, however, represents achallenge. The biopsychosocial implications of atopic dermatitis are discussed using aconcrete case as an example. Case presentation and narrative review of relevant psychopathogenetic models and psychoneuroimmunological pathomechanisms. Using acase of stress-exacerbated atopic dermatitis, the contribution of acute and chronic stressors to the development and worsening of skin inflammation is discussed. Particular attention is paid to the role of the pituitary hypothalamic adrenal axis and neurogenic inflammation as central drivers of barrier disruption and immune imbalance in atopic dermatitis.

Cardiovascular Involvement in SYNE Variants: A Case Series and Narrative Review

Cardiac laminopathies encompass a wide range of diseases caused by defects in nuclear envelope proteins, including cardiomyopathy, atrial and ventricular arrhythmias and conduction system abnormalities. Two genes, namely LMNA and EMD, are typically associated with these disorders and are part of the routine genetic panel performed in affected patients. Yet, there are other markedly fewer known proteins, the nesprins, encoded by SYNE genes, that play a pivotal role in connecting the nuclear envelope to cytoskeletal elements. So far, SYNE gene variants have been described in association with neurodegenerative diseases; their potential association with cardiac disorders, albeit anecdotally reported, is still largely unexplored. This review focuses on the role of nesprins in cardiomyocytes and explores the potential clinical implications of SYNE variants by presenting five unrelated patients with distinct cardiac manifestations and reviewing the literature. Emerging research suggests that SYNE-related cardiomyopathies involve disrupted nuclear–cytoskeletal coupling, leading to impaired cardiac function. Understanding these mechanisms is critical for furthering insights into the broader implications of nuclear envelope proteins in cardiac health and for potentially developing targeted therapeutic strategies. Additionally, our data support the inclusion of SYNE genes in the cardiac genetic panel for cardiomyopathies and cardiac conduction disorders.

A descriptive study of fatal drownings among children and adolescents in the United States, with a focus on retention pond deaths, 2004-2020.

The objective of this study was to characterize fatal drownings among children and adolescents, with a focus on retention pond drownings, and identify risk factors for these fatalities using child death review data. We acquired 2004-2020 National Fatality Review-Case Reporting System data for drowning deaths among youth 0-19 years. Retention pond drownings were identified through case narratives. We analyzed demographics, primary caregiver, supervisor, death investigation, and drowning-related variables across age groups (<1, 1-4, 5-9, 10-14, and 15-19 years) using either the Chi-square test or Fisher's Exact test, as appropriate, with a p-value of <0.05 indicating statistical significance. Of 7,539 drowning deaths reported during the study duration, 265 deaths occurred in retention ponds. Children 1-4 years comprised a greater proportion of retention pond drowning deaths (59.3%) compared to overall drowning deaths (50.9%) in this age group. In 51.3% of retention pond drowning deaths among children <5 years, supervision was needed but not provided. Most (80.4%) retention pond-related deaths among children <5 years and 50.7% of deaths among children 5-19 years were attributed to child neglect, poor or absent supervision, or exposure to hazards. Among all decedents who drowned in retention ponds, 19.1% were found to have a disability or chronic illness. Most retention ponds lacked local ordinances regulating water access (83.5%) and did not have barriers or protection (66.1%) or warning signs (82.0%). Younger children with poor or absent supervision who cannot swim are at high risk of drowning. Retention pond drownings are not infrequent, and most locations lack ordinances regulating water access or requiring barriers, such as fences. Greater efforts are needed to address this common hazard and environmental and policy strategies should be implemented to prevent future deaths.

Language Teachers' Developmental Trajectories as Materials Developers

AbstractLanguage teachers are increasingly expected to develop teaching materials in many contexts. This trend necessitates greater understanding of how language teachers develop their professional practices as materials developers. Applying an ecological perspective in combination with Wenger's theory of Communities of Practice, the present study examines the developmental trajectories of language teachers participating in a materials development community. Adopting a narrative case study approach, this study collected interview data, policy documents, meeting minutes, and personal materials that four language teachers used for developing materials. The findings show that these language teachers' developmental trajectories as materials developers were not linear and were mediated by individual beliefs and policy requirements upon entering the community; their knowledge and skills and the power relations they experienced during the materials development process; and their beliefs and power relations at the end of the project. These findings suggest that language teachers need individualized support and resources at various points throughout their participation in a materials development community to develop their professional practices throughout the process.

The Use of Motivational Interviewing with Chronically Unhoused Veterans

Abstract The Housing First model is embedded in a supportive housing federal program aimed at reducing homelessness by offering housing vouchers and case management services to chronically unhoused veterans with co-occurring disorders. Despite the successes Housing First programs have achieved with the chronic unhoused population, including veterans, the cycle of homelessness continues to exist in this subgroup. These veterans have significant vulnerabilities, such as severe mental health and addiction histories, that contribute to their housing instability. The case narrative in this paper illustrates the story of a chronically unhoused veteran who cycled through episodes of homelessness due to ongoing substance use and evictions. On the veteran's third entry into a Housing First program, the social worker utilized the transtheoretical model (TTM) to evaluate the veteran's readiness to change and applied motivational interviewing (MI) principles to find a representative payee who would support housing stability, even if the veteran experienced a relapse. This approach can be considered harm reduction in supportive housing. Through the application of MI, the veteran exercised self-efficacy, opted for implementing a protective factor, and experienced long-term stable housing.

Distribution Characteristics in Clinical Phenotype and Immunohistochemistry of STK11 Adnexal Tumors: Case Report and Narrative Synthesis.

STK11 adnexal tumors are recently named tumors of the female adnexal region, associated with Peutz-Jeghers syndrome (PJS). There is a lack of studies on the clinical phenotypes of PJS concerning the pathology and molecular characteristics of STK11 adnexal tumors. We searched for 781 relevant studies through PubMed and Web of Science, and preliminary statistical and grouping comparisons were made using the screened study data combined with our patient. A total of 25 patients with STK11 adnexal tumors (excluding tumors with no detectable STK11 alterations) were reported in 4 studies. The tumors were most common in middle-aged women (mean age of 39 years) and typically located at paratubal sites (76%). Nearly half of patients (45%) had PJS manifestations or molecular changes. Compared with sporadic (non-PJS) STK11 adnexal tumors, PJS-associated STK11 adnexal tumors were slightly larger in diameter (mean 12.6 cm vs 8.9 cm) and had a longer interval between first recurrences (median 19 months vs 7 months). Primary tumors with pelvic recurrence had a reduced keratin 7 positive rate and tended to grow in non-paratubal sites. However, overall, the clinicopathological characteristics of PJS-associated tumors and sporadic tumors were similar, as was the immunohistochemical expression of primary and recurrent tumors. More specimens and studies are needed to support these observations and further delineate the characteristics of STK11 adnexal tumors.

“Student engagement is off the charts!”: understanding the co-design and implementation of a data science Pokémon unit for second graders

Preparing elementary-aged children to practice data science literacies is important and understudied. Our research investigates how data science curricula might be effectively designed and integrated into elementary classroom instruction. We use narrative case study methodology, focusing on a single case detailing a second-grade teacher’s approach toward offering students a data science instructional unit. We qualitatively analyzed observations, journals, interviews, and artifacts to document the teacher’s process. Findings suggest the importance of co-designing with peers, posing relevant problems, integrating standards and differentiating instruction, relying on everyday practices, integrating disciplines, and promoting student collaboration when practicing data literacies. Our example offers elementary school educators’ practical ways to deepen children’s engagement and hone data science literacies through data science instructional units.

Avoidable factors associated with maternal death from postpartum haemorrhage: a national Malawian surveillance study

BackgroundDespite strong evidence-based strategies for prevention and management, global efforts to reduce deaths from postpartum haemorrhage (PPH) have failed, and it remains the leading cause of maternal mortality. We conducted...

Identification of Naloxone in Emergency Medical Services Data Substantially Improves by Processing Unstructured Patient Care Narratives

ABSTRACT OBJECTIVES Structured data fields, including medication fields involving naloxone, are routinely used to identify opioid overdoses in emergency medical services (EMS) data; between January 2021 and March 2024, there were approximately 1.2 million instances of naloxone administration. in the United States. To improve the accuracy of naloxone reporting, we developed methodology for identifying naloxone administration using both structured fields and unstructured patient care narratives for events documented by EMS. METHODS We randomly sampled 30,000 records from Kentucky’s state-wide EMS database during 2019. We applied regular expressions (RegEx) capable of recognizing naloxone-related text patterns in each EMS patient’s case narrative. Additionally, we applied natural language processing (NLP) techniques to extract important contextual factors such as route and dosage from these narratives. We manually reviewed cases where the structured data and unstructured data disagreed and developed an aggregate indicator for naloxone administration using either structured or unstructured data for each patient case. RESULTS There were 437 (1.45%) records with structured documentation of naloxone. Our RegEx method identified 547 naloxone administrations in the narratives; after manual review, we determined RegEx yielded acceptable false positives (N = 31, 5.6%), false negatives (N = 23, 4.2%) and performance (precision = 0.94, recall = 0.93). In total, 552 patients had naloxone administered after combining indicators from both structured fields and verified results from unstructured narratives. The NLP approach also identified 246 (47.4%) records that specified route of administration and 358 (69.0%) records with dosage delivered. CONCLUSIONS An additional 115 (26.3%) patients receiving naloxone were identified by using unstructured case narratives compared to structured data. New surveillance methods that incorporate unstructured EMS narratives are critically needed to avoid substantial underestimation of naloxone utilization and enumeration of opioid overdoses.

Increasing Incidence of Pickleball Injuries Presenting to US Emergency Departments: A 10-year Epidemiologic Analysis of Mechanisms and Trends.

Pickleball is one of the fastest-growing sports in the United States. It is popular among seniors but has recently grown across all age groups. As pickleball has gained interest, its corresponding injury burden has also increased. The purpose of this study was to identify pickleball-related injury trends and underlying mechanisms across different age groups presenting to US emergency departments. It was hypothesized that (1) pickleball-related injuries would increase significantly between 2013 and 2022, (2) older age groups would have the greatest frequency of injury, and (3) falls would be the most common mechanism of injury. Descriptive epidemiology study. The National Electronic Injury Surveillance System (NEISS) was queried for pickleball injuries between January 1, 2013, and December 31, 2022. The demographic information, injury site, and diagnosis were recorded, and case narratives were reviewed to identify the injury mechanism. The statistical sample weight assigned for NEISS cases by hospital was used to calculate national estimates (NEs). Injury trends over time were evaluated by linear regression. A total of 1110 NEISS cases representing 66,350 nationally estimated pickleball-related injuries were included. The mean age was 64 ± 14.7 years (range, 4-93 years). Most injuries occurred in those aged 65 to 80 years (NEISS cases = 643; NE = 40,507 [61.1%]), followed by those aged 35 to 64 years (NEISS cases = 349; NE = 20,785 [31.3%]). Falls were the most common injury mechanism overall (NEISS cases = 699; NE = 43,434 [65.5%]). However, being hit with a paddle and a twist/inversion were the most common mechanisms for ages 0 to 17 and 18 to 34 years, respectively. Fractures were the most common diagnosis (NEISS cases = 363; NE = 21,703 [32.7%]), followed by strains/sprains (NEISS cases = 327; NE = 20,419 [30.8%]). Also, 69.1% of all fractures occurred in female players. The wrist was the most injured, accounting for 12.7% of all injuries. Significant increases in pickleball injuries were seen over time (P < .001) and across all age groups (P < .05). There was a significant increase in pickleball-related injuries presenting between 2013 and 2022, with most injuries arising from a fall. Notably, injuries decreased by 14% between 2019 and 2020 but rose again by 41% between 2020 and 2021 during the coronavirus 2019 pandemic. Older players disproportionately presented to the emergency department with pickleball-related injuries. Increased awareness and comprehensive injury prevention initiatives may be warranted to address the considerable prevalence of fractures and overuse/strain injuries.

The shared journey of induced lactation: A case study

Background: Induced lactation or adoptive breastfeeding is a little-spoken-of event and can be life-changing for participants. While not common, it is nonetheless within our realm of practice as midwives and, therefore, important that we understand how our role can support whānau who make this choice. Aim: The aim of this case study is to share a narrative of induced lactation and adoptive breastfeeding from the midwifery and whānau perspectives. The multilayers of midwifery care evident in this case study and breastfeeding success will be discussed, with the hope that this can also support midwives who are caring for LGBTQIA+ whānau who are inducing lactation. Method: This is an anonymised, “instrumental” case study that offers a first-person practitioner narrative and reflection of a single case, representative of a phenomenon that most midwifery tauira (see glossary) and early-career midwives may not readily observe first-hand. Discussion: Three important outcomes are noted. First, the intrapersonal and psychosocial factors that are part of the narrative were incorporated in a care plan providing holistic assessment and clinical decisions, acknowledging the gift of breastfeeding that carried a much larger significance than purely a nutritional choice. Second, collegial relationships support an inclusive experience for all involved. Third, re-telling, reflecting on and analysing the various elements in Anna’s story offer an educational example for in-depth learning and understanding. Conclusion: The professional responsibility of the midwife was a part of the process, and integral to Anna’s positive experience of induced lactation.

Ureaplasma urealyticum infection following organ transplantation: a case report and narrative review

Objective One case of Ureaplasma urealyticum (UU) infection after kidney transplantation was reported, and relevant literature was collected to provide a scientific reference basis for clinical diagnosis and treatment. Methods A case of UU infection after renal transplantation in our hospital was analyzed retrospectively. PubMed, Embase and Cochrane databases were searched for case reports of UU infection after organ transplantation before 30 June 2024. The clinical and laboratory characteristics, treatment and prognosis of UU infection were summarized and analyzed. Results A 65-year-old man underwent renal transplantation on 26 January 2022 due to chronic renal disease (grade 2) caused by focal sclerosing glomerulonephritis. Hyperammonaemia and coma occurred after the operation, and the patient died. A total of 38 case reports or series of cases were included in this study, involving 44 patients. The case reports included 22 cases of kidney transplantation, 11 cases of lung transplantation, 4 cases of heart transplantation,1 case of liver transplantation and 6 cases of multiple organ transplantation. Ureaplasma urealyticum infection occurred in 74.47% of cases within 1 month after transplantation, and the main symptoms after the infection were mental. After the onset of the disease, the most abnormal examination index was the increase of blood ammonia, followed by the increase of white blood cells. Therapeutic drugs included tetracyclines (doxycycline or minocycline), quinolones and azithromycin. The clinical symptoms could be significantly improved after 24 h of taking the fastest-acting medication. The highest mortality rate was in patients infected with Ureaplasma after lung transplantation. Conclusion Early identification of UU and timely and correct drug treatment are essential to saving the lives of patients.

THE INNER DYNAMICS OF THE OLD AND SOCIALLY WITHDRAWN IN JAPAN: INSIGHTS FOR INTERVENTIONS FROM CASE STUDY ANALYSES

Abstract An increasing number of older adults in Japan are refusing social support even when offered. This lack of support elevates their risk of health deterioration, delays evacuation in disaster scenarios, and increases the likelihood of premature and lonely deaths with inadequate closures. This study examines the psychological factors contributing to the lack of motivation among socially isolated older adults in Japan to seek help. We conducted semi-structured one-on-one interviews with nine individuals aged 60 years or older who reside in the community identified as socially isolated by community-based healthcare personnel. Using a narrative case study approach, the study revealed a prevalent concern among these socially isolated individuals about causing inconvenience to others by seeking help. The findings suggest that their reluctance to ask for help may be driven not by a desire to maintain independence but rather by a concern about inconveniencing others. In the context of Japanese culture, maintaining harmony with others is considered important. Asking for help might inconvenience others and potentially disrupt this harmony. To effectively assist those who refuse necessary support, social and community health workers should develop ways of minimizing the perceived burden of the recipients. However, further research is necessary to establish whether these findings are unique to the Japanese cultural context. Examples of innovative strategies to address this challenge will be discussed.

Local Anesthetic Infiltration, Awake Veno-Venous Extracorporeal Membrane Oxygenation, and Airway Management for Resection of a Giant Mediastinal Cyst: A Narrative Review and Case Report.

Background: Mediastinal mass syndrome represents a major threat to respiratory and cardiovascular integrity, with difficult evidence-based risk stratification for interdisciplinary management. Methods: We conducted a narrative review concerning risk stratification and difficult airway management of patients presenting with a large mediastinal mass. This is supplemented by a case report illustrating our individual approach for a patient presenting with a subtotal tracheal stenosis due to a large cyst of the thyroid gland. Results: We identified numerous risk stratification grading systems and only a few case reports of regional anesthesia techniques for extracorporeal membrane oxygenation patients. Clinical Case: After consultation with his general physician because of exertional dyspnea and stridor, a 78-year-old patient with no history of heart failure was advised to present to a cardiology department under the suspicion of decompensated heart failure. Computed tomography imaging showed a large mediastinal mass that most likely originated from the left thyroid lobe, with subtotal obstruction of the trachea. Prior medical history included the implantation of a dual-chamber pacemaker because of a complete heart block in 2022, non-insulin-dependent diabetes mellitus type II, preterminal chronic renal failure with normal diuresis, arterial hypertension, and low-grade aortic insufficiency. After referral to our hospital, an interdisciplinary consultation including experienced cardiac anesthesiologists, thoracic surgeons, general surgeons, and cardiac surgeons decided on completing the resection via median sternotomy after awake cannulation for veno-venous extracorporeal membrane oxygenation via the right internal jugular and the femoral vein under regional anesthesia. An intermediate cervical plexus block and a suprainguinal fascia iliaca compartment block were performed, followed by anesthesia induction with bronchoscopy-guided placement of the endotracheal tube over the stenosed part of the trachea. The resection was performed with minimal blood loss. After the resection, an exit blockade of the dual chamber pacemaker prompted emergency surgical revision. The veno-venous extracorporeal membrane oxygenation was explanted after the operation in the operating room. The postoperative course was uneventful, and the patient was released home in stable condition. Conclusions: Awake veno-venous extracorporeal membrane oxygenation placed under local anesthetic infiltration with regional anesthesia techniques is a feasible individualized approach for patients with high risk of airway collapse, especially if the mediastinal mass critically alters tracheal anatomy. Compressible cysts may represent a subgroup with easy passage of an endotracheal tube. Interdisciplinary collaboration during the planning stage is essential for maximum patient safety. Prospective data regarding risk stratification for veno-venous extracorporeal membrane oxygenation cannulation and effectiveness of regional anesthesia is needed.

An isolated 17,20-lyase deficiency patient achieved a successful live birth after in vitro fertilization: a case report and narrative review.

This study aimed to investigate the genetic etiology in an infertile patient presenting with consistently elevated progesterone levels. Genomic DNA was extracted from the patient's blood sample and subjected to whole-genome sequencing (NGS) using the Illumina NovaSeq platform. Bioinformatic analyses were conducted to identify single nucleotide variants (SNVs) and insertion-deletion mutations (Indels) potentially associated with the patient's clinical phenotype. These variants were subsequently validated using Sanger sequencing. To further assess the functional implications of these genetic variants, three-dimensional protein structure simulations and substrate molecular docking analyses were performed on the variant proteins. A point mutation, c.1096 G > T (p.Val366Leu), was identified in the patient's CYP17A1 gene. Compared to the wild type, the mutant exhibited no significant changes in the overall or local three-dimensional structure, and molecular docking analysis showed no notable difference in binding energy. A literature review indicated that this mutation site is located in the region where the CYP17A1 enzyme interacts with cytochrome b5 (Cyt b5). We report, for the first time, that a novel mutation in the CYP17A1 gene in an infertile woman may have led to isolated 17,20-lyase deficiency. The patient successfully achieved pregnancy and delivered a healthy baby through in vitro fertilization (IVF).

Outcomes of liposuction techniques for management of lipedema: a case series and narrative review.

Lipedema is a commonly underdiagnosed chronic condition. This study aimed to evaluate liposuction techniques for lipedema by conducting a systematic review and presenting our experience. A case series study and a comprehensive review were conducted. We assessed surgical outcomes among patients with lipedema who underwent liposuction. Descriptive and inferential statistics were implemented. In our case series, we used tumescent liposuction, vibration amplification of sound energy at resonance (VASER) liposuction, and waterjet-assisted liposuction (WAL). We also performed a literature review of current concepts and state-of-the-art treatment for lipedema. Twenty-four female patients were included in this study with a median age of 37 years [interquartile range (IQR), 10 years]. A statistically significant difference between preoperative (29.65 kg/m2) and postoperative body mass index (BMI) (26.95 kg/m2; P<0.05) of patients was evidenced. The amount of total fat removal between surgical techniques was statistically different (P<0.001). A statistically significant difference in the amount of total fat removal between surgical techniques was found (P=0.0015). Post-hoc analysis with Dunn's test evidenced a significant difference only between tumescent suction-assisted lipectomy and WAL (P<0.001). Nineteen studies were included in this review. Low complication rates, improvement in patient-reported outcomes, and reduction in conservative therapy requirements were found when evaluating multiple studies in this review. Liposuction has been shown to be a safe and effective alternative in patients with lipedema. It positively impacts clinical and patient-reported outcomes.

Automated redaction of names in adverse event reports using transformer-based neural networks

Abstract Background Automated recognition and redaction of personal identifiers in free text can enable organisations to share data while protecting privacy. This is important in the context of pharmacovigilance since relevant detailed information on the clinical course of events, differential diagnosis, and patient-reported reflections may often only be conveyed in narrative form. The aim of this study is to develop and evaluate a method for automated redaction of person names in English narrative text on adverse event reports. The target domain for this study was case narratives from the United Kingdom’s Yellow Card scheme, which collects and monitors information on suspected side effects to medicines and vaccines. Methods We finetuned BERT – a transformer-based neural network – for recognising names in case narratives. Training data consisted of newly annotated records from the Yellow Card data and of the i2b2 2014 deidentification challenge. Because the Yellow Card data contained few names, we used predictive models to select narratives for training. Performance was evaluated on a separate set of annotated narratives from the Yellow Card scheme. In-depth review determined whether (parts of) person names missed by the de-identification method could enable re-identification of the individual, and whether de-identification reduced the clinical utility of narratives by collaterally masking relevant information. Results Recall on held-out Yellow Card data was 87% (155/179) at a precision of 55% (155/282) and a false-positive rate of 0.05% (127/ 263,451). Considering tokens longer than three characters separately, recall was 94% (102/108) and precision 58% (102/175). For 13 of the 5,042 narratives in Yellow Card test data (71 with person names), the method failed to flag at least one name token. According to in-depth review, the leaked information could enable direct identification for one narrative and indirect identification for two narratives. Clinically relevant information was removed in less than 1% of the 5,042 processed narratives; 97% of the narratives were completely untouched. Conclusions Automated redaction of names in free-text narratives of adverse event reports can achieve sufficient recall including shorter tokens like patient initials. In-depth review shows that the rare leaks that occur tend not to compromise patient confidentiality. Precision and false positive rates are acceptable with almost all clinically relevant information retained.

Exploring deaf student teachers’ academic experiences at a teacher training college in Rwanda

From Eugenics to the institutionalisation period, Deaf students were discriminated against. Their education in African countries is minimal, especially in tertiary institutions, including Rwanda. The study explored the academic experiences of deaf student teachers at a Teacher Training College (TTC) in Rwanda. It used the interpretive paradigm and qualitative research approach. The study employed a narrative case study. The study population comprised two TTC administrators, two deaf student teachers, all the sixteen tutors who taught the deaf student teachers, and two library workers. One TTC administrator, two deaf student teachers, one teacher, and one library worker were purposively sampled, comprising five participants. The study found that the TTC did not have resources to educate deaf student teachers. The study also found that the tutors and the deaf student teachers relied on detailed notes, handouts, and an interpreter. It also found that deaf student teachers preferred Rwandan Sign Language because they had no communication options. The study recommended that the Rwanda Basic Education Board should provide resources for the education of deaf student teachers. Moreover, the Department of Special Needs and Inclusive Education should have a viable Rwandan Sign Language group to educate the hearing TTC community on Rwandan Sign Language.