Case History Research Articles

Importance of early consideration of scaling and sustainability for aging-related care models: Case study of Hospital at Home.

For aging-related research, there is a pressing need to attend to the dissemination and implementation of evidence-based interventions. Some aging-related interventions with established effectiveness may be poorly disseminated and implemented due to behavioral, organizational, payment, or other constraints. To provide insight into the beginning to end process of translation and implementation, we present a case history of the three-decade progression of Hospital at Home (HaH) now nearing national dissemination. We summarize research at various phases with particular attention to implementation considerations. Reviewing over three decades of HaH-related research dating from initial discovery to translation and implementation, we found that the content and importance of different constructs (e.g., inner practice vs. outer environmental setting) and the choice of implementation strategies differed depending on implementation context (testing of effectiveness, scaling, or sustainability). Early effectiveness studies mostly examined implementation issues related to the intervention, the practice setting, and the individuals involved. However, explicit and early consideration of scale and sustainment was not the primary focus. For example, HaH program intake is primarily through hospital emergency departments (ED). Initial efforts would have benefited from incorporating strategies (e.g., incorporating ED leadership into program leadership) to address night and weekend admissions. Many regulatory barriers did not surface during initial considerations. Considering implementation issues late may contribute to delay in bringing discoveries to population impact. The experience with HaH suggests that scale and sustainability bear earlier consideration because barriers and facilitators to implementation are likely to be different in content and importance at different phases of implementation.

Shear wave velocity-based evaluation of cyclic mobility type of liquefaction and validation by centrifuge model tests in LEAP

Existing study shows that small-strain shear modulus is a promising parameter for characterizing soil liquefaction resistance, while liquefaction resistance is liquefaction type dependent. In this study, firstly a revisit of laboratory tests on saturated sands was conducted to explore the relationship between liquefaction resistance CRR and small-strain shear modulus Gmax with emphasis on cyclic mobility type of liquefaction. The investigation indicates that in the stress-normalized space of cyclic resistance and small-strain shear modulus, the fitting curve of soil testing data does not always approach to the coordinate origin and there will be an intercept on the abscissa axis. Based on this finding, a more general form of the power function between liquefaction resistance and small-strain shear modulus is proposed. Then, undrained cyclic triaxial tests were conducted in conjunction with the data available from LEAP to establish the power function between CRR and Gmax for medium dense to dense Ottawa F-65 sand, which leads to an updated characterization model on the basis of Zhou-Chen model. Finally, centrifuge model tests of submerged gently sloping ground of Ottawa F-65 sand conducted at Zhejiang University (i.e., ZJU) for LEAP were used to compile liquefaction and non-liquefaction case histories with shear wave velocity measurement to investigate the validity of the updated model for evaluating the cyclic mobility type of liquefaction. The test results show that the updated model could classify the case history datasets produced by centrifuge model tests well. And the further consideration of initial shear stress acting on the slope could enhance the evaluation performance of this characterization model, which is worth of further research.

Rate of desertification, climate change and coping strategies: Insights from smallholder farmers in Ghana's Upper East Region

Climate change and desertification are global issues that are affecting agricultural activities in Sub-Saharan Africa. These phenomena have made it challenging for smallholder farmers to cope with the emerging global food crises. This article examines the evidence of desertification and climate change and how smallholder farmers in the Upper East Region of Ghana are responding to these threats. Primary data was analysed through interviews and focus group discussions. We used Landsat satellite-based annual mean Normalized Difference Vegetation Index, climate, crop production data, and reports from the Ministry of Food and Agriculture and other NGOs as secondary sources. We interviewed eighty respondents using case history and snowball sampling. The mean annual NDVI declined from 0.5 in 1998 to −0.10 in 2022. NDVI values suggest a decline in green vegetation health to a negative value, suggesting a non-vegetative surface. This means that the process of desertification has progressed to severe levels, resulting in little to no vegetation cover on the land surface. Similarly, rainfall data suggests a sharp decline in annual rainfall while farmers change the types of crops and the timing of planting. Farmers discussed the impact of climate change and desertification on their livelihoods. They have implemented approaches like using synthetic fertilisers, planting drought-resistant crops, practising dry-season farming, irrigating their crops, and building social support networks. Food insecurity and land degradation are major issues due to continuous cropping and population growth. Smallholder farmers suggest providing them with affordable, drought-resistant seedlings with shorter gestation periods to increase food production and avoid insecurity.

A Review of Subsidence Monitoring Techniques in Offshore Environments.

In view of the ever-increasing global energy demands and the imperative for sustainability in extraction methods, this article surveys subsidence monitoring systems applied to oil and gas fields located in offshore areas. Subsidence is an issue that can harm infrastructure, whether onshore or especially offshore, so it must be carefully monitored to ensure safety and prevent potential environmental damage. A comprehensive review of major monitoring technologies used offshore is still lacking; here, we address this gap by evaluating several techniques, including InSAR, GNSSs, hydrostatic leveling, and fiber optic cables, among others. Their accuracy, applicability, and limitations within offshore operations have also been assessed. Based on an extensive literature review of more than 60 published papers and technical reports, we have found that no single method works best for all settings; instead, a combination of different monitoring approaches is more likely to provide a reliable subsidence assessment. We also present selected case histories to document the results achieved using integrated monitoring studies. With the emerging offshore energy industry, combining GNSSs, InSAR, and other subsidence monitoring technologies offers a pathway to achieving precision in the assessment of offshore infrastructural stability, thus underpinning the sustainability and safety of offshore oil and gas operations. Reliable and comprehensive subsidence monitoring systems are essential for safety, to protect the environment, and ensure the sustainable exploitation of hydrocarbon resources.

Electrophysiological auditory measures to identify potential cortical markers of tinnitus

Tinnitus, or the perception of a sound in the absence of an external acoustic stimulus, is a common condition that cannot yet be objectively diagnosed. Current diagnostic tests of tinnitus consist of case history and behavioral measures that rely on subjective responses. This study examined electrophysiological measures, specifically the auditory late response (ALR), mismatch negativity (MMN), and P300 as potential neural biomarkers of tinnitus in both a tinnitus and non-tinnitus control group while utilizing the pitch-matched tinnitus frequencies as the test stimuli. Results of this study found differences in MMN amplitudes and area under the curve, and in P300 topographic maps between tinnitus and control subjects. The differences in MMN responses across groups suggest that dysfunctional processing of acoustic stimuli located near the tinnitus frequency in individuals with tinnitus manifests as soon as 200 ms after initial onset of the stimulus. In addition, results from a global field power analysis and differences in spatial distributions on topographical maps indicate that deficits persist through higher levels of cortical processing. A secondary goal of this study was to determine if electrophysiological measures correlated with reported tinnitus severity on questionnaires. This analysis indicated that P2 latency was a significant predictor of Tinnitus Reaction Questionnaire, Tinnitus Handicap Inventory, and percent of the time participant’s tinnitus was considered bothersome, suggesting that this measure could potentially be used to assess the efficacy of treatment programs for tinnitus.

Aesthetic Value of Furniture Design for the Elderly: Cultural Identity and Era Evolution

A significant improvement to the advancement of the Quality of Life (QoL) for Senior Citizens (SC) has been provided by Furniture Design (FD), which takes into account both their physical requirements and their emotional state. A review of the Aesthetic Value (AV) of FD is made available in this paper, with a particular focus on the integration of Cultural Identity (CI) and historical progress. Studying the role of regionally evocative designs and their impact on people of any age, the work of art explores the methods in which furniture may induce emotions of comfort, simplicity, and location. The analysis significantly underlines the impact it has on SC. The primary emphasis of this archeological research is on the evolution of FD during a period of time and the methods by which current developments have impacted the fundamental concepts that are used in today's society. Within the context of this research project, the difficulties and challenges that are connected with achieving the development of AV FD providing practical assistance for SC are explored. This can be achieved via the application of case histories and an analysis of architectural techniques representing four distinct Asian countries. In conclusion, the results obtained from the current study demonstrate the importance of improving the quality of life of SC by reaching an improved balance between AV, historical value, and feasible results within the context of FD.

The Play of Love, 1230–1578: A Case Study and Edition

ABSTRACT This article offers the first comprehensive history of the “play of love”—a similitude that compares God’s withdrawal in temptation to a mother at play with her young child—from its origin in Ancrene Wisse through its subsequent appearances in English and Latin devotional writing. In Ancrene Wisse, the scene allows an anchorite to understand her emotion in light of God’s love while acknowledging that God’s unprompted withdrawal causes suffering. The play of love was subsequently excerpted, translated into Latin, and circulated in England and on the continent. A Latin compilation misattributed to Richard Rolle, Quandoque tribularis (edited in the appendix), and later Middle English works refashion the play of love to prescribe specific practices or emotions. This case history thus reveals surprising connections between early English vernacular religious writing, Latinate European readers, and later medieval English compilers, as well as an object lesson in these readers’ changing expectations.

Summary of seven Swedish case reports on the microwave syndrome associated with 5G radiofrequency radiation.

The fifth generation, 5G, for wireless communication is currently deployed in Sweden since 2019/2020, as well as in many other countries. We have previously published seven case reports that include a total of 16 persons aged between 4 and 83 years that developed the microwave syndrome within short time after being exposed to 5G base stations close to their dwellings. In all cases high radiofrequency (RF) radiation from 4G/5G was measured with a broadband meter. RF radiation reached >2,500,000 to >3,180,000 μW/m2 in peak maximum value in three of the studies. In total 41 different health issues were assessed for each person graded 0 (no complaint) to 10 (worst symptoms). Most prevalent and severe were sleeping difficultly (insomnia, waking night time, early wake-up), headache, fatique, irritability, concentration problems, loss of immediate memory, emotional distress, depression tendency, anxiety/panic, dysesthesia (unusual touched based sensations), burning and lancinating skin, cardiovascular symptoms (transitory high or irregular pulse), dyspnea, and pain in muscles and joints. Balance disorder and tinnitus were less prevalent. All these symptoms are included in the microwave syndrome. In most cases the symptoms declined and disappeared within a short time period after the studied persons had moved to a place with no 5G. These case histories are classical examples of provocation studies. They reinforce the urgency to inhibit the deployment of 5G until more safety studies have been performed.

A nine-year case history of monitoring a wide pile group part I

This is the first of two papers on a wide pile group. The geology and a geotechnical model of the site are presented, along with the design of a single pile, analysis of a static loading test, and some dynamic tests. Response of the piled foundations comprising 399 bored piles supporting three 70-storey towers on a common mat was monitored. Records consist of results of a static loading test, dynamic tests of four piles, the development of load in 15 piles, and settlement of 40 points during construction and nine years following. At end of construction, the perimeter piles received more load from the towers than did the interior piles and the mat settled on average 90 mm. By the end of the monitoring period, due to the general subsidence, the average settlement of the mat had increased by 50 mm. Most of the settlement is considered to originate from the compression of the soil layers below the pile toe level. A subsequent paper will present the analysis and design of the wide pile group, and the numerical analysis of the static loading test on a single pile and of the wide pile group.

Surgical management of unilateral restrictive strabismus in an 8-month-old dog

ABSTRACT Case history An 8-month-old male, entire, mixed-breed dog was presented with a 1-month history of left exophthalmos and green mucopurulent ocular discharge. Subsequently, exophthalmos resolved but esotropia (medial strabismus) developed in the left eye, prompting referral to an ophthalmologist. Clinical findings At the initial referral consultation, enophthalmos and esotropia of the left eye were identified. The patient showed mild improvement after a 3-week tapering course of oral prednisolone and doxycycline. MRI was performed and showed left medial rectus muscle atrophy with increased contrast enhancement which was consistent with chronic extraocular muscle myositis (EOM). A forced duction test was performed to confirm the diagnosis of fibrosing esotropia, which is likely a sequela of chronic EOM. Diagnosis Fibrosing esotropia presumably caused by untreated EOM. Treatment and outcome One month later, esotropia progressed to a marked ventro-medial strabismus resulting in visual deprivation. Surgical release of the ventral oblique, medial and ventral recti muscles was performed, resulting in immediate resolution of the enophthalmos. Despite a tapering post-operative course of oral prednisolone, mild esotropia was present 4 weeks later. In an effort to stabilise the globe position, the low dose of prednisolone was increased to a higher anti-inflammatory dose before slowly tapering over 2 months. The vision in the left eye was improved after surgery and has been maintained since without further treatment. Clinical relevance This is the first documented case of fibrosing esotropia in a young dog with prior signs of acute exophthalmos. Fibrosing esotropia has been documented in certain breeds or as a sequela to chronic EOM. In this patient, it was presumably caused by EOM, which was strongly supported by the case history, progression and MRI findings. Most historical reports of EOM described it as a bilateral condition that resolves with systemic corticosteroids at an anti-inflammatory dose. EOM has been shown to also present unilaterally and it can progress to strabismus if not promptly recognised and treated with systemic steroids. Surgical management can restore vision when severe strabismus results in visual deprivation.

О некоторых причинах госпитальной летальности при проведении интенсивной терапии пациентов с новой коронавирусной инфекцией COVID-19

Relevance. The outbreak of a new coronavirus infection showed the unpreparedness of the whole world to such an epidemic both from medical institutions and from organizations that evaluate the quality of medical care. Objective. To identify the main predictors affecting the hospital mortality in patients with COVID-19 during intensive care. Materials and methods. 93 patient's case histories of patients who were in in-patient treatment with the main diagnosis COVID-19, community-acquired double -sided polysegmental viral pneumonia, ARDS were subjected to analytical examination. The sample was carried out using the blind method for the period from April 01,2021 to October 31, 2021. Statistical processing was carried out using the Statistica 10.0 program (Windows) and using an online calculator located on the Internet resource at: https://medstatic.ru/calculators/calcrisk.html. Results. In this study, two main groups of predictors of the death of patients with COVID-19 are identified. The first group: the accompanying somatic pathology that was already in patients, and the second are intensive care defects that did not always occur due to the doctor’s poor quality performance of their professional duties. Conclusions. Currently, unquestioning execution of temporary methodological recommendations for the prevention, diagnosis and treatment of new coronavirus infection (COVID-19) is possible only in the conditions of multidisciplinary hospitals based on regional centers, where there are all the necessary resources, which leads to a reduction in cases of deaths among patients. Their poor performance somewhere in remote areas raises many questions.

Importance of case history in disease diagnosis as perceived by medicos

History taking is an important tool available to the medical student to make a reasonable working diagnosis. The process of clinical reasoning helps give a comprehensive view of the patient’s needs and aids in patient centered care. Though 43.9% of the medicos strongly agreed that diagnosis is an important function of a doctor, only 18.3 % of the men and 10.6 % of the women were convinced that a good diagnosis was possible with case taking alone. Overall, only 7.3 % felt confident in taking a good history. The current study shows that history taking and physical examination is taking a lesser role in diagnosis. Communication with the patient is also seen as not necessary. This descriptive study involves 164 medicos (110 final years and 54 interns) who were administered a predetermined questionnaire. Findings were subjected to tests of significance like Chi square at 5% Level of significance.To identify the importance given to history taking in disease diagnosis among medicos. Undergraduate medical education must ensure training in communication, proper history taking and good examination skills. Small-group skills workshops using role-plays followed by effective feedback are ways to certifiable training in medical colleges.

Post-covid Syndrome in the Form of Venous and Arterial Thrombosis Complicated COVID-19

Post-covid syndrome in the form of thrombosis is a common and dangerous complication of COVID-19. To identify the localization, frequency, timing of thrombosis in patients who have undergone COVID-19, the frequency of surgical treatment methods used. A retrospective observational study of 239 case histories of patients (138 women and 101 men) who had COVID-19 in the Department of Vascular Surgery of the National Hospital of the Ministry of Health of the Kyrgyz Republic within the period from August to December 2020. A 42-year-old patient who underwent COVID-19 in March 2020, which gave a post-covid complication in the form of a chronic aneurysm of the infrarenal abdominal aorta five months later. Venous thrombosis as a post-covid syndrome is 74% more common than arterial thrombosis. The incidence of thrombotic post-covid syndrome in women compared to men is 15.4% higher. This trend is most pronounced in the disabled aged 61 and over. Venous thrombosis was most often localized in the veins of the lower extremities, and open surgical interventions were most often performed. People with concomitant diseases, in particular, with diseases of the cardiovascular system, are more susceptible to post-covid complications in the form of thrombosis and thromboembolism. Out of 239 people, 138 people (58%) had concomitant diseases, 101 people (42%) did not have them. Basically, open surgical interventions were performed. In 50% of cases with arterial thrombosis, thromboembolectomy was performed, with venous thrombi, the ligation of the great saphenous vein according to Troyanov accounted for 78% of operations. In the case of an individual clinical patient, laparotomy, nephrectomy on the right, elimination of an aortic aneurysm, aorto-femoral bifurcation prosthetics with an ECOFLONprosthesis were performed. Post-covid syndrome after COVID-19 is mainly localized in the veins of the lower extremities and is much more common among the female population with concomitant diseases. Open surgical operations can effectively eliminate the post-covid syndrome.

‘Confusingly Unique’:

Given the reception of his work, transfer of the custody of the drawing Moscow (c. 1955) by Willem van Genk (1927-2005) to the Rijksmuseum is more remarkable than it might seem. A ‘labelling history’ shows that the man and his work were volleyed back and forth between the categories of psychiatric art, hobbyist art, naive art, art brut and outsider art – this, even though the artist himself would most likely have preferred to be recognized simply as ‘an artist’. The Rijksmuseum finally succeeded in doing so (albeit perhaps unwittingly). At the same time, Van Genk’s ‘case history’ reveals aspects of recent Dutch art history that have long been overlooked, such as the remarkable enthusiasm for naive art in the late nineteen-sixties. It also highlights some of the problems that can arise from our urge to categorize and label, both within and outside art history.

Investigation of a focus of brucellosis among animals and people in the Republic of Tatarstan

Over the past 3 years, the number of new cases of brucellosis has increased in the Russian Federation. Brucellosis remains an important problem in regions with developed livestock farming; however, cases of diseases in animals and humans can also be recorded in other regions. The article describes an outbreak of brucellosis in a peasant farm affecting 148 heads of cattle and 4 farm employees in the Novosheshminsky municipal district of the Republic of Tatarstan. The disease was caused by Brucella abortus. Epizootic and epidemiological maps of the outbreak, sanitary and epidemiological survey activities, and sanitary and hygienic characteristics of the working conditions were analyzed. Data from the case histories of four peasant farm workers with brucellosis are also presented. The most likely cause of the epizootic was the unauthorized import of cattle, and infections in humans were caused by noncompliance with working conditions and personal-protective measures by farm workers. Brucellosis cases are more often recorded in endemic areas. However, with poor veterinary and sanitary control in any territory, epizootics are possible, which pose a danger in terms of damage to the national economy and possible infection in humans, primarily the professional risk groups. The disease does not have pathognomonic symptoms and can be suspected only if doctors are aware of them, evaluate the results of preliminary and periodic medical examinations with laboratory examinations of “at-risk” populations, and subject them to a thorough collection of epidemiological history.

Prognostic value of the neutrophil to lymphocyte ratio in the clinical course of liver cirrhosis

Introduction. The search for simple and informative markers for predicting positive outcomes in patients with liver cirrhosis (LC) does not affect its relevance.Aim. To study the possibility of using the “neutrophil to lymphocyte ratio” indicator as a predictor of development of LC complications and death.Materials and methods. For a retrospective clinical study, 225 case histories of patients with LC were selected from 2008 to 2018. Three groups were formed from them: group 1: patients with LC class A according to Child- Pugh (24n); Group 2: patients with LC class B and C according to Child- Pugh (201n); and group 3: healthy individuals (50n). A correlation analysis of the NLR indicator with the Child- Pugh and MELD scales was carried out. The prognostic value of NLR in the development of complications and death was analyzed.Results. Patients with LC had statistically significantly higher values of NLR compared to healthy individuals (p < 0.001). NLR had a statistically significant positive correlation with the Child- Pugh (p < 0.001) and MELD (p < 0.001) scales. NLR is a statistically significant predictor of the development of complications in patients with LC (p = 0.003). A NLR value > 2.3 had a sensitivity of 0.97 [95% CI: 0.92; 0.99] and specificity 0.19 [95% CI: 0.11; 0.29]. NLR statistically significantly correlated with the number of complications of LC (p<0.001) and served as a statistically significant predictor of death (p<0.001). A NLR value > 4.5 had a sensitivity of 0.24 [95% CI: 0.15; 0.36] and specificity 0.97 [95% CI: 0.92; 0.99].Conclusion. An NLR value of more than 2.3 increases the risk of complications in patients with LC, and an NLR value of more than 4.5 increases the risk of death.

Variability and flexibility of diagnostic procedures as exemplified by speech-language diagnosis of patients in the neurology department of Szpital Czerniakowski sp. z o.o. in Warsaw

The text describes the variability and flexibility of speech-language diagnostic procedures which are adjusted to special needs of patients of neurological ward. The authors use tools that have been specifically developed by them. The diagnostic procedure includes: case history, short conversation, the speech-language abilities assessment (creating and understanding of verbal messages), preliminary assessment of speech abilities using deliberately prepared words and sentences, non-verbal capacities evaluation, primary functions assessment. The authors share the clinical and experimental approach to the speech-language diagnosis and justify the designated procedure for the preliminary speech-language diagnosis. They also underscore thec omplexity of the connections between biopsychic and environmental factors that can influence the process of speech-language diagnosis process.

Healthcare professional students’ skills in sexual health communication and history taking: inter-rater reliability of standardized patients and faculty ratings in dar es Salaam, tanzania- a cross-sectional study

BackgroundLow- and middle-income countries face a disproportionate impact of sexual health problems compared to high-income countries. To address this situation proper interpersonal communication skills are essential for clinician to gather necessary information during medical history-taking related to sexual health. This study aimed to evaluate the interrater reliability of ratings on sexual health-related interpersonal communication and medical history-taking between SPs and trained HCP faculty for health care professional students.MethodsWe conducted a cross-sectional comparative study to evaluate the interrater reliability of ratings for sexual health-related interpersonal communication and medical history-taking. The data were collected from medical and nursing students at Muhimbili University of Health and Allied Sciences, who interviewed 12 Standardized Patients (SPs) presenting with sexual health issues. The video-recorded interviews rated by SPs, were compared to the one rated by 5 trained Health Care Professional (HCP) faculty members. Inter-rater reliability was evaluated using percent agreement (PA) and kappa statistics (κ).ResultsA total of 412 students (mean age 24) were enrolled in the study to conduct interviews with two SPs presenting with sexual health concerns. For interpersonal communication (IC), the overall median agreement between raters was slight (κ2 0.0095; PA 48.9%) while the overall median agreement for medical sexual history-taking was deemed fair (κ2 0.139; PA 75.02%).ConclusionThe use of SPs for training and evaluating medical and nursing students in Tanzania is feasible only if they undergo proper training and have sufficient time for practice sessions, along with providing feedback to the students.

Doing reflexivity in educational research: identifying perspectives to inform positionality

ABSTRACT This paper presents an innovative approach to examine reflexivity in educational research. Adapting Brookfield’s autobiographical lenses to identify the four perspectives from a personal life history (as the mother of a child with multiple chronic illnesses who died aged 18) and professional perspectives (as a paediatric nurse, a teacher, and a researcher) provided a clear structure to identify and articulate reflexivity. The paper draws on my doctoral thesis, a case history which explored how practitioners in early childhood education and care settings created inclusive environments for young children with chronic health conditions. The participants included parents of children with chronic health conditions, thus presenting ethical dilemmas regarding reflexivity. The paper includes vignettes from my thesis which include deeply personal accounts to illustrate how the four perspectives influenced my research. This scholarly engagement set the foundations for my subsequent academic career and for my personal development. The paper concludes with the assertion that engaging with reflexivity is not only a vital ingredient of educational research but also has implications for improving practice, as well as being a tool for personal development.

Examining Opportunities Offered Outside of Home Country in Physical Therapy Education: Considering the Colonial History of Global Health.

Increasingly, PT programs in the United States are providing educational experiences outside of the home country (OHC) where faculty and students engage in global health initiatives. It is important to consider that the field of global health has its historical roots in colonialism, which has led to inequities and injustice. Those who are engaged in this work must assist in reversing this colonial legacy. The purpose of this position paper is to present the colonial history of global health, to provide context, and to spark critical reflection among PT educators about how OHC experiences are developed and configured. As a profession, we must educate ourselves about the history of global health and critically reflect on OHC engagements to ensure that we support equity and justice. We must start by grounding our OHC experiences in health equity and justice. This should be done by considering the colonial history of global health and the privileges we hold as members of academic institutions in the United States. Why we offer OHC experiences in PT education should be investigated and clear to both faculty and students. Excluding this colonial history and its impacts risks perpetuating the historical harms to the health and well-being of the populations we claim to be serving.