A red herring CVA with unexpected outcome: illustrative case

BACKGROUND Disruptions to the integrity of the inner table and trabeculae of the calvaria are rare phenomena. Increasingly rare is the phenomenon of herniation of brain parenchyma through the defects in the skull causing neurological deficit. Surgical intervention is commonly performed but is fraught with risk of brain tissue loss. OBSERVATIONS The authors present a case of a 78-year-old White male presenting with strokelike symptoms who was found to have an intradiploic encephalocele that was successfully treated with surgical intervention and neuroplastic reconstruction of the anatomical deficit. The patient had a marked recovery and had near-complete resolution of symptoms. LESSONS This notably rare phenomenon resolved with neurosurgical intervention, sparing the parenchyma, and provided the patient with perceivably normal contour of the head using a collaborative approach with neuroplastic intervention.

The Relationship between Clouds Containing Multiple Layers 7.5–30 m Thick and Surface Weather Conditions

Previous studies have identified finely laminated, or layered, features within Arctic clouds. This study focuses on quasi-horizontal layers that are 7.5 to 30 m thick, within clouds from 0 to 5 km altitude. No pre-selection for any particular cloud types was made prior to the identification of laminations. We capitalize on the 4-year measurement record available from Eureka, Nunavut (79.6∘ N, 85.6∘ W), using the Canadian Network for the Detection of Atmospheric Composition Change (CANDAC) Rayleigh–Mie–Raman Lidar (CRL; 1 min, 7.5 m resolution). Laminated features are identified on 18% of all days, from 2016–2019. Their presence is conclusively excluded on 12% of days. March, April, and May have a higher measurement cadence and show laminations on 41% of days. Individual months show laminations on up to 50% of days. Our results suggest that laminations are not rare phenomena at Eureka. To determine laminations’ likely contribution to Arctic weather and climate, local weather reports were obtained from the nearby Environment and Climate Change Canada (ECCC) weather station. Days with laminated clouds are strongly correlated with precipitating snow (r = 0.63), while days with non-laminated clouds (r = −0.40) and clear sky days (r = −0.43) are moderately anti-correlated with snow precipitation.

Quiet-Filament Eruptions and Coronal Jets as Causes of Depressions in Microwave Radio Emission

Several solar events with different types of negative microwave bursts have been studied using data from different spectral ranges. The total radio flux data obtained at the Ussuriysk Observatory, the Nobeyama Observatory, the US Air Force Radio Solar Telescope Network (RSTN), and the spectropolarimeter of the Institute of Solar–Terrestrial Physics, Siberian Branch of the Russian Academy of Sciences (ISTP SB RAS) were used. The images were analyzed using data from the SDO/AIA space observatory in the 304 Å channel and the Nobeyama radio heliograph at a frequency of 17 GHz. It was shown that the “isolated” depressions of radio emission were caused by the absorption of radiation from radio sources and/or vast regions of the quiet Sun by low-temperature material of a large eruptive filament in the absence of flares. This confirmed the conclusions of the previous studies. It was revealed that the cause of negative bursts of the “pre-burst depression” type was the screening of a near-limb radio source by the material of coronal jets. In the case of a weak flare accompanying the jet, the negative burst could also be of the “isolated” type. A case of a previously unreported occurrence of a deeper depression of radio emission at high frequencies as compared to low frequencies was considered. It was shown that negative bursts are not as rare phenomena as previously thought.

Ethnomedical specialists and their supernatural theories of disease

Religious healing specialists such as shamans often use magic. Evolutionary theories that seek to explain why laypersons find these specialists convincing focus on the origins of magical cognition and belief in the supernatural. In two studies, we reframe the problem by investigating relationships among ethnomedical specialists, who possess extensive theories of disease that can often appear “supernatural,” and religious healing specialists. In study 1, we coded and analyzed cross-cultural descriptions of ethnomedical specialists in 47 cultures, finding 24% were also religious leaders and 74% used supernatural theories of disease. We identified correlates of the use of supernatural concepts among ethnomedical specialists; incentives and disincentives to patronize ethnomedical specialists; and distinct clusters of ethnomedical specialists that we label prestigious teachers, feared diviners, and efficacious healers. In study 2, we interviewed 84 Maasai pastoralists and their traditional religious and non-religious healing specialists. We found that laypersons relied on medicinal services based on combinations of efficacy, religious identity, and interpersonal trust. Further, laypersons and specialists largely used abstract concepts that were not conspicuously supernatural to describe how local medicines work. We conclude that religious healers in traditional societies often fulfill a practical and specialized service to local clients, and argue that supernatural theories of disease often reflect abstract cognition about rare phenomena whose causes are unobservable (e.g., infection, mental illness) instead of a separate “religious” style of thinking.

Spillover as Movement Agenda Setting: Using Computational and Network Techniques for Improved Rare Event Identification

The increasing availability of data, along with sophisticated computational methods for analyzing them, presents researchers with new opportunities and challenges. In this article, we address both by describing computational and network methods that can be used to identify cases of rare phenomena. We evaluate each method’s relative utility in the identification of a specific rare phenomenon of interest to social movement researchers: the spillover of social movement claims from one movement to another. We identify and test five different approaches to detecting cases of spillover in the largest data set of protest events currently available, finding that an ensemble approach that combines clique and correspondence analysis and an ensemble approach combining all methods perform considerably better than others. Our approach is preferable to other ways of analyzing such cases; compared to qualitative approaches, our computational process identifies many more cases of spillover—some of which are surprising and would likely not be otherwise investigated. At the same time, compared to crude quantitative measures, our approach substantially reduces the “noise,” or identification of false-positive cases, of movement spillover. We argue that this technique, which can be adapted to other research topics, is a good illustration of how the thoughtful implementation of computational methods can allow for the efficient identification of rare events and also bridge deductive and inductive approaches to scientific inquiry.

Time-dependent study of KS → π+π− decays for flavour physics measurements

Nowadays High Energy Physics experiments can accumulate unprecedented statistics of heavy flavour decays that allows to apply new methods, based on the study of very rare phenomena, which used to be just desperate. In this paper we propose a new method to measure composition of K0-$$ \overline{K} $$ K ¯ 0, produced in a decay of heavy hadrons. This composition contains important information, in particular about weak and strong phases between amplitudes of the produced K0 and $$ \overline{K} $$ K ¯ 0. We consider possibility to measure these parameters with time-dependent K0 → π+π− analysis. Due to C P -violation in kaon mixing time-dependent decay rates of K0 and $$ \overline{K} $$ K ¯ 0 differ, and the initial amplitudes revealed in the CP-violating decay pattern. We perform phenomenological study of K0 decay evolution initially produced as a combination $$ a\left.|{K}^0(t)\right\rangle +b\left.|{\overline{K}}^0(t)\right\rangle $$ a K 0 t + b K ¯ 0 t , where a and b, complex amplitudes, could also be dependent on decay time of heavy mother particle. In particular we consider cases of charmed hadrons decays: D+ → K0π+, $$ {D}_s^{+} $$ D s + → K0K+, Λ → pK0 and with some assumptions D0 → K0π0. This can be used to test the sum rule for charmed mesons and to obtain input for the full constraint of the two body amplitudes of D-mesons.

Preparing for medical education after the COVID-19 pandemic: insightology in medicine

It is necessary to reflect on the question, “How to prepare for medical education after coronavirus disease 2019 (COVID-19)?” Although we are preparing for the era of Education 4.0 in line with the 4th industrial revolution of artificial intelligence and big data, most measures are focused on the methodologies of transferring knowledge; essential innovation is not being addressed. What is fundamentally needed in medicine is insightful intelligence that can see the invisible. We should not create doctors who only prescribe antispasmodics for abdominal pain, or antiemetic drugs for vomiting. Good clinical reasoning is not based on knowledge alone. Insightology in medicine is based on experience through Bayesian reasoning and imagination through the theory of mind. This refers to diagnosis of the whole, greater than the sum of its parts, by looking at the invisible using the Gestalt strategy. Identifying the missing process that links symptoms is essential. This missing process can be described in one word: context. An accurate diagnosis is possible only by understanding context, which can be done by standing in someone else’s shoes. From the viewpoint of medicine, Education 4.0 is worrisome because people are still clinging to methodology. The subject we should focus on is “human”, not “artificial” intelligence. We should first advance the “insightology in medicine” as a new paradigm, which is the “essence” that will never change even when rare “phenomena” such as the COVID-19 outbreak occur. For this reason, we should focus on teaching insightology in medicine, rather than teaching medical knowledge.

A larval granuloma in the lung: An extremely rare phenomenon

The formation of pulmonary nodules is associated with benign or malignant pathologies. Based on the sizes, growth rates, and morphological features of nodules, surgical treatment or follow-up can be performed. Pulmonary nodules are frequently encountered in the practice of thoracic surgery. A 37-year-old male patient who had a 2.0¥1.9 cm nodule in the right lung was followed. His medical history revealed no chronic disease. During follow-up, the sizes of the nodule increased and, therefore, it was removed by wedge resection. The pathological examination result was reported as a larval granuloma. In conclusion, larval granulomas in the lung are extremely rare phenomena and should be further examined.

Chronic cough with dual pathologies of pulmonary ossification

An 81-year-old man presented with chronic cough, which did not respond to the initiation of combined bronchodilator/inhaled corticosteroid therapy. CT of the chest revealed calcified nodules throughout the trachea sparing the posterior membrane, and tiny peripheral parenchymal nodules with basal interlobular septal thickening and calcification. Flexible bronchoscopy demonstrated endobronchial nodularity from the proximal trachea to the mid-sections of both main bronchi, sparing the posterior membrane. Histopathology revealed submucosal fibrous connective tissue and benign bone, confirming a diagnosis of tracheobronchopathia osteochondroplastica. CT was consistent with a concurrent diagnosis of dendriform pulmonary ossification. These two rare phenomena often present with non-specific symptoms, and the diagnosis can be made with imaging in both conditions. There is a role for bronchoscopy in the diagnosis of tracheobronchopathia osteochondropastica, and the endobronchial appearance could be diagnostic. The concurrence of both phenomena in our case might represent activity of a common cellular pathway of ossification in both sites.

Remission of Thymoma on Steroid Therapy in a Patient With Atypical Thymoma-Associated Multiorgan Autoimmunity: A Case Report and Literature Review

In up to 34% of cases, thymoma, itself a rare neoplasm, is accompanied by autoimmune disorders, two of which are thymoma-associated multiorgan autoimmunity (TAMA) and paraneoplastic autoimmune multiorgan syndrome (PAMS). Unfortunately, differential diagnosis between these two entities can be challenging since no strict PAMS definition exists and PAMS can overlap with a subgroup of TAMA patients with skin lesions as leading presentation. We present a case of a 68-year-old woman with a diagnosis of thymoma accompanied by myasthenia gravis, hypothyroidism and GvHD-like mucocutaneous lesions that initially could account to both TAMA and PAMS diagnosis. However, following the exclusion of humoral autoimmunity against components of epithelial cells junction, TAMA was finally established. Interestingly, the introduction of corticosteroid therapy for TAMA symptom management resulted in unexpected partial remission of thymoma with no impact on mucocutaneous lesions. Our case study is an example of two extremely rare phenomena accompanying thymomas: unprecedented TAMA presentation with GvHD-like mucositis, which as we postulate should be placed in the spectrum of TAMA, and tumor remission on steroids.