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Author(s):  
Sungjoon Lim ◽  
Jun-Bum Lee ◽  
Myoung Yeol Shin ◽  
In-Ho Jeon

Periprosthetic joint infection (PJI) is one of the most devastating complications that can occur after shoulder arthroplasty. Although staged revision arthroplasty is the standard treatment in many cases, surgical intervention with debridement, antibiotics, and implant retention (DAIR) can be an effective option for acute PJI. We report a complex case of infected reverse shoulder arthroplasty (RSA) in a 73-year-old male. The patient had been previously treated for infected nonunion of a proximal humerus fracture caused by methicillin-resistant Staphylococcus epidermidis. He presented with a sinus tract 16 days after the implantation of RSA and was diagnosed with PJI caused by Serratia marcescens. The patient was successfully treated with DAIR and was free of infection at the last follow-up visit at four years postoperatively.


2022 ◽  
pp. 65-84
Author(s):  
Kai E. Degner ◽  
Sarah K. MacDonald ◽  
Melissa M. Lubin

Four-year public institutions of higher education (IHEs) face increasing pressure to innovate with noncredit credentials. The chapter aims to develop leaders' mental models for navigating unique complexities associated with offering programs that do not award academic credit. First, a review of noncredit literature and organizational science principles explains that noncredit programming is often unaligned with IHE organizational culture and structure. Then, two metaphors for leaders' roles in overcoming barriers to innovation are introduced and critiqued: Buller's organic leadership concept and Christensen and Eyring's higher education DNA concept. Complexity leadership theory is next presented as a mental model to understand three complementary leader roles for fostering innovation with a complex organizational environment. Finally, the chapter's case features three vignettes from public IHE continuing education leaders that exemplify the complexities related to pursuing noncredit credential innovation. Strategies and discussion questions are included.


2021 ◽  
Vol 25 ◽  
pp. 15-30
Author(s):  
David Jutzeler ◽  

In 1977, Otakar Kudrna (*1939-†2021, obituary see Balletto and Leigheb, 2021) published his “Revision of the Genus Hipparchia”, where he classified all the known species and forms of this genus according to characters of wings, androconia, male genital armatures and further subjective criteria. Until today, Kudrna’s study is considered as the guideline of systematics of the genus Hipparchia. He selected there a lectotype specimen of a Rock Grayling male in the Linnaean collection. “Hipparchia hermione Linnaeus, 1764” is therefore, at the moment, the technically correct name to identify the species. The “International Commission of Zoological Nomenclature” (ICZN) has nothing to add at this point; it only comments on cases submitted to it in the Bulletin of Zoological Nomenclature. Within the meaning of the present study and in accordance with Verity (1913), this damaged specimen without abdomen represents the same species as Ignaz Schiffermüller – allegedly the only author of the Vienna directory (see Kudrna and B., 2005, p. 5) – has described under H. alcyone from the Vienna region by referring to a coloured copper engraving published by Rösel von Rosenhof (1755). Kudrna’s “Revision” became the starting point of an extended scientific research activity during my free time containing, as a matter of priority, the examination of problem cases of systematics by checking the preimaginal characters of many rearing series from different sites. It turned out that a number of classifications proposed by Kudrna (1977) had to be reassessed as soon as characters of the pre-imaginal stages were available. The most complex case I have verified concerned the third European Grayling species which Leraut (1990) introduced under the name of Hipparchia genava (Fruhstorfer, 1908). Kudrna (1977) failed to separate this species from H. alcyone (D. & S., 1775). Throughout his life, he never agreed with Leraut’s opinion. In recent years, Kudrna had hoped that genetic examinations would make redundant every rearing attempt by amateur lepidopterists and furnish the proof that his opinion was the correct one. Since he never undertook any rearing experiments, his systematics were based only on prepared imagines being housed in museum collections. He saw himself as a person with the competency to decide within a few minutes upon complex questions of taxonomy and ignored completely the assessments of others. For verifying the effective rank of H. genava, I had to examine also the two most closely related species: Hipparchia fagi and H. alcyone by rearing them all ex ovo with material from several widely spaced sites. Already on finalising my rearing work of this group, it became apparent that Leraut (1990) had been on the absolutely right path by accepting a third Grayling species, within this group. For the first time, I published the results of my rearing attempts between 2002 and 2006 in several articles in the quarterly bulletin Linneana Belgica and I readily provided information on this case to interested colleagues. Over time only, I realized that the Rock Grayling I knew from the volume on butterflies (Diurna) by Forster and Wohlfahrt (1955) as from the guides by Higgins and Riley (1970-84) under the name of H. alcyone had become H. hermione, because of the lectotype designation by Kudrna (1977). A stony path was in front of me to substantiate the factual correctness of the view taken by Leraut (1990). Complex clarifications by Peter Russell furnished well-founded arguments on the complex scientific issue why the use of the name “hermione Linnaeus, 1764” should be rejected for the Rock Grayling previously known as H. alcyone.


Author(s):  
Ankit Selokar ◽  
Sonali Kolhekar ◽  
Shalini Lokhande ◽  
Suwarna Ghugare ◽  
Ruchira Ankar ◽  
...  

Introduction: Necrotizing fasciitis of the perineal and vaginal region is a symptom of Fournier's gangrene, which is caused by a synergistic polymicrobic infection. The clinical presentation varies depending on the original aetiology, ranging from anorectal or vaginal pain with limited evidence of cutaneous necrosis to a rapidly spreading necrosis of the skin and soft tissue, to systemic sepsis without any obvious signs or symptoms. Case history: A 65-year-old male who was admitted in hospital with the chief complaint of Scrotal enlargement, discomfort, hyperemia, pruritus, crepitus, and fever. There may also be a foul-smelling discharge. Symptoms usually appear during a two- to seven-day period. Soft-tissue gas may be present before clinical crepitus is detected. The patient with Fournier gangrene frequently seems poorly on physical examination, with prodromal signs of fever and lethargy lasting 2-7 days. Edema of the overlaying skin is usually present, as is acute pain and tenderness in the genitalia; pruritus may also be present.Skin may show evidence of trauma, surgery, insect or human bites or injection sites, In Respiratory system, B/L Air entry present. In cardiovascular system, S1 and S2 sound heard and Patient get conscious and well oriented to time, place, and person. Then, as quickly as possible, treatment was began; he did not improve after treatment, and treatment would continue till the conclusion of my care. Conclusion: We focus on professional management and superior nursing care in this study so that we may provide the complete treatment that Fournier Gangrene requires while also effectively managing the complex case. After a full recovery, the patient's comprehensive health care team collaborates to help the patient regain his or her previous level of independence and happiness.


Author(s):  
Rishika H. Gabada ◽  
Pooja Kasatwar ◽  
Chaitanya A. Kulkarni

A burst fracture is a descriptive term for an injury to the spine in which the vertebral body is severely compressed. They typically occur from severe trauma, such as a motor vehicle accident or a fall from a height. With a great deal of force vertically onto the spine, a vertebra may be crushed .If it is only crushed in the front part of the spine, it becomes wedge shaped and is called a compression fracture. However, if the vertebral body is crushed in all directions it is called a burst fracture. Burst fractures cause severe pain. The diagnosis of a burst fracture is usually made by x-rays and a CT scan. Occasionally, an MRI scan may be ordered as well, in order to assess the amount of soft tissue trauma, bleeding or ligament disruption. The review of the CT scan and x-rays allows the treating physician to make a determination as to the level of the fracture, whether it is a compression fracture, burst fracture or fracture dislocation. A spinal compression fracture also may be caused by trauma to the spine. Events that may cause trauma to the spine can include: A car accident, a hard fall or a fall from a height of more than 15 feet, landing on the feet, and a blow to the head. Any fall from a standing height that results in a spinal compression fracture or any other fracture most likely indicates weak bones due to osteoporosis. The physical exam should be performed to document both spinal deformity, that is, angulation of the spine or tenderness of the spine at the level of fracture, as well as, a neurologic exam. Neurologic exam should include testing of the muscle strength, sensation, and reflexes of the lower extremities, as well as, testing of bowel and bladder sphincter control. A 36 year old man was brought to the hospital as he had a fall from electric pole approximately 20 feet height. He had sustaining injury to the neck. Surgery was done as patient was diagnosed with C6 burst fracture with fracture dislocation of C5-C7. Therapeutic Interventions includes exercises, strengthening exercises, cervical fracture fixation, and traction.


2021 ◽  
pp. 146394912110591
Author(s):  
Clionagh Boyle

In playing with the concept of ‘credibility’, this article presents a critical examination of the discourse of evidence and the programming of upbringing in early intervention policy and practice. The truth claims of the evidence discourse in policy are explored through a single complex case study of an early intervention city in Northern Ireland. The framework for the study discussed uses Bourdieu's thinking tools of habitus, capital and field alongside Foucauldian discourse analysis to explore the ways in which early intervention policy and practice impact on children, parents and communities. A key question is to consider how evidence is constructed within the discourse and how this can be considered as a Foucauldian regime of truth. Building from the emerging body of critique around scientism and parenting, the study extends this through a sociopolitical lens to the Northern Ireland context. Despite a strong tradition in Northern Ireland of community-based activism and political transition from direct rule to devolution, early intervention policy and programming have tended towards direct read across from Britain and the USA. The study documents that community-based practice struggles within the policy field for recognition, yet ‘home grown’ carries significant social capital within and across communities. The dominant policy discourse of the (in)credible ‘fiscal prize’, transformation through evidence-based interventions contrasts with the backdrop of worsening child poverty in communities. Contrary to the truth claims, this suggests the reproduction rather than transformation of social disadvantage.


2021 ◽  
Vol 8 (12) ◽  
pp. 188
Author(s):  
Federica Troisi ◽  
Katya Lucarelli ◽  
Vito Casamassima ◽  
Tommaso Langialonga ◽  
Rosa Caruso ◽  
...  

In this case report, we describe a complex case of a 67-year-old patient who was suffering from acute heart failure with electrical storm. Clinical case management was based on an integrated approach comprising two different procedures that were complementary and synergistic, and that allowed the patient to reach acute stabilization and to demonstrate mid-term clinical improvement. Complex clinical settings, such as electrical and hemodynamic instability, require complex solutions. The use of an integrated approach that allows physiopathological mechanisms to work together may be beneficial for these patients.


2021 ◽  
pp. 392-395
Author(s):  
Irina ALBADI ◽  
Camelia CIOBOTARU ◽  
Andreea-Alexandra LUPU ◽  
Gelu ONOSE

Introduction. Spasticity, a common post-stroke complication associated with signs and symptoms of upper motor neuron syndrome (1), occurs with a 35% prevalence one year after brain injury (2) and can be severely disabling in young patients (3), regarding locomotor dysfunction and also regarding the quality of life. Stroke incidence in young patients increased in the last decades, being correlated with the increasing substance abuse and sedentariness, excessive alcohol consumption, and smoking (4). Peroneal nerve palsy is the most common cause of neuropathy of the lower limb and, in most cases, is caused due to nerve lesion in the fibula head area (5). Material and method. We present the complex case of a young male patient, former alcohol and narcotics user, who suffered an ischemic stroke in the right middle cerebral artery teritory along with a posttraumatic paresis of the right peroneal nerve. The patient presents motor deficit – right spastic hemiplegia, right foot drop, locomotion and self-care disorders. Results and discussions. The patient followed medical treatment (antiepileptic, neurotrophic factors, vitamins, antiplatelet) and rehabilitation treatment adapted to the current clinical-functional status (thermotherapy, lasertherapy, magnetotherapy and individual kinesiotherapy), with slow favorable evolution of the improvement of locomotion and quality of life disorders. Conclusions. Therapeutic-rehabilitation management of the spastic patient with disability due to brain injury and peripheral traumatic neuropathy represents a challenge because it doesn’t exist a miraculous treatement (yet) to cure completely these nervous injuries. Keywords: post stroke spasticity, peroneal nerve palsy, rehabilitation,


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