Notes

Use them commercially What They Are Proficient at: Mealworms in Circular Food Techniques.
Finally, the safety of ongoing myasthenia gravis immunotherapies during COVID19 pandemic is discussed.

New biologics against B cells, complement and FcRn receptor, are bringing us closer to successful targeted immunotherapies in the chronic management of myasthenia gravis promising an exciting future for antibody-mediated neurological diseases.
New biologics against B cells, complement and FcRn receptor, are bringing us closer to successful targeted immunotherapies in the chronic management of myasthenia gravis promising an exciting future for antibody-mediated neurological diseases.
Although tumors with nerve sheath differentiation are vast, the main clinically significant problems faced by the pathologist are the separation of malignant peripheral nerve sheath tumors (MPNSTs) from histologic mimics, the diagnosis of neurofibromatous neoplasms with atypical features, and the separation of cutaneous neurofibromatous neoplasms from melanoma. This review briefly discusses a variety of common nerve sheath tumors and summarizes recent advances on these diagnostic fronts.

Much of recent work has focused on abnormalities in polycomb repressive complex 2, and the ways in which these abnormalities may be exploited in the diagnosis of MPNSTs. Progress has been made in the diagnostic and clinical understanding of atypical neurofibromatous neoplasms and low-grade MPNSTs. A number of reports have explored the diagnostic distinction between cutaneous neurofibroma and melanoma.

New discoveries show promise in the diagnosis of peripheral nerve sheath tumors, but challenges - old and new - remain.
New discoveries show promise in the diagnosis of peripheral nerve sheath tumors, but challenges - old and new - remain.
In 2017, approximately 11.4 million Americans used opioids inappropriately. Nearly 47,600 deaths in 2017 were attributable to overdose on opioids. Intranasal naloxone was approved by the Food and Drug Administration in 2015 as a rescue medication for opioid overdose. New York State launched a prescription drug monitoring program in 2012, the Internet System for Tracking Over-Prescribing (I-STOP), that required completion before dispensing any controlled substance. Currently, prescribing naloxone at our institution requires 10 clicks and 2 free text boxes. The goal of this project was to increase the prescribing of intranasal naloxone by utilizing EMR automation and visualization tools.

Our intervention embedded a section within the required I-STOP note, displaying the last date naloxone was prescribed and an option to "prescribe intranasal naloxone." If checked, a prepopulated order dialog box was generated.

Intranasal naloxone orders for the institution totaled 65 for 2 months before the intervention axone prescribing increased with the implementation of a visual reminder and a more intuitive ordering experience while preserving provider autonomy. There has been growing investment in artificial intelligence (AI) interventions to combat the opioid-driven overdose epidemic plaguing North America. Although the evidence for the use of technology and AI in medicine is mounting, there are a number of ethical, social, and political implications that need to be considered when designing AI interventions. In this commentary, we describe 2 key areas that will require ethical deliberation in order to ensure that AI is being applied ethically with socially vulnerable populations such as people who use drugs (1) perpetuation of biases in data and (2) consent. We offer ways forward to guide and provide opportunities for interventionists to develop substance use-related AI technologies that account for the inherent biases embedded within conventional data systems. This includes a discussion of how other data generation techniques (eg, qualitative and community-based approaches) can be integrated within AI intervention development efforts to mitigate the limitations of relying on electronic health record data. Finally, we emphasize the need to involve people who use drugs as stakeholders in all phases of AI intervention development.Interprofessional education (IPE) is a required component of the nursing curriculum as it can foster students' abilities to become integral members of the health care team. To facilitate this requirement, an IPE experience focusing on cardiovascular pharmacology was created for nurse practitioner and physician assistant students. The authors developed and utilized a problem-based learning activity and two minicase scenarios. The Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education-Revised was administered before and after the activity to assess students' attitudes toward IPE. This article reviews the planning, development, and implementation of this IPE experience and discusses its challenges.
Translabial ultrasound with systems designed for obstetric imaging is now the commonest diagnostic modality in pelvic floor medicine. This review will outline current clinical utility and introduce recent research in the investigation of pelvic floor disorders, such as urinary and anal incontinence, pelvic organ prolapse, obstructed defecation and of complications after sling and mesh surgery.

There has been significant progress in standardization of imaging methods, and the International Urogynecology Association has developed an online course encouraging this standardization. Tomographic methods are increasingly used for imaging of the levator ani and anal canal. Several comparative studies have investigated concordance between tomographic translabial imaging and competing methods, and the widespread availability of equipment has facilitated interethnic comparative studies. Several meta- analyses have investigated risk factors for major pelvic floor trauma and the role of pelvic floor abnormalities in prolapse recurrence after surgery.

The widespread use of imaging has the potential to change the management of pelvic floor morbidity, such as urinary and anal incontinence, pelvic organ prolapse and related conditions. Even in units and locations where the required systems are not easily accessible, the insights provided by real-time imaging will enhance diagnostic and therapeutic capabilities.
The widespread use of imaging has the potential to change the management of pelvic floor morbidity, such as urinary and anal incontinence, pelvic organ prolapse and related conditions. Even in units and locations where the required systems are not easily accessible, the insights provided by real-time imaging will enhance diagnostic and therapeutic capabilities.
After the Food and Drug Administration Public Health Notification in 2011 regarding transvaginal mesh, there has been a decline in the use of mid-urethral slings (MUS). However, they are an effective treatment option for stress urinary incontinence (SUI) with minimal complications. The management of recurrent SUI after sling continues to be debated.

Long-term follow-up after primary MUS confirms its efficacy and safety. There remains no level 1 evidence for the best next step after a failed MUS. Preferred treatment strategies include placing a repeat MUS with more recent evidence demonstrating no difference in cure rates between transobturator tape and retropubic approach. Pubovaginal slings (PVS) and urethral bulking agents are also acceptable treatment options. A newer bulking agent, polyacrylamide hydrogel, demonstrated excellent short-term success rates in patients after a failed sling.

MUS is an effective treatment option for SUI. Patients who develop recurrent urinary incontinence are a heterogeneous population who must be evaluated for detrusor overactivity, misplaced sling, unrecognized ISD. Patients with ISD are more likely to benefit by a PVS. Other patients with demonstrated recurrent SUI will likely do well with a repeat MUS.
MUS is an effective treatment option for SUI. Patients who develop recurrent urinary incontinence are a heterogeneous population who must be evaluated for detrusor overactivity, misplaced sling, unrecognized ISD. Patients with ISD are more likely to benefit by a PVS. Other patients with demonstrated recurrent SUI will likely do well with a repeat MUS.
Children and adolescents with mental health difficulties, and people associated with them, can experience stigma as a result of these difficulties. This article aims to provide an update on the literature pertaining to mental health-related stigma in children and adolescents.

Recent studies have investigated public stigma, self-stigma and affiliate stigma related to child and adolescent mental health difficulties. Research has typically employed a cross-sectional design. Significant variation was identified in both study methodology and study findings. Qualitative studies offer a unique perspective of stigma from the point of view of the stigmatized individual. Significantly, quantitative analysis has found different variables to be associated with stigma in different geographical locations, even when similar measures are used.

Stigma can have a significant detrimental impact on the quality of life for those affected. Careful attention should therefore be paid to stigma in the assessment and treatment of children and adolescents with mental health difficulties. Furthermore, its impact on their caregivers should not be overlooked. Further research is needed to understand the role of social and cultural factors in the development and impact of stigma, and may aid production of antistigma interventions.
Stigma can have a significant detrimental impact on the quality of life for those affected. Careful attention should therefore be paid to stigma in the assessment and treatment of children and adolescents with mental health difficulties. Furthermore, its impact on their caregivers should not be overlooked. Further research is needed to understand the role of social and cultural factors in the development and impact of stigma, and may aid production of antistigma interventions.Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine carcinoma of unknown origin. We performed a retrospective histologic review of primary cutaneous MCCs diagnosed from 1997 to 2018 in several clinical institutions and literature review to determine the frequency of various unusual morphologic appearances of MCC. Of the 136 primary MCCs identified, intraepidermal carcinoma or epidermotropism was noted in 11/136 (8%) cases. An association with pilar cyst in 1/136 (0.7%) case, with actinic keratosis in 2/136 (1.5%) cases, with either invasive or in situ squamous cell carcinoma (SCC) in 14/136 (10%) cases, with poroma in 1/136 (0.7%), and with basal cell carcinoma in 1/136 (0.7%) case was noted. Trabecular pattern and rosettes were noted in 7/136 (5%) and 3/136 (2%) cases, respectively. There was one case of metastatic MCC in a lymph node with chronic lymphocytic leukemia and one rare case of metastatic MCC and SCC in a lymph node. Although uncommon, differentiation toward other cell lineage can be observed in both primary and metastatic MCCs. The tumor can assume a variety of histologic appearances including association with SCC, basal cell carcinoma, melanocytic neoplasm, and follicular cyst; as well as exhibit glandular, sarcomatous, and mesenchymal differentiation. This diversity of morphologic appearance of MCC reflects the complexity of its underlying pathogenesis.
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