Challenges in the treatment of cutaneous leishmaniasis caused by in four travelers: a case series.

We describe a group of four travelers returning to the United States and Canada who acquired infection in the Peruvian Amazon. Pentavalent antimonials are the preferred treatment option for cutaneous leishmaniasis (CL) in most endemic countries in Central and South America. However, we initially treated our patients with liposomal amphotericin B (LAB) and miltefosine since these are the only two available Food and Drug Administration approved drugs in the United States.

Common ground in AAC: how children who use AAC and teaching staff shape interaction in the multimodal classroom.

Children who use augmentative and alternative communication (AAC) are multimodal communicators. However, in classroom interactions involving children and staff, achieving mutual understanding and accomplishing task-oriented goals by attending to the child's unaided AAC can be challenging. This study draws on excerpts of video recordings of interactions in a classroom for 6-9-year-old children who used AAC to explore how three child participants used the range of multimodal resources available to them - vocal, movement-based, and gestural, technological, temporal - to shape (and to some degree, co-control) classroom interactions.

Diagnostic accuracy of qPCR and microscopy for cutaneous leishmaniasis in rural Ecuador: A Bayesian latent class analysis.

Background: Clinical and laboratory diagnosis of cutaneous leishmaniasis (CL) is hampered by under-ascertainment of direct microscopy.

Methods: This study compared the diagnostic accuracy of qPCR on DNA extracted from filter paper to the accuracy of direct smear slide microscopy in participants presenting with a cutaneous lesion suspected of leishmaniasis to 16 rural healthcare centers in the Ecuadorian Amazon and Pacific regions, from January 2019 to June 2021. We used Bayesian latent class analysis to estimate test sensitivity, specificity, likelihood ratios (LR), and predictive values (PV) with their 95% credible intervals (95%CrI).

Multi-sensorial perceptions of risk: the aesthetics behind (muco)cutaneous leishmaniasis-related stigma in Ecuador.

Previous research on the stigma associated with cutaneous leishmaniasis, a vector-transmitted parasitic disease, focuses on aesthetic appearance affectation as the leading cause of stigmatisation. However, Indigenous populations in the hinterland of Amazonian Ecuador trigger stigma expressions by recognising (muco)cutaneous leishmaniasis, primarily through atypical smell, followed by the odd voice sound, appearance and taste. This empirical way of recognising symptoms relies on embodied forms of identifying a disease, contrasting the Western supremacy of visuality and demanding to be understood multi-sensorial anthropology.

How do parents frame their engagement experience in early intervention? A grounded theory study.

Purpose: Parent and therapist engagement and partnership are critical in early intervention physiotherapy and occupational therapy for infants with cerebral palsy to improve outcomes. The main aim of this study was to understand how parents perceive their engagement experience in early intervention over time.

Methods: Grounded theory methodology was used.

Leishmania species and clinical characteristics of Pacific and Amazon cutaneous leishmaniasis in Ecuador and determinants of health-seeking delay: a cross-sectional study.

Background: Cutaneous Leishmaniasis (CL) affects up to 5.000 people in Ecuador each year. L.

Workplace-based assessments-Articulating the playbook.

Introduction: A workplace-based assessment (WBA) is a learning recording device that is widely used in medical education globally. Although entrenched in medical curricula, and despite a substantial body of literature exploring them, it is not yet fully understood how WBAs play out in practice. Adopting a constructivist standpoint, we examine these assessments, in the workplace, using principles based upon naturalist inquiry, drawing from a theoretical framework based on Goffman's dramaturgical analogy for the presentation of self, and using qualitative research methods to articulate what is happening as learners complete them.

Quality of life of cutaneous leishmaniasis suspected patients in the Ecuadorian Pacific and Amazon regions: a cross sectional study.

Background: Yearly, up to 1 million patients worldwide suffer from cutaneous leishmaniasis (CL). In Ecuador, CL affects an estimated 5000 patients annually. CL leads to reduced Health Related Quality of Life (HRQL) as a result of stigma in the Asian and Mediterranean contexts, but research is lacking for Ecuador.

Clinical criteria for Mucosal Leishmaniasis diagnosis in rural South America: A systematic literature review.

Background: Mucosal Leishmaniasis (ML), a neglected tropical disease caused by Leishmania parasites, impairs the quality of life of under-resourced populations in South America. If not treated promptly, this disease progresses to facial deformities and death. The low sensitivity of microscopy results and the unavailability of other accurate tests hamper the diagnosis.

Parental engagement in early intervention for infants with cerebral palsy-A realist synthesis.

Background: Emphasis on parental engagement strategies within occupational therapy and physiotherapy early intervention (EI) programmes for infants at high risk of cerebral palsy (CP) has increased. This reflects consensus that increasing parent participation enhances treatment efficacy, potentially improving infant and parent outcomes. However, evaluation of parental engagement in EI is complex.

Case Report: Evidence of Tungiasis in the Amazon Rain Forest of Ecuador.

Tungiasis occurs in tropical and subtropical areas in Central and South America and sub-Saharan Africa and is a Neglected Tropical Disease. We diagnosed three cases of tungiasis in a Dutch family visiting indigenous communities in the Amazon basin of Ecuador. Eight days after returning, they presented papular, pruritic, and painful lesions on the feet, with a whitish halo and a blackish central point with abundant whitish eggs upon extraction.

What Attitudes and Values Are Incorporated Into Self as Part of Professional Identity Construction When Becoming a Surgeon?

Purpose: To make explicit the attitudes and values of a community of surgeons, with the aim of understanding professional identity construction within a specific group of residents.

Method: Using a grounded theory method, the authors collected data from 16 postgraduate surgeons through interviews. They complemented these initial interview data with ethnographic observations and additional descriptive interviews to explore the attitudes and values learned by surgeons during residency training (2010-2013).

Visual research in clinical education.

Aim: The aim of this paper is to explore what might be gained from collecting and analysing visual data, such as photographs, scans, drawings, video and screen recordings, in clinical educational research. Its focus is on visual research that looks at teaching and learning 'as it naturally occurs' in the work place, in simulation centres and other sites, and also involves the collection and analysis of visual learning materials circulating in these sites.

Background: With the ubiquity of digital recording devices, video data and visual learning materials are now relatively cheap to collect.

Manufacturing of [(14)C]-Labeled Drug Substance and Drug Product Utilized in Clinical Research: A Case Study of Omecamtiv Mecarbil.

This mini-review describes the Chemistry, Manufacturing and Control activities associated with the manufacture of [(14)C]-labeled drug substance and subsequent drug compounding activities to generate clinical trial material utilized in human absorption, distribution, metabolism, and excretion clinical studies. Due to the unstable nature and increased decomposition rates observed with [(14)C]-labeled compounds, the manufacture, testing, release, formulation, and regulatory filings are uniquely challenging. A case study of the cardiac myosin activator AMG 423 (omecamtiv mercarbil), utilized in a dual oral/intravenous infusion clinical study is presented.

Unsettled teamwork: communication and learning in the operating theatres of an urban hospital.

Aim: To explore the unsettling effects of increased mobility of nurses, surgeons and other healthcare professionals on communication and learning in the operating theatre.

Background: Increasingly, healthcare professionals step in and out of newly formed transient teams and work with colleagues they have not met before, unsettling previously relatively stable team work based on shared, local knowledge accumulated over significant periods of close collaboration.

Design: An ethnographic case study was conducted of the operating theatre department of a major teaching hospital in London.

'You see?' Teaching and learning how to interpret visual cues during surgery.

Context: The ability to interpret visual cues is important in many medical specialties, including surgery, in which poor outcomes are largely attributable to errors of perception rather than poor motor skills. However, we know little about how trainee surgeons learn to make judgements in the visual domain.

Objectives: We explored how trainees learn visual cue interpretation in the operating room.

Music and communication in the operating theatre.

Aims: To observe the extent and the detail with which playing music can impact on communication in the operating theatre.

Background: According to the cited sources, music is played in 53-72% of surgical operations performed. Noise levels in the operating theatre already exceed World Health Organisation recommendations.

Making meaning from sensory cues: a qualitative investigation of postgraduate learning in the operating room.

Purpose: The authors aimed to map and explicate what surgeons perceive they learn in the operating room.

Method: The researchers used a grounded theory method in which data were iteratively collected through semistructured one-to-one interviews in 2010 and 2011 at four participating hospital sites. A four-person data analysis team from differing academic backgrounds qualitatively analyzed the content of the transcripts employing an immersion/crystallization approach.

Surgical decision making in a teaching hospital: a linguistic analysis.

Background: The aim of the study was to gain insight in the involvement of non-operating surgeons in intraoperative surgical decision making at a teaching hospital. The decision to proceed to clip and cut the cystic duct during laparoscopic cholecystectomy was investigated through direct observation of team work.

Method: Eleven laparoscopic cholecystectomies performed by consultant surgeons and specialty trainees at a London teaching hospital were audio and video recorded.

Massive haemorrhage following minimally displaced pubic ramus fractures.

Background: Fractures of the pubic rami are the most frequent osteoporotic pelvic fracture. Although generally innocuous, epidemiologic research demonstrated a decreased survival in patients with pubic rami fractures compared to healthy controls. Sporadic cases of potentially lethal bleedings have been reported.

Nurse-surgeon object transfer: video analysis of communication and situation awareness in the operating theatre.

Background: One of the most central collaborative tasks during surgical operations is the passing of objects, including instruments. Little is known about how nurses and surgeons achieve this. The aim of the present study was to explore what factors affect this routine-like task, resulting in fast or slow transfer of objects.

Communication in the operating theatre.

Background: Communication is extremely important to ensure safe and effective clinical practice. A systematic literature review of observational studies addressing communication in the operating theatre was conducted. The focus was on observational studies alone in order to gain an understanding of actual communication practices, rather than what was reported through recollections and interviews.

Participation of surgical residents in operations: challenging a common classification.

Background: One important form of surgical training for residents is their participation in actual operations, for instance as an assistant or supervised surgeon. The aim of this study was to explore what participation in operations entails and how it might be described and analyzed.

Methods: A qualitative study was undertaken in a major teaching hospital in London.