BUSINESS WRITING INSTRUCTORS work diligently at raising the level of student writing performance in business communication classes. Some students, however, need additional motivation to apply writing concepts and perform to their highest level. Typically, business students are confronted with hypothetical writing situations, such as claim letters, sales letters, and case analysis reports, and they receive instruction in writing principles, such as tone, audience analysis, conciseness, and mechanics. Yet our experience has taught us that students want to see the tangible results of their writing, and one way to do that is to incorporate actual business situations into assignments. If nonprofit organizations are selected, they could benefit financially from well-crafted student-generated documents.The purpose of this article is to provide communication instructors with two persuasive writing assignments that use nonprofit clients as a vehicle. We have designed two assignments that we believe motivate students because of the impact they could have on these
Leiomyosarcoma (LMS) is one of the most common forms of soft tissue sarcoma with approximately 2,500 cases per year in the United States. The symptoms LMS vary depending upon the location, size, and spread of the tumor. In early stages, it may not be associated with any obvious symptoms so diagnosis and treatment may be delayed. In some cases, it can grow quickly and behave aggressively. Most types of LMS occur in the abdomen or in the uterus; although, scrotal LMS can be a very rare presentation of the disease. Here we present our case of a large, ulcerated scrotal LMS originating from subcutaneous tissue but not invading spermatic cord or tunica. Radical orchiectomy with high ligation of spermatic cord was performed, and patient had an uneventful postoperative course. This disease entity remains rare in the literature, and warrants larger studies in order to better understand treatment and oncologic outcomes.When LMS is identified early and is removed by surgical excision, prognosis can be good and full recovery quite likely. When LMS is already large or has spread to other parts of the body, treatment is relatively more complex and the prognosis poor. Hence, prompt diagnosis and treatment of genitourinary LMS require prompt attention, referral to tertiary, referral center should be strongly considered.
Herpes Simplex Virus infections (HSV) are ubiquitous. The neonatal HSV infection (NHSV) is rare. The incidence is estimated globally at only 10.3 per 100,000 births, but it can cause devastating disease in premature infants. Both HSV-1 and HSV-2 can be the etiologic agents in this type of vertically transmittted NHSV infection. Here we describe the pathological findings from a complete autopsy of a very low birth weight infant who succumbed to the infection despite early institution of antiviral treatment. We urge more awareness of this disease with continued surveillance; every effort should be taken to make an early diagnosis and thus prevent this devastating disease.
Anecdotally, many clinicians expect blood components to arrive in standard volumes. Blood components do not come in uniform sizes, however, and institutional experience has revealed platelet units to vary considerably in volume. Since many clinicians are not the ones examining blood products and their volumes prior to transfusion, there is a potential to transfuse a high-volume unit inadvertently to a patient at risk of transfusion-associated fluid overload (TACO), a leading cause of transfusion-related fatalities. The intent of this study was to examine the allocation practices of high-volume platelet units at an academic medical center. Over a six-month period, blood bank technical staff prospectively logged the allocation of high-volume apheresis platelet units with volumes greater than or equal to 400 mL. The staff member who issued the product logged the reason(s), if any, why he or she selected the unit for a particular patient when more than one ABO type-specific product was available. No patient identifiers or data were logged or analyzed in this study. Eighty-seven high-volume platelet units were recorded during the study period. The volumes ranged from 395 to 872 mL, with an average and standard deviation of 571 mL and 92 mL, respectively. Blood bank staff listed the following reasons for their allocation of high-volume platelet unit as follows: the product expiration date in 23 cases (26%), patient age in 13 cases (15%), patient sex in 12 cases (14%), and intraoperative use in 10 cases (11%). This study enumerated the variability in platelet unit volume, with some units containing likely double or triple the volume of the ordering clinicians expectations. Blood bank technologists made clinical decisions in the allocation of high-volume units in three-quarters of the documented cases. This underscores a need to provide clearly-defined guidelines for allocating such units, as well as a mechanism for clinicians to request lower-volume units, particularly for patients at risk of TACO.
A n unvaccinated teenage male with no known past medical history presented to the emergency department (ED) with complaints of headache, back and neck pain, and fever with chills for 2 days before presentation. In addition, he reported constipation (bowel movement only every 3 days), rhinorrhea, and congestion. He denied abdominal pain, shortness of breath, or photophobia. Social history revealed that he had traveled alone from Central America to the United States and had spent ;7 days in the Sonoran Desert of Mexico and southern Arizona with only crackers, apples, and small amounts of water (source unknown). The patient had been in United States Border Patrol custody for ;2 weeks before presenting to the ED.The patient's vital signs at presentation revealed a temperature of 37.1°C, heart rate of 71 beats/minute, respiratory rate of 19 breaths/minute, blood pressure of 114/ 68 mm Hg, and an oxygen saturation of 95%. A thorough physical exam was unremarkable. His complete blood count, including white blood cells, was normal; and his electrolyte panel showed hyponatremia of 126 mmol/liter, hypochloremia of 90 mmol/liter, and hypocalcemia of 8.4 mg/dl. Additionally, the patient's transaminases were elevated (aspartate transaminase 144 IU/liter, alanine aminotransferase 73 IU/liter, and alkaline phosphatase 83 IU/liter). The patient was admitted for management of hyponatremia and additional workup.On the evening of the 1st day of admission, the patient had a fever of 40.5°C and heart rate of 82 beats/minutes, as well as new diarrhea and continuing headache and chills. The patient's first set of blood cultures was drawn during this febrile episode. Treatment with cefepime (2 g every 8 h) was initiated on the 2nd day of admission, when both the aerobic and anaerobic blood culture bottles were flagged positive by the BD Bactec FX system. Gram stain of the positive blood culture broth revealed Gram-negative rods. Molecular testing of the positive blood culture broth via the Verigene Gram-negative blood culture panel (Luminex Corporation, Austin, TX) did not identify the pathogen. After a report of the patient's positive blood culture with Gramnegative rods and because of the patient's new-onset diarrhea, a BioFire FilmArray gastrointestinal pathogen panel (BioFire Diagnostics, LLC, Salt Lake City, UT) was ordered on a stool specimen, with Salmonella spp. and Shigella/enteroinvasive Escherichia coli isolates detected.Subculture of the positive blood culture broth revealed gray nonhemolytic colonies on 5% sheep's blood agar and lactose-nonfermenting colonies on both MacConkey II agar (clear colonies) and Hektoen enteric agar (green colonies with slight H 2 S production [Fig. 1A]). The isolate tested spot indole and oxidase negative. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) identification of the isolate via Vitek MS (bioMérieux, Durham, NC) identified Salmonella enterica
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