This article reports the interdisciplinary treatment of a girl born with a complete bilateral cleft lip and palate. She had congenitally missing maxillary lateral incisors and canines and mandibular incisors, canines, and second premolars in addition to third molars. At age 11 years 2 months, she was treated with rapid maxillary expansion followed by bonding of the maxillary arch. Cranial harvested alveolar bone graft surgery was done at age 17 years 2 months. Mandibular arch treatment was started at age 19 years using single tooth implants initially as orthodontic anchorage devices and secondarily as prosthetic abutments. Teeth were placed in strategic positions for a 4 incisor fixed partial denture cemented on the 2 lateral incisor implants and screw-retained crowns on premolar implants. The maxillary arch was restored with screw-retained crowns on canine implants with lateral incisors in cantilever and pink ceramic. Two years posttreatment records at age 22 years 6 months showed long-term stability with good occlusion, facial balance, and smile esthetics.
  To quantify geographic variation in anticoagulant use and explore what resident, nursing home, and county characteristics were associated with anticoagulant use in a clinically complex population.
 
  A repeated cross-sectional design was used to estimate current oral anticoagulant use on December 31, 2014, 2015, and2016.
 
  Secondary data for United States nursing home residents during the period 2014-2016 were drawn from the Minimum Data Set 3.0 and Medicare Parts A and D. Nursing home residents (≥65years) with a diagnosis of atrial fibrillation and ≥6months of Medicare fee-for-service enrollment were eligible for inclusion. Residents in a coma or on hospice were excluded.
 
  Multilevel logistic models evaluated the extent to which variation in anticoagulant use between counties could be explained by resident, nursing home, and county characteristics and state of residence. Proportional changes in cluster variation (PCVs), intraclass correlation coefficients (ICCs), and adjusted odds ratios (aORs) were estimadult population at high risk for ischemic stroke, less than half of the residents received treatment with anticoagulants. Variation in treatment across counties was partially attributable to the characteristics of residents, nursing homes, and counties. Comparative evidence and refinement of predictive algorithms specific to the nursing home setting may be warranted.Somatic difficulties, solitude and the loss of independence are challenges facing ageing people, whatever their culture. However, when one is far from one's home, one's country, one's family, in a complex political and social context, this stage of life can be even more of an ordeal.The arrival of a baby, in all cultures, is a special moment for the parents, which brings with it numerous changes. The specificity of mixed couples magnifies these changes and requires certain elements to be negotiated in order to help the new family blend together. A clinical story shows how to envisage a creative way of constituting a mixed family.Over recent years, more and more unaccompanied minors have been arriving on French territory in search of a better future. As a result of their complicated journey before, during and after the migration, these youngsters have specific psychological needs which are not always recognised by the professionals working with them.  https://www.selleckchem.com/products/Eloxatin.html  Research has highlighted the elements weakening the educational alliance between youngsters and the adults surrounding them.Going through adolescence during migration carries risks, especially when parents must discover their new world at the same time as passing on their values. Teenagers in search of their identity and creativity can endanger themselves as well as their family. A mixed approach is therefore necessary to give meaning to the passing on of traditions.As part of a clinical practice which aims to alleviate the psychological suffering of children in situations of migration and/or uprooting, a discussion can be undertaken regarding the cultural aetiologies of migrant families whose children present autism spectrum disorders. The transcultural context enables families to travel between worlds as well as share their collective imagination regarding psychological suffering using graphic expression and narrative elements.Death has become a topic in our society and talking about it with young children is often the source of numerous questions on the part of adults, especially parents. How should we talk about death with young children? Does the migration process play a role in certain families? Do they draw on their culture of origin, their cultural or religious customs? Interviews carried out with ten parents provide some insights.The arrival of a child is accompanied by a psychological crisis for the future parents. In a context of migration, the parents are exposed to additional factors of vulnerability which further accentuate the intrapsychological and intersubjective change of "becoming a parent". The clinical situation of a family referred for a transcultural consultation shows how the choice of the baby's name can illustrate this issue.Cross-cultural consultation often uses metaphors. These promote narration, facilitate the therapeutic alliance, and allow psychic elaborations that release our patients' pains. The terms and conditions of their use, as well as their purposes, are more and more determined. They draw from imagination and therapists' lived experiences, in classical stories, in tales and fables from various cultures. This gives them real therapeutic potential, which must be learned to use.The Maison de Solenn at Cochin hospital in Paris provides transcultural care to a local migrant population. The transcultural approach consists in taking into account the cultural dimension in care and favours, through a specific technique, the sharing of cultural representations between professionals and families. The therapists can move around the hospital to provide advice as and when required, notably to facilitate care and compliance and to ensure there are no misunderstandings regarding treatments. In some situations, we recommend a transcultural consultation which consists in forming a group of several therapists from diverse professional and cultural backgrounds, to discuss a complex situation with the patient and their family.