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The service concept plays a key role in service design and development. But while the term is used frequently in the service design and new service development literature, surprisingly little has been written about the service concept itself and its important role in service design and development. The service concept defines the how and the what of service(More)
The prevalence of autoimmune associations was determined in 113 patients with primary biliary cirrhosis who participated in a therapeutic trial of D-penicillamine. Eighty-four percent of the patients had at least one associated autoimmune disease and 41% had two or more such diseases in addition to primary biliary cirrhosis. Keratoconjunctivitis sicca,(More)
Hemostatic aspects of antiphospholipid syndrome (APS) present unique challenges to clinicians and laboratory personnel alike, particularly in the perioperative period. These challenges are especially evident in patients requiring cardiac valve replacement surgery. However, the literature outlining the optimal approach in such patients is limited. We present(More)
Lyme disease is a multisystem disorder caused by a tick-transmitted spirochete, Borrelia burgdorferi. The diagnosis is based on clinical findings in most patients, particularly those with erythema migrans or exposure to geographic locations endemic for the disease. Detection of a specific antibody to B. burgdorferi is a useful confirmatory test in many(More)
OBJECTIVE We report the first case of restrictive cardiomyopathy occurring in a patient with the eosinophilia-myalgia syndrome. DESIGN In this article, we discuss the various clinical manifestations of the eosinophilia-myalgia syndrome. MATERIAL AND METHODS In a 46-year-old woman with the eosinophilia-myalgia syndrome, orthopnea, chronic persistent(More)