Just A Coincidence? Whether Intention in Artistic Expression Alters Significance: An Analysis and Comparison of Herman Melville\u27s Moby-Dick and Matt Kish\u27s Moby-Dick in Pictures: One Drawing for Every Page

Using examples from Melville\u27s Moby-Dick and Matt Kish\u27s Moby-Dick in Pictures: One Drawing for Every Page, this paper explores how intention and coincidence contribute to perception of literature and art. There are too many patterns and details for certain aspects of Moby-Dick to be just a coincidence, and when the novel is viewed with this in mind, it changes the reader\u27s relationship with the text and subsequently inspired artwork. By questioning the relationship with coincidence and intention as it relates to truth in storytelling and art, the reader by extension begins to question the very same in their own lives

Improving Skin Cancer Screening in Primary Care

Skin cancer is one of the most common forms of cancer in the United States, with melanoma having the highest rate of mortality of all forms of skin cancer (CDC, 2019). However, there is hesitancy among primary care providers to perform skin cancer screenings (Oliveria et al., 2011). Prevention and early detection of melanoma is key. Melanoma has been known to be highly curable when found early. This makes early detection even more important in order to prevent metastasis and potential mortality (Bruce et al, 2017). The use of targeted screening tools can potentially save lives when utilized in primary care. This project was carried out in a rural, Midwestern public health clinic. The implementation of the SAMScore questionnaire was completed for adult patients seen during office visits from August 24, 2020 through November 25, 2020. Providers involved in the project reviewed survey answers with patients to determine level of risk. Dermatology referrals were recommended to those found to be high-risk. All patients involved in this project were provided education on skin cancer and preventive measures. Of the 19 patients screened, four were found to be high-risk for melanoma with one patient being diagnosed with melanoma after referral to dermatology. This project provided not only an educational opportunity for patients, but it also brought forth a screening method that is quick, concise, and financially feasible. Although this project consisted of a small sample size, future replications can easily be implemented in a larger and more diverse primary care setting

How should you further evaluate an adult with a testicular mass?

Perform a scrotal ultrasonography immediately to determine whether emergency surgery is necessary for patients with an exam or history that suggests testicular torsion or rupture (strength of recommendation [SOR]: B, based on cohort trials of patient oriented outcomes). In less urgent cases, ultrasound is also useful for verifying diagnoses made by physical exam, and to exclude conditions such as neoplasm, for which further workup is indicated (SOR: C, based on expert opinion). In those cases in which ultrasound and clinical exam are inconclusive or confl- icting, magnetic resonance imaging (MRI) can provide additional information to improve management and decrease unnecessary surgery (SOR: B, based on cohort trials of patient-oriented outcomes)

Mechanical and Physical Property Characterization of Macroporous Recycled-Aggregate Pervious Concrete

Pervious concrete has been widely used in pavement applications to help alleviate environmental issues related to urban stormwater runoff and pollution. While horizontal infrastructure (e.g., pavements) represent the majority of applications over the past few decades, pervious concrete is now being considered for other building infrastructure applications, such as sound barriers, insulation, and vertical garden walls. These new applications necessitate different physical and mechanical properties (e.g., ultra-high porosities) than pervious pavements. In response to this need, this research defines macroporous pervious concrete (MPC) as a pervious concrete with a minimum porosity of 30% and proposes it as a possible material solution for these new applications. The objective of this work was to characterize the mechanical and physical properties of the MPC under simulated field conditions. Due to the anticipated low strength of ultra-high porosity concrete, the impact of two binder additives, namely sand and titanium dioxide (TiO2), on the compressive strength of MPC was investigated. In addition, the effect of recycled aggregates on the mechanical and physical properties was assessed herein. To compare permeability of MPC to normal (< 30% porosity) pervious concrete, a modified Carman-Kozeny equation was proposed to predict permeability. Results demonstrate that MPC has a lower compressive strength and higher permeability than normal pervious concrete. Additionally, the use of recycled aggregates in lieu of virgin aggregates in MPC does not compromise its mechanical properties, but does impact MPC physical properties. Rather than being controlled by the parameters of unit weight, porosity, and aggregate type that usually govern the mechanical properties of normal pervious concrete, the strength of the MPC binder solely governs its mechanical performance. Furthermore, the data show that cement-binder additions of 7% sand or 2.5% TiO2 improve compressive strengths of recycled-aggregate MPC by 19% and 7%, respectively and that simultaneous use of both additives increase MPC compressive strength by 28%

Assessing competency for concealed-weapons permits - The physician's role

Shortly after the shootings in Newtown, Connecticut, two of us received letters from our county sheriff in North Carolina asking whether one of our patients had medical or physical conditions that would preclude issuance of a permit to carry a concealed weapon. Uncomfortable with our limited knowledge about such permits and our expected role, and fearing that our participation could affect our relationships with patients, we began exploring the ethical, legal, and policy considerations regarding physician involvement in this process