A review of Canters\u27 Assertive Discipline

Discipline procedures in our schools today vary not only from building to building but from classroom to classroom. Teachers are expected to maintain good discipline, but are often left to interpret a few general rules in the student handbook as they see fit. Rules in the individual classrooms are often left to the teacher. While many administrators see value in allowing teachers to maintain this type of control, others are implementing school-wide programs of discipline. Assertive Discipline, developed by Lee and Marion Canter in the mid 1970\u27s, is just one of many discipline packages available for implementation

Strategies for morbidity control of axillary dissection for breast cancer

Breast cancer accounts for one third of all cancers in females in the Netherlands I and the incidence has been increasing world-wide in the past decades 2.. For the majority of patients, surgery forms the primary treatment of choice 3. Dissection of the axillary lymph nodes has been part of the surgical treatment since the introduction of radical mastectomy at the end of the nineteenth century 4 and has remained an important element in the management of breast cancer up until the present day 5. iniiiaily, lymph node dissection was considered to be essential for the cure of breast cancer, but over the last decades it has been primarily regarded as a staging procedure, with the secondary purpose of maintaining local control in the axilla 6,7, In the absence of reliable, non-invasive techniques, axillary lymph node dissection remains the most important method for determining axillary node status, A number of studies have reported the adverse effects of axillary lymph node dissection, which include seroma formation 8, edema of the arm and breast ,),10, shoulder dysfunction 11,12 and loss of sensation in the distribution area of the intercostobrachial nerves 11,13, The length of hospital stay after axillary lymphadenectomy for breast cancer is usually determined by the need for wound and drain management of the patient 14-16, Recently. clinicians have begun to explore the possibilities of earlier discharge of the patient, and the conclusion has been made that this offers saf

The composition of serous fluid after axillary dissection

Objective: To analyse the composition of the serous fluid formed after axillary dissection Design: Descriptive study Setting: University hospital and teaching hospital, The Netherlands Subjects: 16 patients whose axillas were dissected as part of a modified radical mastectomy for stage I or II breast cancer. Main outcome measures: Chemical and cellular composition of axillary drainage fluid on the first, fifth, and tenth postoperative days compared with the same constituents in blood and with reported data on the composition of peripheral lymph. Results and conclusion: On the first postoperative day the drainage fluid contained blood contents and a high concentration of creatine phosphokinase (CPK). After day one it changed to a peripheral lymph-like fluid but containing different cells, more protein, and no fibrinogen, making coagulation impossible. The reduction in the fluid production must be caused by other wound healing processes, such as formation of scars and connective tissue

Exploring the Optimal Thermal Mass to Investigate the Potential of a Novel Low-Energy House Concept

In conventional buildings thermal mass is a permanent building characteristic depending on the building design. However, none of the permanent thermal mass concepts are optimal in all operational conditions. We propose a concept that combines the benefits of buildings with low and high thermal mass by applying hybrid adaptable thermal storage (HATS) systems and materials to a lightweight building. The HATS concept increases building performance and the robustness to changing user behavior, seasonal variations and future climate changes. In this paper the potential of the novel HATS concept is investigated by determining the sensitivity of the optimal thermal mass of a building to the change of seasons and to changing occupancy patterns. The optimal thermal mass is defined as the quantity of the thermal mass that provides the best building performance (based on a trade-off between the building performance indicators). Building performance simulation and multi-objective optimization techniques are used to define the optimal thermal mass of a case study in the Netherlands. Simulation results show that the optimal quantity of the thermal mass is sensitive to the change of seasons and occupancy patterns. This implies that the building performance will benefit from implementing HATS. Furthermore, the results show that using HATS reduces the heating energy demand of the case study with 26% and reduces weighted over- and underheating hours with 85%

Mandibular dental implant placement immediately after teeth removal in head and neck cancer patients

BACKGROUND: Little is known about immediate implant placement in head and neck cancer patients. We studied implant survival and functional outcomes of overdentures fabricated on implants placed immediately after removal of the lower dentition during ablative surgery or preceding primary radiotherapy (RT). METHODS: Inclusion criteria were primary head and neck cancer, dentate lower jaw, and indication for removal of remaining teeth. Two implants to support a mandibular overdenture were placed immediately after extraction of the dentition during ablative surgery, or prior to starting primary radiotherapy. Standardized questionnaires and clinical assessments were conducted (median follow-up 18.5 months, IQR 13.3). RESULTS: Fifty-eight implants were placed in 29 patients. Four implants were lost (implant survival rate 93.1%). In 9 patients, no functional overdenture could be made. All patients were satisfied with their dentures. CONCLUSIONS: Combining dental implant placement with removal of remaining teeth preceding head neck oncology treatment results in a favorable treatment outcome

Multi Domain Design: Integration and Reuse

Design of mechatronic systems is becoming increasingly complex. Companies must continuously reduce time-to-market while increasing the quality, diversity, and functionality of their products. As a result, more and more specialists from various domains are needed to develop such products. To reduce time-to-market, many companies look to reducing the time it takes to design a product. Many focus on the reuse of design objects, leading to libraries of templates and standard components to speed up their design process. However, these reusable design objects are developed and maintained in the specialists’ domains, resulting in communication and integration issues between these domains. This paper discusses these issues and proposes a combined approach for model reuse, design integration, and communication between the designers, design tools, and models involved. A case study at a multi-national company successfully demonstrated that the approach leads to a faster and more consistent design process

Surgical resection for persistent seroma, following modified radical mastectomy

<p>Abstract</p> <p>Background</p> <p>Seroma formation following modified radical mastectomy with axillary lymph node dissection for breast cancer is a most common wound complication. In our experience seroma occurs in approximately 50% of patients undergoing mastectomy. Postmastectomy seromas usually vanishes within a few weeks after operation.</p> <p>Case presentation</p> <p>In this report we present the case of a 73 year old woman who had undergone mastectomy with axillary lymph node dissection for breast cancer, complicated by lymphorrhea and formation fibrous encapsulated seroma resistant to conservative treatment which required surgical resection.</p> <p>Conclusion</p> <p>We stand in opinion that in some cases of prolonged seromatous effusion with confirmed formation of thick walled reservoir the operation with resection and closure of supplying regional lymph vessels may be the best treatment, if possible preceded by arm lymphoscyntygraphy.</p

The impact of loco-regional recurrences on metastatic progression in early-stage breast cancer: a multistate model

To study whether the effects of prognostic factors associated with the occurrence of distant metastases (DM) at primary diagnosis change after the incidence of loco-regional recurrences (LRR) among women treated for invasive stage I or II breast cancer. The study population consisted of 3,601 women, enrolled in EORTC trials 10801, 10854, or 10902 treated for early-stage breast cancer. Data were analysed in a multivariate, multistate model by using multivariate Cox regression models, including a state-dependent covariate. The presence of a LRR in itself is a significant prognostic risk factor (HR: 3.64; 95%-CI: 2.02-6.5) for the occurrence of DM. Main prognostic risk factors for a DM are young age at diagnosis (</=40: HR: 1.79; 95%-CI: 1.28-2.51), larger tumour size (HR: 1.58; 95%-CI: 1.35-1.84) and node positivity (HR: 2.00; 95%-CI: 1.74-2.30). Adjuvant chemotherapy is protective for a DM (HR: 0.66; 95%-CI: 0.55-0.80). After the occurrence of a LRR the latter protective effect has disappeared (P = 0.009). The presence of LRR in itself is a significant risk factor for DM. For patients who are at risk of developing LRR, effective local control should be the main target of therapy