Sister Mary Joseph's Nodule at a University Teaching Hospital in Northwestern Tanzania: A Retrospective Review of 34 cases.

Sister Mary Joseph's nodule is a metastatic tumor deposit in the umbilicus and often represents advanced intra-abdominal malignancy with dismal prognosis. There is a paucity of published data on this subject in our setting. This study was conducted to describe the clinicopathological presentation and treatment outcome of this condition in our environment and highlight challenges associated with the care of these patients, and to proffer solutions for improved outcome. This was a retrospective study of histologically confirmed cases of Sister Mary Joseph's nodule seen at Bugando Medical Centre between March 2003 and February 2013. Data collected were analyzed using descriptive statistics. A total of 34 patients were enrolled in the study. Males outnumbered females by a ratio of 1.4:1. The vast majority of patients (70.6%) presented with large umbilical nodule > 2 cm in size. The stomach (41.1%) was the most common location of the primary tumor. Adenocarcinoma (88.2%) was the most frequent histopathological type. Most of the primary tumors (52.9%) were poorly differentiated. As the disease was advanced and metastatic in all patients, only palliative therapy was offered. Out of 34 patients, 11 patients died in the hospital giving a mortality rate of 32.4%. Patients were followed up for 24 months. At the end of the follow-up period, 14(60.9%) patients were lost to follow-up and the remaining 9 (39.1%) patients died. Patients survived for a median period of 28 weeks (range, 2 to 64 weeks). The nodule recurred in 6 (26.1%) patients after complete excision. Sister Mary Joseph's nodule of the umbilicus is not rare in our environment and often represents manifestation of a variety of advanced intra-abdominal malignancies. The majority of the patients present at a late stage and many with distant metastases. The patient's survival is very short leading to a poor outcome. Early detection of primary cancer at an early stage may improve the prognosis

The Wright Patent Lawsuit: Reflections on the Impact on American Aviation

The Wright brothers, it must be conceded, were the first to fly a powered, heavier-than-air machine in sustained flight and under control. To deny them this rightful distinction is to willfully ignore fact (Hayward, 1912). Their contributions to aviation are innumerable, and without their insight, man may have been years awaiting what they accomplished in 1903. The Wrights\u27 status as first in flight notwithstanding, their treatment of the issues surrounding the patent which was taken on their aircraft was harmful to the progress of aviation in the years following their success at Kitty Hawk. To claim that they owed the world the whole of their invention, and by extension, the profits arising from it, is unreasonable; but to suppose that in pursuit of their rightful gains, they would not impede any other from pursuing experimentation and improvement of aircraft is an expectation that is difficult to argue. In litigating against all those they deemed infringers upon their basic ideas, the Wrights forestalled what may well have been more collaborative and productive progress in aircraft design

Connecticut in the American Civil War: Slavery, Sacrifice, and Survival

Understanding the Importance of Connecticut’s War Experience In 1965 John Niven published a well-researched book Connecticut for the Union as part of the centenary commemoration of the Civil War. The momentous African-American protest movements, a Second Reconstruction, were at ...

William Lloyd Garrison: Abolition, Democracy, and Radical Reform

Story of an Unlikely Duo Since the international entanglements commencing with the Second World War, an exclusive national history of the United States has proven to be a woefully parochial and an inadequate paradigm. Comparative analysis, particularly a focus on the Atlantic world, is n...

Tracing the History of the Ornithopter: Past, Present, and Future

Since the earliest recorded history, humans have shared a nearly universal desire for the freedom of flight. This obsession with escaping gravity\u27s unblinking gaze to somehow slip aloft, even for a fleeting moment, has inspired many to wax poetic about the dream of flight. Looking to nature\u27s design, man for years attempted to replicate the flight of the bird, and even its predecessor, the pteranodon, in many a bid to break free of his earthly bonds. Though science eventually shifted its focus to balloons, and then to fixed-wing flight, as a means of sustaining flight, the freedom and effortless grace of birds is as captivating now as it ever was. From the earliest days of man\u27s dreams of launching himself skyward to today\u27s advanced designs, flapping-wing craft, known generally as ornithopters, have held a constant place in the quest to achieve the flowing elegance of flight so easily mastered by nature\u27s own aeronauts. In the past several years, aircraft which capitalize on the mechanics of bird flight have enjoyed a renaissance of sorts. From the recent first flight of a human-powered ornithopter, to flapping-wing designs incorporated in nano-scale unmanned vehicles, aviation design has in many ways come full circle. This paper examines the history of, and influences on, ornithopters and their design, and investigates developments and future trends of this uniquely inspired aircraft

Identification of Causal Paths and Prediction of Runway Incursion Risk using Bayesian Belief Networks

In the U.S. and worldwide, runway incursions are widely acknowledged as a critical concern for aviation safety. However, despite widespread attempts to reduce the frequency of runway incursions, the rate at which these events occur in the U.S. has steadily risen over the past several years. Attempts to analyze runway incursion causation have been made, but these methods are often limited to investigations of discrete events and do not address the dynamic interactions that lead to breaches of runway safety. While the generally static nature of runway incursion research is understandable given that data are often sparsely available, the unmitigated rate at which runway incursions take place indicates a need for more comprehensive risk models that extend currently available research. This dissertation summarizes the existing literature, emphasizing the need for cross-domain methods of causation analysis applied to runway incursions in the U.S. and reviewing probabilistic methodologies for reasoning under uncertainty. A holistic modeling technique using Bayesian Belief Networks as a means of interpreting causation even in the presence of sparse data is outlined in three phases: causal factor identification, model development, and expert elicitation, with intended application at the systems or regulatory agency level. Further, the importance of investigating runway incursions probabilistically and incorporating information from human factors, technological, and organizational perspectives is supported. A method for structuring a Bayesian network using quantitative and qualitative event analysis in conjunction with structured expert probability estimation is outlined and results are presented for propagation of evidence through the model as well as for causal analysis. In this research, advances in the aggregation of runway incursion data are outlined, and a means of combining quantitative and qualitative information is developed. Building upon these data, a method for developing and validating a Bayesian network while maintaining operational transferability is also presented. Further, the body of knowledge is extended with respect to structured expert judgment, as operationalization is combined with elicitation of expert data to create a technique for gathering expert assessments of probability in a computationally compact manner while preserving mathematical accuracy in rank correlation and dependence structure. The model developed in this study is shown to produce accurate results within the U.S. aviation system, and to provide a dynamic, inferential platform for future evaluation of runway incursion causation. These results in part confirm what is known about runway incursion causation, but more importantly they shed more light on multifaceted causal interactions and do so in a modeling space that allows for causal inference and evaluation of changes to the system in a dynamic setting. Suggestions for future research are also discussed, most prominent of which is that this model allows for robust and flexible assessment of mitigation strategies within a holistic model of runway safety