Raman Spectroscopy Techniques for the Detection and Management of Breast Cancer

Breast cancer has recently become the most common cancer worldwide, and with increased incidence, there is increased pressure on health services to diagnose and treat many more patients. Mortality and survival rates for this particular disease are better than other cancer types, and part of this is due to the facilitation of early diagnosis provided by screening programmes, including the National Health Service breast screening programme in the UK. Despite the benefits of the programme, some patients undergo negative experiences in the form of false negative mammograms, overdiagnosis and subsequent overtreatment, and even a small number of cancers are induced by the use of ionising radiation. In addition to this, false positive mammograms cause a large number of unnecessary biopsies, which means significant costs, both financially and in terms of clinicians' time, and discourages patients from attending further screening. Improvement in areas of the treatment pathway is also needed. Surgery is usually the first line of treatment for early breast cancer, with breast conserving surgery being the preferred option compared to mastectomy. This type of operation achieves the same outcome as mastectomy - removal of the tumour - while allowing the patient to retain the majority of their normal breast tissue for improved aesthetic and psychological results. Yet, re-excision operations are often required when clear margins are not achieved, i.e. not all of the tumour is removed. This again has implications on cost and time, and increases the risk to the patient through additional surgery. Currently lacking in both the screening and surgical contexts is the ability to discern specific chemicals present in the breast tissue being assessed/removed. Specifically relevant to mammography is the presence of calcifications, the chemistry of which holds information indicative of pathology that cannot be accessed through x-rays. In addition, the chemical composition of breast tumour tissue has been shown to be different to normal tissue in a variety of ways, with one particular difference being a significant increase in water content. Raman spectroscopy is a rapid, non-ionising, non-destructive technique based on light scattering. It has been proven to discern between chemical types of calcification and subtleties within their spectra that indicate the malignancy status of the surrounding tissue, and differentiate between cancerous and normal breast tissue based on the relative water contents. Furthermore, this thesis presents work aimed at exploring deep Raman techniques to probe breast calcifications at depth within tissue, and using a high wavenumber Raman probe to discriminate tumour from normal tissue predominantly via changes in tissue water content. The ability of transmission Raman spectroscopy to detect different masses and distributions of calcified powder inclusions within tissue phantoms was tested, as well as elucidating a signal profile of a similar inclusion through a tissue phantom of clinically relevant thickness. The technique was then applied to the measurement of clinically active samples of bulk breast tissue from informed and consented patients to try to measure calcifications. Ex vivo specimens were also measured with a high wavenumber Raman probe, which found significant differences between tumour and normal tissue, largely due to water content, resulting in a classification model that achieved 77.1% sensitivity and 90.8% specificity. While calcifications were harder to detect in the ex vivo specimens, promising results were still achieved, potentially indicating a much more widespread influence of calcification in breast tissue, and to obtain useful signal from bulk human tissue is encouraging in itself. Consequently, this work demonstrates the potential value of both deep Raman techniques and high wavenumber Raman for future breast screening and tumour margin assessment methods

The Social Enterprise Law Market

During the last seven years, over thirty states have passed at least one social enterprise statute. These social enterprise statutes allow the formation of a plethora of new entity types, including low-profit limited liability companies, benefit corporations, benefit limited liability companies, public benefit corporations, and social purpose corporations. Social enterprises have attracted increasing academic attention, but virtually nothing has been written on if and how states are competing for these entities. This Article attempts to fill that void, while also providing a history of the social enterprise forms, a comparative analysis, and recommendations for states that wish to engage in jurisdictional competition in the social enterprise law market

Leadership Rounding to Improve Patient Satisfaction in Pediatric Ambulatory Care

Practice Problem: Low patient satisfaction has been linked to poor treatment compliance, patients leaving the practice, staff decreased job satisfaction, and high staff turnover (Haskard Zolnierek & DiMatteo, 2009; Prakash, 2010). Magnet reporting has identified wide discrepancies in ambulatory clinics, with some clinics reporting below benchmark patient satisfaction ratings. PICOT: In pediatric ambulatory and primary care services, how will the implementation of leader-led customer service rounding, compared to current practice, increase family and/or patient satisfaction over 4 weeks? Evidence: Key findings are that the rounding needs to be population-specific, intentional, and swiftly followed up when problems are identified. The body of evidence suggests that implementing leadership rounding in a setting such as pediatric ambulatory care could benefit the patients served by building trust and communication. Intervention: Implementation of a leadership rounding survey modified from current hospital rounding tools on patients and families by nursing leaders. Outcome: While post-data results did not have a statistically significant change from the pre-data results, several identified needs for the clinics were discovered. Clinical significance, in this project, addresses the family-identified needs for change, which will impact future care. Conclusion: Rounding on families in pediatric ambulatory care is an integral part of the care that can identify patient satisfaction needs and practice differences between clinics, leading to more consistency in patient satisfaction in the future

CRIMES AND OFFENSES Georgia Residential Mortgage Fraud Act: Enact the Georgia Residential Mortgage Fraud Act ; Provide a Short Title; Provide for Definitions; Define the Criminal Offense of Residential Mortgage Fraud; Provide for Venue; Provide Penalties; Authorize District Attorneys and the Attorney General to Investigate and Prosecute Cases of Residential Mortgage Fraud; Provide for the Forfeiture of Real and Personal Property; Amend the Georgia RICO (Racketeer Influenced and Corrupt Organizations) Act, so as to Include Residential Mortgage Fraud within the Definition of Racketeering Activity; Provide for Findings and a Statement of Purpose; Provide for Related Matters; Provide an Effective Date; Repeal Conflicting Laws; and for Other Purposes

The Georgia Residential Mortgage Fraud Act defines the crime of residential mortgage fraud. The Act also provides the possible venues for prosecuting residential mortgage fraud in Georgia. Moreover, the Act lays out guidelines for punishing those involved in residential mortgage fraud and gives the district attorneys and the attorney general the power to investigate and prosecute possible cases of residential mortgage fraud. The Act allows for forfeiture of property involved in residential mortgage fraud to the State of Georgia. Furthermore, the Act adds residential mortgage fraud to the Georgia RICO Act

From Pork to Mutton: A Zooarchaeological Perspective on Colonial New Amsterdam and Early New York City

This article analyzes the zooarchaeological remains from historical deposits to increase our understanding of the relationship between diet and ethnicity in early colonial New York City. Excavations at the Broad Financial Plaza recovered faunal remains documenting approximatley two centuries of historical occupation (middle 17th to the middle of the 19th century), a sequence rivaled by few other early colonial North American localities. Several trends are apparent in the data. Relative frequencies of pig remains declined while mutton and cattle increased correspondingly as New Amsterdam became the British colony of New York and as the Dutch residents on the block were replaced by inhabitants with British surnames. Wild animals such as deer decresead rapidly with the urbanization of Manhattan island during the British administration. Also, Old World rats appeared in the earliest levels, implying they were a part of New York life from the earliest colonial periods

Future care: rethinking technology enhanced aged care environments

© 2018, Emerald Publishing Limited. Purpose: Cutting-edge hospital and residential care architecture and interior design aim to address the emotional and practical needs of patients, staff and visitors. Yet, whilst improving on past practice, current approaches to design still rarely recognise or respond to individuals. The purpose of this paper is to provide a review of design-led research into digital technology across disciplines for the personalisation of healthcare environments and is informed by the authors’ ongoing hospital-based research. Design/methodology/approach: This review is based on a design anthropology framework providing insight into designing for changing the experience for older patients in current healthcare contexts and future focused strategies, integrating digital technologies and human-centred design across scale and disciplines. It is informed by ongoing hospital studies based on design-led research methodology, drawing on design anthropology and ethnographical methods. Findings: Technology enhanced, human-centred, assistive devices and environments implemented into healthcare across scale are developing but integration is needed for meaningful experiences. Research limitations/implications: This review is a positioning paper for design-led research into digital technology across scale and medium. Practical implications: This paper provides the basis for practical research including the ongoing hospital-based research of the authors. Social implications: This approach potentially enhances emotional experiences of connected healthcare. Originality/value: Future care scenarios are proposed, with technology and human experience as key drivers. Individualised and personalised solutions better cater for diversity. Within this context, it is strategic to question and test new ways of crafting the older persons care experience. This paper brings new direction to this discussion

Nuclear Equation of State from Observations of Short Gamma-Ray Burst Remnants

The favoured progenitor model for short $\gamma$-ray bursts (SGRBs) is the merger of two neutron stars that triggers an explosion with a burst of collimated $\gamma$-rays. Following the initial prompt emission, some SGRBs exhibit a plateau phase in their $X$-ray light curves that indicates additional energy injection from a central engine, believed to be a rapidly rotating, highly magnetised neutron star. The collapse of this `protomagnetar' to a black hole is likely to be responsible for a steep decay in $X$-ray flux observed at the end of the plateau. In this letter, we show that these observations can be used to effectively constrain the equation of state of dense matter. In particular, we show that the known distribution of masses in binary neutron star systems, together with fits to the $X$-ray light curves, provide constraints that exclude the softest and stiffest plausible equations of state. We further illustrate how a future gravitational wave observation with Advanced LIGO/Virgo can place tight constraints on the equation of state, by adding into the picture a measurement of the chirp mass of the SGRB progenitor.Comment: accepted for publication in Phys. Rev.