A Case of Primary Squamous Cell Carcinoma of the Liver Arising in a Solitary Cyst

A case of primary squamous cell carcinoma in a pre-existing hepatic cyst is presented. A review of the literature suggests that this rare type of liver tumor tends to arise from solitary, nonparasitic cysts, lined with squamous epithelium. Effective therapy is not available, the prognosis is grave

Angel Whispers : Reverie Transcription

https://digitalcommons.library.umaine.edu/mmb-ps/1361/thumbnail.jp

Beet Workers of Colorado

The sugar-beet industry was chosen as the subject matter for this Thesis since Boulder is in the heart of the sugar-beet territory. &nbsp; The composition portrays a group of beet workers who are busy weeding the beets. A background of farm houses and mountains provides a suitable or typical setting for the workers. &nbsp; The panel thirty-three inches by forty-five inches was made of '1 Presdwood' 1 treated with a casein size and ground which affords the best surface for the medium used. Egg tempera was selected as the medium because of its numerous possibilities in soft-textured surfaces and luminous color quality. &nbsp; This Thesis problem afforded a splendid opportunity for the application of principles of composition, color theory, and techniques in medium learned in academic work.</p

Assessing time use in long-term institutional care:development, validity and inter-rater reliability of the Groningen Observational instrument for Long-Term Institutional Care (GO-LTIC)

BACKGROUND: Limited research has examined what is actually done in the process of care by nursing staff in long-term institutional care. The applied instruments employed different terminologies, and psychometric properties were inadequately described. This study aimed to develop and test an observational instrument to identify and examine the amount of time spent on nursing interventions in long-term institutional care using a standardized language. METHODS: The Groningen Observational instrument for Long-Term Institutional Care (GO-LTIC) is based on the conceptual framework of the Nursing Interventions Classification. Developmental, validation, and reliability stages of the GO-LTIC included: 1) item generation to identify potential setting-specific interventions; 2) examining content validity with a Delphi panel resulting in relevant interventions by calculating the item content validity index; 3) testing feasibility with trained observers observing nursing assistants; and 4) calculating inter-rater reliability using (non) agreement and Cohen's kappa for the identification of interventions and an intraclass correlation coefficient for the amount of time spent on interventions. Bland-Altman plots were applied to visualize the agreement between observers. A one-sample student T-test verified if the difference between observers differed significantly from zero. RESULTS: The final version of the GO-LTIC comprised 116 nursing interventions categorized into six domains. Substantial to almost perfect kappa's were found for interventions in the domains basic (0.67-0.92) and complex (0.70-0.94) physiological care. For the domains of behavioral, family, and health system interventions, the kappa's ranged from fair to almost perfect (0.30-1.00). Intraclass correlation coefficients for the amount of time spent on interventions ranged from fair to excellent for the physiological domains (0.48-0.99) and poor to excellent for the other domains (0.00-1.00). Bland Altman plots indicated that the clinical magnitude of differences in minutes was small. No statistical significant differences between observers (p > 0.05) were found. CONCLUSIONS: The GO-LTIC shows good content validity and acceptable inter-rater reliability to examine the amount of time spent on nursing interventions by nursing staff. This may provide managers with valuable information to make decisions about resource allocation, task allocation of nursing staff, and the examination of the costs of nursing services

Analysis for the Design of a Sustainable Housing Complex in Haiti

This paper presents sustainable strategies for the design of a prototype sustainable housing complex in tropical climate that applies specifically to Haiti. The tropical climate zone is hot and humid with abundant rainfall and luxuriant vegetation growth. Despite its beautiful environment most of the countries in this zone are undeveloped and poverty manifests itself in different faces especially in poor housing condition. In this study, the history, geography, and culture of Haiti are analyzed in the context of family unit, community, and economic aspects. The climate conditions are also investigated in the context of residents’ comfort and energy savings. The construction materials appropriate for Haiti climate are explored. Rainwater harvesting and gray water reuses are discussed. Finally, sustainable design principles are proposed. Sustainable housing design refers to a strategy to plan and build a housing complex that uses efficient energy and water management while minimizing the overall adverse health and environmental problems. This means keeping the conventional comfort and environment conditions in housing by using natural sources of energy, like sun and wind, to provide natural heating, cooling, ventilation, lighting, and water management while contributing to a responsible natural resources use. The proposed guiding principles target to be utilized for the design of sustainable housing complex in Haiti located in a tropical climate

Hypofractionated or Conventionally Fractionated Adjuvant Radiotherapy After Regional Lymph Node Dissection for High-Risk Stage III Melanoma

Aims: Adjuvant radiotherapy can be beneficial after regional lymph node dissection for high-risk stage III melanoma, as it has been shown to reduce the risk of recurrence in the node field. However, the optimal fractionation schedule is unknown and both hypofractionated and conventionally fractionated adjuvant radiotherapy are used. The present study examined the oncological outcomes of these two approaches in patients treated in an era before effective systemic immunotherapy became available. Materials and methods: This retrospective cohort study involved 335 patients with stage III melanoma who received adjuvant radiotherapy after therapeutic regional lymph node dissection for metastatic melanoma between 1990 and 2011. Information on tumour characteristics, radiotherapy doses and fractionation schedules and patient outcomes was retrieved from the institution's database and patients' medical records. Results: Hypofractionated radiotherapy (median dose 33 Gy in six fractions over 3 weeks) was given to 95 patients (28%) and conventionally fractionated radiotherapy (median dose 48 Gy in 20 fractions over 4 weeks) to 240 patients (72%). Five-year lymph node field control rates were 86.0% (95% confidence interval 78.4–94.4%) for the hypofractionated group and 85.5% (95% confidence interval 80.5–90.7%) for the conventional fractionation group (P = 0.87). There were no significant differences in recurrence-free survival (RFS) (41.7%, 95% confidence interval 32.5–53.5 versus 31.9%, 95% confidence interval 26.1–38.9; P = 0.18) or overall survival (41.2%, 95% confidence interval 32.1–52.8 versus 45.0%, 95% confidence interval 38.7–52.4; P = 0.77). On multivariate analysis, extranodal spread was associated with decreased RFS (P = 0.04) and the number of resected lymph nodes containing metastatic melanoma was associated with decreased RFS (P = 0.0006) and overall survival (P = 0.01). Conclusion: Lymph node field control rates, RFS and overall survival were similar after hypofractionated and conventionally fractionated adjuvant radiotherapy. The presence of extranodal spread and an increasing number of positive lymph nodes were predictive of an unfavourable outcome