Name: Add name here
HIM 2214 Module 6: Medical Record Abstracting
Instructions: In this medical record abstracting assignment you will first need to download and the records (history & physical, surgery consultation, operative report, pathology report and discharge summary) for a patient with digestive system problems. (Recommend reading them in the order listed).
Save your answers to the following related questions in this document and submit them for this module's assignment.
1. Define the terms diverticulosis and diverticulitis.
2. What is the pathophysiology of diverticulitis?
3. What is a hiatal hernia?
4. Describe some of the signs or symptoms a person with a hiatal hernia might have.
5. What is a pulmonary embolus?
6. What was the etiology (cause) of the pulmonary embolus for this patient?
7. What is gastritis?
8. Which problem is likely a contributor to the patient’s Type II diabetes mellitus?
9. What was the purpose of the barium enema?
10. What does the abbreviation HEENT stand for?
11. What is thrombophlebitis?
12. What is a surgical resection?
13. Define anastomosis.
14. What is ferrous gluconate and what is it used to treat?
15. What condition is the drug Darvocet used to treat?
16. What are electrolytes?
17. What is exogenous obesity?
18. Where is the femoral pulse found/taken?
19. Where is the popliteal pulse found/taken?
20. What is hepatosplenomegaly?
21. Which condition(s) is/are the drug Humulin used to treat?
22. What is an adenocarcinoma?
23. Which condition(s) is/are the drug Lanoxin used to treat?
24. What is the purpose of ordering the blood test PTT?
25. What is a colon stricture?
26. What is/are the etiologies associated with colorectal cancer?
27. What is the medical term for gallstones?
28. Which condition(s) is the drug Zantac used to treat?
29. What does the pathology report indicate about the spread of the carcinoma in this patient?
30. What is the etiology of Type II diabetes mellitus?
· Academic arguments are designed to get someone to agree with the author, who may use pathos (emotion), logos (logic and facts) and ethos (authority and expertise) to persuade.
Academic arguments are not about ranting, screaming or otherwise increasing conflict, but in fact are the opposite: They attempt to help the other person understand what the author believes to be right (opinion) based on the evidence presented (authority, logic, facts).
For your topic for your final paper, what kinds of arguments can you develop for your claim (thesis, main idea)?
Health Record Face Sheet
Record Number:
005
Age:
67
Gender:
Male
Length of Stay:
3 days
Service:
Inpatient Hospital Admission
Disposition:
Home
Discharge Summary
Patient is a 67-year-old male. He saw the doctor recently with abdominal pain and constipation. A barium enema showed diverticulosis and perhaps a stricture near the sigmoid and rectal junction. He was scoped by the doctor, who saw a stricture at that point and sa ...
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: July CasesSean M. Fox
Dr. Kelsey Lena is an Emergency Medicine Resident and Drs. Michael Avery and Joshua Davis are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s topics include:
• Malignant Bowel Obstruction
• Liver Laceration
• Sigmoid Volvulus
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: July CasesSean M. Fox
Dr. Kelsey Lena is an Emergency Medicine Resident and Drs. Michael Avery and Joshua Davis are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s topics include:
• Malignant Bowel Obstruction
• Liver Laceration
• Sigmoid Volvulus
Gi hemorrhage/ problem oriented case based teaching- my online classSelvaraj Balasubramani
GI Hemorrhage- Problem Based Learning- Case Scenario Triggers
You can watch the answers in the following video in YouTube
https://www.youtube.com/watch?v=i_UrQ2oSVEQ&t=31s
Introduction: Liver herniation through surgical incision is very rare. Moreover, it is exceptional for the left hepatic lobe to herniate
through sternotomy incision.
Presentation of the case: We present herein a 66 year old woman admitted to ER complains about upper abdominal pain. Abdominal CT scan showed herniation of part of left hepatic lobe through previous sternotomy incision. Conservative measures were successful in managing her symptoms.
Discussion: Till now only few cases of liver herniation through scar of sternotomy have been documented.
Conclusion: Although it is rare, left hepatic lobe may herniate through sternotomy incision.
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...Sean M. Fox
Dr. Kelsey Lena is an Emergency Medicine Resident and Drs. Michael Avery and Joshua Davis are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s topics include:
• Splenic Rupture
• Obstructive jaundice
• Ovarian Torsion
ADMISSION HISTORY AND PHYSICALPatient Name Jonathan Jones.docxAMMY30
ADMISSION HISTORY AND PHYSICAL
Patient Name:
Jonathan Jones
MR#:
44579
Attending Physician:
Ajay Shah, M.D.
DOB:
12/24/89
Chief Complaint:
27 yo [
year old
] male presents with 2 days of worsening right lower quadrant belly pain, nausea, and vomiting.
History of Present Illness (HPI):
2 days prior to admission, the patient began complaining of diffuse belly pain that initially felt like indigestion. Over the course of the day, this pain grew progressively worse, localizing in the right lower quadrant. This pain became constant and dull and radiated to the back. The evening prior to admission the patient was awakened by pain and nausea. He drank some Alka-Seltzer and attempted to return to sleep, shortly after which he began vomiting nonbloody or bilious emesis. Shortly thereafter, the patient decided to come to the ED [
Emergency Department
].
The patient indicates he did have a fever but did not take his temperature. He denies chills, testicular pain, blood in the stool, or recent weight change. The patient’s last bowel movement was yesterday, with some small amounts of mucus but otherwise normal. He notes a history of irritable bowel syndrome. However, he states that this pain is different than the pain he has had in the past.
Past Medical History (PMH):
Irritable bowel syndrome, last exacerbation 6 months ago. The rest of the past medical history is unremarkable.
Past Surgical History (PSH):
Tonsillectomy and adenoidectomy in early childhood. Umbilical hernia repair at age 4.
Medications:
None.
Allergies:
NKDA
Social History:
The patient is employed as a computer programmer. He is married and has no children. He has a 10-year pack-history (in this case, 5 years, two packs a day) of smoking. He drinks alcohol rarely.
Family History:
Both parents are alive and well. One sister has a history of GERD.
Review of Systems:
12-point review of systems was performed and was negative except for those items noted in the HPI above.
Physical Examination
General:
The patient is an alert and oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78. Pulse 68 and regular. Temperature 38.56°C (101.4°F).
HEENT:
Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears clear. Throat normal.
Neck:
The neck is supple with no carotid bruits.
Lungs:
The lungs are clear to auscultation and percussion.
Heart:
RRR, no m/g/r.
Abdomen:
Nondistended. Bowel sounds are normal. There is rebound tenderness on the left side, with discomfort and guarding upon palpation in the right lower quadrant, and positive psoas sign [
pain on extension of right thigh with patient lying on left side
].
Extremities:
No clubbing, cyanosis, or edema, distal extremities warm and well perfused.
Laboratory Data:
Hemoglob.
Name 1. The table shows the number of days per week, x, that 100.docxgilpinleeanna
Name
1. The table shows the number of days per week, x, that 100 students use the gym at a local high school.
x
frequency
Relative
frequency
Cumulative
frequency
0
3
1
12
2
33
3
28
4
11
5
9
6
4
1. The table shows the number of days per week, x, that 100 students use the gym at a local high school.
a. Complete the table
b. Display the information as either a pie chart, a horizontal bar chart, or a vertical bar chart.
c. Determine the mean, median, minimum frequency, maximum frequency, range, Q1, Q3 and the standard deviation, Sx
d. Based on the information and chart, what can you say about the distribution.a. Complete the table
b. Display the information as either a pie chart, a horizontal bar chart, or a vertical bar chart.
c. Determine the mean, median, minimum frequency, maximum frequency, range, Q1, Q3 and the standard deviation, Sx
d. Based on the information and chart, what can you say about the distribution.
Theme one is to identify the types of cultures or models of cultures and how they work or fit within an organization
Learning Activity #1
Using your reading material create a chart that describes the type, characteristics of the culture, associated values that would be important to keep the culture alive, and kinds of organizations structures that work best for culture. Compare and contrast them in your explanation of the chart. For instance what culture might work for Joe at the new sawmill and then which one might work at Purvis' shoe company.
Theme two: How to Create, Change, and Align Culture to the Structure and Vision.
Organizational Structure
Preface:
A leader’s job is to create the direction for the company to move forward. The leader does this in steps. Here are the steps of the process:
First, the leader designs the vision and mission for the company and second, the leader must establish an organizational structure which promotes the vision, mission and empowers the employees to keep the forward movement in the organization.
In creating the structure various factors must be considered.
· First and foremost is the purpose of the company or organization. What type of structure will best accomplish that goal? Certainly a company like UPS needs a somewhat rigid structure that is set up to focus on procedure and time sensitivity. Since UPS has as its goal to get the correct parcels to the right customers in the fastest way possible, variance in procedures or ways of accomplishing the tasks would never work. A tight delineated structure is imperative.
· Along with the purpose the leader must look at the vision of the organization. Where does the leader want the organization to go? How best can the structure provide for the future? Will the vision call for expansion into other countries or simply call for product development changes? Do you plan a struct ...
Name _____________________Date ________________________ESL.docxgilpinleeanna
Name _____________________ Date ________________________
ESL 408 Remembered Event Worksheet
1) What is the most memorable, significant event in your life?
2) What important lesson(s) or applications are there from this event?
3) Complete the chart below. Add at least 5 details to each part of the storyline.
Story Element
Details
Exposition
Rising Action
Climax
Falling Action
Resloution
...
More Related Content
Similar to Name Add name hereHIM 2214 Module 6 Medical Record Abstractin.docx
Gi hemorrhage/ problem oriented case based teaching- my online classSelvaraj Balasubramani
GI Hemorrhage- Problem Based Learning- Case Scenario Triggers
You can watch the answers in the following video in YouTube
https://www.youtube.com/watch?v=i_UrQ2oSVEQ&t=31s
Introduction: Liver herniation through surgical incision is very rare. Moreover, it is exceptional for the left hepatic lobe to herniate
through sternotomy incision.
Presentation of the case: We present herein a 66 year old woman admitted to ER complains about upper abdominal pain. Abdominal CT scan showed herniation of part of left hepatic lobe through previous sternotomy incision. Conservative measures were successful in managing her symptoms.
Discussion: Till now only few cases of liver herniation through scar of sternotomy have been documented.
Conclusion: Although it is rare, left hepatic lobe may herniate through sternotomy incision.
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...Sean M. Fox
Dr. Kelsey Lena is an Emergency Medicine Resident and Drs. Michael Avery and Joshua Davis are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s topics include:
• Splenic Rupture
• Obstructive jaundice
• Ovarian Torsion
ADMISSION HISTORY AND PHYSICALPatient Name Jonathan Jones.docxAMMY30
ADMISSION HISTORY AND PHYSICAL
Patient Name:
Jonathan Jones
MR#:
44579
Attending Physician:
Ajay Shah, M.D.
DOB:
12/24/89
Chief Complaint:
27 yo [
year old
] male presents with 2 days of worsening right lower quadrant belly pain, nausea, and vomiting.
History of Present Illness (HPI):
2 days prior to admission, the patient began complaining of diffuse belly pain that initially felt like indigestion. Over the course of the day, this pain grew progressively worse, localizing in the right lower quadrant. This pain became constant and dull and radiated to the back. The evening prior to admission the patient was awakened by pain and nausea. He drank some Alka-Seltzer and attempted to return to sleep, shortly after which he began vomiting nonbloody or bilious emesis. Shortly thereafter, the patient decided to come to the ED [
Emergency Department
].
The patient indicates he did have a fever but did not take his temperature. He denies chills, testicular pain, blood in the stool, or recent weight change. The patient’s last bowel movement was yesterday, with some small amounts of mucus but otherwise normal. He notes a history of irritable bowel syndrome. However, he states that this pain is different than the pain he has had in the past.
Past Medical History (PMH):
Irritable bowel syndrome, last exacerbation 6 months ago. The rest of the past medical history is unremarkable.
Past Surgical History (PSH):
Tonsillectomy and adenoidectomy in early childhood. Umbilical hernia repair at age 4.
Medications:
None.
Allergies:
NKDA
Social History:
The patient is employed as a computer programmer. He is married and has no children. He has a 10-year pack-history (in this case, 5 years, two packs a day) of smoking. He drinks alcohol rarely.
Family History:
Both parents are alive and well. One sister has a history of GERD.
Review of Systems:
12-point review of systems was performed and was negative except for those items noted in the HPI above.
Physical Examination
General:
The patient is an alert and oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78. Pulse 68 and regular. Temperature 38.56°C (101.4°F).
HEENT:
Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears clear. Throat normal.
Neck:
The neck is supple with no carotid bruits.
Lungs:
The lungs are clear to auscultation and percussion.
Heart:
RRR, no m/g/r.
Abdomen:
Nondistended. Bowel sounds are normal. There is rebound tenderness on the left side, with discomfort and guarding upon palpation in the right lower quadrant, and positive psoas sign [
pain on extension of right thigh with patient lying on left side
].
Extremities:
No clubbing, cyanosis, or edema, distal extremities warm and well perfused.
Laboratory Data:
Hemoglob.
Name 1. The table shows the number of days per week, x, that 100.docxgilpinleeanna
Name
1. The table shows the number of days per week, x, that 100 students use the gym at a local high school.
x
frequency
Relative
frequency
Cumulative
frequency
0
3
1
12
2
33
3
28
4
11
5
9
6
4
1. The table shows the number of days per week, x, that 100 students use the gym at a local high school.
a. Complete the table
b. Display the information as either a pie chart, a horizontal bar chart, or a vertical bar chart.
c. Determine the mean, median, minimum frequency, maximum frequency, range, Q1, Q3 and the standard deviation, Sx
d. Based on the information and chart, what can you say about the distribution.a. Complete the table
b. Display the information as either a pie chart, a horizontal bar chart, or a vertical bar chart.
c. Determine the mean, median, minimum frequency, maximum frequency, range, Q1, Q3 and the standard deviation, Sx
d. Based on the information and chart, what can you say about the distribution.
Theme one is to identify the types of cultures or models of cultures and how they work or fit within an organization
Learning Activity #1
Using your reading material create a chart that describes the type, characteristics of the culture, associated values that would be important to keep the culture alive, and kinds of organizations structures that work best for culture. Compare and contrast them in your explanation of the chart. For instance what culture might work for Joe at the new sawmill and then which one might work at Purvis' shoe company.
Theme two: How to Create, Change, and Align Culture to the Structure and Vision.
Organizational Structure
Preface:
A leader’s job is to create the direction for the company to move forward. The leader does this in steps. Here are the steps of the process:
First, the leader designs the vision and mission for the company and second, the leader must establish an organizational structure which promotes the vision, mission and empowers the employees to keep the forward movement in the organization.
In creating the structure various factors must be considered.
· First and foremost is the purpose of the company or organization. What type of structure will best accomplish that goal? Certainly a company like UPS needs a somewhat rigid structure that is set up to focus on procedure and time sensitivity. Since UPS has as its goal to get the correct parcels to the right customers in the fastest way possible, variance in procedures or ways of accomplishing the tasks would never work. A tight delineated structure is imperative.
· Along with the purpose the leader must look at the vision of the organization. Where does the leader want the organization to go? How best can the structure provide for the future? Will the vision call for expansion into other countries or simply call for product development changes? Do you plan a struct ...
Name _____________________Date ________________________ESL.docxgilpinleeanna
Name _____________________ Date ________________________
ESL 408 Remembered Event Worksheet
1) What is the most memorable, significant event in your life?
2) What important lesson(s) or applications are there from this event?
3) Complete the chart below. Add at least 5 details to each part of the storyline.
Story Element
Details
Exposition
Rising Action
Climax
Falling Action
Resloution
...
Name Bijapur Fort Year 1599 Location Bijapur city.docxgilpinleeanna
Name: Bijapur Fort
Year: 1599
Location: Bijapur city in Bijapur District of the Indian state of Karnataka
The fort precinct is studded with the historical fort, palaces, mosques, tombs and
gardens.
Built by Yusuf Adil Shah, during the rule of Adil Shahidynasty.
https://en.wikipedia.org/wiki/Bijapur,_Karnataka
https://en.wikipedia.org/wiki/Bijapur_district,_Karnataka
https://en.wikipedia.org/wiki/States_and_territories_of_India
https://en.wikipedia.org/wiki/Karnataka
https://en.wikipedia.org/wiki/Adil_Shahi
Name: Adham Khan's Tomb
Year: 1561
Location : Qutub Minar, Mehrauli, Delhi,
Built for 16th-century tomb of Adham Khan, a general of the Mughal Emperor Akbar.
It consists of a domed octagonal chamber in the Lodhi Dynasty style and Sayyid
dynasty early in the 14th century.
https://en.wikipedia.org/wiki/Qutub_Minar
https://en.wikipedia.org/wiki/Mehrauli
https://en.wikipedia.org/wiki/Delhi
https://en.wikipedia.org/wiki/Adham_Khan
https://en.wikipedia.org/wiki/Mughal_Emperor
https://en.wikipedia.org/wiki/Akbar
https://en.wikipedia.org/wiki/Lodhi_Dynasty
https://en.wikipedia.org/wiki/Sayyid_dynasty
https://en.wikipedia.org/wiki/Sayyid_dynasty
These two objects are both tomb and have it’s own style form certain dynasty.
I chose these two objects is because they are both architecture and I can talk more about
how different dynasty influences the design of the architecture.s
Week 10 Assignments – XBRL
DUE DATE: Sunday midnight of Week 6, submitted in a MS Word (or Excel if
computations required) document with filename format:
Last First_Week X hwk.doc or .xls Make sure your name appears on each page of the
homework using the header function.
Homework questions:
1. Why do you think it took from 1999, when the XBRL concept was invented, until 2009
for the SEC require that public filers adopt?
2. From the PWC Webcast on XBRL, what are the differences between the “bolt-on” and
“embedded” approach to XBRL?
3. If you worked in the Finance and Accounting department of a company, how could you
use XBRL tags to help in your job? Could XBRL tagging help other functions in a
company do their jobs?
4. US public filers are required to begin tagging and reporting financial data using XBRL
beginning in 2009. From earlier in this course, they also have many major projects that
are required now or in the coming years (IFRS, Fair Value, etc.). Aside from the obvious
benefit of job creation for CPA’s and the companies which provide these
services/software ☺, what impact do you think these requirements are going to have on
companies? Will this divert attention and resources from their core business or will this
be like all other changes they go through (e.g. SOX), an intense implementation then
business as usual?
...
Name _______________________________ (Ex2 rework) CHM 33.docxgilpinleeanna
Name: _______________________________ (Ex2 rework)
CHM 3372, Winter 2016
Exam #2 Re-work
Due Wed, 3/2/16
1. Make the ketone below from 13C-labeled formaldehyde and propane. Make certain to keep
track of your labels throughout your synthesis. (27 points)
O
Name: _______________________________ (Ex2 rework)
2. (a) The reaction below can form two possible diastereomeric products. Draw the structures of
both products, and the mechanism of the formation of either one. (4 points)
O
1. LiAlH4
2. NH4Cl, H2O
(b) What characterizes a thermodynamic product of a reaction (any reaction)? What
characterizes a kinetic product of reaction? (2 points)
(c) Which product from part (a) would you expect to be the thermodynamic product? Why? (2
points)
(d) Which product would you expect to be the kinetic product? Why? (Note that this is not
necessarily the "non-thermodynamic" product.) (2 points)
(e) When this reaction is performed, regardless of what the temperature is, only one of the two
possible products is ever formed. Which one? (1 points)
(f) Why is the other diastereomer never formed? What must occur in order for it to be formed,
which will never occur with this particular reagent? Why? (3 points)
(g) Although the other diastereomer is never formed directly in this reaction, gentle heating with
aqueous acid will isomerize the initial product into the other diastereomer. Draw the mechanism
of the isomerization, and comment on why this isomerization occurs -- why one diastereomer
will react completely to form the other. (5 points)
Name: _______________________________ (Ex2 rework)
3. This page seems like it was tough on Q#3. Let’s see if you do better the second time around.
From the three alcohols shown, provide syntheses for the molecules below. For any SN2 or E2
reactions, use only non-halogen leaving groups – use a different leaving group which was
covered in Ch. 11. (12 points)
From: Make:
OH
OH
CH3 OH
O
O
CH3
O
O
O
Name: _______________________________ (Ex2 rework)
4. (a) Once again, write the oxidation state of the metal (each complex is neutral, Nickel is
Group 10; OTf is triflate, CF3SO3-), number of d electrons, and total valence electrons for the
metal in each complex, and indicate what type of reaction is occurring. (8 points)
H Ni
OTf
PPh3
Ni
OTf
PPh3H
Ni
OTf
PPh3
Ni
OTf
PPh3
Ni
OTf
PPh3
H
(b) What are the reactant(s) and product(s) of the reaction? (This time, they are not drawn for
you.) (2 points)
(c) If the ethylene molecule were deuterated completely (CD2=CD2), where would the deuterium
atoms end up in the product? Draw the structure, showing the position(s) of the deuterium
atoms. Assume the catalytic cycle has run several times already. (2 points)
Name: _______________________________ (Ex2 rework)
5. (a) I defined a conjugated system gener ...
Name 1 Should Transportation Security Officers Be A.docxgilpinleeanna
Name:
1
Should Transportation Security Officers Be Armed?
It is the opinion of this writer that Transportation Security Officers (TSOs) should not be
armed. It is my intent to illustrate that point in this paper. During my research I will weigh the
advantages and disadvantages of arming TSOs, examining each side of the argument. I will also
offer a potential solution that while costly will still prove to be less costly than arming TSOs.
What has led to this discussion? For a majority of our society it takes years and certain
events to take place in our lives for change to occur. Those events include graduating High
School/College, getting married, or having children. In a matter of only five short minutes on
the morning of November 1st, 2013, some individual’s lives changed forever. On that morning
Paul Anthony Ciancia, age 23, opened fire in Terminal 3 of the Los Angeles International
Airport (LAX). His senseless acts killed a TSO, while injuring six other individuals. The
shooting has been debated over and over again on whether it is a terrorist act or not. The
activities before, during, and after the shooting will show the acts were certainly a terrorist
attack. But more importantly could any deaths or injuries have been avoided if the TSOs were
armed? These is the question that will continue to be debated and one that will be addressed in
this paper.
Synopsis of the event that led up to this argument:
Shortly after being dropped off at the airport by his roommate, Paul Ciancia pulled out a
rifle and began opening fire. He was carrying luggage that was filled with a semiautomatic .223
caliber Smith & Wesson M&P-15 rifle, five 30-round magazines, and hundreds of additional
rounds of ammunition ("Lax shooting suspect," 2013). Walking up to the TSA checkpoint,
Ciancia pulled out a rifle and opened fire hitting TSO Gerardo Hernandez in the chest. Ciancia
Name:
2
then apparently moved into the screening area where he continued to fire striking two other
TSOs and a male citizen. According to eye witnesses, Ciancia continually asked civilians if they
were TSA officers, when they said “no” he moved on without shooting them ("Lax shooting:
Latest," 2013). Ciancia made it as far as the food court some five minutes after the first shots
were fired. He was then surrounded by LAX police officers who engaged him in a gunfight.
Shortly after the gunfight ended Ciancia was taken into custody where he had to be transported
to a nearby trauma hospital for gunshot wounds (Abdollah, 2013).
In total eight individuals had to be treated at the scene. Four victims were treated for
gunshot wounds, while the others were treated for other injuries ("6 hospitalized after," 2013).
The sole suspect Paul Ciancia was carrying a note on him that stated he “wanted to kill TSA”
and describe them as “pigs”, the note also mentioned “fiat currency” and “NWO” ("Lax shooting
...
Name Don’t ForgetDate UNIT 3 TEST(The direct.docxgilpinleeanna
Name: Don’t Forget
Date:
UNIT 3 TEST
(The directions and procedures for this test are the same as for the previous Unit test.)
Save this test on your computer, and complete the questions by marking correct answers with the “text color” function in WORD ( ) located on the “home” toolbar.Please attach your completed test to the assignment submission page.
Section I
Please identify problems of vagueness, overgenerality and ambiguity (double meaning) in the following passages. Then explain briefly how/why the passage exemplifies that problem. (Some examples may contain more than one problem.)
1. Who was Hitler? He was an Austrian.
__vague
__overgeneral
__ambiguous
Explanation:
2. The judge sanctioned the firm's criminal conduct.
__vague
__overgeneral
__ambiguous
Explanation:
3. "Turn right here!"
__vague
__overgeneral
__ambiguous
Explanation:
4. (From a Student Code of Conduct- Sexual impropriety in the dorms after 6:00 pm is forbidden.
__vague
__overgeneral
__ambiguous
Explanation:
5. Did Donald win the election? Well, he did get quite a few votes!
__vague
__overgeneral
__ambiguous
Explanation:
6. How are Henry’s finances? Oh, he’s really quite well off!
__vague
__overgeneral
__ambiguous
7. Bertha Belch, as missionary from Africa, will be speaking tonight at the Calvary Chapel. Come and hear Bertha Belch all the way from Africa.
__vague
__overgeneral
__ambiguous
Explanation:
8. Lower Slobovia can’t be a very well-run country. I mean, it’s not particularly democratic!
[Careful: Think about the various aspects of these claims before answering.]
__vague
__overgeneral
__ambiguous
Section II. Definitions
Please indicate whether the following are stipulative, persuasive, lexical or precising definitions.
9. Postmodern means a chaotic and confusing mishmash of images and references that leaves readers and viewers longing for the days of a good, well-told story.
__ stipulative
__ persuasive
__ lexical
__ précising
10. A triangle is a plane figure enclosed by 3 straight lines.
__ stipulative
__ persuasive
__ lexical
__ precising
11. An arid region, for purposes of this study, is any region that receives an average of less than 15 inches of rain per year
__ stipulative
__ persuasive
__ lexical
__ precising
14. A Blanker is someone who sends holiday cards without signatures or personalized messages
__ stipulative
__ persuasive
__ lexical
__ precising
15. Tragedy, in literary terms, means a serious drama that usually ends in disaster nd that focuses on a single character who experiences unexpected reversals in fat, often falling from a position of authority and power because of an unrecognized flaw or misguided action
__ stipulative
__ persuasive
__ lexical
__ précising
Section III. Strategies for Defining
Please indicate whether the following lexical definitions are ostensive definitions, enumerative definitions, definitions by s ...
Name Add name hereConcept Matching From Disease to Treatmen.docxgilpinleeanna
Name: Add name here
Concept Matching: From Disease to Treatment
Using your textbooks, complete the empty squares on the table below to match specific diseases with their pathology, pathophysiology and pharmacological treatment. Be sure to use appropriate medical terminology when adding information. You should review two different sources at a minimum to develop your brief synopses.
Example of completed row:
Disease
Body system
Signs/Symptoms
Pathophysiology
Treatment(s) (Pharm & Other)
Acne vulgaris
Integumentary system
Non-inflammatory comedones or inflammatory papules, pustules or modules. Symptoms can include pain, erythema and tenderness
Release of inflammatory mediators into the skin, with follicle hyperkeratinization, Propionibacterium acne colonization, and excess production of sebum
Depending on severity, topical mediations include benzyol peroxide or retinoid drugs. Hormonal drugs (such as oral contraceptives), and in some cases antibiotics may be used for severe inflammatory acne. Nonpharmacological treatments include dermabrasion or phototherapy
Disease
Body System
Signs/Symptoms
Pathophysiology
Treatment(s)
Atopic Dermatitis
Multiple Sclerosis
Squamous cell carcinoma
Osteoporosis
Osteosarcoma
Rheumatoid arthritis
Epilepsy
Psoriasis
Alzheimer’s Disease
...
Name Abdulla AlsuwaidiITA 160Uncle VanyaMan has been en.docxgilpinleeanna
Name Abdulla Alsuwaidi
I
TA 160
"Uncle Vanya"
“Man has been endowed with reason,
with the power to create, so that he can add to what he's been given.
But up to now, he hasn't been a creator, only a destroyer.
Forests keep disappearing, rivers dry up,
wild life's become extinct, the climate's ruined,
and the land grows poorer and uglier”
The play “Uncle Vanya” written by Anton Chekhov is a pearl of the classics of Russian literature. Anton Chekhov left a great legacy in a form of his plays and short stories for the classics of world literature. Without a shadow of doubt, this masterpiece, written by one of the most prominent the Russian playwrights of his time, should be read with further analysis and discussion. “Uncle Vanya” is a realist play and Chekhov tried to make its scenes as true-to-life as possible. Chekhov spent one year writing “Uncle Vanya” and introduced a number of changes between the years 1896 – 1897. The final version of his play is famous worldwide. The plot of the play narrates a heartbreaking story of how the main hero, Ivan Petrovich Voynitsky or Uncle Vanya that was a rather calm and quiet man undergoes a moral “rebirth” developing a spirit of a rebellion. Uncle Vanya, the main hero of the play, can be characterized as a bitter aging man who spent his life in toil working for his brother-in-law. Chekhov depicted the character of uncle Vanya as a misanthrope who recognized the miserable nature of other characters.
Moreover, Chekhov’s play also involves a number of other important issues that are experienced by the play’s characters. These issues include the feeling of pointless life lacking meaning, missed opportunities, and the most touching feeling of blind admiration. It should be admitted that Chekhov used to create hidden meaning in his plays to make the readers think critically not only of his work but of their lives either. Therefore, in the play, Chekhov made every character individualistic. For instance, the central character in the play, Uncle Vanya, cares about patrimony and the Serebryakov’s family’s property. Throughout the play, uncle Vanya finds himself dismissed and rejected without the right for an opinion. Chekhov also pointed out the suffering of other characters who struggle to change their lives for better. The play consists of a number of personal dramas that are interconnected.
It can be stated that Chekhov included a number of opposite lines in his play such as the choice between obedience or riot, feeling of admiration and disrespect. The following lines from the play demonstrate the feeling of disappointment and understanding the pointlessness of a situation: “”I’m mad — but people who conceal their utter lack of talent, their dullness, their complete heartlessness under the guise of the professor, the purveyor of learned magic — they aren’t mad” (Uncle Vanya). Uncle Vanya is concerned about the wasted years and the thought of how his life could look like in case he used the opportun ...
Name Sophocles, AntigoneMain Characters Antigone, Cre.docxgilpinleeanna
Name:
Sophocles, Antigone
Main Characters: Antigone, Creon (the King), Ismene (Antigone’s sister), the Chorus, the Guard, Haimon (Creon’s and Euridike’s son), Euridike (Creon’s wife/Haimon’s mother), Teiresias (the prophet), the messenger.
1. Aristotle writes that the tragic hero suffers from a harmartia or error. Who is the tragic hero of the play? Why do you think so?
2. Who is in the right? Antigone? Creon? Both? Neither? Why?
3. What makes this play tragic?
4. What is the role of the chorus in this production? How do they fit into the play?
5. What do you think about the way the production differentiates between divine law and human law? Which characters do you think are more closely linked to what (kind of) law?
6. Why is this art? What is the relationship between Antigone and a painting or a statue, such that we can call them both art?
...
N4455 Nursing Leadership and ManagementWeek 3 Assignment 1.docxgilpinleeanna
N4455 Nursing Leadership and Management
Week 3 Assignment 1: Financial Management Case Study v2.2
Name:
Date:
Overview: Financial Management Case Study
One of the important duties of a nurse leader is to manage personnel and personnel budgets. In this assignment, you will assume the role of a nurse manager. You will use given data to make important decisions regarding budgets and staffing.
Some nurse managers have computer spreadsheets or software applications to help them make decisions regarding budgets and staffing. You will only need simple mathematical operations* to perform the needed calculations in this assignment because the scenario has been simplified. Furthermore, some data have been provided for you that a nurse leader might need to gather or compute in a real setting. Still, you will get a glimpse of the complexity of responsibilities nurse leaders shoulder regarding financial management.
· To calculate the percent of the whole a given number represents, follow these steps:
Change the percentage to a decimal number by moving the decimal twice to the left (or dividing by 100).
Multiply the new decimal number by the whole.
Example: What is 30% of 70?
30%= .30; (.30) × 70 = 21
· To find out what percentage a number represents in relation to the whole, follow these steps:
Divide the number by the whole (usually the small number by the large number).
Change the decimal answer to percent by moving the decimal twice to the right (or multiplying by 100).
Example: What percent of 45 is 10?
10 ÷ 45 = .222; so, 10 is 22% of 45.
* You will only need addition, subtraction, multiplication, and division.
Case Study
You are the manager for 3 West, a medical/surgical unit. You have been given the following data to assist you in preparing your budget for the upcoming fiscal year.
Patient Data
ADC: 54
Budget based on 5.4 Avg. HPPD
(5.4 HPPD excludes head nurse and unit secretaries)
Staff Data
Total FTEs
37.0 Variable FTEs
1.0 Nurse Manager
2.2 Unit Secretaries
40.2 Total FTEs
Staffing Mix
RN
65%
LVN
20%
NA
15%
Average Salary Scale per Employee
(Fringe benefits are 35% of salaries)
Nurse Manager
$77,999.00 per year
Registered Nurses (RN)
$36.00 per hour
Licensed Vocational Nurses (LVN)
$24.00 per hour
Nurse Aides (NA)
$13.50 per hour
Unit Secretary (US)
$11.25 per hourRubric
Use this rubric to guide your work on this assignment.
Criteria
Target
Acceptable
Unacceptable
Question 1
Both % and FTEs column totals within ± 2 of correct answers
(13-16 Points)
Either % or FTEs column totals within ± 2 of correct answers
(5-12 points)
Neither % nor FTEs column totals within ± 2 of correct answers
(0-4 points)
Question 2
All column (except Hours and Salary) totals within ± 2 of correct answers
(17-20 Points)
At least 4 column totals within ± 2 of correct answers
(5-16 points)
Less than 4 column totals within ± 2 of correct answers
(0-4 points)
Question 3
A. Table
All ...
Name Habitable Zones – Student GuideExercisesPlease r.docxgilpinleeanna
Name:
Habitable Zones – Student Guide
Exercises
Please read through the background pages entitled Life, Circumstellar Habitable Zones, and The Galactic Habitable Zone before working on the exercises using simulations below.
Circumstellar Zones
Open the Circumstellar Zone Simulator. There are four main panels:
· The top panel simulation displays a visualization of a star and its planets looking down onto the plane of the solar system. The habitable zone is displayed for the particular star being simulated. One can click and drag either toward the star or away from it to change the scale being displayed.
· The General Settings panel provides two options for creating standards of reference in the top panel.
· The Star and Planets Setting and Properties panel allows one to display our own star system, several known star systems, or create your own star-planet combinations in the none-selected mode.
· The Timeline and Simulation Controls allows one to demonstrate the time evolution of the star system being displayed.
The simulation begins with our Sun being displayed as it was when it formed and a terrestrial planet at the position of Earth. One can change the planet’s distance from the Sun either by dragging it or using the planet distance slider.
Note that the appearance of the planet changes depending upon its location. It appears quite earth-like when inside the circumstellar habitable zone (hereafter CHZ). However, when it is dragged inside of the CHZ it becomes “desert-like” while outside it appears “frozen”.
Question 1: Drag the planet to the inner boundary of the CHZ and note this distance from the Sun. Then drag it to the outer boundary and note this value. Lastly, take the difference of these two figures to calculate the “width” of the sun’s primordial CHZ.
CHZ Inner Boundary
CHZ Outer Boundary
Width of CHZ
NAAP – Habitable Zones 1/7
Question 2: Let’s explore the width of the CHZ for other stars. Complete the table below for stars with a variety of masses.
Star Mass (M )
Star Luminosity (L )
CHZ Inner Boundary (AU)
CHZ Outer Boundary (AU)
Width of CHZ (AU)
0.3
0.7
1.0
2.0
4.0
8.0
15.0
Question 3: Using the table above, what general conclusion can be made regarding the location of the CHZ for different types of stars?
Question 4: Using the table above, what general conclusion can be made regarding the width of the CHZ for different types of stars?
Exploring Other Systems
Begin by selecting the system 51 Pegasi. This was the first planet discovered around a star using the radial velocity technique. This technique detects systematic shifts in the wavelengths of absorption lines in the star’s spectra over time due to the motion of the star around the star-planet center of mass. The planet orbiting 51 Pegasi has a mass of at least half Jupiter’s mass.
Question 5: Zoom out so that you can compare this planet to those in our solar system (you can click-hold-drag to change t ...
Name Class Date SKILL ACTIVITY Giving an Eff.docxgilpinleeanna
Name Class Date
SKILL ACTIVITY
Giving an Effective Presentation
Directions: Read the information about oral presentations. Then
complete an outline for your own presentation.
One kind of oral presentation is a speech in which you explain
a position, or opinion, about an issue. After your speech, the
audience asks questions and you answer them. Preparing is the
first step. Use the following list as a guide to prepare.
• Decide what opinion you will take—for or against—and why.
• Write a short opening statement that gives your opinion.
• Gather facts and examples that support your opinion.
• Write a short conclusion that restates your opinion.
• Brainstorm a list of questions that your audience might ask.
Write down answers to the questions.
• Practice your presentation. Keep track of how long your
speech takes.
When you make the presentation, follow these steps:
• Begin with your opening statement.
• Give facts and examples that support your opinion.
• Conclude by stating your opinion again in different words.
• Answer questions from the audience. Listen carefully to make
sure you understand each question.
• While you are speaking, remember to look at your audience.
• Speak loudly and clearly so they can hear you.
Directions: Prepare and give a presentation on the following
topic: Is the increase in temporary employment a good thing for
American workers? Copy the following outline onto your own
paper to begin organizing your ideas.
I. Your opening statement:
II. Facts and examples that support your opinion:
1–5.
III. Your conclusion:
IV. Questions the audience may ask:
1–5.
V. Answers to these questions:
1–5.
BODY%RITUAL%AMONG%THE%NACIREMA%%
Horace%Miner%
%
From%Horace%Miner,%"Body%Ritual%among%the%Nacirema."%Reproduced%by%permission%of%the%
American%Anthropological%Association%from%The%American%Anthropologist,%vol.%58%(1956),%pp.%
503S507.%
%
Most%cultures%exhibit%a%particular%configuration%or%style.%A%single%value%or%pattern%of%perceiving%
the%world%often%leaves%its%stamp%on%several%institutions%in%the%society.%Examples%are%"machismo"%
in%Spanish>influenced%cultures,%"face"%in%Japanese%culture,%and%"pollution%by%females"%in%some%
highland%New%Guinea%cultures.%Here%Horace%Miner%demonstrates%that%"attitudes%about%the%
body"%have%a%pervasive%influence%on%many%institutions%in%Nacireman%society.%
The%anthropologist%has%become%so%familiar%with%the%diversity%of%ways%in%which%different%peoples%
behave%in%similar%situations%that%he%is%not%apt%to%be%surprised%by%even%the%most%exotic%customs.%
In%fact,%if%all%of%the%logically%possible%combinations%of%behavior%have%not%been%found%somewhere%
in%the%world,%he%is%apt%to%suspect%that%they%must%be%present%in%some%yet%undescribed%tribe.%%This%
point%has,%in%fact,%been%expressed%with%respect%to%clan%organization%by%Murdock.%In%this%light,%
the%magical%beliefs%and%practices%of%the%Nacirema%present%such%unusual%aspect ...
Name Speech Title I. Intro A) Atten.docxgilpinleeanna
Name:
Speech Title
I. Intro:
A) Attention getter --
B) Purpose Statement --
C) Thesis --
II. BODY
A) Main Point Number 1:
a)
b)
c)
transition --
B) Main Point Number 2:
a)
b)
c)
transition --
C) Main Point Number 3:
a)
b)
c)
transition –
III. CONCLUSION:
A) Summary statement --
B) Memorable conclusion --
References
List all references on a separate page with the word “References” centered at the top.
Name: Suepin Nguyen
Hygiene Saves Lives
I. Intro: To give an informational speech about Ignaz Philipp Semmelweis
A) Attention getter – On each square centimeter of your skin, there are about 1,500
bacteria. That’s a lot of germs. According to a study conducted by Michigan State
University researchers, 95% of people do not properly wash their hands long enough to
kill the infection causing germs and bacteria (Jaslow, “95 Percent of People Wash Their
Hands Improperly: Are You One of Them?”).
B) Purpose Statement - That’s gross. While I can’t force you to wash your hands, perhaps
today I can help you realize just how much history and evidence is behind this crucial
bathroom ritual.
C) Thesis – Today, I will inform you all about Ignaz Philipp Semmelweis by discussing first
about his practice and studies, second about his scientific methods that saved a lot of
lives, and third about the germ theory we all take for granted.
II. BODY:
A) Main Point Number 1: To begin, I want to introduce Ignaz Philipp Semmelweis.
a) Ignaz Semmelweis became a physician and earned his doctorate degree in medicine
in 1844. This time period was known as the start of the golden age of the physician
scientist” (NPR.org). This means that doctors were expected to have scientific
training. Doctors were more interested in numbers and collecting data (Justin Lessler,
an assistant professor at Johns Hopkins School of Public Health).
b) In 1846, Dr. Semmelweis showed up for his new job in the maternity clinic at the
General Hospital in Vienna. Due to the time period, Dr. Semmelweis thought like a
physician scientist and wanted to figure out why so many women in maternity wards
were dying from childbed fever (Davis, “The Doctor Who Championed
Hand-Washing and Briefly Saved Lives”).
c) So what did he do? He collected data of his own. He studied two maternity wards in
the hospital. One was staffed by all male doctors and medical students, and the other
by female midwives. He tallied up the number of deaths in each ward and found that
women in the clinic staffed by doctors and medical students died at a rate 5 times ...
n engl j med 352;16www.nejm.org april 21, .docxgilpinleeanna
n engl j med
352;16
www.nejm.org april
21, 2005
1630
P E R S P E C T I V E
verse populations and less inclusive health care pro-
grams, cautioned Joanne Lynn, a senior research-
er with the RAND Corporation and director of the
Washington Home Center for Palliative Care Stud-
ies in Washington, D.C. “There isn’t a huge demand
for assisted suicide in good care systems, but there
could be a huge demand in much less adequate care
systems,” Lynn said.
Psychiatrist Linda Ganzini of Oregon Health and
Sciences University agrees that her state’s high-
quality system of palliative care is the factor most
responsible for keeping the number of assisted-sui-
cide cases low. “Your safety net is your end-of-life
care and your hospice care,” she said. “It’s not the
safeguards that you build into the law.”
1.
Colburn D. Why am I not dead? The Oregonian. March 4,
2005:A01.
2.
Tolle SW, Tilden VR, Drach LL, Fromme EK, Perrin NA, Hedberg
K. Characteristics and proportion of dying Oregonians who person-
ally consider physician-assisted suicide. J Clin Ethics 2004;15:111-8.
3.
Ganzini L, Nelson HD, Lee MA, Kraemer DF, Schmidt TA,
Delorit MA. Oregon physicians’ attitudes about and experiences
with end-of-life care since passage of the Oregon Death with Dig-
nity Act. JAMA 2001;285:2363-9.
4.
House of Lords Select Committee on the Assisted Dying for
the Terminally Ill Bill. Volume I: Report. HL Paper 86-I.
The story of Terri Schiavo should be disturbing to
all of us. How can it be that medicine, ethics, law,
and family could work so poorly together in meet-
ing the needs of this woman who was left in a per-
sistent vegetative state after having a cardiac ar-
rest? Ms. Schiavo had been sustained by artificial
hydration and nutrition through a feeding tube
for 15 years, and her husband, Michael Schiavo, was
locked in a very public legal struggle with her par-
ents and siblings about whether such treatment
should be continued or stopped. Distortion by inter-
est groups, media hyperbole, and manipulative use
of videotape characterized this case and demon-
strate what can happen when a patient becomes
more a precedent-setting symbol than a unique hu-
man being.
Let us begin with some medical facts. On Feb-
ruary 25, 1990, Terri Schiavo had a cardiac arrest,
triggered by extreme hypokalemia brought on by an
eating disorder. As a result, severe hypoxic–ische-
mic encephalopathy developed, and during the sub-
sequent months, she exhibited no evidence of high-
er cortical function. Computed tomographic scans
of her brain eventually showed severe atrophy of
her cerebral hemispheres, and her electroenceph-
alograms were flat, indicating no functional activ-
ity of the cerebral cortex. Her neurologic examina-
tions were indicative of a persistent vegetative state,
which includes periods of wakefulness alternating
with sleep, some reflexive responses to light and
noise, and some basic gag and swallowing respons-
es, but no signs of emotion, wi ...
Name:
Class:
Date:
HUMR 211 Spring 2018 - Midterm
Copyright Cengage Learning. Powered by Cognero. Page 1
Indicate the answer choice that best completes the statement or answers the question.
1. Each of the following is considered the business of social welfare except:
a. telling people how to live their lives.
b. ending all types of discrimination and oppression.
c. providing child-care services for parents who work outside the home.
d. rehabilitating people who are addicted to alcohol or drugs.
2. Which of the following statements is consistent with the residual view of social welfare?
a. Recipients are viewed as being entitled to social services and financial help.
b. Social services and financial help should be provided to an individual on a short-term basis, primarily during
emergencies.
c. It is associated with the belief that an individual’s difficulties are due to causes largely beyond his or her
control.
d. There is no stigma attached to receiving funds or services. In this view, when difficulties arise, causes are
sought in the society, and efforts are focused on improving the social institutions within which the individual
functions.
3. Which of the following is consistent with an institutional view of social welfare?
a. Social services and financial aid should be provided only when other measures or efforts have been exhausted.
b. Causes for client’s difficulties are sought in the society.
c. Clients are to blame for their predicaments because of personal inadequacies.
d. Recipients are required to perform certain low-grade work assignments to receive financial aid.
4. The Elizabethan Poor Law of 1601 established three categories of relief recipients:
a. the insane, the poor, and the disabled.
b. the insane, dependent children, and the poor.
c. the able-bodied poor, the impotent poor, and dependent children.
d. the disabled, wives of prisoners, and the poor.
5. Before 1930 social services and financial assistance for people in need were provided primarily by _____.
a. churches and voluntary organizations
b. federal and state institutions
c. richer European countries
d. the military
6. President Clinton and the Republican-controlled Congress abolished Aid to Families with Dependent Children (AFDC)
in 1996 and replaced it with:
a. Welfare Services for Single Mothers.
b. Temporary Assistance to Needy Families.
c. Conditional Aid to Single Parents.
d. Assistance for Poor Families.
Indicate whether the statement is true or false.
Name:
Class:
Date:
HUMR 211 Spring 2018 - Midterm
Copyright Cengage Learning. Powered by Cognero. Page 2
7. One of the businesses of social welfare is to provide adequate housing for the homeless.
a. True
b. False
8. In the past, social welfare has been more of a pure sci ...
NAME ----------------------------------- CLASS -------------- .docxgilpinleeanna
NAME ----------------------------------- CLASS -------------- DATE -----------
THE
Source Articles from
WALL STREET JOURNAL.
CLASSROOM EDITION
Chapter 17 International Trade
This article from the April2004 Wall Street Journal Classroom Edition offers a
broader view of a long-running trend in global trade: the movement of manufacturing
jobs to other countries. In "Two-Way Street," Journal staff reporters Joel Millman
and Norihiko Shirouzu explain that while many manufacturing jobs are indeed
streaming out of the U.S., some foreign companies are eagerly creating new manufac-
turing jobs in the U.S.
Before reading the article, you may want ro look up the following terms: proxim-
ity, incentives, rhetoric, value chain.
uBut free trade works both
ways, and just as U.S.
companies look overseas
for workers, a lot of foreign
companies have been
expanding their operations
in the U.S. and creating new
jobs for Americans. The
attractions for them are better
business conditions, proxim-
ity to the ever-expanding U.S.
consumer market, and the
promise of incentives that
many U.S. communities offer
to attract new investment.''
Free trade has hammered a lot of U.S. towns, making it easier for companies to send manu-facturing jobs south of
the border or overseas, and
idling hundreds of American
factories and tens of thousands
of workers.
But free trade works both
ways, and just as U.S. compa-
nies look overseas for workers,
a lot of foreign companies have
been expanding their opera-
tions in the U.S. and creating
new jobs for Americans. The
attractions for them are better
business conditions, proximity
to the ever-expanding U.S.
consumer market, and the
promise of incentives that
many U.S. communities offer
to attract new investment.
In 1999, for example,
Gruma, Mexico's largest pro-
ducer of corn flour and tor-
tillas, wanted to extend its
sa les territory in the eastern
U.S. The manufacturer found
that the quickest way was to
buy a rival, Barnes Foods, ven-
dor of the regional Pepito
brand in Goldsboro, N .C ..
After closing the $12 million
transaction, Gruma found something else: a com-
munity eager to offer incentives to persuade the
Mexican company to invest
millions more.
Within a year, Gruma
delighted Goldsboro by agree-
ing to buy an empty warehouse
the city owned outside rown.
The building had sat for four
years, after officials spent more
than $1 million trying to mar-
ket it as parr of an industrial
park. By promising to invest
$13 million locally, and add
100 jobs to Barnes's payroll,
Gruma got $200,000 chopped
off the building's sale price and
another $200,000 in grants to
defray infrastructure costs.
Gruma also received job-cre-
ation tax credits to offset
almost $200,000 annually
from its state corporate income
tax. Ultimately, the Mexican
company well exceeded the
n urn ber of new hires it
promised, tripling its Golds-
boro work force to nearly 200. ...
Name Understanding by Design (UbD) TemplateStage 1—Desir.docxgilpinleeanna
Name:
Understanding by Design (UbD) Template
Stage 1—Desired Results
Q Established Goals:
Students will understand to add and subtract of the numbers.
Understandings:
The student will understand some of the terms and symbols that are very important to add or subtract numbers.
Essential Questions:
What does the mean plus or add?
How can we find the different between two numbers?
What does “=” mean? And when can we use it?
Students will know the most popular of the three symbols:
1- "+" to add the numbers.
2- "-" to subtract the numbers.
3- "=" to equal the numbers.
Students will be able to
· Use the terms 'add, plus, equals, minus, and the difference between them'.
· Use number line to model and determine the difference between two numbers, e.g. “Difference between 7 and 4 is 3”.
· Use the symbols for plus (+), minus (–) and equals (=).
Stage 2 – Assessment Evidence
Performance Tasks:
•
I am math teacher (R) and I have been hired by the principal and council (A) of The School of Riyadh for elementary students who are 11 years old. The exercise will target the addition and subtraction of the math. I must illustrate and define each one. (G) I am going to use audio aids in teaching them then the students are going to write down new ideas in a table that I have made in a booklet. (P) The table contains topics and underneath each topic, there are three boxes that contain each pillar. Each box has to have the particular picture that defines each pillar and must be colorful as well. All this is in stapled booklet. (S) The cost of the tablet and booklets are $100. This task must be completed in one week (S2).
Other Evidence:
How were addition and a subtraction derived? (E)
How is addition translated to sunbathing? (I)
How is addition or subtraction use in our world? (A)
How does addition compare to subtraction? (P)
How can I best recognize addition and subtraction? (SK)
Stage 3 – Learning Plan
Learning Activities:
Differentiated Instruction
White Cube
(Basic Level)
EXPLAIN
Big Idea:
INTERPRET
APPLICATION
PERSPECTIVE
Unit:
Cubing Examples
using
the Six
Facets of
Understanding
EMPATHY
SELF-KNOWLEDGE
Differentiated Instruction
Red Cube
(Intermediate Level)
KNOWLEDGE
Big Idea:
.
COMPREHENSION
APPLICATION
ANALYSIS
Unit:
Cubing Examples
using
Bloom’s Taxonomy
SYNTHESIS
EVALUATION
Differentiated Instruction
(Advanced Level)
ThinkDOTS
Sternberg’s Triarchic Model
●
SC
Big Idea:
●●
SA
●●●
SC
●●
●●
SP
Unit:
Cubing Examples
using
ThinkDots and
Sternberg
●●●
●●
SP
KEY:
SC = Creativity
SP = Practical
SA = Analytical
●●●
●●.
SA
G
U
Q
S
T�
OE
L
L
Running head: KEEPING SCORE 1
Keeping Score
Jillian Grantham
Grantham University
KEEPING SCORE 2
Abstract
Proposed changes to Little League scoring policies can seriously affect the elements that make
this game not only popular, but beneficial to th ...
Name MUS108 Music Cultures of the World .docxgilpinleeanna
Name MUS108 Music Cultures of the World Points /40
Winter 2018 Exam 2
(Take Home, open notes – NOT open book)
Matching – (1 point each, 8 points total)
Match each term with one of the following cultures by writing the corresponding letter in the blank space:
A. India
B. Bali
C. Ireland
1. _______sitar
2._______kilitan telu
3._______kecak
4._______gamelan
5._______Sean-nós
6._______beleganjur
7._______alap
8._______céilí
9. Describe Irish music. Please include information from each of the 3 different “eras” discussed in the book. (4 points)
10. Describe a raga in detail, with much attention paid to form, instruments, and development/barhat. (4 points)
11. What effect did the potato famine have on the culture and music of Ireland? (6 points)
12. What is ombak? Please explain it in detail, including how it is achieved. (4 points)
13. What is the difference between ceili and session? (2 points)
5. Listening Exercise – 12 points ( 4 points each) Sound Files are on Moodle!!!
Listen to the sound clips. See if you can guess what culture/tradition they come from. You may even be able to guess the type/form of music. Please write down your thought process. What are the clues? Why might it be from one particular culture? Listen to instruments, form, texture. The right answer is not the goal. What I need to see is your reasoning. You could get full credit even if you guess the wrong culture, provided your reasoning is sound. Complete sentences are not needed; lists are fine.
Clip 1.
Clip 2.
Clip 3.
...
Name Date Test 6(Units 6 and 7)Save this test on yo.docxgilpinleeanna
Name:
Date:
Test 6
(Units 6 and 7)
Save this test on your computer, and complete the questions by marking correct answers with the “text color” function ( ) located on the “home” toolbar
Section I.Multiple Choice/True and False
1.
One of the central tenets of homeopathy is the (unfounded) assertion that water retains a "memory" of substances dissolved in it, even when the solution becomes so weak that no trace of the original substance is present. However, if we accept this hypothesis, then any quantity of tap water would have already acquired all the beneficial chemicals, and all the harmful ones too. This . . . scenario weakens the hypothesis of water memory.
This refutation is a(n)
a. reduction to the absurd
b. counterexample
c. appeal to countervailing evidence
d. post hoc
e. suppressio veri
The premises of this argument are dependent: “Dogs make better pets than cats. They’re smarter, more sociable, more loyal, and easier to train.”
True
False
2.
If we can show that any premise of an argument is false, that argument has been successfully refuted.
True
False
3.
We may have good reason to question the credibility of a source if
a. the source was not in a good position to judge accurately
b. the source has proven unreliable in the past
c. the issue is not one that can be settled by expert opinion
d. all of the above
4.
Showing that one of its crucial* premises is in principle unverifiable refutes (defeats) the argument
True
False
*Note: What Bassham titles a “critical” premise I am referring to as a “crucial premise”, because I want to avoid the ambiguity involved in the former expression (between “critical” as essential and “critical” as criticizing.)
5.
The premises of this argument are dependent: “Dogs make better pets than cats. They’re smarter, more sociable, more loyal, and easier to train.”
True
False
6.
The circumstance that a crucial premise is unsupported always renders an argument bad. (careful)
True
False
7.
The principle of rational acceptance is a crucial technique for evaluating any claim. (careful)
True
False
8
There are legitimate and important ways of criticizing an argument that still don’t contribute to refuting it.
True
False
A fuzzy argument can still be a good argument due to its intrinsic merits.
True
False
9.
A fuzzy argument can still be a good argument due to its intrinsic merits.
True
False
Section II.Short Answers
10.
Please indicate any two of the characteristics that might serve to justify accepting a claim as a legitimate premise.
11.
Name any three of the conditions that might lead to question a claim based on your own sensory experience?
12.
Please indicate any 2 of the methods for showing a premise to be dubious or false:
13.
What is the principle of rational acceptance?
14.
Glenn Beck: “The Federal Government threatening to take over the State Parks if the State Government decides to privatize its parks! That's sh ...
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
Name Add name hereHIM 2214 Module 6 Medical Record Abstractin.docx
1. Name: Add name here
HIM 2214 Module 6: Medical Record Abstracting
Instructions: In this medical record abstracting assignment you
will first need to download and the records (history & physical,
surgery consultation, operative report, pathology report and
discharge summary) for a patient with digestive system
problems. (Recommend reading them in the order listed).
Save your answers to the following related questions in this
document and submit them for this module's assignment.
1. Define the terms diverticulosis and diverticulitis.
2. What is the pathophysiology of diverticulitis?
3. What is a hiatal hernia?
4. Describe some of the signs or symptoms a person with a
hiatal hernia might have.
5. What is a pulmonary embolus?
6. What was the etiology (cause) of the pulmonary embolus for
this patient?
7. What is gastritis?
8. Which problem is likely a contributor to the patient’s Type II
diabetes mellitus?
9. What was the purpose of the barium enema?
10. What does the abbreviation HEENT stand for?
11. What is thrombophlebitis?
2. 12. What is a surgical resection?
13. Define anastomosis.
14. What is ferrous gluconate and what is it used to treat?
15. What condition is the drug Darvocet used to treat?
16. What are electrolytes?
17. What is exogenous obesity?
18. Where is the femoral pulse found/taken?
19. Where is the popliteal pulse found/taken?
20. What is hepatosplenomegaly?
21. Which condition(s) is/are the drug Humulin used to treat?
22. What is an adenocarcinoma?
23. Which condition(s) is/are the drug Lanoxin used to treat?
24. What is the purpose of ordering the blood test PTT?
25. What is a colon stricture?
26. What is/are the etiologies associated with colorectal cancer?
27. What is the medical term for gallstones?
28. Which condition(s) is the drug Zantac used to treat?
29. What does the pathology report indicate about the spread of
the carcinoma in this patient?
30. What is the etiology of Type II diabetes mellitus?
3. · Academic arguments are designed to get someone to agree
with the author, who may use pathos (emotion), logos (logic and
facts) and ethos (authority and expertise) to persuade.
Academic arguments are not about ranting, screaming or
otherwise increasing conflict, but in fact are the opposite: They
attempt to help the other person understand what the author
believes to be right (opinion) based on the evidence presented
(authority, logic, facts).
For your topic for your final paper, what kinds of arguments can
you develop for your claim (thesis, main idea)?
Health Record Face Sheet
Record Number:
005
Age:
67
Gender:
Male
Length of Stay:
3 days
Service:
4. Inpatient Hospital Admission
Disposition:
Home
Discharge Summary
Patient is a 67-year-old male. He saw the doctor recently with
abdominal pain and constipation. A barium enema showed
diverticulosis and perhaps a stricture near the sigmoid and
rectal junction. He was scoped by the doctor, who saw a
stricture at that point and said he couldn’t rule out a carcinoma.
Upper GI showed a hiatal hernia and duodenal diverticulum.
Ultrasound showed gallstones. The patient had some bladder
incontinence. He has had atrial fibrillation, diabetes, and takes
Lanoxin. Otherwise, he is doing quite well. He has had a
previous right total hip. At the time of admission, it was
thought that he had a stricture, rule out carcinoma, diabetes
mellitus, exogenous obesity, past history of atrial fibrillation,
previous right total hip. His chest film showed some chronic
blunting of the right costophrenic angle, but otherwise was
negative. His admission EKG showed what was thought to be a
normal sinus rhythm. His blood type was AB-positive.
Urinalysis was negative.
Hemoglobin was 13.3, white blood cell count 7,600. PT 12, PTT
was 23. The CEA, which came back several days later, was
quite high at 856. Glucose is 127, albumin is 3.4. Other labs
were normal. After mechanical and chemical bowel prep, he was
taken to surgery. First, we laparoscoped to see if we could do
this resection with the scope. When we found that it was
adherent to loops of adjacent small bowel, he had an open
resection. A large carcinoma of the rectosigmoid junction was
found and resected with an end-to-end anastomosis. A segment
of small bowel that was stuck to the tumor was also resected,
5. and a functional end-to-end anastomosis was done. At least four
separate liver metastases were noted. Needle biopsy of that was
done as well. The pathology report showed moderate to poorly
differentiated carcinoma, bases through the wall of the colon
and into the perirectal fat. The small intestine was not involved.
The liver metastases were also positive. The patient had a rather
smooth postoperative course. He was thought to be ready for
discharge on the sixth postoperative day. He was seen in
consultation prior to surgery by the doctor, who managed his
medical problems and diabetes and will arrange for appropriate
medication at the time of discharge. He was sent home on
Darvocet for pain. Ferrous Gluconate 324 mg three times a day
for a month to restore his blood count. He is to resume his other
previous medications. He is to restrict his activities for 2
months and to see me in the office in 8 days.
Final Diagnosis:
1. Invasive adenocarcinoma of the rectosigmoid, metastatic to
the liver
2. Type II diabetes mellitus
3. Exogenous obesity
4. Atrial fibrillation
5. Previous right total hip replacement
Surgical Procedure: Resection of rectosigmoid with low pelvic
anastomosis with an EEA, small bowel resection, liver biopsy.
History & Physical
Patient is a 67-year-old male. He has been in to see the doctor
recently with abdominal pain and complains that he was unable
to move his bowels. He was admitted and subsequently had
6. endoscopy following a number of x-rays. The x-rays showed
diverticulosis of the sigmoid and perhaps a stricture near the
sigmoid rectal junction. This was difficult to delineate because
of overlapping loops of bowel. The patient had an upper GI
showing hiatal hernia and a duodenal diverticulum, and an
ultrasound showing gallstones. The patient was subsequently
seen by the doctor. A week ago today, the doctor performed
upper GI endoscopy, which showed a little antral gastritis. A
sigmoidoscopic examination showed, at about 25 cm, a
narrowed area of the bowel with edema and stricture, and some
blood oozing from above. Doctor said that he could not be sure
whether this was strictly a diverticular stricture or whether
there was a tumor above this point. The patient has otherwise
been pretty healthy.
He had a previous fracture in the right hip. He had pulmonary
embolus secondary to thrombophlebitis in his legs on two
different occasions. He is not a smoker and seldom drinks. He
has no known allergies. Both parents are deceased. He has had
type II diabetes for about 5 years and takes Tolinase 150 mg
two times a day. He has had atrial fibrillation in the past and
takes Lanoxin 0.125 mg a day for that condition. He has never
had hypertension, heart disease (other than the atrial
fibrillation), or stroke. He has no chest pain or shortness of
breath. He has had quite a bit of heartburn and indigestion, but
this definitely has been improved by Zantac. He has some
bladder incontinence
Physical Examination
He weighs 174. He is 5’ 61/2” tall. BP 152/84 on the right,
148/78 on the left. Pulse was 80. Examination of the HEENT
was negative. The patient seemed extremely alert. Him has good
carotid pulses without bruits. No goiter or nodes in the neck.
The heart rate was regular. The heart was not enlarged. There
was no murmur. The lungs were clear to auscultation and
percussion. There was a low midline scar. No
hepatosplenomegaly. There was a little left lower quadrant
7. tenderness. Rectal exam was not repeated. He had good femoral,
popliteal, and dorsalis pedis pulses. The ankles were quite
thick. There was a scar on his right hip from previous surgery.
Neurologic function is normal. His skin tended to be sweaty and
clammy, which he says is the normal case for his.
Impression
1. Stricture of the sigmoid seen on barium enema and
colonoscopy, probably secondary to diverticular disease,
causing obstructive symptoms, 2. Type II diabetes mellitus, 3.
Exogenous obesity, 4. Past history of atrial fibrillation. Plan:
Resection.
Surgical Consultation
It was a pleasure to see your patient, who is well known to me
from my office. He is a pleasant 67-year-old white, obese male
who, over the past 3 to 4 months, has had increasing amounts of
difficulty with bowel movements. He has a complaint of small,
pencil-thin bowel movements with some blood noted. The
patient also had some difficulty
with upper GI indigestion, as well as gastritis. He has been
evaluated per gastroenterology at the hospital and diagnosed
with antral gastritis as well as diverticulosis, diverticulitis with
narrowing of the sigmoid colon, approximately 25 cm via
colonoscopy. The patient has had a workup that included an
upper GI series and endoscopies that have shown the above
problem, etiology yet to be determined. The patient has a rather
strong family history of having similar type of etiologies.
Apparently, his three sisters have had similar surgeries,
surgery-like etiology secondary to narrowing of sigmoid colon,
and difficulties with irritable bowel–type symptoms. The patient
has had difficulty with his bowel movements for many years.
However, during the past 3 months they have become somewhat
bloodier, as well as worsened in types. The patient came to my
office approximately 3 months ago with the above etiology.
Workup was done then and is on previous chart for review.
8. His past medical history is consistent with type II diabetes
mellitus. He is currently on Tolinase bid with fairly good
control at home when the patient follows his diet. The patient
does not have a history of smoking, nor does he drink. He
currently lives alone. The patient had a hip replacement
approximately a year or year and half ago with no sequelae. The
patient has previous history of pulmonary embolus. However, he
has had no difficulty with the previous surgery noted.
The medication protocol at home includes one-a-day aspirin and
Tolinase bid basis. He is also taking Lanoxin 0.125 mg for
previous history of atrial fibrillation, which has currently been
controlled with normal sinus rhythm for the last 1-year period
of time noted. The patient has been evaluated for urinary
incontinence secondary to a low-lying bladder. The patient has
been in fairly good health except for mild diabetes mellitus,
which is controlled with diet as well as oral medications.
Otherwise, he has done well and has been in fairly stable
condition up to the recent history with his colon problems.
On physical examination, the patient’s general HEENT, eyes,
ears, nose, and throat are basically clear. Neck does not show
any cervical nodes. Neck is clear for adenopathy. Lungs are
clear to auscultation; no rales, rhonchi, or friction rubs. No
wheezing. The heart rate is regular rate and rhythm. Abdomen is
soft, not overtly tender at this time. Extremities do not show
any edema. Cranial nerves are grossly intact as tested. The
patient’s EKG shows that of normal sinus rhythm, as evaluated
by the consultant. The lab work shows a glucose of 127. BUN
and creatinine are within normal limits, as are the electrolytes.
Albumin is slightly low at 3.4, with a total protein of 6.0. The
liver function profile, SGOT, alk. phos., and bilirubin are
within normal limits, as well as triglycerides.
Diagnostic Impressions
1.
Diverticulosis/diverticulitis with sigmoid constriction, etiology
9. to be determined,
rule out primary disease, that of diverticulosis or diverticulitis
versus overt tumor
2.
Diabetes mellitus
3.
Atrial fibrillation by history, current normal sinus rhythm
4.
Generalized obesity
Recommendations
1.
Will put the patient on medication protocol, Lanoxin for control
of atrial fibrillation,
normal sinus rhythm.
2.
Will start a sliding scale Insulin, with regular Humulin Iinsulin
while he is
undergoing surgery. Back on Tolinase postsurgery if control is
indicated at that
time.
Operative Report
Preoperative Diagnosis: Probable diverticular stricture of the
sigmoid, rule out carcinoma
Postoperative Diagnosis: Carcinoma of the sigmoid invading
into adjacent small bowel with metastases to the liver
Procedure: Attempted laparoscopic bowel removal, open
exploration with resection of the sigmoid colon and end-to-end
anastomosis with 28 mm EEA. Resection of segment of small
bowel with direct extension of the tumor into that area with the
functional end-to-end anastomosis, doing a side-to-side
anastomosis, biopsy of liver metastases.
10. Patient is a 67-year-old male who presented with abdominal
pain and constipation. Barium enema suggested diverticular
stricture. Patient was seen in consultation by the doctor, who
sigmoidoscoped the patient and found a stricture at about 25
cm. Doctor could not see above the stricture, so we could not
rule out carcinoma. Patient understood the nature of the
problem, the proposed surgical risk, and its possible
complications, and consented to it. He was given a mechanical
and chemical bowel prep.
Patient was brought to surgery and an NG tube was placed in
the stomach and a Foley in the bladder. He was placed in the
lithotomy position; routine prep and drape were done. We made
a small incision in the right upper quadrant, directly into the
peritoneal cavity and inserted the Hasson cannula, insufflated
the peritoneal cavity with C02. Once we had a good tent, we
examined the peritoneal cavity and could not really see the liver
because we were so close to it. We then dissected out the
sigmoid after we put in three other cannulas, a 12-mm in the
right lower quadrant, a 10-mm in the left lower quadrant, and a
5-mm in the left upper quadrant. These were put in under direct
vision. We then grasped the sigmoid and dissected it off the left
pelvic gutter, and dissected down toward the bladder. We could
not get the small bowel to easily come up out of the pelvis. We
then put the colonoscope through the rectum and came up to 25
cm, where we saw not a diverticular stricture, but a carcinoma.
We marked this point. When we were dissecting, we found the
small bowel to be adherent at this time and we elected to open,
so the trocars and instruments were all removed. We then made
a midline incision and, on inspection, found a large mass in the
pelvis. We had already freed up the left side of the sigmoid
colon with laparoscope. We identified the ureter and pushed it
away, opened the right pelvic peritoneum and identified the
right ureter, and then transected the bowel above the junction of
the sigmoid and descending colon with the GIA. We then
11. divided the mesentery between Kelly clamps, including the
inferior mesenteric terminal branch. These were all divided and
ligated with heavy silks. We pulled the small bowel off the side,
but it did look like there was some direct invasion there, and
then further mobilized the tumor and the upper rectum. We
divided all the mesentery between Kelly clamps and ligated
with heavy silk.
We then transected the rectum through its middle and upper one
thirds, with TA55 on the distal side and Kocher on the proximal
side, and then removed the specimen. We brought the proximal
end of the bowel out, cleaned it off of fat and mesentery, put a
pursestring instrument on it, excised the bowel distal to the
pursestring instrument, opened the pursestring instrument, and
then incised it. The size was 28 mm. We then put the anvil of
EEA in the proximal bowel and tightened it down with
pursestring. We put the EEA instrument up through the rectum,
pushed the trocar up through the suture line, then connected the
anvil to the EEA instrument and tightened it down under direct
vision, cut the bowel making the anastomosis and removed the
EEA. We then filled the pelvis with saline, clamped the bowel
proximally, and put in the colonoscope to obtain a good
anastomosis with no bleeding and no leak of air.
We then aspirated the fluid in the pelvis. We resected the
segment of the small bowel with GIA and did a functional end-
to-end anastomosis and transected the bowel loop outside the
anastomosis with a TA55. We actually had done this before we
completed the rectal anastomosis, and when we went back we
found a hematoma in the mesentery.
We dissected through the hematoma to get it controlled, ligated
the bleeders with heavy silk, but then we had to resect another
10 cm of small bowel and then did another functional end-to-
end anastomosis and closed the enterotomy with TA55 and the
mesentery with fine silks. This gave us a nice anastomosis with
good pink bowel, pretty close to the cecum.
We then noted there to be at least three, maybe four, metastases
scattered over different areas of the right lobe of the liver. One
12. was biopsied with a Tru-cut needle and the biopsy site
cauterized. We then had a correct sponge, instrument, and
needle count. We closed the fascia of the right upper quadrant
puncture wound with some interrupted silk Vicryls and closed
the muscles with interrupted Vicryls. The other smaller ports
were closed by skin clips. We then closed the fascia of the
peritoneum of the midline wound with running suture of #l
Vicryl and the fascia with interrupted figure 8 #l Vicryl, closed
the skin with clips, and applied sterile dressings. Sponge,
instruments, and sharp counts were again correct. The patient
tolerated the procedure well and we trust he will do well.
Pathology Report
Specimen—Origin:
I.
Small bowel sigmoid colon
II.
Liver biopsy
Pathologic Diagnosis:
I.
Segments of small bowel: Serosal adhesions
Colon: Invasive adenocarcinoma, moderate to poorly
differentiated, extending into pericolic adipose
Lymph nodes, small bowel mesentery: Negative for metastasis
(0/6 nodes)
Lymph nodes, pericolic: Negative for metastasis (0/6)
Pericolic adipose: Metastatic adenocarcinoma