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\"How much do you really know about medieval knights? What happened to a captured knight? Who was the greatest knight? Each page in this series presents a large full-color illustration and simple paragraph containing fun facts about gear, historical figures, and day-to-day life that encourage kids to explore this high-interest topic in more detail.\"--Provided by publisher.

Whole breast irradiation delivered once per day over 3–5 weeks after breast conserving surgery reduces local recurrence with good cosmetic results. Accelerated partial breast irradiation (APBI) delivered over 1 week to the tumour bed was developed to provide a more convenient treatment. In this trial, we investigated if external beam APBI was non-inferior to whole breast irradiation. We did this multicentre, randomised, non-inferiority trial in 33 cancer centres in Canada, Australia and New Zealand. Women aged 40 years or older with ductal carcinoma in situ or node-negative breast cancer treated by breast conserving surgery were randomly assigned (1:1) to receive either external beam APBI (38·5 Gy in ten fractions delivered twice per day over 5–8 days) or whole breast irradiation (42·5 Gy in 16 fractions once per day over 21 days, or 50 Gy in 25 fractions once per day over 35 days). Patients and clinicans were not masked to treatment assignment. The primary outcome was ipsilateral breast tumour recurrence (IBTR), analysed by intention to treat. The trial was designed on the basis of an expected 5 year IBTR rate of 1·5% in the whole breast irradiation group with 85% power to exclude a 1·5% increase in the APBI group; non-inferiority was shown if the upper limit of the two-sided 90% CI for the IBTR hazard ratio (HR) was less than 2·02. This trial is registered with ClinicalTrials.gov, NCT00282035. Between Feb 7, 2006, and July 15, 2011, we enrolled 2135 women. 1070 were randomly assigned to receive APBI and 1065 were assigned to receive whole breast irradiation. Six patients in the APBI group withdrew before treatment, four more did not receive radiotherapy, and 16 patients received whole breast irradiation. In the whole breast irradiation group, 16 patients withdrew, and two more did not receive radiotherapy. In the APBI group, a further 14 patients were lost to follow-up and nine patients withdrew during the follow-up period. In the whole breast irradiation group, 20 patients were lost to follow-up and 35 withdrew during follow-up. Median follow-up was 8·6 years (IQR 7·3–9·9). The 8-year cumulative rates of IBTR were 3·0% (95% CI 1·9–4·0) in the APBI group and 2·8% (1·8–3·9) in the whole breast irradiation group. The HR for APBI versus whole breast radiation was 1·27 (90% CI 0·84–1·91). Acute radiation toxicity (grade ≥2, within 3 months of radiotherapy start) occurred less frequently in patients treated with APBI (300 [28%] of 1070 patients) than whole breast irradiation (484 [45%] of 1065 patients, p<0·0001). Late radiation toxicity (grade ≥2, later than 3 months) was more common in patients treated with APBI (346 [32%] of 1070 patients) than whole breast irradiation (142 [13%] of 1065 patients; p<0·0001). Adverse cosmesis (defined as fair or poor) was more common in patients treated with APBI than in those treated by whole breast irradiation at 3 years (absolute difference, 11·3%, 95% CI 7·5–15·0), 5 years (16·5%, 12·5–20·4), and 7 years (17·7%, 12·9–22·3). External beam APBI was non-inferior to whole breast irradiation in preventing IBTR. Although less acute toxicity was observed, the regimen used was associated with an increase in moderate late toxicity and adverse cosmesis, which might be related to the twice per day treatment. Other approaches, such as treatment once per day, might not adversely affect cosmesis and should be studied. Canadian Institutes for Health Research and Canadian Breast Cancer Research Alliance.

This online survey study examined the most frequently performed and most important clinical procedural skills (CPSs) and location of CPSs training in a sample of 102 primary care nurse practitioners across a 6 state/jurisdiction region of the United States. Results indicated that 7 CPSs were reported as being performed at least once a week by > 30% of participants, and the same 7 CPSs were reported as very important by > 50% of participants. Results facilitate formation of a list of core CPSs for primary care nurse practitioners for standardization of CPSs curricular requirements. •Deciding which clinical procedural skills to teach in nurse practitioner programs is garnering interest among educators and other stakeholders.•Limited literature addresses the types of clinical procedural skills taught in primary care nurse practitioner programs or performed in practice.•Results identified the 7 clinical procedural skills performed most often and rated as most important by participants.•Four of the most frequently performed and most important clinical procedural skills lie within a registered nurse or medical assistant scope of practice, which merits further investigation.

NP programs educate NPs in CPS commonly encountered in the care of specific populations. However, NPs transitioning to practice do so in a wide variety of settings and provide care to patients with a wide diversity of acuities whose care and management may require recognition of the need or performance of new CPS. Statement of the problem. With primary care NPs functioning in varied settings and roles requiring additional CPS knowledge and skills, NPs have expressed lack of preparedness regarding CPS. Although some evidence identified those CPS considered important to and frequently performed by NPs, the literature provides insufficient evidence to identify the CPS performed most frequently and rated as most important by primary care NPs in practice, and existing curricular standards lack clarity regarding which CPS to include in program curricula. This project aimed to conduct a practice analysis of the most frequently performed and most important CPS to primary care NPs in one region of the country to provide data to inform regional and national stakeholders regarding the current state of primary care NP CPS, and to guide standardization of primary care NP CPS curricular requirements. The Donabedian Model provided the theoretical underpinning for this project. The model component Structure represented academia and CCNE, individual state/jurisdiction boards of nursing, and the individual clinical practice settings. The model component Process represented the NP’s CPS knowledge and skills to diagnose and treat his patient in accordance with established practice standards. The model component Outcomes represented the patient’s receipt of high-quality care to facilitate improved health, and delivery of high-quality care also represented the outcome for the practice settings. Method. This project utilized a correlational design with a cross-sectional approach of a convenience sample, to recruit 102 NPs working in primary care in one multi-state/jurisdiction regions of the United States. Laustsen’s (2013) PCCSSI was modified and served as the data collection tool. The Catholic University of America IRB reviewed and approved the project before commencing to ensure the protection of human subjects. Data cleaning, frequency analysis to check for errors, outliers, and missing data, and Little MCARs test assessed for missing data patterns prior to analysis. This project answered five specific questions. Results. Question one: What is the frequency of individual CPS performance by primary care NPs? The results demonstrate of the 94 CPS surveyed, 62 were reported as performed “never” by > 50% of participants. Of the remaining 32 CPS, seven were reported as being performed “at least once a week” by > 30% of participants. Question two: What is the level of importance of individual CPS performed by primary care NPs? The results demonstrate of the 94 CPS surveyed, 43 were reported as “not important” by > 50% of participants. Of the remaining 51 CPS, eight were reported as “very important” by > 50% of participants. Question three: Does a relationship exist between the frequency and level of importance of CPS? The results demonstrated significant associations between frequency and importance in all 50 CPS examined, with effect sizes ranging from moderate to large. Question four: Does the level of importance and frequency of performance vary by geographic practice setting (urban vs. suburban vs. rural)? The results demonstrated significant associations between importance and location in 8 of the 50 CPS and demonstrated significant associations between frequency and location in 16 of the 50 CPS. Question five: For a CPS, does a relationship exist across performance of the CPS, importance of the CPS and receipt of CPS training in a NP program? Results across frequency, importance, and training demonstrated that the highest-order interaction (frequency x importance x training) was significant for three CPS: abscess- incision and drainage; splinting: wrist and hand; and eye irrigation. Summary of conclusions. Prior research from an exemplar study by Kennedy-Malone et al. (2008) supports this project’s finding that certain CPS are more likely to be performed more often by participants practicing in suburban or rural areas than by participants practicing in urban areas. As no prior literature examined a potential relationship between frequency and importance, the findings of this project and its use of inferential statistical tests constitutes a seminal appraisal of the current state of primary care NP CPS in one multistate/ jurisdiction region, providing information to NONPF for consideration of recommendations for curricular content. The identification of frequently performed CPS, which may lie within a RN or medical assistant scope of practice, merits further investigation. Examination of why NPs are performing CPS which can be performed by RNs or medical assistants needs to be addressed to facilitate clearer identification of actual CPS required in academic NP programs. In conclusion, this project advanced the examination of primary care NP CPS, furnishing data to facilitate the design of future studies exploring these topics, as well as to drive formation of a list of core CPS for primary care NPs for standardization of CPS curricular requirements.

Diagnostic reference levels assist in the optimisation of radiation exposure parameters within a medical imaging facility. As no Australian DRLs currently exist, radiation doses from mammography in BreastScreen Queensland are analysed. Program-based DRLs of 1.1 and 1.4 mGy are proposed for digital radiography and computed radiography mammography systems, respectively.

The present study, in an attempt to provide conceptual clarification of issues surrounding cross-cultural psychotherapy in South Africa, explores a variety of problems which may arise in the practice of psychotherapy in this context. This involves an examination of the implications of a notion of culture for the broader socio-political context in this country.Interviews were conducted with qualified clinical psychologists who work in contexts where they are engaged in psychotherapy with people from different cultural backgrounds in order to obtain qualitative data regarding their perceptions and conceptualisations of cross-cultural psychotherapy.It was found that themes similar to those elicited from a review of the relevant literature were discussed by the psychologists that were interviewed. These themes are conceptualised as a dialectic which is then explored using the framework of cybernetic complementarities. A conceptual clarification of cross cultural-psychotherapy is presented in an attempt to resolve this dialectic.Recommendations for further research in this context are made.