Three Rivers College

Abstract Community colleges are two‐year educational institutions that represent a global movement embedded in local community norms. Community colleges serve local economic needs by offering affordable courses that transfer to four‐year institutions; technical and occupational training; continuing and remedial education programs; and workforce development. In the USA they have become a key point of entry to college for those who could not otherwise afford or access a college education, and a key provider of English as a second language to adult immigrants. Community college student populations tend to be made up of both lower socioeconomic levels and under‐represented groups; thus, they serve a democratizing function within higher education and the larger society. These institutions face particular challenges because success, funding, and political capital in higher education are tied to a neoliberal emphasis on degree completion and upward social mobility, yet efforts to increase retention and accelerate the time to degree completion can undermine efforts at accommodating the most vulnerable students. This entry examines the open‐door and democratizing functions of community colleges, and the competing challenges on economic and political levels experienced by these institutions.

Hemodialysis (HD), from the clinical perspective, involves the HD machine, blood lines or tubing, and a dialyzer that mimics the physiologic action of the kidneys to clear the blood of wastes or by-products. A literature review was performed to identify preventative measures of coagulation during HD treatment. EBSCOhost, Academic Search Premier, MEDLINE, and PubMed were used. Seventy-nine (79) related articles were found. Sixty-one (61) were excluded, and 18 were included in the study. Low-dose/unfractionated heparin, low molecular weight heparin(s), airless tubing system, specially formulated dialyzers, continuous saline flushes, and contact activation inhibitor-AB023, combining heparin-coated dialyzers with intermittent saline flushes, are useful preventive measures. It is important to evaluate the individual needs of each patient in making decisions regarding treatment.

The auricular composite graft consists of a free tissue graft containing part of the auricular cartilage attached to its overlying skin. The survival of the auricular composite graft depends primarily on its size, and a graft diameter of 1- 2 cm has been previously reported as the critical cut-off size. The auricular composite graft is a reliable option for the reconstruction of skin defects of the nasal sidewall and the nasal ala, and its survival rates can be enhanced with the utilization of specific surgical techniques. These include increasing the contact surface with skin de-epithelization/ perichondrial underlay in the surgical bed, injection of autologous platelet-rich plasma, and non-strangulating nasal sidewall splinting. Here, we report a 64-year-old man with a skin lesion in the right nasal ala who underwent Mohs micrographic surgery. The lesion was reconstructed with the use of composite auricular skin graft.

Nasal airway obstruction is a prevalent chief complaint in the contemporary facial plastic surgery practice. Studies report an asymmetric distribution of plastic surgeons across the United States with a disproportionately high concentration of surgeons practicing in urban areas. The lack of elective specialist care creates unique challenges for these patients who may need to travel and dedicate time to reach a nasal surgery expert. We conducted a retrospective chart review to report our experience from practicing functional nasal surgery in such a non-urban setting in the United States. A total of 103 patients underwent functional nasal surgery (FNS) between May 2015 and August 2021 including septoplasty, inferior turbinate reduction, septorhinoplasty and nasal valve procedures. We present the epidemiological characteristics, surgical techniques used and postoperative complications and illuminate the unique characteristics of practicing FNS in the non-urban setting.

With Sticks and Stones, Peter Kuper reveals why he is a significant figure in the field of visual storytelling as he presents this wordless narrative, a "picture story of epic proportions" (Kuper jacket).This wordless book is part of a larger tradition of graphic narratives that began when Frans Masereel "established an historical pre cedent for modern graphic storytelling" when he published his first novel without words in 1919 (Eisner Graphic Storytelling 1).Sticks and Stones, like the wordless texts of Masereel, Lynd Ward, and Otto Niickel, deals with serious issues and substantial themes.This book chronicles the rise of an empire and tackles issues of birth and death, and war and peace while it presents a "cautionary tale for our present-day world" (Kuper jacket).Sticks and Stones opens with images of a volcano, which ultimately generates the story's main character.The reader sees this character mature, and when he meets other people, they begin to construct a city.With a little opposition, the main character assumes the role of leader of this civilization.Then, these people dis cover the existence of a rival civilization, which is shown in color instead of the muted black and white stencil of the original civilization.This presentation of color symbolizes the cultural differences of the two empires as this empire is dominated by wood, or sticks, not stone, and has fire, games, and music.Soon, however, the people of the stone world decide to attack this empire.The only person to object to this declaration of war is imprisoned for his disobedience.

The Afghan osteotomy was combined with external fixation on 19 patients (23 extremities) with late-onset tibia vara. The average weight was 258 lb and all patients weighed >95th percentile. The average preoperative deformity was 28.2°. The average intraoperative correction was 27.6°. Average healing time was 141 days. The mean follow-up was 2.7 years. Based on radiographic correction, at long-term follow-up, there were 15 excellent, two fair, and six poor results. The quality of the initial correction was the only significant variable, and it was borderline (p = 0.0587). Complications included loss of alignment, peroneal nerve palsy, superficial pin tract infection, deep infection, and fracture. This method offers a technically simple procedure with a relatively low complication rate. It allows early mobilization and provides the ability to manipulate the correction postoperatively. An excellent long-term outcome is predicated on achieving an acceptable initial correction as determined by intraoperative mechanical axis radiographs.