Cowden syndrome - Diagnostic skin signs

Cowden syndrome is a rare autosomal dominant familial cancer syndrome with a high risk of breast cancer. The most important clinical features include carcinomas of the breast and thyroid, and hamartomatous polyps of the gastrointestinal tract. There are characteristic mucocutaneous features which allow early recognition of the disease and are generally present before internal malignancies develop. We report on a woman in whom the diagnosis of Cowden syndrome was first made after she had been treated for both breast cancer and melanoma. Copyright (C) 2001 S. KargerAG, Basel

What Happens at the Intersection of Policy and Practice? Examining Role Conflict and Professional Alienation of Occupational Therapy Professionals in Complex Environments

ABSTRACT To examine what happens at the intersection of policy and practice, this dissertation utilizes a three-article format to advance public administration scholarship and contribute to health system research about occupational therapy. This work creates bridging links between public administration scholarship in the areas of street-level bureaucracy and policy alienation and the occupational therapy profession. The articles combine to inform the occupational therapy community by providing empirical findings to validate role conflict and professional alienation experiences of practicing occupational therapy professionals when implementing policy in practice. The Article One thesis asserts that while policy content matters, it is vital to understand the context of policy, and by extension, the context of practice as a response to policy implementation. Drawing on institutional theory, this work offers an historical review of policy-specific critical junctures in occupational history and how policy has influenced occupational therapy practice. Article Two connects institutional theory, street-level bureaucracy scholarship, and policy alienation research to explain the experience of role conflict related to implementation of productivity standards for occupational therapy professionals. Article Three utilizes street-level bureaucracy theory and policy alienation scholarship to provide the foundation for introducing “professional alienation” as an extension of policy alienation constructs. The article examines the extent to which occupational therapy professionals feel pressured to alienate core professional values, such as client-centered care, in practice. Articles Two and Three present the empirical findings from this original research study, which employed online survey methodology to explore the relationship of professional profile characteristics and work context factors with the two dependent variables of interest – role conflict and professional alienation. T-tests and multiple regression analyses indicate that professional profile characteristics such as professional credential/status and direct treatment provider designation influence role conflict and professional alienation. Work context factors that contribute to role conflict and professional alienation appear related to practice parameters and policy expectations in specific practice environments such as long term care/skilled nursing facilities and pediatric practice settings. This study lends support for future research including frontline storytelling of occupational therapy professionals, exploration of context differences, and coping strategies of frontline workers

From Women-Staffed to Women-Led: Gender and Leadership in Academic Libraries, 1974-2018.

This article reviews post-1974 scholarly literature on women’s leadership in academic libraries, with the emphasis on the United States. The purpose of this synthesis is to highlight research areas and themes that have significantly expanded the profession’s knowledge about gender and its impact at the top administrative level. The article starts with a brief overview of theories of gender and leadership before tracing scholarship on the gendered career patterns singled out in Schiller’s work (1974). The article then focuses on additional issues related to gender and library administration, including leadership styles, perceptions of differences between male and female leaders, and the lack of diversity among academic library women directors

Effect of nocturnal oxygen and acetazolamide on exercise performance in patients with pre-capillary pulmonary hypertension and sleep-disturbed breathing: randomized, double-blind, cross-over trial

Aim Sleep-disturbed breathing (SDB) is common in pre-capillary pulmonary hypertension (PH) and impairs daytime performance. In lack of proven effective treatments, we tested whether nocturnal oxygen therapy (NOT) or acetazolamide improve exercise performance and quality of life in patients with pre-capillary PH and SDB. Methods This was a randomized, placebo-controlled, double-blind, three period cross-over trial. Participants received NOT (3 L/min), acetazolamide tablets (2 × 250 mg), and sham-NOT/placebo tablets each during 1 week with 1-week washout between treatment periods. Twenty-three patients, 16 with pulmonary arterial PH, 7 with chronic thromboembolic PH, and with SDB defined as mean nocturnal oxygen saturation 10 h−1 with daytime PaO2 ≥7.3 kPa participated. Assessments at the end of the treatment periods included a 6 min walk distance (MWD), SF-36 quality of life, polysomnography, and echocardiography. Results Medians (quartiles) of the 6 MWD after NOT, acetazolamide, and placebo were 480 m (390;528), 440 m (368;468), and 454 m (367;510), respectively, mean differences: NOT vs. placebo +25 m (95% CI 3-46, P= 0.027), acetazolamide vs. placebo −9 m (−34-17, P = 0.223), and NOT vs. acetazolamide +33 (12-45, P < 0.001). SF-36 quality of life was similar with all treatments. Nocturnal oxygen saturation significantly improved with both NOT and acetazolamide. Right ventricular fractional area change was greater on NOT compared with placebo (P = 0.042) and acetazolamide (P = 0.027). Conclusions In patients with pre-capillary PH and SDB on optimized pharmacological therapy, NOT improved the 6 MWD compared with placebo already after 1 week along with improvements in SDB and haemodynamics. ClinicalTrials.gov NTC0142719

MALDI-TOF MS for the identification of cultivable organic-degrading bacteria in contaminated groundwater near unconventional natural gas extraction sites

Groundwater quality and quantity is of extreme importance as it is a source of drinking water in the United States. One major concern has emerged due to the possible contamination of groundwater from unconventional oil and natural gas extraction activities. Recent studies have been performed to understand if these activities are causing groundwater contamination, particularly with respect to exogenous hydrocarbons and volatile organic compounds. The impact of contaminants on microbial ecology is an area to be explored as alternatives for water treatment are necessary. In this work, we identified cultivable organic-degrading bacteria in groundwater in close proximity to unconventional natural gas extraction. Pseudomonas stutzeri and Acinetobacter haemolyticus were identified using matrix-assisted laser desorption/ionization-time-of-flight-mass spectrometry (MALDI-TOF MS), which proved to be a simple, fast, and reliable method. Additionally, the potential use of the identified bacteria in water and/or wastewater bioremediation was studied by determining the ability of these microorganisms to degrade toluene and chloroform. In fact, these bacteria can be potentially applied for in situ bioremediation of contaminated water and wastewater treatment, as they were able to degrade both compounds.info:eu-repo/semantics/publishedVersio

Laser-Spectroscopic Investigation of OH-Radical Concentrations in the Exhaust Plane of Jet Engines

Hydroxyl radical (OH) emissions are relevant for oxidation reactions in the post flame chemistry of exhaust gases emitted from jet engines. No direct measurements of OH concentrations are available to date due to the low abundance and the short lifetime of this radical species. The first application of a combined technique based on Raman scattering and laser_induced fluorescence (LIF) spectrometry is presented here for measurements in the exhaust gases of a commercial jet engine operated in a test rig. From the measurements, upper limits for OH concentrations in the exit plane were determined in the range of 90 ppbv for take off and 80 ppbv for ap_idle. The values are significantly below the predictions of model calculations based on HONO and HNO3 in_flight concentration measurements presented recently. Possibilities for further increase of the detection sensitivity for OH are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86750/1/Sick34.pd

Stopping and Radial Flow in Central 58Ni + 58Ni Collisions between 1 and 2 AGeV

The production of charged pions, protons and deuterons has been studied in central collisions of 58Ni on 58Ni at incident beam energies of 1.06, 1.45 and 1.93 AGeV. The dependence of transverse-momentum and rapidity spectra on the beam energy and on the centrality of the collison is presented. It is shown that the scaling of the mean rapidity shift of protons established for AGS and SPS energies is valid down to 1 AGeV. The degree of nuclear stopping is discussed; the IQMD transport model reproduces the measured proton rapidity spectra for the most central events reasonably well, but does not show any sensitivity between the soft and the hard equation of state (EoS). A radial flow analysis, using the midrapidity transverse-momentum spectra, delivers freeze-out temperatures T and radial flow velocities beta_r which increase with beam energy up to 2 AGeV; in comparison to existing data of Au on Au over a large range of energies only beta_r shows a system size dependence