Gorlin syndrome in a patient with skin type VI

Gorlin syndrome, also known as nevoid basal cell carcinoma syndrome, is a rare autosomal dominant disorder that is characterized by multiple basal cell carcinomas developing at a young age, keratocystic odontogenic tumors of the jaw, palmar or plantar pits, calcification of the falx cerebri, and skeletal abnormalities. Nevoid basal cell carcinoma syndrome is caused by mutations in the PTCH1 or SUFU genes. Our patient with Fitzpatrick skin type VI was diagnosed with Gorlin syndrome based on the presentation of multiple major diagnostic characteristics. Although he is 33 years old, he has not developed any multiple basal cell carcinomas to date

Tufted angioma presenting with subclinical coagulopathy

Tufted angioma is a rare, benign vascular tumor of uncertain pathogenesis, characterized histopathologically by "tufts" of capillaries within the dermis. A life-threatening coagulopathy, Kasabach-Merritt phenomenon, occurs in approximately 10% of cases of tufted angioma and is characterized by profound thrombocytopenia and fibrinogen consumption. We present an asymptomatic 10-month-old boy who presented with an erythematous patch of the right upper extremity and subsequently was diagnosed by biopsy with tufted angioma. Baseline laboratory workup of our patient revealed mildly decreased fibrinogen and elevated D-dimer levels without thrombocytopenia or elevated partial thromboplastin time. This suggests that asymptomatic patients with tufted angioma may present with coagulopathy in the absence of Kasabach-Merritt phenomenon. This also highlights the importance of obtaining baseline laboratory workup in patients presenting with tufted angioma

Exploring Work Satisfaction of Women in Educational Leadership from a Racial Perspective During Times of Crisis

In education, critical shifts and pandemic repercussions have heightened pressures. Women leaders, particularly those of color, grapple with gender and racial inequalities that shape their roles (Sanchez-Hucles & Davis, 2010). This study explores women\u27s leadership experiences, focusing on work satisfaction through a racial lens. Utilizing Resilience Theory, it delves into women\u27s perceptions, employing a quantitative approach through an electronic survey at a women educators\u27 conference. Examining racial categories, the research uncovers correlations between work satisfaction, job fit, commitment, and work-family balance. ANOVA results show no significant job satisfaction differences based on race, while Welch t-test identifies varied responses. Findings illuminate the intricate interplay of gender, race, and job satisfaction, shaped by cultural, social, and personal factors. These results, seen in the context of critical times in education, underscore the resilience of women in leadership roles. Acknowledging these dynamics, especially for women of color, enriches understanding for aspiring women leaders facing diverse educational leadership challenges

Igniting Resilience During Critical Times: Reflections of Women Superintendents

This qualitative study sought to explore the perceptions of women school superintendents in K -12 public schools in Texas about the challenges they face as leaders and how they endure these impactful challenges, particularly during critical times such as the COVID-19 pandemic. Using Polidore’s Resilience Theory (2004) as the theoretical framework, the study sought to determine which of the nine resilience qualities, either innately possessed or through acquisition over time, helped to sustain the women superintendents during adverse situations associated with the highest level of leadership in a school district. The nine qualities of resilience include: religion, flexible locus of control, optimistic bias, autonomy, commitment, change, positive relationships, education viewed as important, and efficacy. Implications from this study are far-reaching and note-worthy for any position in educational leadership. The results from this study may positively enhance the experiences, retention, sustainability, effectiveness, and longevity of both women and men in one of the most important roles in a school district - the superintendency. Key words: resilience, women superintendents, women educational leaders, critical times, COVID-19 pandemic, Resilience Theor

Fortification and health: challenges and opportunities.

Fortification is the process of adding nutrients or non-nutrient bioactive components to edible products (e.g., food, food constituents, or supplements). Fortification can be used to correct or prevent widespread nutrient intake shortfalls and associated deficiencies, to balance the total nutrient profile of a diet, to restore nutrients lost in processing, or to appeal to consumers looking to supplement their diet. Food fortification could be considered as a public health strategy to enhance nutrient intakes of a population. Over the past century, fortification has been effective at reducing the risk of nutrient deficiency diseases such as beriberi, goiter, pellagra, and rickets. However, the world today is very different from when fortification emerged in the 1920s. Although early fortification programs were designed to eliminate deficiency diseases, current fortification programs are based on low dietary intakes rather than a diagnosable condition. Moving forward, we must be diligent in our approach to achieving effective and responsible fortification practices and policies, including responsible marketing of fortified products. Fortification must be applied prudently, its effects monitored diligently, and the public informed effectively about its benefits through consumer education efforts. Clear lines of authority for establishing fortification guidelines should be developed and should take into account changing population demographics, changes in the food supply, and advances in technology. This article is a summary of a symposium presented at the ASN Scientific Sessions and Annual Meeting at Experimental Biology 2014 on current issues involving fortification focusing primarily on the United States and Canada and recommendations for the development of responsible fortification practices to ensure their safety and effectiveness

Cool Companions to White Dwarfs from the 2MASS Second Incremental Data Release

We present near-infrared magnitudes for all white dwarfs (selected from the catalog of McCook & Sion) contained in the 2 Micron All Sky Survey Second Incremental Data Release(2MASS 2IDR). We show that the near-IR color-color diagram is an effective means of identifying candidate binary stars containing a WD and a low mass main sequence star. The loci of single WDs and WD + red dwarf binaries occupy distinct regions of the near-IR color-color diagram. We recovered all known unresolved WD + red dwarf binaries located in the 2IDR sky coverage, and also identified as many new candidate binaries (47 new candidates out of 95 total). Using observational near-IR data for WDs and M-L dwarfs, we have compared a sample of simulated WD + red dwarf binaries with our 2MASS data. The colors of the simulated binaries are dominated by the low mass companion through the late-M to early-L spectral types. As the spectral type of the companion becomes progressively later, however, the colors of unresolved binaries become progressively bluer. Binaries containing the lowest mass companions will be difficult to distinguish from single WDs solely on the basis of their near-IR colors.Comment: 18 pages, including 2 figures, accepted for publication in Ap

Objective and subjective assessments of normal walking pace, in comparison with that recommended for moderate intensity physical activity

Despite its common application and widely reported health benefits, walking, in relation to pace and intensity, is under-researched. Few studies have addressed whether people normally walk at a pace that meets the public health recommendations for moderate intensity physical activity (1.34-1.79 ms-1) and there is no known research on individuals' perceptions of factors which influence walking pace. This study aimed to objectively assess if participants were reaching the pace required for moderate intensity physical activity during normal walking. This was examined via a Global Positioning System (GPS) over a 1 km outdoor walk and a timed 150 m trial. In both tests participants (n=10, 3 men, 7 women, mean age 54±8 y) were instructed to walk at their normal pace. Through short interviews, the study also investigated the factors that participants' thought influenced their pace. All participants successfully walked at a pace considered as moderate intensity (≥1.34 ms-1). Height was significantly correlated with normal walking pace. The interviews provided an in depth insight into factors that affect walking pace; ground surface and footwear were mentioned frequently and the influence of the weather provided conflicting views, prompting a need for further research in the area. The GPS device showed enormous potential as a human locomotion measurement tool, enabling participants to walk unobstructed and unobserved in an outdoor setting, making the results relevant to real life situations

Objective and subjective assessments of normal walking pace, in comparison with that recommended for moderate intensity physical activity

Despite its common application and widely reported health benefits, walking, in relation to pace and intensity, is under-researched. Few studies have addressed whether people normally walk at a pace that meets the public health recommendations for moderate intensity physical activity (1.34-1.79 ms-1) and there is no known research on individuals' perceptions of factors which influence walking pace. This study aimed to objectively assess if participants were reaching the pace required for moderate intensity physical activity during normal walking. This was examined via a Global Positioning System (GPS) over a 1 km outdoor walk and a timed 150 m trial. In both tests participants (n=10, 3 men, 7 women, mean age 54±8 y) were instructed to walk at their normal pace. Through short interviews, the study also investigated the factors that participants' thought influenced their pace. All participants successfully walked at a pace considered as moderate intensity (≥1.34 ms-1). Height was significantly correlated with normal walking pace. The interviews provided an in depth insight into factors that affect walking pace; ground surface and footwear were mentioned frequently and the influence of the weather provided conflicting views, prompting a need for further research in the area. The GPS device showed enormous potential as a human locomotion measurement tool, enabling participants to walk unobstructed and unobserved in an outdoor setting, making the results relevant to real life situations

I have such a hard time hitting myself, I thought it\u27d be easier : Perspectives of hospitalized patients on injecting drugs into vascular access devices

Background: Hospital patients who use drugs may require prolonged parenteral antimicrobial therapy administered through a vascular access device (VAD). Clinicians\u27 concerns that patients may inject drugs into these devices are well documented. However, the perspectives of patients on VAD injecting are not well described, hindering the development of informed clinical guidance. This study was conducted to elicit inpatient perspectives on the practice of injecting drugs into VADs and to propose strategies to reduce associated harms.Methods: Researchers conducted a focused ethnography and completed semi-structured interviews with 25 inpatients at a large tertiary hospital in Western Canada that experiences a high rate of drug-related presentations annually.Results: A few participants reported injecting into their VAD at least once, and nearly all had heard of the practice. The primary reason for injecting into a VAD was easier venous access since many participants had experienced significant vein damage from injection drug use. Several participants recognized the risks associated with injecting into VADs, and either refrained from the practice or took steps to maintain their devices while using them to inject drugs. Others were uncertain how the devices functioned and were unaware of potential harms.Conclusions: VADs are important for facilitating completion of parenteral antimicrobial therapy and for other medically necessary care. Prematurely discharging patients who inject into their VAD from hospital, or discontinuing or modifying therapy, results in inequitable access to health care for a structurally vulnerable patient population. Our findings demonstrate a need for healthcare provider education and non-stigmatizing clinical interventions to reduce potential harms associated with VAD injecting. Those interventions could include providing access to specialized pain and withdrawal management, opioid agonist treatment, and harm reduction services, including safer drug use education to reduce or prevent complications from injecting drugs into VADs

Evaluating Intervention Fidelity: An Example from a High-Intensity Interval Training Study

AimIntervention fidelity refers to the degree to which an experimental manipulation has been implemented as intended, but simple, robust methods for quantifying fidelity have not been well documented. Therefore, we aim to illustrate a rigorous quantitative evaluation of intervention fidelity, using data collected during a high-intensity interval training intervention.DesignSingle-group measurement study.MethodsSeventeen adolescents (mean age ± standard deviation [SD] 14.0 ± 0.3 years) attended a 10-week high-intensity interval training intervention, comprising two exercise sessions per week. Sessions consisted of 4-7 45-s maximal effort repetitions, interspersed with 90-s rest. We collected heart rate data at 5-s intervals and recorded the peak heart rate for each repetition. The high-intensity exercise criterion was ≥90% of individual maximal heart rate. For each participant, we calculated the proportion of total exercise repetitions exceeding this threshold. A linear mixed model was applied to properly separate the variability in peak heart rate between- and within-subjects. Results are presented both as intention to treat (including missed sessions) and per protocol (only participants with 100% attendance; n=8).ResultsFor intention to treat, the median (interquartile range) proportion of repetitions meeting the high-intensity criterion was 58% (42% to 68%). The mean peak heart rate was 85% of maximal, with a between-subject SD of 7.8 (95% confidence interval 5.4 to 11.3) percentage points and a within-subject SD of 15.1 (14.6 to 15.6) percentage points. For the per protocol analysis, the median proportion of high-intensity repetitions was 68% (47% to 86%). The mean peak heart rate was 91% of maximal, with between- and within-subject SDs of 3.1 (-1.3 to 4.6) and 3.4 (3.2 to 3.6) percentage points, respectively.ConclusionsSynthesising information on exercise session attendance and compliance (exercise intensity) quantifies the intervention dose and informs evaluations of treatment fidelity