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A patient was referred for urgent evaluation of cyanosis. Although she had symptoms and signs of an upper respiratory tract infection, she had a normal cardiorespiratory examination and normal transcutaneous oxygen saturation. Further evaluation revealed a benign cause for the cyanosis.
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We have used two strategies to study 14 hemophilia B families from 11 kindreds for possible carrier detection and prenatal diagnosis. First, we sequentially used the Factor IX probes (sequentially with restriction enzymes Taq I, Xmn I, and Dde I), and the linked probes p45h (Taq I), p45d (Pst I), and 52a (Taq I) for restriction fragment length polymorphism (RFLP) analysis. Second, we searched for useful variant Taq I digestion fragments using the Factor IX complementary DNA. Two separate new Taq I variants in exon VIII were identified. Using both strategies, 11 of 14 families (from 9 of 11 kindreds) were informative for further studies. In five kindreds studied in detail, the carrier status of all 11 at risk females was determined and prenatal diagnosis could be offered to the offsprings of each of the six carriers identified. Thus, in this study, we have identified a higher proportion of informative families than has previously been reported.
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In clinical work using the Illness Beliefs Model, therapeutic leverage is focused on challenging constraining beliefs of family members that are contributing to their suffering. This challenge occurs in many ways, including offering alternative facilitating beliefs that may lead to healing rather than suffering. This article describes an exemplar of clinical work with a family who sought services in the Family Nursing Unit at the University of Calgary, with the presenting concern of unresolved grief. This analysis describes the therapeutic conversation that occurred between the family and a team of nurse clinicians, where the young woman's beliefs about grief and mothering were distinguished as beliefs that were contributing to her emotional pain and her belief in her mothering capabilities. The nursing team offered alternative beliefs of which the family rapidly embraced and, subsequently, experienced diminishment of the suffering previously experienced.
The equatorial Pacific Ocean atoll islands of Kiritimati and Teraina encompass great physical, chemical and biological variability within extreme lacustrine environments. Surveys of lake chemistry and sediments revealed both intra- and inter-island variability. A survey of more than 100 lakes on Kiritimati found salinities from nearly fresh to 150 ppt with the highest values occurring within the isolated, inland portions of the island away from the influence of groundwater or extreme tides. Dissolved oxygen (DO) and pH values also showed considerable variability with a less regular spatial pattern, but were both generally inversely related to salinity. Series of lakes, progressively more isolated from marine communication, present a modern analog to the chemical and morphologic evolution of presently isolated basins. Sediments on both islands consist of interbedded red and green silt, possibly degraded bacterial mat, overlying white, mineralogenic silt precipitate. Variability may be indicative of shifts in climatological parameters such as the El Niño Southern Oscillation (ENSO) or the Pacific Intertropical Convergence Zone (ITCZ).
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