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Gabriel Clark
Gabriel Clark

Loose



The incident occurred at roughly 2 a.m. Tuesday, according to the U.S. Army Corps of Engineers. Of 11 total barges, 10 became loose from a tugboat; three barges became pinned to the dam, and one additional barge was pinned against a pier, the agency said.




loose



Loose anagen syndrome is inherited in an autosomal dominant or sporadic fashion. Clinically it manifests as diffuse non-scarring alopecia in children. Recognition of this self-limited condition is important as it should be distinguished from other infectious, reactive, or inherited alopecia. This activity outlines the diagnostic and therapeutic options for loose anagen syndrome and highlights the role of the interprofessional team in the recognition and management of this condition.


Objectives:Describe the etiology of loose anagen syndrome.Review the typical presentation of loose anagen syndrome. Outline management options for patients affected by loose anagen syndrome.Explain the need for a well-integrated, interprofessional team approach to improve care for patients with loose anagen syndrome.Access free multiple choice questions on this topic.


Hair loss is a common phenomenon encountered among physicians. It has a myriad of underlying causes. Loose anagen hair syndrome is a non-scarring alopecia that results from defects of keratinization.[1] Abnormalities are primarily of the inner root sheath of anagen follicles. As opposed to normal anagen follicles that demonstrate dense, compact, well-oriented cells of the inner root sheath and cuticle, hairs of loose anagen hair syndrome exhibit vacuolization and intercellular edema of Huxley cells and dyskeratotic changes in Henle cells and the hair shaft.


An anagen hair shaft has 3 layers: the medulla, cortex, and cuticle from the center out. The cuticle interlocks with the inner root sheath cuticle and it is abnormal keratinization of this inner root sheath that is central to loose anagen hair syndrome.[5]


A K6HF mutation of keratin has been described in some families with loose anagen hair syndrome.[6] This mutation results in premature keratinization of the inner root sheath and impaired adhesion of the cuticle of the inner root sheath to neighboring structures.[1]


A pull test is the cornerstone of diagnosis in loose anagen hair syndrome. It is performed by using gentle traction on approximately 40 to 60 scalp hairs. Telogen hairs normally represent 10% of scalp hairs, and thus, removal of 4 to 6 hairs is a normal finding in the hair pull test. Loose anagen hair syndrome, similar to telogen effluvium, will result in greater amounts of hair removed. Despite easy removal from the scalp, individual hairs in loose anagen hair syndrome have normal tensile strength and are not brittle. Hairs can be examined under light microscopy by dry-mounting the hair on a glass slide with a cover slip placed over top. In loose anagen hair syndrome anagen, hairs lack inner root sheaths and external root sheaths with a ruffled cuticle.[5] As loose hairs may be seen in unaffected individuals some propose a positive hair test contain 50% or more of anagen hairs.[1]


Diagnosis is usually based upon clinical history, physical exam, and light microscopy. Further stratification into clinical subtypes of loose anagen hair syndrome includes (1) sparse short hair, (2) diffuse or patchy unruly hair, and (3) adults with the excessive shedding of anagen hairs.[7] The utility of this is uncertain as it does not relate to changes in treatment and effect on prognosis is also uncertain. Additional laboratory testing is not routinely necessary.[8] Although usually a solitary self-resolving condition, if other comorbidities occur investigation of underlying syndromic diseases may be needed. Sporadic cases of loose anagen hair syndrome coexisting with Noonan syndrome, neurofibromatosis type 1, atopic dermatitis, trichorhinophalangeal syndrome, nail-patella syndrome, and FG syndrome have been described.[2]


Treatment is often unnecessary as the disease is often self-limited and improves with age. If treatment is pursued, topical minoxidil has been used as first-line therapy for those with significant disease burden.[1] The mechanism by which minoxidil is thought to be beneficial is by prolongation of the anagen phase.[3] Biotin therapy has been shown to be of no benefit,[7] and otherwise, only gentle hair care to avoid removal of loosely anchored hairs is recommended.[5]


Loose anagen hair syndrome is a disease in which diagnosis is made clinically, and treatment revolves around decreasing trauma to easily detached anagen hairs. As the disease process primarily affects young children, pediatricians and pediatric nurse practitioners and physician assistants are likely to be the first to encounter these patients. Awareness of loose anagen hair syndrome and differentials is crucial for diagnosis, and referral to a dermatologist may assist in providing the best patient care. Discussion with parents revolves around lifestyle modification and minimizing trauma to hair with routine combing, washing, and styling. Treatment may be considered with minoxidil applied topically. Biotin or additional nutritional supplementation has not been shown to be helpful.[1][5][8] (Level V)


Other Impacts: The loose leaf collection program is weather-dependent. Cold, wet weather, especially snow and ice, can tremendously slow or even suspend the program for several days with each occurrence. City staff continually monitors the weather and assess our ability to safely provide services. If collections are suspended or staff is diverted to address snow and ice events or substantial rain events, the collection schedule will be adversely affected.


Giving meaning to loose parts requires us to think about the possibilities of how a child learns and consider the materials and environments she uses. Loose parts create endless possibilities and invite creativity. For example, if a child picks up a rock and starts to play, most likely that rock can become anything the child wants it to be. Imagination, creativity, curiosity, desire, and need are the motivation of loose parts.


Loose parts are materials that can be moved, carried, combined, redesigned, lined up, and taken apart and put back together in multiple ways. Loose parts can be used alone or combined with other materials. There is no set of specific directions for materials that are considered loose parts. The child is the direction.


A term strongly connected to loose parts is open-ended. Open ended materials, environments, and experiences encourage problem solving and are child centered. Children involve themselves in concrete experiences using loose parts, which lead to explorations that occur naturally, as opposed to adult directed. However, adults do play important, intentional roles in preparing, guiding, and documenting open ended learning experiences.


Simple Loose Leaf was started in 2013 by three siblings and we run it together to this day. We started this journey to help make loose leaf tea more approachable and fun. We offer 150+ different loose leaf teas that can be experienced in our sample subscriptions, gift tea memberships, samples, or our 4 ounce containers.


Curbside loose leaf collection is available twice a year to single family homes & townhouses only. Collection is made weekly on your recycling collection day, however there may be a one to two-day delay during busy periods. Place leaves at the street curb by 7 a.m. on your recycling day. Leaves placed in alleys or mews will not be collected.


Emergency teams are working to secure 10 barges that broke loose from a tugboat on the Ohio River along the waterfront in Louisville, Ky., including a barge carrying some 1,400 metric tons of methanol that is partially submerged. It's one of three wayward barges that have wedged themselves next to a dam near a power station.


Ten barges broke loose on the Ohio River near Louisville, with three of the wayward vessels coming to rest against part of a dam structure in the water. Google Maps/Screenshot by NPR hide caption


This guide shows how to use the loose file layout to validate and share Windows 10 apps without needing to package them. Registering loose file layouts allows developers to quickly validate their apps without the need to package and install the apps.


Windows provides multiple developer tools to register loose file layouts on local and remote devices. You can choose from WinAppDeployCmd (Windows SDK Tool), Windows Device Portal, PowerShell, and Visual Studio. Below we will go over how to register loose files using these tools. But first, ensure that you have following setup:


On the Device Portal's Apps Manager page, you can also register optional loose file layouts for your main app by selecting the I want to specify optional packages checkbox and then specifying the network share paths of the optional apps.


Do periods of persistently loose monetary policy increase financial fragility and the likelihood of a financial crisis? This is a central question for policymakers, yet the literature does not provide systematic empirical evidence about this link at the aggregate level. In this paper we fill this gap by analyzing long-run historical data. We find that when the stance of monetary policy is accommodative over an extended period, the likelihood of financial turmoil down the road increases considerably. We investigate the causal pathways that lead to this result and argue that credit creation and asset price overheating are important intermediating channels. 041b061a72


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