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Blue Rubber Bleb Nevus Syndrome: surgical eradication of gastrointestinal bleeding gastritis nsaids symptoms order pyridium with mastercard. The blue rubber bleb nevus syndrome: a case with prominent head and neck findings gastritis low stomach acid purchase generic pyridium on-line. Blue rubber bleb nevus disease: an uncommon cause of gastrointestinal tract bleeding gastritis daily diet plan order cheapest pyridium and pyridium. Interferon alfa-2a for disseminated intravascular coagulation in a patient with blue rubber bleb nevus syndrome: a case report gastritis burning stomach order pyridium. Cavernous hemangiomatosis involving the brain, spinal cord, heart, skin and kidney. Blue rubber bleb nevus syndrome and pulmonary hypertension: an unusual association. Multiple vascular malformations in the blue rubber bleb nevus syndrome: a case with aneurysm of vein of Galen and vascular lesions suggesting a link to the Weber-OslerRendu syndrome. Multiple subcutaneous hemangiomas, together with multiple lipomas, occurring in enormous numbers in an otherwise healthy, muscular subject. A study of 459 cases of lipoma with review of literature on infiltrating angiolipoma. Pharyngeal traumatic neuromas and traumatic neuromas with mature ganglion cells (pseudoganglioneuromas). Oral traumatic neuroma with mature ganglion cells: a case report and review of the literature. Comparative light microscopic and immunohistochemical study of traumatic and palisaded encapsulated neuromas of the skin. Traumatic neuroma of the oral cavity: report of thirty-one new cases and review of the literature. Palisaded encapsulated neuroma (solitary circumscribed neuroma of skin) of the eyelid: report of two cases and review of literature. Multi-focal diffuse glomus tumor: a case report of glomangiomyoma and review of the literature. Cutaneous muscle neoplasms: Clinical features, histologic findings, and treatment options. Clinical features of multiple cutaneous and uterine leiomyomatosis, an underdiagnosed tumor syndrome. Familial cutaneous leiomyomatosis is a two-hit condition associated with renal cell cancer of characteristic histopathology. On evaluation, the patient had multiple papules around her mouth as well as on her groin. Further history and physical found the patient to have features consistent with Goltz syndrome. Pathology confirmed focal dermal hypoplasia, papillomas of the mouth, and condyloma of the genitals. Patents with Goltz syndrome commonly develop papillomas in the oral and genital region. Given the widespread lesions, our patient presents a diagnostic and treatment conundrum. We review the recent literature on Goltz and discuss the therapeutic challenge presented in our patient. Patient History We present a 27-year-old female referred to our dermatology clinic by her primary physician for warts of the mouth and genitals. Our patient reported lesions around her mouth present for approximately one year and lesions in her genital area for over three years. She reports no symptoms of her oral lesions, and describes itching and burning of the lesions in the genital area. The patient did report being rather promiscuous in her late teens and early twenties. On physical exam, the patient was noted to have two 4mm, flesh-colored, verrucous papules on the left commissure, with a few scattered 2mm pink papules periorally. There were many 2-8mm, flesh-colored, pedunculated and verrucous papules scattered bilaterally in the genital area and inner thighs.
In absolute terms gastritis diet ������� buy pyridium master card, the loss was $33 gastritis diet ���� cheap pyridium online american express,516 for the average house price and $23 gastritis diet how long order pyridium with paypal,156 for the median price gastritis or gallstones order pyridium australia. Panels a, b, c, and d of exhibit 4 chart the distribution of the time between foreclosure sale and bankruptcy filing and between foreclosure sale and bankruptcy termination, as well as the ratio of sale price to estimated property value at the time of bankruptcy filing, adjusted for inflation and house price growth and adjusted for lender loss rate. Contrary to our findings in the bankruptcy sample, however, they found that most foreclosed properties were sold for more than the outstanding amount due on the mortgage for the foreclosure sample. Thus, filers update their house price forecast annually and their unemployment rate forecast quarterly. Note that we adopted different forecasting frequencies for the two series to avoid perfect collinearity of the two variables. Households that filed for bankruptcy in 2002 expected a higher house price growth rate going forward than those that filed in 2001, which is consistent with ex post movements in house prices at that time. As expected, households that have been delinquent on their mortgages for more than a year and households whose mortgage debt service exceeds 50 percent of their income are more likely to have their houses foreclosed. In particular, the foreclosure probability increases by 17 percentage points if the filer has been more than a year delinquent on mortgages and by 10 percentage points if the house was unaffordable. A house that was already in foreclosure for tax reasons is also more likely to be foreclosed. The probability of foreclosure decreases with house tenure; that is, the longer a household has owned its home, the less likely the house will be foreclosed. It also decreases significantly (by 24 percentage points) if Exhibit 5 Probit Estimation Result: Foreclosure Outcome Variable More than 1 year delinquent on mortgage at filing Mortgage loan-to-value ratio Mortgage loan-to-value ratio squared Housing unaffordable House tenure Already in foreclosure (including tax lien) at filing Already in tax lien foreclosure at filing Subprime mortgage lender Local lender Previous bankruptcy experience Filer hired attorney Job tenure Married Household size Recently divorced Unemployment experience Medical debt exceeds 10% of total debt Total debt in default/income Asset/total debt Mortgage arrearage/total debt in default Income/local median household income (%) House value/local median house value (%) Local household living below poverty line (%) Local median annual housing cost/median home value (%) Estimated state house price growth rate for the next 5 years Estimated county unemployment rate growth rate for the next 5 years Estimate 0. For dummy variables, marginal effects are calculated for discrete change from 0 to 1. Adverse events, such as unemployment, on the other hand, increase the likelihood of foreclosure significantly. Among financial and income variables, mortgage arrearage relative to total debt in default increases the probability of foreclosure. None of the regional economic variables matter, with the exception of housing costs: in areas with higher local housing costs-measured as the sum of mortgage payment, property tax, utilities, and insurance-it is more likely that the filer will lose his or her house to foreclosure. Time to Sale Exhibit 6 reports our second-stage estimation results concerning the time between foreclosure sale and bankruptcy filing. We present results with and without the Heckman selection bias adjustment (Heckman, 1979), and they look similar for variables of significance. Explanatory variables at this stage include, at the time of bankruptcy filing- · Whether the filer has been delinquent on his or her mortgage payment for more than a year. Exhibit 6 Heckman Two-Step Estimation Result: Foreclosure Time With Adjustment Variable Estimate Standard Deviation 3. Tax lien foreclosures substantially lengthen the time between the bankruptcy filing and the foreclosure sale (by about 13 months). This is because tax lien foreclosure in Delaware is the only foreclosure that provides borrowers redemption rights for up to a year. The presence of redemption rights complicates the foreclosure process and discourages potential buyers from purchasing the property. It also takes longer to foreclose houses in areas with higher housing costs and houses with subprime mortgages. By contrast, foreclosed houses sell faster at times when households expect higher housing price growth. Remember that the loss rate equals the sum of the sales price adjusted for inflation, local house price appreciation, and transaction cost, minus mortgage outstanding, all as a proportion of mortgage outstanding. Note also that, for lender buy-backs, we used the price at which the lender subsequently sold the property to a third party. In the event that the sale price was booked at a symbolic $10 or less, we excluded the observation from our estimation. The explanatory variables in the second stage are exactly the same as those used to estimate time to sale. These household-specific variables affect the time to sale mainly through their influence on whether the house will be foreclosed in the first place. Cityscape 129 Carroll and Li Exhibit 7 Heckman Two-Step Estimation Result: Lender Loss Rate With Adjustment Variable More than 1 year delinquent on mortgage at filing Mortgage loan-to-value ratio Mortgage loan-to-value ratio squared Housing unaffordable Already in foreclosure (including tax lien) at filing Already in tax lien foreclosure Filer hired attorney Subprime mortgage Lender local Income/local median household income House value/local median house value Local household living below poverty line Local median annual housing cost/median home value (%) Estimated state house price growth rate (annual, %) Estimated county unemployment growth rate (annual, %) Mills ratio Estimate 0.
In the last two 5-year plans treating gastritis diet purchase 200 mg pyridium with amex, it has been clearly indicated that for the economy to grow at the rate of 9% gastritis jugo de papa cheap pyridium 200 mg amex, it is important that agriculture should grow at least by 4% per annum gastritis diet ������������� buy discount pyridium 200 mg. In spite of the considerable emphasis given by government in the agriculture sector gastritis doctor discount 200 mg pyridium overnight delivery, productivities of most of the crops are considerably lower as compared to major countries of the world. This indicates that there is still a considerable scope of increasing per-unit-area productivity in the country, provided soil and water quality is maintained for achieving the targeted potential. In this context, important issue that needs to be addressed is whether soil resources of the country are adequate to meet the food demands for rapidly increasing human population. Due to development of high yielding fertilizer responsive cultivars and increased use of fertilizer nutrients and agrochemicals in the post green revolution period in tandem with the enhanced availability of irrigation water, agriculture witnessed major transformation in terms of increased crop intensity and productivity per unit area during post 80s. Within micro-environment also, regenerative capacity of the soil contributes towards sustainability of agroecosystem. Thus, enhancement and maintenance of soil regenerative capacity is essential for the sustainability of agriculture and for meeting basic needs of rising population of country. Although quantitative estimate is not available, contribution of soil in agricultural production during pre-green revolution period was assumed to be higher than during later period when seed, water, fertilizers and agrochemicals played larger role (Yadav et al. As majority of essential nutrient elements are taken up by plant roots, quality of rhizospheric environment is important for higher fertilizer nutrient use efficiency and agricultural profitability. Optimum root proliferation, proper vertical air diffusion and absence of any adverse interactions among soil constituents are some of the soil criteria which determine rhizosphere quality for higher nutrient use efficiency. Beside several inappropriate agricultural management practices, excessive build-up of several elements/compounds has been attributed to declining soil quality in and around the root zone. Wide variation in climates, land topography, soil types are some of the major drivers responsible for such large biodiversity. However, with the progress of modern civilization, humans additionally use land as a dumping site for solid 1. Except in forest ecosystem at far away from pollution activities, positive balances of heavy metals have been estimated during computation of trace elements budget (KabataPendias and Pendias 1992). This is due to their higher rate of inputs through fertilizers, sludges, manures, residue recycling, atmospheric inputs etc. In the quest of rapid growth in the national economy, India is increasingly pushing forth for rapid urbanization, industrialization and transportation; all of which are competing for agriculturally important natural resources like land and water. From 2001 to 2010, it was observed that each state lost about 1% of its total geographical area due to diversion of agricultural land for urban expansion and magnitude of such diversion has been increasing steadily (Pandey and Seto 2015). Large scale urbanization, industrialization and associated environmental alteration and their impact on soil quality pose a threat to biodiversity as evident from the extensive studies conducted at several developed countries. Although industry has several adverse impacts on agriculture, their influential & dependency relationship is many a times quite complex because of the unlimited human need. Different agricultural and industrial requirements and activities affecting environment and human life and their relationships are depicted below in. Above complex relationships among different economic and social sectors and associated activities indicate that most of the anthropogenic activities are essential for meeting expectations and need of increasing population and socio-economic development of the country; and any such developmental activities leaves irreparable damage to the environment including its natural resources. This is a transition period for many developing economies like India to strike a balance between industrial development and environmental protection so as to feed the bulging population adequately with quality food as well as to improve the comfort and quality of lifestyle. Although considerable researches are being conducted by different institutes under Indian Council of Agricultural Research as well as by State Agricultural Universities to address the issues of declining soil quality due to faulty agricultural practices, insufficient research efforts have been put to address the issue of soil and water pollution arising from high inputs of contaminated fertilizers, soil amendments and agro-chemicals. In the early Anthropocene, rural population dominated but in the last 7080 years, urban centers expanded rapidly with higher concentrations of people. These urban centers and their encompassing ecosystems initiated a new set of environmental problems mostly related to land surface sealing, water use, waste management, and an insatiable appetite for food, fiber and energy needs. Apart from the threat of land consumption by non-agricultural activities like urbanization, transport and industrialization, soil contamination by different pollutants has become a major cause for deterioration of its health; and in the long run the polluted soil may not be fit to grow food which in turn may affect Indian economy directly or indirectly through reduction in raw material supply to industries and emergence of several socio-economic problems. Urbanization and industrialization exploited natural resources and damaged the environment through their activities at every phases and processes of operation. It is evident from several environmental tragedies that pollution from various sources particularly from industries and mining had negative impact on environment which was mostly irreversible in nature, and cause extinction of species resulting in loss of unique genetic resources of valuable use.
Most managers have little time for reflection and careful planning because they spend most of their time either in face-to-face encounters or in putting out "fires gastritis diet foods eat order discount pyridium on line. Moments between meetings may be spent scribbling thoughts about how to approach an emerging problem gastritis attack diet cheap 200 mg pyridium mastercard. Successful managers make the time to develop strategies in those areas in which anticipation and preparation are necessary (McCall & Segrist gastritis symptoms lower back pain cheap 200 mg pyridium visa, 1980; Mintzberg gastritis symptoms months cheap pyridium line, 1973). The following, three-phase model illustrates the importance of developing a strategy and following through in the delegation process and offers a guide to managers. However, it is the quality of this diagnosis and planning that will largely determine the success of delegation. Managers who are too busy to prepare to delegate usually are those who "hoard" unreasonable quantities of work themselves or, alternatively, "dump" assignments on staff members without providing them with sufficient notice to allow them to plan their own work schedules. The predelegation phase is the responsibility of the manager and primarily is done alone. The key questions in this phase are: 176 the Pfeiffer Library Volume 20, 2nd Edition. Figure 2 outlines the interpersonal, informational, and decisional aspects of the assessment phase. Phase 2: the Interaction the interaction phase is the heart of the delegation process; it determines, more than anything else, the outcome of a delegated function. The extent to which it is managed well will give meaning to the preparatory and follow-up work done in Phases 1 and 3. What levels of authority, accountability, and responsibility will be given along with the work? How can the manager help to create an atmosphere of trust that will be conducive to better communication? Figure 3 outlines the interpersonal, informational, and decisional aspects of the interaction phase. Phase 2, the Interaction Because the interaction phase is primarily a communication process, success depends on both the communication skills of the manager and the employee and the quality of the existing relationship between them. Where there is bad feeling or poor communication between manager and employee, the likelihood that understanding and motivation will result is very low. A manager cannot delegate successfully unless the staff member accepts the work willingly and competently. Trust between the manager and employee creates greater openness in the discussion about the tasks in question and the ability and readiness of the employee to accept the assignment. This includes trust that the employee will fulfill his or her commitment, which means that the manager should fulfill his or her obligations and then allow the employee to get on with the job. Only when expectations, guidelines and resources are clearly understood can the job be accomplished as desired. Copyright © 1998 Jossey-Bass/Pfeiffer the manager should not assume that the employee understands what is desired simply because he or she asks no questions or raises no objections. Contracting between the manager and the employee regarding how and when the work will be completed is the last pillar on which the interaction rests. The Authority Gap There is one way in which many managers undermine their desired outcomes. This is by creating an "authority gap," withholding an unreasonable portion of authority from the employee even when it is needed to accomplish a given task. When an employee performs consistently in a competent manner, it is quite reasonable for that person to expect increased autonomy and discretion in the execution of his or her responsibilities. The Authority Gap Rectangle A reflects a healthy balance between the two factors, both, in this case, being relatively low. However, as performance continues to improve, authority should, but often does not, increase correspondingly. Rectangle B reflects this condition, with the portion of authority not realized representing the "authority gap. Copyright © 1998 Jossey-Bass/Pfeiffer 179 Phase 3: the Follow-Through Out of sight, out of mind.
Ethical egoism states that a person should act so as to create the greatest good for her- or himself gastritis diet �������� cheap pyridium 200mg. A leader with this orientation would take a job or career that she or he selfishly enjoys (Avolio & Locke gastritis diet in pregnancy order pyridium 200 mg with mastercard, 2002) gastritis tratamiento order pyridium canada. Self-interest is an ethical stance closely related to transactional leadership theories (Bass & Steidlmeier gastritis diet ulcer pyridium 200mg mastercard, 1999). Ethical egoism is common in some business contexts in which a company and its employees make decisions to achieve its goal of maximizing profits. For example, a midlevel, upward-aspiring manager who wants her team to be the best in the company could be described as acting out of ethical egoism. From this viewpoint, the morally correct action is the action that maximizes social benefits while minimizing social costs (Schumann, 2001). Altruism is an approach that suggests that actions are moral if their primary purpose is to promote the best interests of others. From this perspective, a leader may be called on to act in the interests of others, even when it runs contrary to his or her own self-interests (Bowie, 1991). Authentic transformational leadership (Chapter 8) is based on altruistic principles (Bass & Steidlmeier, 1999; Kanungo & Mendonca, 1996) and altruism is pivotal to exhibiting servant leadership (Chapter 10). The strongest example of altruist ethics can be found in the work of Mother Teresa, who devoted her life to helping the poor. Quite different from looking at which actions will produce which outcomes, deontological theory is derived from the Greek word deos, which means "duty. Telling the truth, keeping promises, being fair, and respecting others are all examples of actions that are inherently good, independent of the consequences. The deontological perspective focuses on the actions of the leader and his or her moral obligations and responsibilities to do the right thing. In the late 1990s, the president of the United States, Bill Clinton, was brought before Congress for misrepresenting under oath an affair he had maintained with a White House intern. At one point during the long ordeal, the president appeared on national television and, in what is now a famous speech, declared his innocence. Because subsequent hearings provided information that suggested that he may have lied during this television speech, many Americans felt President Clinton had violated his duty and responsibility (as a person, leader, and president) to tell the truth. From a deontological perspective, it could be said that he failed his ethical responsibility to do the right thing-to tell the truth. These theories are called virtue-based theories; they focus on who leaders are as people. Furthermore, it is believed that virtues and moral abilities are not innate but can be acquired and learned through practice. People can be taught by their families and communities to be morally appropriate human beings. The Greek term associated with these theories is aretaic, which means "excellence" or "virtue. Rather than telling people what to do, attention should be directed toward telling people what to be, or helping them to become more virtuous. Based on the writings of Aristotle, a moral person demonstrates the virtues of courage, temperance, generosity, self-control, honesty, sociability, modesty, fairness, and justice (Velasquez, 1992). Applying ethics to leadership and management, Velasquez has suggested that managers should develop virtues such as perseverance, public-spiritedness, integrity, truthfulness, fidelity, benevolence, and humility. In essence, virtue-based ethics is about being and becoming a good, worthy human being. When practiced over time, from youth to adulthood, good values become habitual, and part of the people themselves. By telling the truth, people become truthful; by giving to the poor, people become benevolent; by being fair to others, people become just. Our virtues are derived from our actions, and our actions manifest our virtues (Frankena, 1973; Pojman, 1995). Centrality of Ethics to Leadership As discussed in Chapter 1, leadership is a process whereby the leader influences others to reach a common goal.
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