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To assess long-term outcomes of lichen sclerosus (LS) in the female pediatric population, specifically in relation to patient age, treatment type and duration, and remission. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Retrospective chart review was conducted to identify female pediatric patients (0-18 years of age) who were diagnosed with LS between January 1, 2015 and January 1, 2020 at the University of North Carolina Dermatology and/or Obstetrics and Gynecology Departments. Patients were contacted via telephone for follow-up interviews consisting of a series of questions regarding patient age, symptom onset, time of diagnosis, treatment, and current symptoms.Of the 128 patients identified, 61 patients consented and participated in follow-up interviews. At the time of study follow-up, 55/61 (90%) of participants reported their symptoms were improved. Patients reported using a variety of treatments, with medium- to high-potency topical steroids being the most common. At the time of follow-up, 53/61 (87%) of patients reported being asymptomatic, 37/53 (70%) of whom were not using any form of maintenance therapy. Those who achieved symptom resolution did so at an average of 8.4 years of age. There was no significant difference in age in asymptomatic patients receiving maintenance therapy and those receiving no maintenance therapy. There was a positive correlation for the duration of LS treatment and time in remission (P.001). Increased patient age at time of follow-up also correlated positively with time in remission (P.001).In our cohort, the need for continued maintenance therapy was not correlated with age or, by proxy, pubertal status. Thus, LS remission might be determined more by early and successful pharmacological interventions.

Chief residents are typically selected as leaders from the senior-most residents in a residency program. The definition of the role likely varies widely between various residency programs. We aimed to gain a better understanding of responsibilities of chief residents in dermatology programs and to identify selection methods. After institutional review board review, we created a Qualtrics survey distributed through a listserv of program directors (PDs) from US dermatology residency programs. Of 51 survey responses, 100% had chief residents, and 35.3% had all senior residents designated as chief residents. The majority of programs used several selection processes, but most frequently PD selection (n = 20). Programs (76%) reported other leadership opportunities for seniors. The most important attribute in selecting a chief resident was helpfulness, and PDs rated their perceived resident satisfaction with the selection process as an 8.24 out of 10, with 10 being most satisfied. Additional benefits for chief residents were reported at 86.9% (n=40) of programs. Most programs select chief residents based on merit. There is perceived satisfaction of residents regarding this process, and most programs report additional benefits for their chief residents.

Atopic dermatitis (AD) is a common disease of childhood, and some patients experience a prolonged clinical course into adolescence and adulthood. Systemic management is required when AD is not adequately controlled with topical medications. Our aim is to provide a comprehensive review of commonly used systemic immunomodulating agents in childhood and adult AD, including cyclosporine A (CsA), azathioprine (AZA), methotrexate (MTX) and mycophenolate mofetil (MMF), which are prescribed off-label in the United States, as well as dupilumab, an FDA-approved biologic. We will also provide a brief overview of emerging systemic therapies currently under investigation.

Atopic dermatitis (AD) is a common disease of childhood, and infantile AD may manifest from birth to 2 years. Guidelines for the management of infantile AD are lacking, and our aim is to provide a comprehensive review of best practices and possible interventions. We will focus on topical therapy, since the use of systemic immunomodulating agents in infantile AD is rarely advised. Topical agents include emollients, topical corticosteroids (TCS), topical calcineurin inhibitors (TCIs), and phosphodiesterase 4 (PDE-4) inhibitors. We will also provide a brief overview of promising emerging therapies currently under investigation in the pediatric population.

Background/objectives Atopic dermatitis (AD) is the most common skin disease of childhood and is often more severe in African American than white children. The reason for this disparity is unknown, but recent research indicates that it may be due to a combination of environmental and genetic factors. The objective of this article was to explore the relationship between measures of structural racism and residential segregation within pediatric AD. Methods An in-office, online survey consisting of 58 questions spanning 5 domains (demographics, in-home crowding, community crowding, air quality, and litter) was administered to a convenience sample of 201 pediatric AD patients (age 0-18 years). Survey data were geocoded and linked to a measure of structural racism (ie, residential segregation). Results African American children were more likely to live in rented homes, be in lower income families, have caregivers with lower educational attainment, and be exposed to tobacco smoke. The same factors that were associated with worse AD severity in this study were also found in published literature, emphasizing the role of social determinants of health and racial differences in AD severity. Additionally, this study found that living in highly segregated communities was more likely to be associated with severe AD in African American children. Conclusions Consistent with reported literature, socioeconomic status, race, and the physical environment appear to affect AD severity. This investigation adds structural racism as an important community characteristic that likely has significant effects on AD severity for African American Children.

PURPOSE OF REVIEW Several chronic inflammatory skin disorders have been linked to metabolic syndrome (MetS) and an increased risk for cardiovascular disease. In this review, we will summarize the recent evidence on the association between psoriasis, hidradenitis suppurativa (HS), and atopic dermatitis (AD) and metabolic syndrome with careful attention to this association among the pediatric population. RECENT FINDINGS Historically, psoriasis has exhibited the most robust association with MetS in the literature. Recent studies show that the prevalence of MetS appears to be higher among patients with HS and can be associated with MetS even in mild disease. A relationship between AD and MetS is still under debate, but research has shown a clear link between pediatric AD and being overweight or obese. SUMMARY There are no current consensus guidelines for metabolic syndrome in the pediatric population, and its clinical implications in children are still unclear. Nevertheless, providers should be aware of the shared underlying inflammatory state and link between several cutaneous disorders and metabolic syndrome. Early diagnosis and proper disease management of these at risk populations has the potential to assist in disease control and mitigate future cardiovascular disease.

The personal statement is a required component of the residency application, offering applicants the opportunity to showcase their personality as well as unique thoughts and experiences not explicitly stated elsewhere in their application. Although the applicant-generated nature of personal statements can gauge an applicant's professionalism, creativity, sound judgement, and tact, specific criteria for evaluating personal statements and comparing them to one another is lacking. Research on the value of personal statements in the application process is also lacking. The purpose of this research project is to quantify the perceived value of the personal statement to program directors and faculty members of U.S. dermatology programs involved in residency application review. Analysis of our survey responses determined that although the majority of participants consider the personal statement to be a necessary element of an application, it was rated least important compared to other components of the application. An applicant's Medical Student Performance Evaluation, clerkship grades, research projects and publications, board scores, and letters of recommendation were consistently rated as more important than the personal statement. These findings suggest the personal statement lacks the standardization needed for decision makers to confidently choose the best new dermatology residents for their program.

The personal statement is a required component of the residency application, offering applicants the opportunity to showcase their personality as well as unique thoughts and experiences not explicitly stated elsewhere in their application. Although the applicant-generated nature of personal statements can gauge an applicant's professionalism, creativity, sound judgement, and tact, specific criteria for evaluating personal statements and comparing them to one another is lacking. Research on the value of personal statements in the application process is also lacking. The purpose of this research project is to quantify the perceived value of the personal statement to program directors and faculty members of U.S. dermatology programs involved in residency application review. Analysis of our survey responses determined that although the majority of participants consider the personal statement to be a necessary element of an application, it was rated least important compared to other components of the application. An applicant's Medical Student Performance Evaluation, clerkship grades, research projects and publications, board scores, and letters of recommendation were consistently rated as more important than the personal statement. These findings suggest the personal statement lacks the standardization needed for decision makers to confidently choose the best new dermatology residents for their program.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse reaction characterized by a morbilliform cutaneous eruption, fever, lymphadenopathy, and multiorgan involvement. Alopecia universalis is a variant of alopecia areata characterized by complete loss of hair on the entire body. Herein, we report a case of alopecia universalis that presented after DRESS.

Single-point turning is a fabrication process that is fundamental to manufacturing, comprising a significant portion of value-added operations. Vibration at the tool/workpiece interface affects surface finish, residual stress, and chemical reactivity of machined components. This phenomenon also affects tool life and therefore production cost. The study and measurement of this phenomenon has traditionally been done using a transducer in contact with the cutting tool or is in line with the cutting tool/tool holder assembly. While this setup has been acceptable for laboratory studies, implementation on actual production platforms has not been widespread, with open loop machine tool parameter control still being the norm. The goal of this study involves the use of a noncontact transducer (microphone) to gauge detectability and measurability of machine tool vibration attributable to the single-point turning process performed on a manual lathe situated in a shop floor environment. Such measures as characterization of the frequency content transmitted and the sound pressure level measured while machining a group of materials of interest are quantified and discussed. The results of the work show that the acoustic energy attributable to single-point turning is detectable using the noncontacting sensor, producing energy mostly in the ultrasonic (f > 20 kHz) range. Individual materials of interest (M42 tool steel, tungsten tantalum alloy, aluminum 6061, and Nitronic 33 stainless steel) are shown to emit distinct frequency signatures when excited using identical process parameters. Potential sources of ultrasonic acoustic emission are postulated and discussed, along with control of the turning process using the acoustic signal as an input and selected process parameter changes as the output.

Dupilumab is a relatively new and quite effective medication for recalcitrant atopic dermatitis in patients over 6 years of age. Here, we present a 12-year-old girl with progressively worsening episodic facial swelling and erythema while treated with dupilumab. This case highlights the possibility of angioedema as an adverse effect of dupilumab treatment.

The personal statement is a narrative written by an applicant to residency programs to discuss his/her interests and express his/her personality, but it is unclear how the personal statement impacts the dermatology residency application process. The aim of this study was to analyze personal statements from applicants to a dermatology program at a major academic institution to identify common themes and determine if certain themes were associated with successful matching. All personal statements submitted to the dermatology residency program at UNC School of Medicine (Chapel Hill, North Carolina) during the 2012 application cycle (N=422) were analyzed to identify 9 common themes of content. Certain themes differed in prevalence between matched and unmatched applicants. Further investigation is needed to elucidate the impact of personal statement themes and other application content on the residency selection process.

This case report presents a patient who, while undergoing oral isotretinoin therapy for acne vulgaris, developed onychocryptosis and asymptomatic external urethritis. These uncommon adverse events are not well-documented in medical literature. While his urethritis spontaneously resolved, his onychocryptosis symptoms necessitated surgical intervention. This report illustrates both cosmetic and functional adverse effects of isotretinoin and provides insight into the progression of these reactions over time.

In this study, lithium hydride (LiH) and its hydrolysis products were investigated non-destructively with neutron radiography and neutron computed tomography. Relative neutron transmission intensities ( I / I 0 ) were measured for LiOH, Li 2 O and LiH, and their linear attenuation coefficients calculated from this data. We show that 7Li is necessary for creating large differences in I / I 0 for facile identification of these compounds. The thermal decomposition of LiOH to Li 2 O was also observed with neutron radiography. Computed tomography shows that the samples were fairly homogeneous, with very few macroscopic defects. The results shown here demonstrate the feasibility of observing LiH hydrolysis with neutron imaging techniques in real time.

The processing of polymer-bonded explosives is not widely reported in the literature, especially the machining of explosive surrogates in the combined planing and grinding operation known as plano-grinding. The process of machining long pieces of an inert substitute using a wax binder to hold sugar particles together and then subjecting the surrogate material to a linear cutting motion to generate chip fragments is described. The aim and purpose of this work is to analyze the machining of explosive surrogates in terms of chip formation models (oscillating and stress ratio models) and similarity models (chip compression ratio, Poletica, and Peclet numbers). The analysis of machining is compared to standard engineering materials so that the explosives engineer can benchmark machining performance of explosive surrogates to standard materials. The article concludes with statements on how to improve the understanding of machining of explosive surrogates with specifically engineered abrasive cutting tools.

Metallurgical process development in greenfield projects must define the comminution flowsheet and establish the equipment sizes that are required to deliver the project design criteria. These are critical steps that heavily influence the financial performance of the project, requiring a detailed understanding of the ore properties of the project resources and the best practice methods to size comminution machines. This paper reviews current practices for determining the ore characteristics relevant to comminution circuit design. Particular attention is given to the design of sampling and testing programs, and the methods commonly applied to size crushers and mills for conventional size reduction applications in mineral processing.

Acrodermatitis dysmetabolica (AD) is a rare, newly termed, and poorly understood disease that appears to be clinically similar to acrodermatitis enteropathica (AE). Both diseases are characterized by the triad of periorificial and acral dermatitis, diarrhoea, and alopecia. Unlike AE, which is caused by zinc deficiency, AD is caused by numerous metabolic disorders. One such disorder is maple syrup urine disease (MSUD), a genetic deficiency of branched chain α-ketoacid dehydrogenase, the enzyme that degrades the branched-chain amino acids (BCAAs) isoleucine, leucine and valine. Treatment involves restricting BCAAs to prevent accumulation. We report a case of an infant being treated for MSUD, who developed the triad of AE/AD after a period of poor BCAA formula intake. The child was found to have low isoleucine and normal zinc levels. Increasing the isoleucine dose improved the eruption, thus the diagnosis of AD secondary to isoleucine deficiency was made. This case emphasizes the importance of carefully balancing BCAA levels while treating MSUD, as deficiency can precipitate AD.

Traditional machining processes, where material is removed by a cutting tool from a workpiece, can introduce residual stresses at the surface of machined pieces. This paper provides an examination of an alternative machining methodology called modulated tool path machining. The ultimate objective of this research is to determine the effects of modulated tooling path machining processes, as applied to control chip geometry, on the surface stress of selected materials. Residual stresses in machined samples were characterised through the use of X-ray diffraction by comparing the modulated path method with a more traditional material removal technique (i.e. constant surface speed and constant contact).This paper is part of a Themed Issue on Measurement, modelling and mitigation of residual stress.

The slurry level in AG/SAG and ball mills has an influence on their power draw, which in some instances can be profound. This is particularly the case with so-called slurry pooling in AG/SAG mills which can result in significant lowering of power draw. From a predictive viewpoint there are currently no published models that explicitly describe the influence of slurry level on power draw and the relationship between slurry level, slurry flow and pulp lifter design. Citic SMCC Process Technology Pty Ltd has developed such a model and in this paper its structure is described. Examples are given of both AG/SAG and ball mills of how the model responds to changes in slurry level. These examples are used to explain the observed phenomena of slurry pooling and the decrease in power draw observed in ball mills after start-up when feed is first introduced into the mill.

There is a lack of research on the impact of the Electronic Residency Application Service (ERAS) photograph on the residency selection process.We sought to elucidate the role of the ERAS photograph in the dermatology residency selection outcome and to determine if photographs submitted by matched applicants differ from those of unmatched applicants.We analyzed ERAS photographs submitted by dermatology residency applicants based on photograph characteristics related to composition, attire, facial expression, hairstyle, and accessories.Candidates who smiled, wore glasses, and wore jackets in their photographs were more likely to match. There was no difference in the rate of matching among applicants depending on whether their photograph was of professional quality or whether they wore formal attire in their pictures. Gender specific characteristics were not found to be influential in the match outcome for male applicants. Among female applicants, having hair to the shoulders or longer was associated with a positive match outcome.Certain characteristics of the ERAS photographs were found to be associated with a more favorable match outcome. Further biases inferred from these photographs might be present in the dermatology selection process. We suggest blinding the selection committees to ERAS application photographs prior to granting residency interviews.