Treatment of Hailey-Hailey Disease of the vulva: a retrospective case series

Background: Hailey-Hailey disease (familial benign chronic pemphigus) of the vulva is a rare autosomal dominant dermatosis characterized by malformation of desmosomes and bullae, particularly in intertriginous areas. Cases: We reviewed the cases of 5 women followed at a single academic institution over a period of 17 years. Of the 5 patients, 4 carried a diagnosis of Hailey-Hailey at the time of presentation to our institution, and one was diagnosed on biopsy. 3 were members of a family group. Initial treatment of choice was a topical steroid (betamethasone in 3, fluocinonide and hydrocortisone in 1 each), vulvar skin guidelines, tepid soaks, a skin protectant (A&D; ointment, zinc oxide) and additional treatment (crotamiton in 1, clotrimazole in 2, and Polysporin in 1). Final treatment regimens in 3 patients followed long term were zinc oxide/A&D; and betamethasone-clotrimazole ointment in all 3, nystatin-triamcinolone ointment in 2, oral minocycline in 1, oral fluconazole prn in 1, and topical tacrolimus in 1. Treatment courses were complicated by superimposed fungal infections, superimposed bacterial infections, and lichen simplex chronicus flares. These were treated with antifungals, topical clindamycin and metronidazole, and steroid-antifungal bursts, respectively. Three of five patients followed long term achieved successful remission with occasional flares. Discussion: Treatment of Hailey-Hailey disease must be tailored to the individual patient. Adherence to vulvar skin care guidelines is critical for the remission of Hailey-Hailey disease. Treatment is long-term and may be complicated by episodes of fungal and bacterial superinfection and lichen simplex chronicus

Can children's instructional gameplay activity be used as a predictive indicator of reading skills?

For children who may face reading difficulties, early intervention is a societal priority. However, early intervention requires early detection. While much research has approached the issue of identification through measuring component skills at single timepoints, an alternative is the utilisation of dynamic assessment. To this point, few initiatives have explored the potential for identification through progress data from play in digital literacy games. This study explored how well growth curves from progress data in a digital intervention can predict reading performance after gameplay compared to measuring component skills at a single timepoint (school entry). 137 six-year-old students played the digital Graphogame for 25 weeks. Latent growth curve analyses showed that variation in trajectories explained variation in literacy performance to a greater extent than risk status at school entry. Findings point to a potential for non-intrusive reading assessment in the application of a serious digital game in first grade

Global fetal DNA methylation and birth outcomes in obese women

Pregnant women who are obese are more likely to have gestational diabetes, gestational hypertension, pre-eclampsia, macrosomia, operative vaginal delivery, and cesarean delivery. Obesity also has adverse implications for the neonate. Congenital anomalies are more common in children born to obese women. These include neural tube defects, gastroschisis, cardiovascular anomalies, and others. Although the connection between maternal obesity and chronic health conditions has been described, the mechanism by which this occurs is less well understood. Changes to the epigenetic structure of offspring DNA have been proposed as one such mechanism

Anodic dissolution of metals in oxide-free cryolite melts

The anodic behavior of metals in molten cryolite-alumina melts has been investigated mostly for use as inert anodes for the Hall-Héroult process. In the present work, gold, platinum, palladium, copper, tungsten, nickel, cobalt and iron metal electrodes were anodically polarized in an oxide-free cryolite melt (11%wt. excess AlF3 ; 5%wt. CaF2) at 1273 K. The aim of the experiments was to characterize the oxidation reactions of the metals occurring without the effect of oxygen-containing dissolved species. The anodic dissolution of each metal was demonstrated, and electrochemical reactions were assigned using reversible potential calculation. The relative stability of metals as well as the possibility of generating pure fluorine is discussed

Advancing integrative “one-health” approaches to global health through multidisciplinary, faculty-led global health field courses

AbstractBackgroundSince 2003, the University of Wisconsin-Madison Global Health Institute, together with collaborating campus and in-country partners, has offered immersive, multidisciplinary, faculty-led, global health field courses in Ecuador and Thailand. These courses aim to help students to develop a working understanding of integrative one-health approaches and acquire the skills to work effectively across disciplines. That is, we aim to foster an appreciation of the role of culture in perceptions of health, disease, and health care; the complex interactions of animal-human-ecosystem health and disease; and the value of integrating cross-disciplinary and cross-cultural perspectives and skills to solve complex public health problems.MethodsStudents from various University of Wisconsin-Madison health faculties travelled, lived (accommodation included homestays in indigenous or rural communities), learnt, and engaged in community-health assessments or service-learning projects as a multidisciplinary team. We recruited students through annual presentations in each University of Wisconsin school or college and through recommendations from past participants. We recorded student reflections during the course, at course completion, and after graduation.FindingsBetween 2003 and 2014: 215 students from the University of Wisconsin have taken part in the global health field courses. Students came from the fields of human medicine (53 [25%]), veterinary medicine (35 [16%]), nursing (40 [19%]), pharmacy (41 [19%]), and other degree programs (46 [21%]). Results of the in-course and post course assessments consistently show strong student satisfaction with many aspects of the programme, including safety, faculty mentorship, the value of the multidisciplinary approach, depth of learning, and programme cost. Former participants also report use of cross-cultural skills in their professional practice, work with populations from cultures other than their own, positive effects on their decisions for career activities, and the belief that immersive cross-cultural experiences should be a required part of professional training for all health professional students. Finally, the courses undergo independent programme evaluations (including in-country observation and interviews with participants and stakeholders) approximately every 5 years.InterpretationProgramme directors continue to seek improvements related to: sustainable faculty engagement from various disciplines; development of increasingly specific course group learning objectives, competencies, and assessment tools; sustainability of impacts on community-level health and wellbeing; continuity between University of Wisconsin-Madison and in-country university and community partners; and scholarship support and other approaches so that cost does not exclude interested students from participating.FundingThe GHI is supported through a combination of university, grants, and philanthropic funding; these field courses do not have specific, separate funding. Students self-fund participation in the courses

A New Narrowbeam, Multi-Frequency Scanning Radiometer and Its Application to In-Flight Icing Detection

A narrow-beam (1 degree beamwidth), multi-channel (20 to 30 and 89 GHz), polarized (89 vertical and horizontal) radiometer with full azimuth and elevation scanning capabilities has been built with the purpose of improving the detection of in-flight icing hazards to aircraft in the near airport environment. This goal was achieved by co-locating the radiometer with Colorado State University's CHILL polarized Doppler radar and taking advantage of similar beamwidth and volume scan regiments. In this way, the liquid water path and water vapor measurements derived from the radiometer were merged with CHILL's moment fields to provide diagnoses of water phase and microphysics aloft. The radiometer was field tested at Colorado State University's CHILL radar site near Greeley, Colorado, during the summer of 2009. Instrument design, calibration and initial field testing results are discussed in this pape

Investigating the use of patient involvement and patient experience in quality improvement in Norway: rhetoric or reality?

Background Patient involvement in health care decision making is part of a wider trend towards a more bottom-up approach to service planning and provision, and patient experience is increasingly conceptualized as a core dimension of health care quality. The aim of this multi-level study is two-fold: 1) to describe and analyze how governmental organizations expect acute hospitals to incorporate patient involvement and patient experiences into their quality improvement (QI) efforts and 2) to analyze how patient involvement and patient experiences are used by hospitals to try to improve the quality of care they provide. Methods This multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews and non-participant observation of key meetings and shadowing of staff at the meso and micro levels in two purposively sampled Norwegian hospitals. Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011–2012). Results Governmental documents and regulations at the macro level demonstrated wide-ranging expectations for the integration of patient involvement and patient experiences in QI work in hospitals. The expectations span from systematic collection of patients’ and family members’ experiences for the purpose of improving service quality through establishing patient-oriented arenas for ongoing collaboration with staff to the support of individual involvement in decision making. However, the extent of involvement of patients and application of patient experiences in QI work was limited at both hospitals. Even though patient involvement was gaining prominence at the meso level − and to a lesser extent at the micro level − relevant tools for measuring and using patient experiences in QI work were lacking, and available measures of patient experience were not being used meaningfully or systematically. Conclusions The relative lack of expertise in Norwegian hospitals of adapting and implementing tools and methods for improving patient involvement and patient experiences at the meso and micro levels mark a need for health care policymakers and hospital leaders to learn from experiences of other industries and countries that have successfully integrated user experiences into QI work. Hospital managers need to design and implement wider strategies to help their staff members recognize and value the contribution that patient involvement and patient experiences can make to the improvement of healthcare quality

First Attempt at Spectroscopic Detection of Gravity Modes in a Long-Period Pulsating Subdwarf B Star -- PG 1627+017

In the first spectroscopic campaign for a PG 1716 variable (or long-period pulsating subdwarf B star), we succeeded in detecting velocity variations due to g-mode pulsations at a level of 1.0-1.5 km/s.The observations were obtained during 40 nights on 2-m class telescopes in Arizona, South Africa,and Australia. The target,PG1627+017, is one of the brightest and largest amplitude stars in its class.It is also the visible component of a post-common envelope binary.Our final radial velocity data set includes 84 hours of time-series spectroscopy over a time baseline of 53 days. Our derived radial velocity amplitude spectrum, after subtracting the orbital motion, shows three potential pulsational modes 3-4 sigma above the mean noise level, at 7201.0s,7014.6s and 7037.3s.Only one of the features is statistically likely to be real,but all three are tantalizingly close to, or a one day alias of, the three strongest periodicities found in the concurrent photometric campaign. We further attempted to detect pulsational variations in the Balmer line amplitudes. The single detected periodicity of 7209 s, although weak, is consistent with theoretical expectations as a function of wavelength.Furthermore, it allows us to rule out a degree index of l= 3 or l= 5 for that mode. Given the extreme weakness of g-mode pulsations in these stars,we conclude that anything beyond simply detecting their presence will require larger telescopes,higher efficiency spectral monitoring over longer time baselines,improved longitude coverage, and increased radial velocity precision.Comment: 39 pages, 9 figures, 4 tables, ApJ accepted. See postscript for full abtrac

The Risk of Getting Worse: Predictors of Deterioration After Decompressive Surgery for Lumbar Spinal Stenosis: A Multicenter Observational Study

ObjectiveTo investigate the frequency and predictors of deterioration after decompressive surgery for single and 2-level lumbar spinal stenosis.MethodsProspectively collected data were retrieved from the Norwegian Registry for Spine Surgery. Clinically significant deterioration was defined as an 8-point increase in Oswestry disability index (ODI) between baseline and 12 months' follow-up.ResultsThere were 2181 patients enrolled in the study. Of 1735 patients with complete 12 months follow-up, 151 (8.7%) patients reported deterioration. The following variables were significantly associated with deterioration at 12 months' follow-up; decreasing age (odds ratio [OR] 1.02, 95% confidence interval [95% CI] 1.00–1.04, P = 0.046), tobacco smoking (OR 2.10, 95% CI 1.42–3.22, P = 0.000), American Society of Anesthesiologists grade ≥3 (OR 1.80, 95% CI 1.07–2.94, P = 0.025), decreasing preoperative ODI (OR 1.05, 95% CI 1.02–1.07, P = 0.000), previous surgery at the same level (OR 2.00, 95% CI 1.18–3.27, P = 0.009), and previous surgery at other lumbar levels (OR 2.10, 95% CI 1.19–3.53, P = 0.009).ConclusionsOverall risk of clinically significant deterioration in patient-reported pain and disability after decompressive surgery for lumbar spinal stenosis is approximately 9%. Predictors for deterioration are decreasing age, current tobacco smoking, American Society of Anesthesiologists grade ≥3, decreasing preoperative ODI, and previous surgery at same or different lumbar level. We suggest that these predictors should be emphasized and discussed with the patients before surgery