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OBJECTIVE To study a picosecond 755-nm alexandrite laser for the removal of tattoos to confirm the efficacy of this therapy, focusing on the effect of therapy on the target lesion as well as the surrounding tissues and quantifying the number of necessary treatments. DESIGN Fifteen patients with tattoos were enrolled. Treatments were scheduled approximately 6 ± 2 weeks apart. Standard photographs using 2-dimensional imaging were taken at baseline, before each treatment, and 1 month and 3 months after the last treatment. SETTING Dermatology clinic at SkinCare Physicians in Chestnut Hill, Massachusetts. PATIENTS Fifteen patients with darkly pigmented tattoos. MAIN OUTCOME MEASURES Treatment efficacy was assessed by the level of tattoo clearance in standard photographs. These photographs were assessed by a blinded physician evaluator and based on a 4-point scale. Efficacy was also assessed based on physician and patient satisfaction measured on a 4-point scale. RESULTS Twelve of 15 patients with tattoos (80%) completed the study. All 12 patients obtained greater than 75% clearance. Nine patients (75%) obtained greater than 75% clearance after having 2 to 4 treatments. The average number of treatment sessions needed to obtain this level of clearance was 4.25. All 12 patients (100%) were satisfied or extremely satisfied with the treatment. Adverse effects included pain, swelling, and blistering. Pain resolved immediately after therapy, while the swelling and blistering resolved within 1 week. Hypopigmentation and hyperpigmentation were reported at the 3-month follow-up. CONCLUSION The picosecond 755-nm alexandrite laser is a safe and very effective procedure for removing tattoo pigment.
OBJECTIVE To summarize and critically appraise the evidence on the measurement properties of clinician-, patient-, and observer-reported outcomes, measuring any construct of interest in patients with all types of vitiligo. DATA SOURCES Electronic databases including PubMed (1948 to July 2011), OVID EMBASE (1980 to July 2011), and CINAHL (EBSCOhost) (1982 to July 2011) were searched. STUDY SELECTION Two authors independently screened all records for eligibility. For inclusion, the study population had to include patients with vitiligo, for which outcome measures were developed or evaluated on their measurement properties. The initial search retrieved 1249 records, of which 14 articles met the inclusion criteria. DATA EXTRACTION Characteristics of the included instruments, study population, and results of the measurement properties were extracted. The Consensus-Based Standards for the Selection of Health Status Measurement Instruments (COSMIN) 4-point checklist, combined with quality criteria for measurement properties, was used to calculate the overall level of evidence per measurement property of each instrument. Independent extraction and assessment was performed by 2 authors. DATA SYNTHESIS Eleven different measurement instruments were identified. Strong evidence was found for a positive internal consistency of the Dermatology Life Quality Index. For other instruments, the evidence of measurement properties was limited or unknown. CONCLUSIONS Recommendations on the use of specific outcome measures for vitiligo should be formulated with caution because current evidence is insufficient owing to a low number of studies with poor methodological quality and unclear clinical relevance. To recommend outcome measures for vitiligo, further research on measurement properties of clinical relevant outcome measures for vitiligo according to COSMIN quality criteria is needed.
An 83-year-old man with a history of diabetes and chronic obstructive pulmonary disorder (COPD) (taking prednisone, 5 mg/d) was admitted to our facility with a monthlong history of persistent right arm swelling, erythema, and pain. He had multiple prior admissions for this issue and was treated with oral and intravenous antibiotics for a suspected “cellulitis.” His skin symptoms worsened despite treatment, and he developed an extensive superimposed pustular eruption with sinus tracts involving the entire forearm and a portion of the upper arm (Figure 1). Workup included ultrasonography, which showed no fluid collection, and magnetic resonance imaging, which showed soft-tissue swelling without evidence of any underlying myositis or osteomyelitis. A Tzanck smear failed to show multinucleated giant cells. Punch biopsy specimens for culture and histopathologic analysis were obtained (Figure 2 and Figure 3). What is your diagnosis?
UNLABELLED This article has been retracted. See Notice of Retraction. OBJECTIVE To investigate the effectiveness of early depth assessment of local burns, the depth of which is difficult to assess with the naked eye, by dermoscopy. DESIGN The morphological findings of burn wounds were prospectively evaluated by dermoscopy and videomicroscopy. Prior to dermoscopic and videomicroscopic measurement, clinical assessment was performed. All patients received conservative treatment for 21 days after injury. SETTING A burns unit at a primary care hospital. PARTICIPANTS Thirty-two patients with 41 intermediate-depth local burn wounds were included. Inclusion criteria were time to presentation greater than 24 hours after injury and total burn size greater than 1% and less than 10% of the total body surface area. MAIN OUTCOME MEASURES Primary healing within 21 days (superficial partial thickness) and failure of primary healing within 21 days (deep partial thickness). The accuracy, sensitivity, and specificity of the assessment according to the algorithm proposed in this study were evaluated by dermoscopy, and the accuracy of the dermoscopic measurements was compared with videomicroscopic measurements and clinical assessments. RESULTS The results of dermoscopic measurements according to the proposed algorithm showed an accuracy of 93%, sensitivity of 86%, and specificity of 100%. The dermoscopic measurements were significantly more accurate compared with clinical assessment (P = .01). CONCLUSIONS Dermoscopy is a noninvasive, portable, relatively inexpensive, and effective approach for assessment of the burn wound healing potential. It is more accurate if compared with clinical observation in burn depth assessment. It has a broader utility and is equally or more accurate compared with the more expensive videomicroscopy.
An 83-year-old man with a history of diabetes and chronic obstructive pulmonary disorder (COPD) (taking prednisone, 5 mg/d) was admitted to our facility with a monthlong history of persistent right arm swelling, erythema, and pain. He had multiple prior admissions for this issue and was treated with oral and intravenous antibiotics for a suspected “cellulitis.” His skin symptoms worsened despite treatment, and he developed an extensive superimposed pustular eruption with sinus tracts involving the entire forearm and a portion of the upper arm (Figure 1). Workup included ultrasonography, which showed no fluid collection, and magnetic resonance imaging, which showed soft-tissue swelling without evidence of any underlying myositis or osteomyelitis. A Tzanck smear failed to show multinucleated giant cells. Punch biopsy specimens for culture and histopathologic analysis were obtained (Figure 2 and Figure 3). What is your diagnosis?
OBJECTIVE:To ascertain and clarify the effectiveness and advantages of the geometric staged excision technique for the removal of lentigo maligna (LM) and lentigo maligna melanoma (LMM).DESIGN:This was a retrospective review of a patient database composed of 293 cases of LM and LMM.SETTING:The Laser and Dermatologic Surgery Center in St Louis, Missouri, an academic-affiliated, private dermatologic surgery center.PATIENTS:All patients with a diagnosis of LM and LMM treated by staged excision from 1999 to 2007.MAIN OUTCOME MEASURES:The overall rate of recrudescence, margins required for clearance, stages required for clearance, and lesional characteristics were examined.RESULTS:The rate of recrudescence after geometric staged excision was 1.7% (4/239), with a mean of 32.3 months of follow-up. The mean margin to clearance after excision was 6.6 mm for LM and 8.2 mm for LMM. A total of 11.7% of LMM was initially diagnosed as LM on biopsy, with the invasive component discovered during the excision.CONCLUSIONS:Geometric staged excision is an optimal method of removal of LM and LMM given its low rate of recrudescence and ability for complete examination of the peripheral and deep margins of the specimens.
The teaching of research methods is common across multiple fields in the social and educational sciences for establishing evidence-based practices and furthering the knowledge base through scholarship. Yet, specific to mixed methods, scant information exists as to how to approach teaching complex concepts for meaningful learning experiences. Thus, the purpose of this mixed research study was to examine strategies used by selected U.S.based leading mixed methodologists in mixed research courses as related to significant learning goals for course design. In addition, we examined the extent that their philosophical stances influenced teaching and course objectives for student learning. Participants were 12 leading mixed methodologists who were instructors of mixed research courses from various institutions representing multiple conceptual stances applicable to the teaching of mixed research. Instructional practices are presented for instructors to consider when designing and teaching mixed research and general research methodology courses across disciplines.
Background The large caliber of head hair in hair transplantation imparts a coarse hairline, whereas natural hairlines are typically softer. In hirsute individuals, transplantation of leg hair to the hairline may result in a superior aesthetic appearance. Observation A total of 1025 leg hair follicles in 1 patient were grafted to an area 0.5 to 1.0 cm in front of and 0.5 to 1.0 cm internal to the vanguard hair of the original hairline and temporal recesses; the other patient received approximately 1000 leg hairs and 600 head hairs to advance and soften his hairline and to create a custom widow's peak. Transplantation resulted in a fully grown and soft-looking hairline after 9 months in the first patient, with growth of 75% to 80% of the transplanted leg hair. The mean length of the transplanted leg hair was longer than the length of the original leg hair, with less curliness but similar hair width. Transplanted leg hair width was significantly finer compared with existing head hair width. After 4 years, results were sustained, minimizing concerns that subsequent hair loss might result from leg hair cycle variations. In the second patient, similar results were observed at 3 years. Conclusion The use of leg hair in transplantation provides additional options in patients with hairlines that need to be refined.
The paper investigates the behavior of Bare Singulars (BS) and Bare Mass (BM) nouns in Brazilian Portuguese (BrP) in two acceptability experiments. The traditional view on the BS (Munn & Schmitt, 2005) argues that its syntax and semantics differs from that of BM nouns, because they behave differently when combined with predicates of individuation, reflexives and reciprocals. Individuating predicates select for atomic individuals, and mass nouns do not denote atoms in a semi-lattice structure, is the explanation. Relying on Basso (2007), two experiments were conducted to verify the hypothesis predicted by the traditional view. Behind our enterprise is the intuition that BS are in some sense massive (Camacho & Pezatti, 1996). The experiments were applied to 200 speakers. The predictions of the traditional view are not fulfilled: BM nouns are acceptable by more than a half of the speakers, and some BS sentences are unacceptable. The second experiment evaluated whether the distribution of acceptability was due to natural atomicity (Rothstein, 2008). Although there seems to be some influence, the results are not conclusive. Compared to French, English and German 1 , the determiner system in Brazilian Portuguese (BrP, from now on) may be said to be completely overt because, besides quantificational determiners, type <t>, the determiner 1 For English, the traditional reference is Carlson (1977); for French, and German, Schaden (2009). 76 João Vinicius A. Braga, Laiza de Sena, Ruan Mariano & Roberta P. de Oliveira phrase, of type e, ranges from overtly definite and indefinite phrases, both singular and plural, to a complete system of bare noun phrases in argument position: bare singulars (1a), bare plurals (1b) and bare mass, in (1c): (1) a. Minhoca cava buraco grande. worm digs hole big b. Minhocas cavam buracos grandes. worms dig big holes c. Leite faz bem pra saúde. 2 Milk makes well for health ‘Milk is healthy’. This paper investigates the behavior of the Bare Singular (BS, from now on), (1a), in comparison to bare mass nouns (BM), (1c), in contexts used by the here labeled “traditional view” (from Munn & Schmitt, 1999 on) to support the claim that the BS and the BM are syntactically and semantically distinct. This claim relies on one empirical fact: only the BS may combine with individuating predicates – i.e. predicates that select for an atomic individual –, mainly distributive predicates like ‘pesar 20 kilos’ (to weigh 20 kilos), reciprocals and reflexives. This view ignores the intuition that the BS and the BM nouns are alike. In fact, the similarities between the BS and the BM in BrP seem to be stronger than the ones between the Bare Plural and the Bare Mass in English, the existence of which were the point of departure of Link’s seminal analysis (1983). This intuition clearly underlies Camacho & Pezatti (1996) functionalist description of the nominal domain in BrP. It also finds support in the syntactic distribution of the BS and the BM, which have gone unnoticed in the literature. 3 In this paper, we closely investigate the pertinence of the generalization that only BSs combine with individuating predicates.. In the traditional view BSs are number neutral, i.e. they denote both atoms and pluralities. This explains why BSs phrases may be resumed anaphorically by a singular or a plural pronoun. Given Chierchia’s proposal for the denotation of mass nouns – they denote both atoms and pluralities –, one expects that the BS and the BM behave alike. But, as shown by Munn & Schmitt, they don’t, because only the BS is a count noun, and this justifies going back to Link’s ontological distinction between stuff-things, which are atom-less, and countable/atomic things, which come into units. 4 However, the predictions raised by the traditional view do not find empirical support: both experiments show that speakers reject sentences 2 BrP also has definite mass noun phrases: (1) O leite faz bem pra saúde. The milk makes well for health. Milk is healthy. 3 Pires de Oliveira & Rothstein (in preparation). 4 Following Link (1982), the nominal domain is understood to be structure as a semi-lattice. Bare singular and bare mass nouns in Brazilian Portuguese 77 where the BS is combined with individuating predicates, and they accept sentences where a bare mass noun is combined with this same type of predicate. This empirical finding jeopardizes the generalization the traditional view wants to explain while it shows that the explanation for the contrast between BS and BM, which does exist, as the experiments also show, cannot be described as between atomic and non-atomic predicates. If this were the case, the traditional view predictions should be confirmed, but they were not. Since in the first experiment, most of the examples were of non-prototypical mass and count nouns, because our intuition was that these nouns would contradict the traditional view, we decided to run a second experiment where we also investigate whether the relevant parameter was natural versus non-natural atomicity. This last hypothesis was not confirmed. Experiments of acceptability are still not very common in the formal tradition in linguistics, but there are increasingly more psycholinguistic experiments about grammatical predictions. 5 We take for granted the validity of acceptability experiments. The first section presents the evidences supporting the traditional view and our own judgments of grammaticality of non prototypical examples of mass and count nouns, for instance ‘mobília’ (furniture) and ‘cerca’ (fence). The former is a naturally atomic mass noun, whereas the later is a non-naturally atomic count noun (Rothstein’s 2008). In the second section, we introduce the general design of the experiments. The third section is devoted to the description of the first empirical test. In section 4, we present the second empirical experiment. Both experiments were applied to 200 students. Finally, we conclude that the predictions of the traditional view do not find empirical support, and that the hypothesis that speakers’ judgments were biased by natural atomicity, analyzed in the second experiment, was inconclusive. 1. A criticism of the Tradicional View The traditional view argues that the bare singular does not behave like bare mass nouns in contexts which ask for individuation, as with reciprocals, reflexives, and individuating predicates such as ‘pesar X kilos (nessa idade)’ (to weigh X kilos (in this age)). That the bare mass noun is incompatible with any operation of individuation is expected under the traditional view, because mass nouns do not have atoms. It is also expected that the BS, because it is countable, though number neutral, does accept atomization. Sentence (2) is fine, because ‘criança’ (child) is countable, whereas sentence (3) is ungrammatical, because ‘ouro’ (gold) cannot be individuated, since it has no atoms (Munn & Schmitt, 1999, 2005; Schmitt & Munn, 2002; Müller & Paraguassu, 2006; Paraguassu & Müller, 2008): 5 See, for instance, Featherston & Stenefeld (2007), and Weskott & Fanselow (2008). 78 João Vinicius A. Braga, Laiza de Sena, Ruan Mariano & Roberta P. de Oliveira (2) Criança (nessa idade) pesa 20 kg. Child (in-this age) weighs 20 kilos. ‘Children weigh 20 kilos at this age.’ (3) * Ouro pesa duas gramas Gold weighs two grams. The same contrast appears when the BS and the BM nouns are combined with other predicates that select for atoms, as exemplified below (all the examples are from Munn & Schmitt (2005) and Schmitt & Munn (2002)): (4) Elefante cai um atrás do outro. Elephant falls one behind of-the other. ‘Elephants fall one after the other’ (5) * Ouro cai um atrás do outro. Gold falls one behind of-the other. ‘Gold falls one after the other’. Moreover, both reflexives and reciprocals are fine with the countable bare singular, but not with bare mass nouns (Schmitt & Munn, 2002), because they ask for atomic individuals: (6) Criança briga uma com a outra. Child fights one with the other. ‘Children fight with one another.’ (7) * Ouro realça um o outro. Gold enhances one the other. ‘Gold enhances each other.’ (8) Criança se lava sozinha. Child herself washes alone. ‘Children wash themselves alone.’ However, the above examples are prototypical mass and count nouns: ‘ouro’ (gold), ‘criança’ (child), and ‘elefante’ (elephant), respectively. But, as authors like Gillon (1992) and Chierchia (1998) argue, one should be careful to rely on the idea that only countable nouns are atomic for several reasons: (i) there are atomic mass nouns, the most quoted example is ‘furniture’ in English; and (ii) languages differ with respect to the distinction between mass and count nouns – from a prosaic perspective, in English ‘lentils’ is countable, but ‘lentilha’ (lentils) in BrP is mass; from a broader one, there may be languages, Chinese is often quoted as such a language, where this distinction Bare singular and bare mass nouns in Brazilian Portuguese 79 is not given 6 . For Chierchia mass nouns have atoms, although they may be vague. Coming from the countable side, Rothsthein (2008) argues that there are count nouns which are not naturally atomic – whose atomicity depends on contextual parameters –, ‘fence’ (‘cerca’), for instance. Rothstein (2008) distinguishes three notions of atoms: natural atomicity, semantic atomicity and formal atomicity. Natural atomicity should be language independent because it relies on the fact that “things” in the world come clearly into units, like boys or furniture. This criterion does not coincide with the distinction between mass and count nous: there are mass nouns – ‘mobília’ (furniture), for instance – that are naturally atomic, though massive, and count nouns like ‘cerca’ (fence) that are not naturally atomic, though countable. Our suspicion is that the generalization raised by the traditional view arises because the examples chosen are all prototypical nouns, i.e. mass nouns without atoms and atomi
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Confluent and reticulated papillomatosis is a rare disorder that is most often clinically confused with tinea versicolor, even when CARP presents in a typical fashion.The current report of an unusual variant of the hypopigmented variant of CARP in dark-skinned patients underscores the importance of keeping a high clinical suspicion for CARP in patients who present with lesions that resemble tinea versicolor, in particular in darkly pigmented individuals in whom antifungal therapy has failed.Hypopigmented CARP responds to minocycline but appears to require several months of treatment and adjuvant topical tazarotene in recalcitrant cases.
