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Purpose of Review: Teledermatology, an expanding care model rooted in telehealth, has the potential to overcome traditional healthcare constraints. This review reflects on recent literature and focuses on the impact of teledermatology on acne vulgaris, a common dermatological condition. Recent Findings: Teledermatology care models can employ both consultative or direct-care models through real-time video or asynchronous "store-and-forward" methods. Studies indicate high diagnostic accuracy and effective management for common skin conditions, which reduces the need for unnecessary in-person visits. Access to care is enhanced, although challenges persist. For example, teledermatology prevents providers from doing common, in-office procedures. Additionally, teledermatology must contend with internet connectivity issues, discrepancies in care based on race, and the quality of physician or patient-generated photos. While this review provides valuable insights, it is limited due to the scarcity of relevant literature, emphasizing the need for further research in this evolving field. Summary: Patient perspectives are generally favorable towards teledermatology, but there still remains a perception of substandard care. Health systems should consider developing care platforms that implement both synchronous and asynchronous models.

Background: There is no standard method of identifying adverse events in clinical trials. Objective: To determine whether 3 different methods of questioning patients about adverse events in a clinical trial affect the frequency of reported events. Design: Randomized, single-blind, controlled trial. Setting: A Veterans Administration medical center, San Francisco, California. Participants: Men 50 years of age or older who had benign prostatic hyperplasia. Measurement: Frequency of self-reported medical problems. Intervention: The authors randomly assigned 214 men who were undergoing a 1-month, single-blind, placebo run-in period during an existing clinical trial to 3 groups to test different self-administered methods of assessing medical problems at the end of the run-in period. The first group was asked an open-ended question; the second group was asked an open-ended, defined question; and the third group was given a checklist of 53 common side effects. Results: All 214 patients completed the study. Patients assigned to the checklist group reported a total of 238 adverse events; in comparison, patients who were asked an open-ended question or an open-ended, defined question reported 11 and 14 adverse events, respectively (P < 0.001). The percentage of patients reporting any adverse event was also much higher in the group assigned to the checklist (77%) than in the first group (14%) or second group (13%) (P < 0.001). Limitations: The study included only relatively healthy, well-educated, middle-aged men and assessed only self-reported medical problems after the participants had taken placebo for 1 month. All personnel overseeing the study were aware of the group assignments. Conclusions: Different methods of collecting patient data regarding adverse events lead to large differences in the reported rates of adverse events in clinical trials, potentially reducing the validity of comparisons between the side effect profiles of drugs and other interventions.

Randomised clinical trials provide the most valid means of establishing the efficacy of clinical therapeutics. Ethical standards dictate that patients and clinicians should not consent to randomisation unless there is uncertainty about whether any of the treatment options is superior to the others ('equipoise'). However, true equipoise is rarely present; most randomised trials, therefore, present challenging ethical dilemmas. Minimising the tension between science and ethics is an obligation of investigators and clinicians. This article briefly reviews several techniques for addressing this issue and suggests that unbalanced randomisation, a technique rarely employed in current clinical trial practice, may be useful for enhancing the ethical design of human experimentation. Keywords: Medical ethics; clinical trials; research design; random allocation; decision making; human experimentation

The Veterans Health Administration is exploring ways to reform the current Veterans Affairs (VA) system in accordance with the changing health care environment of managed care. One proposal is for the VA to enlarge its patient base by expanding eligibility to include spouses of veterans. To compare reported preventive health care services received by male veterans and their spouses and to measure whether spouses would choose to receive their medical care through a VA medical center, we randomly selected 230 married male veterans and mailed self. administered questionnaires to be completed by them and their spouses; 170(74%) eligible subjects completed the questionnaire. The mean age of the veterans and spouses was 73.6 and 67.4 years, respectively. Veterans reported significantly higher rates of receipt of recommended preventive services than their spouses in all 5 areas assessed, including blood pressure measurement; influenza, pneumococcal, and tetanus vaccinations; and serum cholesterol measurement. Veterans were significantly more satisfied than their spouses with their current health care. Finally, 83% (95% confidence interval, 77% to 89%) of spouses reported that they would choose to receive their medical care at the VA medical center if allowed to do so. These findings suggest that spouses of male veterans represent a sizable group that could be incorporated into the VA system, especially given their strong desire to do so. (Jain S, Avins AL, Mendelson T. Preventive health services and access to care for male veterans compared with their spouses. West J Med 1998; 168:499-503), The Veterans Health Administration (VHA) operates the largest system of direct health care by the government, through a network of 173 hospitals, approximately 550 outpatient and community-based ambulatory care clinics, [...]

Current recommendation for the treatment of hypercho-lesterolemia include drug therapy for persons at sufficiently elevated risk for coronary heart disease. However, no guidelines incorporate the effects of alternative intervention that decrease risk for coronary heart disease but are specifically to alter blood lipids. We did a simulation study to estimate the number of hypercholesterolemic adults who would continue to exceed a high-risk threshold after receiving aspirin, antihypertensive medication, and estrogen-replacement therapy. We found that of all persons who are currently candidates for hypolipidemic medication because they are at high risk for coronary heart disease, 6 to 8 million would no longer have this therapy recommended if the abilities of alternative interventions to reduce risk were considered. Pharmaceutical cost savings associated with alternative interventions range from $3 to $4 billion per year. Current guidelines should be revised to account for this effect., Evidence suggests that the use of alternative treatments to lower risk for heart disease may reduce the need for drugs to lower cholesterol levels. Alternative therapies include medications to reduce blood pressure, aspirin, and hormone-replacement treatments. A simulation model has shown that six to eight million people would no longer be advised to take cholesterol lowering medications if these alternative therapies were effective in reducing risk for heart disease. This would result in a national drug cost savings of $3 billion to $4 billion per year.

Introduction Isaac Babel (1894-1940), one of the greatest Russian writers of this century, gained renown for a relatively small body of work. His range, however, is broad: from the vitality [...]

Aziz Ghazal's zeal to direct and produce 'The Brave' was surpassed only by his obsession with his estranged family. Thus, the fictional story of a man who agreed to star in a snuff film to give his family a better life has become a real-life story of murder and suicide.

Animator Tim Burton may be considered a genius in the design of things macabre. With Henry Selick, Burton has returned to Walt Disney Co to produce 'The Nightmare Before Christmas,' an animated musical featuring a manic-depressive skeleton as the lead character.

The 80-minute black-and-white version of the new Walt Disney animated feature 'Aladdin' was turned down by top executives even after three years of development work and six months of active production. Finally, after more than a year of revision, 'Aladdin' comes out as a comedy-adventure for boys.

* Objective.--To examine the prescribing patterns and predictors of physician choice in the selection of intravenous thrombolytic therapy for the treatment of acute myocardial infarction. Design.--Survey of a random sample of 250 California cardiologists between July 1989 and February 1990. Results.--The adjusted response rate was 66%. For a patient presenting within 30 minutes after the onset of an uncomplicated acute anterior-wall myocardial infarction, 98% of respondents reported that they would prescribe a thrombolytic agent, 79% chose tissue plasminogen activator, and 21 % chose streptokinase. Users of tissue plasminogen activator were nine times more likely than streptokinase users to perceive tissue plasminogen activator as superior for early coronary artery recanalization, although most users of tissue plasminogen activator and streptokinase perceived no difference between the two agents for improvement in ejection fraction and mortality. Estimates of side effects did not distinguish the two groups. Users of streptokinase were eight times more likely to practice in a health maintenance organization than were users of tissue plasminogen. For a self-paying patient, 36% of users of tissue plasminogen activator said that they would switch to streptokinase, and 27% would switch for a patient insured by Medicaid. Conclusions.--These results indicate that physicians place great emphasis on surrogate end points. Physicians vary in their willingness to use more expensive therapies over cheaper alternatives, even when their perceptions of the relative risks and benefits are similar. The patient's insurance status and the provider's practice setting may exert an important influence on doctors' clinical choices. (Arch Intern Med. 1992;152:1665-1672)

Movie director Richard Donner directs an exciting flight scene for the ending of the movie 'Radio Flyer.' The movie, portraying two young brothers' escape from a cruel step-father, portrays child abuse and conveys the message that something can be done about it.

The effectiveness of acupuncture for chronic low back pain (cLBP) has not been studied specifically in the 65-and-older population. To inform the validity and generalizability of future acupuncture studies among older adults, we characterized elderly participants’ prior experience with and views toward acupuncture and tested for clinical and sociodemographic differences between acupuncture-naïve and non-naïve participants.

The advent of global branding in the 1980s and the coming of the fashion stylist in the 1990s have contributed to the decline of Hollywood-style dressing. The magazines also contributed to the trend by not wanting the movie stars, especially the males, to look too elegant.

Byline: Jenni Avins Michele Bachmann may have tried to demagogue the issue ('President Bachmann will allow you to buy any lightbulb you want!' she announced on the campaign trail last [...]

Byline: Jenni Avins A south Jersey marsh in a December drizzle isn't pleasant. It's gray. And there's a great deal of mud. But with a guide like John Zander--all strong [...]

Movie director Robert Zemeckis reported that computer graphics were used to create some of the footages in the film 'Forrest Gump.' The film, which stars Tom Hanks, is about a popular businessman who socialized with prominent political figures and celebrities.

Insufficient evidence to treat The American Journal of Cardiology recently devoted a supplement to the hypertriglyceridaemias,(1) reviving the problem of whether a high serum triglyceride concentration should be treated to [...]

Byline: Jenni Avins Last year, Deitch Projects and the Haring Foundation reproduced a 1982 Haring mural at Houston and Bowery. In July, Deitch had twin Brazilian artists, who go by [...]

The article offers ways to improve teaching and advance student learning requires weaving together the curriculum that students engage with the professional learning of teachers. It mentions that curriculum materials have the potential to promote teacher learning when intentionally designed to do so. The article adds ECMs support science teachers' developing pedagogical knowledge, content knowledge, and pedagogical content knowledge (PCK) in instances of instructional decision making.

Background: Prior research suggests that adding triglyceride determinations to measurements of total cholesterol and cholesterol subfractions may improve the prediction of coronary heart disease (CHD). Objective: To determine the additional value of measuring triglyceride levels, in addition to cholesterol levels and subfractions, for predicting CHD. Study Design: A set of secondary analyses of previously reported studies. Methods: We performed secondary analyses of data from the Multiple Risk Factor Intervention Trial, the Lipid Research Clinics Coronary Primary Prevention Trial, and the Lipid Research Clinics Prevalence and Mortality Follow-Up Study. Predictor variables included the levels of fasting triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and fasting blood glucose; age; blood pressure; cigarette smoking; body mass index; and postmenopausal estrogen use. Analytic methods included Cox proportional hazards models, calculation of stratified crude incidence rates, and measurement of the area under the receiver operating characteristic curve. Main Outcome Measures: Outcome variables were fatal and nonfatal myocardial infarctions. Results: With few exceptions, no significant interactions between cholesterol subfractions and triglyceride levels were found and receiver operating characteristic curve analyses revealed that triglyceride measurements did not improve discrimination between those subjects who did and did not suffer CHD events. In men, categorical analyses employing both triglyceride and cholesterol levels were similar to those using cholesterol categories alone. In the one study of women, those subjects with both a high-risk cholesterol profile and high triglyceride levels were more likely to have a CHD event, though this finding was based on fewer subjects and CHD events. Conclusion: These data suggest that, in men, measurement of serum triglyceride levels does not provide clinically meaningful information about CHD risk beyond that obtainable by measurement of serum cholesterol subfractions alone. Arch Intern Med. 2000;160:1937-1944

I love clothes. While my foodie friends taste summer in a perfectly ripened tomato, I prefer the pleasure of cotton voile on salty, sun-kissed skin. For most of my life, [...]

The fine-jewelry craze is at a fever pitch. Here's what to invest in now. It's an exciting moment for aficionados of fine jewelry. Business is booming, auction houses are smashing [...]

Colloidal self-assembly is a promising bottom-up route to a wide variety of three-dimensional structures, from clusters to crystals. Programming hierarchical self-assembly of colloidal building blocks, which can give rise to structures ordered at multiple levels to rival biological complexity, poses a multiscale design problem. Here we explore a generic design principle that exploits a hierarchy of interaction strengths and employ this design principle in computer simulations to demonstrate the hierarchical self-assembly of triblock patchy colloidal particles into two distinct colloidal crystals. We obtain cubic diamond and body-centered cubic crystals viadistinct clusters of uniform size and shape, namely, tetrahedra and octahedra, respectively. Such a conceptual design framework has the potential to reliably encode hierarchical self-assembly of colloidal particles into a high level of sophistication. Moreover, the design framework underpins a bottom-up route to cubic diamond colloidal crystals, which have remained elusive despite being much sought after for their attractive photonic applications.

Griffith says she is still in love with Don Johnson, although she filed for divorce. The 37-year-old actress stars in the upcoming film, 'Milk Money.' She discusses her children, career, creativity and other topics.

There were 9,151 outlet stores in the US in 1993, accounting for sales of $9.9 billion. However, outlet store values may be diminishing as they become more like shopping malls. One study showed a 20% average savings over retail, despite an outlet claim that 44% is the savings average.

Tim Coates' opinion piece, 'Libraries in Crisis' (3rd June) cannot go unanswered. Our opening hours exceed the official Public Library Standards, and increased by 17.5 hours per week in 2004/05. [...]

Background: Left bundle-branch block (BBB) is considered an important predictor of poor outcome in patients with acute myocardial infarction, but the consequences of right BBB are not well understood. Objectives: To 1) estimate the prevalence of left and right BBB in patients with myocardial infarction; 2) compare the clinical characteristics of and treatments received by patients with left, right, or no BBB; and 3) determine the independent association of left BBB and right BBB with in-hospital death. Design: Retrospective cohort study. Setting: Multicenter registry of 1571 U.S. hospitals. Patients: 297 832 patients with acute myocardial infarction who had left, right, or no BBB on initial electrocardiography. Measurements: Presence and type of BBB, clinical characteristics of patients, therapies given, and [n-hospital death. Results: Patients with left BBB (n = 19 967; 6.7%) or right BBB (n = 18 354; 6.2%) were older and had more comorbid illness and congestive heart failure than patients with no BBB. Among patients for whom thrombolytic therapy was clearly indicated, fewer patients with left or right BBB (16.6% and 32.0%, respectively) than patients with no BBB (66.5%) received this therapy (P [is less than] 0.001). Fewer patients with left or right BBB (60.6% and 67.3%, respectively) than patients with no BBB (75.6%) received aspirin within the first 24 hours (P [is less than] 0.001), and fewer patients with left or right BBB (23.9% and 31.8%, respectively) than patients with no BBB (40.4%) received [Beta]-blockers within the first 24 hours (P [is less than] 0.001). Unadjusted in-hospital mortality rates were almost twice as high for patients with left or right BBB (22.6% and 23.0%, respectively) as for patients with no BBB (13.1%) (P [is less than] 0.001). Compared with no BBB and no ST-segment elevation, left BBB was associated with a 34% increase (odds ratio, 1.34 [95% Cl, 1.28 to 1.39]) and right BBB was associated with a 64% increase (odds ratio, 1.64 [Cl, 1.57 to 1.71]) in the risk for in-hospital death, after adjustment for potential confounders. Conclusions: In patients with acute myocardial infarction, prevalences of right and left BBB are similar. Patients with BBB have more comorbid conditions, are less likely to receive therapy, and have an increased risk for in-hospital death compared with patients with no BBB. Compared with left BBB, right BBB seems to be a stronger independent predictor of in-hospital death., Patients with bundle-branch blocks may be less likely to receive treatment after a heart attack, and more likely to die while hospitalized. Bundle-branch blocks (BBB) are electrical conduction defects in the heart. Researchers compared 297,832 heart attack patients, based on the presence or absence of a BBB. Only 16-32% of patients with BBBs received clot-dissolving drugs when indicated, while 67% of patients with electrically normal hearts received the drugs. Twenty-three percent of patients with a BBB died in the hospital, compared to only 13% of patients with no BBB.

The article offers travel tips for different destinations including Western Ireland, Charleston, South Carolin, and Revelstoke, British Columbia.

The article presents the author's views on the benefits and limits of redundancy in deployment systems of model rockets. He defines redundancy which is the use of more devices to perform a task than what is necessary to ensure that the system will continue operating even if one of the devices fail. He comments that redundancy makes the system more reliable, however redundancy also increases the chance of early firing.

The use of dietary supplements for treating a wide range of health conditions has grown rapidly in the United States. In the field of men’s health, the most common dietary supplement used is an extract of the berry of the saw palmetto plant, with which men commonly self-medicate in order to treat lower urinary tract symptoms. Throughout the past two decades, substantial literature has emerged examining the biologic and clinical effects of saw palmetto extracts. Several lines of evidence suggest that saw palmetto may exert physiologic effects consistent with a beneficial clinical effect on the mechanisms of benign prostatic hyperplasia. Although most clinical studies tend to suggest a modest efficacy benefit of saw palmetto, more recent studies are less consistent and the precise clinical value of saw palmetto for treating lower urinary tract symptoms remains undefined. Overall, there appear to be few safety concerns with short-term use of this herbal medicine, although large-scale and longer-term safety studies have not been performed. Higher-quality studies are currently underway to better define the potential benefits and risks of plant-based extracts for treating symptoms related to benign prostatic hyperplasia.The use of dietary supplements for treating a wide range of health conditions has grown rapidly in the United States. In the field of men’s health, the most common dietary supplement used is an extract of the berry of the saw palmetto plant, with which men commonly self-medicate in order to treat lower urinary tract symptoms. Throughout the past two decades, substantial literature has emerged examining the biologic and clinical effects of saw palmetto extracts. Several lines of evidence suggest that saw palmetto may exert physiologic effects consistent with a beneficial clinical effect on the mechanisms of benign prostatic hyperplasia. Although most clinical studies tend to suggest a modest efficacy benefit of saw palmetto, more recent studies are less consistent and the precise clinical value of saw palmetto for treating lower urinary tract symptoms remains undefined. Overall, there appear to be few safety concerns with short-term use of this herbal medicine, although large-scale and longer-term safety studies have not been performed. Higher-quality studies are currently underway to better define the potential benefits and risks of plant-based extracts for treating symptoms related to benign prostatic hyperplasia.

Discusses 19th century composer Johannes Brahms' compositions for the cello. Brahms' study of the cello; Composition of `Sonata in E minor opus 38' and `F major Cello Sonata'; Brahms' friendship with cellist Robert Hausmann.

The three-decade long controversy surrounding the status of triglycerides as an independent risk factor for coronary heart disease is presented. The studies that reported an association and the clinical trials of cholesterol-lowering medications are examined. Because of the inconsistency between the observational findings and the consistently negative clinical trial findings, treatment of isolated hypertriglyceridemia cannot be recommended at present.