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Background The Physician Insurers Association of America established a voluntary registry in 1985 that contains 239,756 closed claims. The registry is maintained for educational programs to reduce patient injury and medical professional liability (MPL) claims. Objective This report provides a description of MPL claims against dermatologists. Methods Descriptive techniques are used to present summary information for the dermatologic claims in the registry. Results Of 239,756 closed claims, 2704 (1.1%) involve dermatologists. Of the 2704 closed claims, 775 (28.7%) resulted in an average indemnity payment of $137,538. The most common allegation was improper procedure performance. The most prevalent procedure was operative procedures on the skin. Error in diagnosis was the next most common allegation. The most common diagnosis was malignant melanoma. Malignant melanoma claims were paid in 42.2% of cases with an average indemnity payment of $436,843. Limitations The data are subject to selection and reporting biases. In addition, the registry does not contain exposure data, so incidences and prevalences are not calculable. Conclusions MPL issues are important to all practicing dermatologists. The most common allegation against dermatologists in this study was improper performance of operative procedures on the skin, excluding skin grafts. Error in diagnosis of malignant melanoma was the next most common allegation. Malignant melanoma claims were paid in 42.2% of cases with an average indemnity payment of $436,843. By focusing on the risk management of these procedures and this diagnosis, dermatologists can have the largest impact on reducing patient injuries and consequent MPL claims.

SUMMARY Antibodies directed against intercellular epithelial structures (ICE) have been important in the diagnosis of pemphigus vulgaris. Our study of thirty-seven patients with maculopapular eruptions following therapy with penicillins, clearly indicate that antibodies morphologically indistinguishable from those found by standard techniques in pemphigus vulgaris are also found here. Indirect staining by fluorescence and horse-radish peroxidase indicated localization against ICE identical to that seen in pemphigus, in about half the patients. Direct staining of skin from two penicillin-allergic patients revealed similar staining in the familiar pattern, which closely resembles the network of lines in giraffe skin. Detection of circulating antibody directed against a component of epithelium introduces new insight into the pathophysiology of maculopapular penicillin eruptions, although further work is required to show what the exact relationship is to pemphigus vulgaris, the potentially fatal skin disease.

This research assessed the importance of rendering specific details when creating a virtual forest. Specifically, we examined memory for computer-generated trees using a modified recognition task in which participants were shown a target tree, engaged in a distractor task, and then ranked the similarity of seven foils to the original tree they had seen. Five of the foils represented changes on only one dimension of the tree whereas the other two foils represented modifications to either five features previously identified as salient or all nine tree features. Results showed that similarity rankings were largely based on overall structural similarity of the trees as opposed to similarity on smaller details such as branch thickness or leaf size. Additionally, perceived similarity rankings varied as a function of the symmetry of the tree. Virtual forests need to show realism for different features depending on the forest type.

Recent research on the design of virtual environments has focused on the important perceptual characteristics of man-made “carpentered” environments, rather than on VEs of natural environments. The present research examines memory for characteristics of natural settings consisting of virtual trees. Participants viewed either a symmetrical or asymmetrical virtual tree and then re-created it using custom-designed tree editing software. Memory was more accurate for the symmetrical tree. Across trees, participants were most accurate re-creating gross structural dimensions of a tree such as height and leaf size, and were particularly inaccurate at re-creating the curvature of tree branches. Our conclusion is that the design of virtual environments should focus on accurately representing gross structural properties of trees, rather than on using high levels of detail to accurately portray trunk and branch curvature.

Virtual drama is based on the use of a shareable virtual world as a stage setting, withavatars controlled by actors and audience members. The Caracol Time Travel Project wasan experiment in the use of virtual drama for learning about archaeology. Eighteenundergraduate students at the University of Central Florida used a locally developed Java-based system for sharing VRML worlds. They designed and constructed a virtual drama toteach basic concepts of Mesoamerican archaeology and the cultural history of the ancientMaya for middle schools. This paper presents their story design and details of the systemwe developed to support interaction in this shared virtual world. We then discussperformance issues, lessons learned and newer features that we did not have available atthe time. Copyright # 2001 John Wiley & Sons, Ltd.

ExploreNet is an experimental environment for creating and delivering networked "virtual worlds." This system's style of user interaction was inspired by the concept of a "habitat" as first articulated in the LucasFilm's Habitat system. Players enter and interact in a habitat via their animated alter egos, called "avatars." Habitats may be created for many purposes, including social interaction, entertainment and education. Our focus has been to facilitate the creation of habitats in which virtual communities of learners and mentors interact. This paper presents details of the current ExploreNet system, including its user interface, the means it provides for creating complex behaviors, details of its implementation, the outcomes of several experiments using this system, and our plans for its natural migration to a World Wide Web-based system.

Simulating physically realistic complex fluid behaviors in a distributed interactive simulation (DIS) presents a challenging problem for computer graphics researchers. The authors consider how solving the 2D Navier-Stokes equations via a computational fluid dynamics method lets us map surfaces into 3D and achieves realistic real-time fluid surface behaviours.

The Virtual Environment Performance Assessment Battery (VEPAB) is a set of tasks developed to support research on training applications of virtual environment (VE) technology. VEPAB measures human performance on vision, locomotion, tracking, object manipulation, and reaction time tasks performed in three-dimensional, interactive VEs. It can be used to provide a general orientation for interacting in VEs and to determine both entry level performance and skill acquisition of users. In addition, VEPAB allows comparison of task performance, side effects and aftereffects, and subjective reactions across different VE systems. By providing benchmarks of human performance, VEPAB can promote continuity in training research involving different technologies, separate research facilities, and dissimilar subject populations. This paper describes the development of VEPAB and summarizes the results of two experiments, one to test the sensitivity of the tasks to differences between input control devices and the other to examine practice effects.

The lack of compelling content has relegated many promising entertainment technologies to laboratory curiosities. Although mixed-reality techniques show great potential, the entertainment business is not about technology. To penetrate these huge markets, MR technology must become transparent for the content to have full effect. To achieve this goal, we have devised a framework that lets us integrate concepts from disparate areas such as theme parks, theater, and film into a comprehensive research methodology. We believe that our framework, which has already helped us create content for MR entertainment systems, can provide these benefits to other developers as well.

In computer-based interactive narrative, a key challenge is the conflict between user agency and authorial control of the story quality. In this paper, we use the constructs of character status and status shifts from improvisational and interactive theatre to further engage users in the creative process of co-creating the story. Based on the cognitive semantics theory of force dynamics, we develop a computational model of status shifts.

A key challenge in computer-based interactive narrative is the conflict between user agency and authorial control of the story quality. Valuable lessons can be learned from improvisational and especially interactive theatre, where various narrative and interactive strategies have been developed to engage users in the process of co-creating the story. In this paper, we focus on the use of character status and status shifts. Specifically, we present and illustrate a computational model of status shifts based on the cognitive semantics theory of force dynamics.

An early University of Central Florida (UCF) Institute for Simulation and Training project funded through the Florida High Technology and Industry Council was to develop a plan for an Experimental Prototyping Classroom (EPC). This was to be a facility that served as an applications labaratory for the testing of new training technologies under controlled but realistic settings. The intent was to break the current pattern of having the contractor field test and debug a new training technology application during the initial stages of the actual implementation. In addition, it was anticipated that there would be spin‐offs that would benefit graduate students in instructional technology and related programmes. While a true EPC has yet to be created at UCF, this paper outlines some of the related technology‐based projects that have developed with recent years.

Mixed Reality (MR), and its predecessor Virtual Reality (VR), has been primarily viewed as a visual science, with much less attention given to the other senses, despite clear evidence of their importance, especially audio. In fact, in military operation in urban environments, audio is often a more primary sense than vision, providing a soldier with an early warning system that needs to be honed and trained. Our research program, in contrast, treats the auditory sense as an equal to the visual. The consequences are MR experiences that have much greater impact than those in which audio is just an after thought. However, given the depth and breadth of graphics research, we are compelled to learn from this mature area. Thus, we are constantly striving to find results from graphics research that have useful analogies in the audio domain. Lessons learned from these analogies, especially as concern people's perception expectations, are the focus of this paper.

Given the increasing demographic diversity in the United States, clarifying relationships between race, color, ethnicity, and disease processes is critical.We sought to examine the correlation between objective measures of skin pigmentation, racial identification, and physician-diagnosed and self-reported skin phototypes.A total of 558 participants (76 nonwhite) were evaluated. A subset underwent spectrometric readings and digital photography of the upper aspect of the inner arm. Self-identified race was compared with 7 measures of pigmentation.Race correlates best with physician-diagnosed skin phototype (r = 0.55, P.01), whereas self-reported skin phototype, spectrometry, and colorimetry correlate poorly with race (r = 0.28,0.40, and r-0.31, respectively, P.01). Associations between race and subjective measures strengthen among patients with darker skin.Objective measures of pigmentation fail to correlate well with race, whereas race correlates moderately with physician-diagnosed skin phototype. Including objective methods of analyzing skin color may reduce subjective influences of race in assessing photosensitivity and potential risk for skin cancer.

Over the past 50 y, research in skin biology and diseases has changed dramatically. These changes include (i) who is doing the research, from M.D. clinician dermatologists to predominantly Ph.D. research scientists and full-time or nearly full-time M.D. and M.D.–Ph.D. scientists, (ii) where, from small laboratories in the U.S.A. to large laboratories and multiinvestigator collaborations worldwide, (iii) what, from a focus on common skin diseases to an emphasis on understanding basic processes in skin, both in normal and disease states, and (iv) how, from patient observations, histology, and clinical immunology to cell and tissue culture, molecular biology and genetics, genomics and proteomics. Financing of this research has also changed, from the use of clinical surplus funds supplemented by U.S. government (National Institutes of Health, Veterans Administration, and other) monies to a greater dependence on government and private (pharmaceutical industry and philanthropy) funding. The future, funding issues aside, promises great advances with translation of basic knowledge to the diagnosis, prevention, and treatment of skin diseases.

A 'rehearsal style' system called PROSPR, designed to aid authors of procedural training material, is presented. While PROSPR is a prototype, it demonstrates the utility of the programming-by-rehearsal paradigm within the context of procedural training. The object-oriented approach helps the programmer and the author to support the mental models between real-world objects and their representations in simulation. The graphical interface allows the procedures created to become a dynamic world where a student can interact with graphical representations as if they were actual objects themselves. Presently the system is best used to train students in procedures which consist of a series of stimulus-response pairs. Each correct trainee action triggers the next simulated screen event. >