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Infliximab is frequently used to treat both inflammatory bowel disease (IBD) and psoriasis. We reviewed the medical records of 73 children with IBD receiving infliximab therapy and identified 6 (8%) cases of infliximab-induced psoriasis. Five (83%) had Crohn disease and 4 (67%) were girls. The psoriatic lesions appeared on the face (n = 5; 83%) and perineum (n = 1; 17%). A median of 13 doses were administered during a median duration of 21 months. All of the patients were continued on infliximab to maintain clinical remission of IBD. Educating children with IBD and their caregivers about this paradoxical phenomenon and periodic dermatology evaluation may promote patient care.

The Homeland Security Advisory System (HSAS) was established by the Department of Homeland Security to communicate the risk of a terrorist event. In order to explore the potential psychological impacts of HSAS we analyzed the effects of terror alerts on the law enforcement community. We used data from the New Jersey Cop 2 Cop crisis intervention hotline. Incidence Rate Ratios--interpreted as average relative increases in the daily number of calls to the Cop 2 Cop hotline during an increased alert period--were computed from Poisson models. The hotline received a total of 4,145 initial calls during the study period. The mean daily number of calls was higher during alert level elevation compared to prior 7 days (7.68 vs. 8.00). In the Poisson regression analysis, the Incidence Rate Ratios of number of calls received during elevated alert levels compared to the reference period of seven days preceding each change in alert were close to 1, with confidence intervals crossing 1 (i.e. not statistically significant) for all lag periods evaluated. This investigation, in the context of New Jersey law enforcement personnel, does not support the concern that elevating the alert status places undue stress upon alert recipients.

Ophthalmological examination of a 55-year-old white woman with longstanding ocular histoplasmosis syndrome (OHS) and recently diagnosed multiple sclerosis revealed poor central vision, peripapillary atrophy, extensive subretinal pigment deposition (fi gure), old choroidal neovascularisation (CNV; fi gure), and punched-out chorioretinal scars in the absence of any anterior segment and vitreous infl ammation. Cirrus HD retinal optical coherence tomography (OCT) scan revealed markedly disrupted topography of the internal limiting membrane and retinal pigment epithelium layers resulting from extensive chorioretinal scarring (fi gure). The so-called peaks and valleys seen on retinal OCT in this patient are in stark contrast to the smooth contours of these layers in eyes of healthy individuals. Characterised clinically by CNV and retinal scarring after exposure to histoplasma, OHS is thought to arise from spread of histoplasma spores that obstruct choroidal vessels in the eyes, although the fungus has only rarely been isolated from aff ected eyes. The patient likely developed OHS after prolonged exposure to chicken farms during young adulthood while living in the southern USA, a region known as the “Histo Belt” because of a high incidence of infection with histoplasmosis. In endemic areas within the USA, the Caribbean, and central and South America, OHS is a major cause of central vision loss in young adults. OHS, when accompanied by active CNV, can be treated with laser photocoagulation or injected anti-vascular endothelial growth factor therapy to prevent CNVinduced scarring. Our patient was previously treated with several courses of laser photocoagulation in the left eye, but was untreated in the depicted right eye because of the absence of active CNV. Her vision has remained stable for the past 10 years. Notably, OCT is an inexpensive tool for evaluation of retinal and macular pathology in a growing number of systemic disorders that result in ocular signs and symptoms.

Diaphragms are common and economical structural systems which resist in-plane forces produced by wind and earthquake. The analysis of such a system is highly indeterminate and complex. This paper develops a method for the analysis of partial composite action in layered diaphragms. The method extends the theory development by Newmark, et al. and utilizes a finite difference approach in the solution. Results of analysis include strains, stresses, deflections, and interlayer slip. The method developed here is compared to available test data, and sample results are presented.

This paper presents a theoretical study of glue laminated lumber diaphragms. All glue lines are made up of elastomeric adhesives having stiffnesses of 90 psi‐900 psi. The use of such adhesives provides an incomplete partial composite. Three parameters which influence the behavior of diaphragms are studies. These include the stiffness of glue lines, the number of courses, and properties of the decking. Analytical results show that a large number of layers produces flexible diaphragms. It is also shown that gluing a few of the courses along the outer edges of the diaphragm may be sufficient to provide the proper strength and serviceability. In addition, the use of higher grade wood for the outer layers provides economical means of obtaining the strength required.