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Cutaneous adnexal tumours (ATs) encompass a variegated group of hamartomas and benign or malignant tumours, originating from the hair follicle, sebaceous, eccrine or apocrine glands that may simulate other cutaneous neoplasms. This study aims to provide a comprehensive overview of the spectrum of clinical and dermoscopic features of ATs, to better define these lesions and assist in the differential diagnosis. We performed a two-step systematic search of the literature in PubMed, Embase and Cochrane Library databases from inception until 4 September 2020. In the first step, we aimed to define histological variants of ATs with descriptions of dermoscopic criteria. The second step included a search for the name of each previously identified AT variants in the same databases adding 'AND (epilum* or dermosc* or dermatosc*)'. All study types in English language reporting dermoscopic images of ATs were included. Collisions between ATs and other inflammatory or neoplastic skin lesions were excluded, with the exception of collisions with a sebaceous nevus. The protocol of this study was prospectively registered in PROSPERO (CRD42021244677). In total, 206 articles met our inclusion criteria, encompassing 372 ATs in 365 patients. Most ATs were apocrine-eccrine (n = 217, 58.3%, n = 173 benign) with a prevalence of poromas (n = 82), followed by follicular ATs (n = 88, 23.7%, n = 83 benign) and sebaceous ATs (n = 67, 18.0%, n = 49 benign). Most patients had a single AT lesion (320, 86.0%), while 42 (11.3%) had multiple ATs. A syndrome causing multiple ATs was identified in 15 patients. Histopathological analysis revealed 82% benign (n = 305) and 18.0% malignant (n = 67). ATs were classified according to their ability to mimic four groups of more common skin tumours: basal cell carcinoma, squamous cell carcinoma, melanocytic lesions and benign cutaneous lesions. Moreover, we have highlighted the ability of malignant variants of ATs to simulate benign skin lesions. This systematic review offers a comprehensive overview of the common clinical and dermoscopic features of follicular, sebaceous and apocrine-eccrine ATs and details possible differential dermoscopic features.

Background The objective of our study is to compare the predicted hospital admission disposition based on the level of risk as determined by the modified Trauma-Specific Frailty Index (mTSFI) score with those determined by arbitrary decisions made based on the Emergency Severity Index (ESI) severity level. Methods We surveyed 100 trauma patients ages 50 and older, admitted to a level 1 trauma center between April 2019 and July 2019. We retrospectively reviewed the hospital admission disposition of each patient under the ESI, which was then compared to the mTSFI-predicted hospital admission disposition. The mTSFI scores were calculated by surveying each patient. Statistical analysis was performed to identify any statistical significance of concordance and discordance when comparing the mTSFI and ESI. Results The average age was 57.6 ± 4.2 years old in the non-geriatric group vs 76.3 ± 7.3 years old in the geriatric group. There was a male predominance in both groups (61% vs 69.5%). The mTSFI identified a higher percentage of triage discordance in the non-geriatric group (73%) compared to the geriatric cohort (53%) (95% difference CI, [39.6-40], P = .05). Discussion Non-geriatric patients have higher recorded rate of frailty than previously recognized and screening should begin at age 50, not 65. The mTSFI may be an effective tool to appropriately triage adult trauma patients at increased risk due to frailty and may reduce in-hospital complications.

The potential of our present technological devices is almost beyond our imagination. The actual use is insignificant by comparison with the potential, but it is significant in amount of effectiveness. The following suggestions, it is hoped, will help realize some of that potential: 1. Publicize the success stories of instructional technology; 2. Encourage experimentation; 3. Make more funds available for these types of instructional activities; and 4. Evaluate them so as to establish any financial advantages or significant instructional effectiveness. (Author/GO)

A STUDY OF VOCATIONAL-TECHNICAL EDUCATION IN THE PUBLIC SCHOOLS OF MISSOURI, COMMISSIONED BY THE GOVERNOR, CONCERNED THE AVAILABILITY, THE CLIENTELE, THE CURRICULUM, THE RELATION OF ENROLLMENT TO EMPLOYMENT OPPORTUNITIES, THE INVOLVEMENT OF PERSONS OUTSIDE THE SCHOOLS, AND ANCILLARY SERVICES OF THESE PROGRAMS. ITS OBJECTIVE WAS TO PROVIDE THE BASIS FOR RECOMMENDATIONS TO IMPROVE THE STATE'S VOCATIONAL-TECHNICAL EDUCATION SERVICES. SOME OF THE 25 RECOMMENDATIONS WERE THAT (1) THE STATE BE DIVIDED INTO SIX GEOGRAPHIC DISTRICTS AND ONE POST-SECONDARY UNIT WITH AN ADMINISTRATOR RESPONSIBLE FOR THE MANAGERIAL ACTIVITIES WITHIN EACH, (2) A RESEARCH SECTION BE DEVELOPED, (3) 10 INTERNSHIPS TO DEVELOP LEADERSHIP FOR VOCATIONAL EDUCATION IN MISSOURI BE DEVELOPED AND MAINTAINED JOINTLY BY THE STATE DIVISION OF VOCATIONAL EDUCATION, THE UNIVERSITY OF MISSOURI, AND THE LOCAL SCHOOL DISTRICTS, (4) THE COMPREHENSIVE HIGH SCHOOLS BE GIVEN FIRST PRIORITY FOR DEVELOPING VOCATIONAL EDUCATION PROGRAMS, (5) THE PROGRAMS BE ADAPTED TO SERVE SMALL HIGH SCHOOLS, (6) AREA VOCATIONAL SCHOOLS BE DEVELOPED ONLY TO SUPPLEMENT THE VOCATIONAL EDUCATION PROGRAMS IN COMPREHENSIVE HIGH SCHOOLS AND NOT AT THE EXPENSE OF HIGH SCHOOL PROGRAMS IN RESIDENTIAL AREA HIGH SCHOOLS, AND (7) MORE VOCATIONAL-TECHNICAL EDUCATION PROGRAMS BE PROVIDED FOR PERSONS WHO HAVE COMPLETED HIGH SCHOOL OR WHO ARE BEYOND THE NORMAL AGE OF HIGH SCHOOL ATTENDANCE AND THAT SUCH SERVICES BE PROVIDED IN MORE LOCATIONS AND FOR MORE OCCUPATIONS. (EM)

THIS APPENDIX TO VT 004 417 INCLUDES (1) A TAXONOMY OF EDUCATIONAL CHANGE, WHICH DEFINES THE ACTIVITIES OF THE EDUCATIONAL CHANGE PROCESS AND PRESENTS THEM IN CHART FORM, (2) PROGRAM EVALUATION AND REVIEW TECHNIQUE (PERT) GENERAL INFORMATION AND MASTER SCHEDULE REPORTS, WHICH DEFINES TERMS AND EXPLAINS AND ILLUSTRATES A WORK-BREAKDOWN STRUCTURE, WORK SHEET, "WAS-IS" CHART, OUTLOOK ANALYSIS, AND MASTER SCHEDULE WORK REPORTS, (3) TABULATIONS OF DATA FOR THE STUDY OF ORGANIZATION FOR THE ADMINISTRATION OF VOCATIONAL-TECHNICAL EDUCATION, WHICH GIVES THE LEGAL BASIS FOR SELECTION OF STATE OFFICERS, ADMINISTRATION, TEACHERS AND STATE STAFF, STUDENT ENROLLMENT, SCHOOLS, AND INCOME AND EXPENDITURES FOR VOCATIONAL EDUCATION IN THE STATES, (4) SUPPLEMENTARY MATERIALS FOR THE STUDY OF PERCEPTIONS OF STATE-LEVEL ADMINISTRATION OF VOCATIONAL-TECHNICAL EDUCATION, WHICH INCLUDES RESPONDENT GROUPINGS DESIGNATIONS, A SUMMARY OF ITEMS AND STATISTICAL ANALYSIS OF CLUSTERS, AND THE GROUP INTERVIEW GUIDE AND ITS STATISTICAL ANALYSIS, (5) SUPPLEMENTARY MATERIALS FOR ANALYSIS OF SELECTED STATE VOCATIONAL-TECHNICAL EDUCATION STAFF POSITIONS, WHICH INCLUDES THE PERSONAL REPORT OF WORK ACTIVITY, AND (6) THE FORMAT AND CRITERIA FOR SELF-ANALYSIS OF STATE AGENCIES FOR VOCATIONAL-TECHNICAL EDUCATION, THE PRELIMINARY DRAFT OF THE STUDY BY ALLEN LEE, PRINCIPAL INVESTIGATOR. (EM)

THE OBJECTIVES OF FIVE RELATIVELY INDEPENDENT STUDIES WERE TO DESCRIBE AND INDICATE DIFFERENCES OF ORGANIZATION, PERSONNEL, AND SERVICE IN THE STATES, IDENTIFY AND ANALYZE PERCEPTIONS OF STATE AGENCY ROLES AND FUNCTIONS, ANALYZE ACTIVITIES OF SELECTED PROFESSIONAL STAFF POSITIONS, DESIGN AND FIELD TEST AN INSTRUMENT FOR SELF ANALYSIS OF STATE AGENCIES, AND ANALYZE STATE AND FEDERAL EXPENDITURES FOR VOCATIONAL PROGRAMS. DATA WERE OBTAINED IN VISITS TO THE STATES AND PUERTO RICO THROUGH GROUP AND INDIVIDUAL INTERVIEWS AND RECORDS, AND OTHER DOCUMENTS. CONCLUSIONS INCLUDED--(1) THERE WAS GREAT VARIATION AMONG THE 50 STATES IN THE RATIO OF PROFESSIONAL STAFF MEMBERS IN THE STATE AGENCY TO VOCATIONAL TEACHERS, (2) THE STATE DEPARTMENT OF VOCATIONAL EDUCATION WAS LESS CONFIDENT ABOUT THE JOB IT WAS DOING THAN WAS THE GROUP TO WHICH IT WAS IMMEDIATELY RESPONSIBLE, (3) ALL GROUPS INDICATED THE MAJOR PORTION OF THEIR TIME WAS SPENT PLANNING, CONSULTING, COMMUNICATING, AND TRAVELING, WITH THE MAJOR FOCI PROBLEM IDENTIFICATION AND DEFINITION, AND PROGRAM DESIGN AND DEVELOPMENT, AND (4) THE TOTAL EXPENDITURES MORE THAN DOUBLED BETWEEN 1962-63 AND 1965-66. A "FORMAT AND CRITERIA FOR SELF-ANALYSIS BY STATE AGENCIES FOR VOCATIONAL-TECHNICAL EDUCATION" WAS DESIGNED, DEVELOPED, PARTIALLY REFINED AND INITIALLY FIELD TESTED. VOLUME II (VT 004 418) CONTAINS THE APPENDIX TO THESE STUDIES. (EM)

No randomized controlled trial has investigated the efficacy of hypnosis for reducing pain and improving wound-healing in children with burns. This randomized controlled trial aimed to investigate whether hypnosis decreases pain, anxiety, and stress and accelerates wound-healing in children undergoing burn wound procedures. Children (4-16 years) with acute burns presenting for their first dressing change were randomly assigned to a Hypnosis Group who received hypnosis plus standard care or a Standard Care Group who received standard pharmacological and nonpharmacological intervention. Repeated measures of pain intensity, anxiety, stress, and wound-healing were taken at dressing changes until ≥95% wound re-epithelialization. Data for 62 children were analyzed on an intent-to-treat basis using Generalized Estimating Equations (n = 35 Standard Care Group; n = 27 Hypnosis Group). An effect on the primary outcomes of pain and wound healing was not supported {self-reported pain intensity largest Mean Difference [MD] = -0.85 (95% confidence interval [CI]: -1.91 to 0.22), P = 0.12; MD for re-epithelialization = -0.46 [95% CI: -4.27 to 3.35], P = 0.81}. Some support was found for an effect on the secondary outcomes of preprocedural anxiety (MD = -0.80 [95% CI: -1.50 to -0.10], P = 0.03 before the second dressing change) and heart rate as a measure of stress (MD = -15.20 [-27.20 to -3.20], P = 0.01 and MD = -15.39 [-28.25 to -2.53], P = 0.02 before and after the third dressing change). Hypnosis may be effective for decreasing preprocedural anxiety and heart rate in children undergoing repeated pediatric wound care procedures but not for reducing pain intensity or accelerating wound healing.

OBJECTIVE Clinical factors contributing to benzodiazepine failure in treating status epilepticus (SE) include suboptimal dosing and seizure duration. As many benzodiazepine-refractory episodes of SE arise from acute etiologies, we sought to determine whether etiology impacts SE treatment. METHODS The potency of diazepam to terminate SE induced by lithium-pilocarpine (LiPilo-SE) or kainic acid (KA-SE) in 3-week-old rats was studied by video-electroencephalography. Synaptic γ-aminobutyric acid type A receptor (GABAR)-mediated currents were recorded from dentate granule cells using voltage-clamp electrophysiology. Surface expression of γ2 subunit-containing GABARs and Kv4.2 potassium channels in hippocampal slices was determined using a biotinylation assay. Expression of phosphorylated forms of β2/3 and γ2 subunits was determined using phosphospecific antibodies and Western blotting. RESULTS Diazepam failed to terminate late SE in LiPilo-SE animals but was successful in terminating KA-SE of 1- and 3-hour duration. One hour after SE onset, GABAR-mediated synaptic inhibition and γ2 subunit-containing GABAR surface expression were reduced in LiPilo-SE animals. These were unchanged in KA-SE animals at 1 and 3 hours. Phosphorylation of γ2 subunit residue S327 was unchanged in both models, although GABAR β3 subunit S408/409 residues were dephosphorylated in the LiPilo-SE animals. Kv4.2 potassium channel surface expression was increased in LiPilo-SE animals but reduced in KA-SE animals. INTERPRETATION SE-model-dependent differences support a novel hypothesis that the development of benzodiazepine pharmacoresistance may be etiologically predetermined. Further studies are required to investigate the mechanisms that underlie such etiological differences during SE and whether etiology-dependent protocols for the treatment of SE need to be developed. Ann Neurol 2018;83:830-841.

The Objectives of the study were to investigate whether 400 µg inhaled salbutamol influences 3 km running time-trial performance and lung function in eucapnic voluntary hyperpnoea positive (EVH+ve) and negative (EVH-ve) individuals. Fourteen male participants (22.4 ± 1.6yrs; 76.4 ± 8.7kg; 1.80 ± 0.07 m); (7 EVH+ve; 7 EVH-ve) were recruited following written informed consent. All participants undertook an EVH challenge to identify either EVH+ve (↓FEV1>10%) or EVH-ve (↓FEV110% from baseline) in FEV1 following any time-trial. Administration of 400µg inhaled salbutamol does not improve 3 km time-trial performance in either mild EVH+ve or EVH–ve individuals despite significantly increased HR and FEV1.