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A 40-year-old woman presented with painful ulcerations on the bilateral lower extremities. A biopsy confirmed the diagnosis of livedoid vasculopathy (LV). She was treated initially with aspirin and pentoxifylline, and with the addition of dipyridamole she has had no recurrence of her ulcerations to date. Despite this positive response to treatment she reported numbness and paresthesias in her legs. Nerve conduction studies confirmed a diagnosis of mononeuritis multiplex. This case highlights mononeuritis multiplex as a rarely described complication of LV, and suggests that early recognition of symptoms and a multidisciplinary approach are necessary for optimal management of this condition.

A 61-year-old immunosuppressed renal transplant patient with inflammatory bowel disease presented with tender pink nodules on the trunk and extremities. An initial biopsy was suggestive of metastatic Crohn disease, but after disease persistence, a second biopsy revealed disseminated Mycobacterium haemophilum. Atypical mycobacterial infections should be considered in immunosuppressed patients. This case highlights the complexities of diagnosing such infections in patients with an underlying granulomatous condition and the particular growth requirements of M. haemophilum.

The deterministic motions of clouds and turbulence, despite their chaotic nature, nonetheless follow simple statistical power-law scalings: a fractal dimension D relates individual cloud perimeters p to measurement resolution, and turbulent fluctuations scale with separation distance through the Hurst exponent ℌ. It remains uncertain whether atmospheric turbulence is best characterized by split isotropy that is three-dimensional with ℌ = 1/3 at small scales and two-dimensional with ℌ = 1 at large scales, or by wide-range anisotropic scaling with an intermediate value of ℌ. Here, we introduce an "ensemble fractal dimension" De – analogous to D – that relates the total cloud perimeter per domain area 풫 as seen from space to measurement resolution, and show theoretically how turbulent dimensionality and cloud edge geometry are linked through ℌ = De − 1. Observationally, by progressively coarsening the resolution of cloud mask arrays from various global satellite platforms and a numerical simulation of a tropical domain we find the scaling De ~ 5/3, or ℌ ~ 2/3, a value nearly consistent with a previously proposed "23/9D" anisotropic turbulent scaling. Remarkably, the same scaling links two "limiting case" estimates of 풫 evaluated at the planetary scale and the Kolmogorov microscale, as separated by 11 orders of magnitude, suggesting that cloud and turbulent behaviors are constrained by basic planetary parameters. [ABSTRACT FROM AUTHOR]

Cloud area distributions are a defining feature of Earth's radiative exchanges with outer space. Cloud perimeter distributions n (p) are also interesting because the shared interface between clouds and clear sky determines exchanges of buoyant energy and air. Here, we test using detailed model output and a wide range of satellite datasets a first-principles prediction that perimeter distributions follow a scale-invariant power law n (p) ∝ p-(1+β) , where the exponent β = 1 is evaluated for perimeters within moist isentropic atmospheric layers. In model analyses, the value of β is closely reproduced. In satellite data, β is remarkably robust to latitude, season, and land–ocean contrasts, which suggests that, at least statistically speaking, cloud perimeter distributions are determined more by atmospheric stability than Coriolis forces, surface temperature, or contrasts in aerosol loading between continental and marine environments. However, the satellite-measured value of β is found to be 1.26 ± 0.06 rather than β = 1. The reason for the discrepancy is unclear, but comparison with a model reproduction of the satellite perspective suggests that it may owe to cloud overlap. Satellite observations also show that scale invariance governs cloud areas for a range at least as large as ∼ 3 to ∼ 3 × 10 5 km 2 , and notably with a corresponding power law exponent close to unity. Many prior studies observed a much smaller range for power law behavior, and we argue this difference is due to inappropriate treatments of the statistics of clouds that are truncated by the edge of the measurement domain. [ABSTRACT FROM AUTHOR]

BACKGROUND Patients undergoing Mohs micrographic surgery (MMS) are given detailed wound care instructions to prevent postoperative complications. Previous studies have revealed low treatment adherence in general dermatology, but adherence to postoperative wound care and its potential association with poor surgical outcomes remain largely unstudied. OBJECTIVE To determine the frequency and causes of wound care nonadherence in patients who underwent MMS. MATERIALS AND METHODS A questionnaire containing a modified Eight-Item Morisky Medication Adherence Measure Scale was administered to Mohs patients at their 1 to 2 weeks postoperative visit. RESULTS Sixty-three patients were solicited and consented to completing the questionnaire. The average modified Eight-Item Morisky Medication Adherence Measure Scale score was 7.4 of 8, indicating high adherence. Old age and wound care assistance were associated with increased adherence. Factors contributing to nonadherence included feeling well, being too busy, wound care causing discomfort, and being with friends or family. One patient (1.6%) with high adherence developed an epidermal inclusion cyst within the scar. No other complications were observed. CONCLUSION Most MMS patients demonstrated high adherence to wound care instructions, and nonadherence was not associated with postoperative complications. [ABSTRACT FROM AUTHOR]

The article focuses on the importance of integrating business education into dermatology residency programs. Topics include the significance of understanding the healthcare ecosystem for medical providers, teaching fundamental business principles to residents to inform decision-making, and the need for a standardized dermatology-specific curriculum that covers coding, billing, insurance, and other business-related aspects.

This paper is the second in a series in which kilometer-scale-resolving observations from the Atmospheric Radiation Measurement Program and output from the University of California, Los Angeles/Colorado State University cloud-resolving model (CRM) are used to evaluate the single-column model (SCM) version of the National Centers for Environmental Prediction Global Forecast System model. Part I demonstrated that kilometer-scale cirrus properties analyzed by applying the SCM's assumptions about cloud vertical overlap and horizontal homogeneity to its profiles of cloud water/ice mixing ratio, cloud fraction, and snow flux differed from the cloud radar observations while the CRM simulation reproduced most of the observed cirrus properties. The present study evaluates, through a comparison with the CRM, the SCM's representation of detrainment from deep cumulus and ice-phase microphysics in an effort to better understand the findings of Part I. This study finds that, although the SCM's detrainment rate profile averaged over the entire simulation period is comparable to the CRM's, detrainment in the SCM is comparatively sporadic and vertically localized. Too much detrained ice is sublimated when first detrained. Snow formed from detrained cloud ice falls through too deep of a layer. These aspects of the SCM's parameterizations may explain many of the differences in the cirrus properties between the SCM and the observations (or between the SCM and the CRM), and suggest several possible improvements for the SCM: 1) allowing multiple coexisting cumulus cloud types as in the original Arakawa-Schubert scheme, 2) prognostically determining the stratiform cloud fraction, and 3) explicitly predicting the snow mixing ratio. These would allow better representation of the detrainment from deep convection, better coupling of the volume of detrained air with cloud fraction, and better representation of snow flux.

Abstract: Before using a fluid dynamics physically based wildfire model to study wildfire, validation is necessary and model results need to be systematically and objectively analyzed and compared to real [...]

This study describes and demonstrates a new method for identifying deficiencies in how cloud processes are represented in large-scale models. Kilometer-scale-resolving cloud radar observations and cloud-resolving model (CRM) simulations were used to evaluate the representation of cirrus clouds in the single-column model (SCM) version of the National Centers for Environmental Prediction Global Forecast System model for a 29-day period during June and July 1997 at the Atmospheric Radiation Measurement Program site in Oklahoma. To produce kilometer-scale cirrus statistics from the SCM results, synthetic subgrid-scale (SGS) cloud fields were generated using the SCM's cloud fraction and hydrometeor content profiles, and the SCM's cloud overlap and horizontal inhomogeneity assumptions. Three sets of SCM synthetic SGS cloud fields were analyzed. Two NOSNOW sets were produced in which clouds did not include snow; one set used random overlap, the other, maximum/random. In the SNOW set, clouds included snow and random overlap was used. The three sets were sampled in the same way as the cloud-radar-detected cloud fields and the CRM-simulated cloud fields. The mean cirrus cloud occurrence frequency for the SCM NOSNOW cloud fields agrees with the observed value as well as the CRM's does, while that for SCM SNOW cloud fields is only half that observed. In most aspects, the SCM's cirrus properties differ significantly from the cloud radar's and the CRM's, which generally agree. In comparison, there are too many physically thin SCM NOSNOW cirrus layers (most occupy only a single model layer) and too many physically thick SCM SNOW cirrus layers (most are thicker than 4 km). For the optically thin subset of cirrus layers, 1) the mean, mode, and median ice water path, and layer-mean ice water content (IWC) values for the SCM are significantly larger than the observed and CRM values; 2) the SCM layer-mean IWCs decrease with cloud physical thickness, opposite to the observations and CRM results; and 3) the range of layer-mean effective radii in the SCM thin cirrus is too narrow.

A study conducted to find out whether, cardiac-resynchronization therapy is more beneficial with or without an implantable defibrillator, is presented. According to the study, when combined with an implantable defibrillator, cardiac-resynchronization therapy reduces mortality significantly.

Cloud radar data collected at the Atmospheric Radiation Measurement (ARM) Program's Southern Great Plains site were used to evaluate the properties of cirrus clouds that occurred in a cloud-resolving model (CRM) simulation of the 29-day summer 1997 intensive observation period (IOP). The simulation was 'forced' by the large-scale advective temperature and water vapor tendencies, horizontal wind velocity, and turbulent surface fluxes observed at the Southern Great Plains site. The large-scale advective condensate tendency was not observed. The correlation of CRM cirrus amount with Geostationary Operational Environmental Satellite (GOES) high cloud amount was 0.70 for the subperiods during which cirrus formation and decay occurred primarily locally, but only 0.30 for the entire IOP. This suggests that neglecting condensate advection has a detrimental impact on the ability of a model (CRM or single-column model) to properly simulate cirrus cloud occurrence. The occurrence, vertical location, and thickness of cirrus cloud layers, as well as the bulk microphysical properties of thin cirrus cloud layers, were determined from the cloud radar measurements for June, July, and August 1997. The composite characteristics of cirrus clouds derived from this dataset are well suited for evaluating CRMs because of the close correspondence between the timescales and space scales resolved by the cloud radar measurements and by CRMs. The CRM results were sampled at eight grid columns spaced 64 km apart using the same definitions of cirrus and thin cirrus as the cloud radar dataset. The composite characteristics of cirrus clouds obtained from the CRM were then compared to those obtained from the cloud radar. Compared with the cloud radar observations, the CRM cirrus clouds occur at lower heights and with larger physical thicknesses. The ice water paths in the CRM's thin cirrus clouds are similar to those observed. However, the corresponding cloud-layer-mean ice water contents are significantly less than observed due to the CRM's larger cloud-layer thicknesses. The strong dependence of cirrus microphysical properties on layer-mean temperature and layer thickness as revealed by the observations is reproduced by the CRM. In addition, both the CRM and the observations show that the thin cirrus ice water path during large-scale ascent is only slightly greater than during no ascent or descent.