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IMPORTANCE: The US health care system generates substantial global waste. Skin biopsies are frequently performed by dermatologists and represent a practical and scalable opportunity for waste reduction interventions in dermatology clinics. OBJECTIVE: To develop and implement a systematic framework for decreasing skin biopsy tray waste in dermatology clinics. DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study was conducted at 4 outpatient clinic sites within a single institution between October 2021 and April 2022. The clinic site with the greatest skin biopsy tray waste production was selected for intervention. Waste audits before and after the intervention quantified the number of wasted supplies per skin biopsy tray in dermatology clinics. The participants were dermatology residents, faculty, nurses, medical assistants, and clinic managers. INTERVENTIONS: Provision of educational materials about climate change and health care and standardizing biopsy tray setup to decrease wasted supplies. MAIN OUTCOMES AND MEASURES: Quantity of wasted skin biopsy tray supplies (gauze squares, alcohol pads, cotton swabs, and adhesive bandages) before and after interventions. RESULTS: In waste audits in 4 outpatient dermatology clinics (comprising 98 skin biopsy trays), prior to intervention, 100% of skin biopsy trays had more than 2 wasted supplies within targeted outpatient dermatology clinics at the Stanford Cancer Institute with a mean (SD) of 10.1 (3.4) wasted items per biopsy tray. Following the quality improvement-based interventions, only 16% of skin biopsy trays had more than 2 wasted supplies and the mean (SD) number of wasted supplies per tray decreased to 1.6 (1.3). CONCLUSIONS AND RELEVANCE: Results of this quality improvement study suggest that through collaboration with all members of the clinical team including physicians, medical assistants, nurses, and clinic managers, skin biopsy tray setup modifications may be associated with reduced waste in outpatient dermatology clinics. This study presents a framework that accounts for different factors in the production of waste in individual clinic settings, and thus can be adapted within additional dermatology clinics.

The lacustrine Itapema Formation in the Santos Basin locally comprises 102m thick clinoforms identified seismically and corroborated by several well penetrations. Individual clinoforms, as proven by well penetrations, are composed of 102m thick successions of basinward-dipping molluscan grainstones and rudstones. Manual dip picking of borehole images shows upward-increasing dips consistent with seismic geometries and a predominance of longshore sediment transport. Clinoforms are bound at their top and base by strata with significantly lower dips recognizable on both seismic and borehole images. Elevated gamma-ray log responses together with sidewall core samples indicate that these intervals correspond to more argillaceous facies which are interpreted as lake flooding events. While the existence of bona fide clinoforms is demonstrated by a range of subsurface data, their precise origin remains enigmatic. The majority of the bivalve genera that make up the grain-supported carbonates appear to be infaunal or semi-infaunal. As such the clinoforms represent large bars produced through the re-working of bivalves from lower-energy depositional environments by shore-parallel currents.

Children and youth with special health care needs (CYSHCN) are at an increased risk for abuse and neglect, and they experience worse outcomes during and after child protective services involvement, as compared to typically developing peers. Identifying and monitoring these vulnerable youth is essential for reducing disparities and optimizing service delivery. However, many states, including Illinois, lack systems for efficient identification and monitoring.

Background:Tacrolimus is a potent immunosuppressant used in organ transplant recipients; an ointment formulation is being developed as a therapeutic agent for atopic dermatitis. Objective:Our purpose was to define the pharmacokinetics and evaluate tacrolimus 0.3% ointment as therapy for moderate to severe atopic dermatitis. Methods:Thirty-nine patients, 5 to 75 years of age, received 14 applications over 8 days. Serial blood samples were collected on days 1 and 8, with predose samples collected on days 2 through 7. Overall response and signs/symptoms were rated daily on days 1 through 11. Incidence of adverse events and laboratory profile were determined. Results:Mean area under the curve (0.9 to 42.5 ng ·hr/ml) was highly variable and appeared to be related to size of application area. No systemic accumulation of tacrolimus was observed. Comparison to historical intravenous data indicates that absolute bioavailability of topical tacrolimus was less than 0.5%. Ninety-five percent of patients showed at least good improvement. All adverse events were transient. Burning was the most common application site adverse event and vasodilatation ("flushing/warmth") was the most common nonapplication site adverse event. No drug-related changes in laboratory profile were observed. Conclusion:The results of this study suggest that tacrolimus 0.3% ointment may be a safe and effective therapy for atopic dermatitis. (J Am Acad Dermatol 1998;38:69-76.)