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The sizes and shapes of ice crystals influence the radiative properties of clouds, as well as precipitation initiation and aerosol scavenging. However, ice crystal growth mechanisms remain only partially characterized. We present the growth processes of two complex ice crystal habits observed in Arctic mixed‐phase clouds during the Ny‐Ålesund AeroSol Cloud ExperimeNT campaign. First, are capped‐columns with multiple columns growing out of the plates' corners that we define as columns on capped‐columns. These ice crystals originated from cycling through the columnar and plate temperature growth regimes, during their vertical transport by in‐cloud circulation. Second, is aged rime on the surface of ice crystals having grown into faceted columns or plates depending on the environmental conditions. Despite their complexity, the shapes of these ice crystals allow to infer their growth history and provide information about the in‐cloud conditions. Additionally, these ice crystals exhibit complex shapes and could enhance aggregation and secondary ice production. Plain Language Summary: Snowflakes formed in the atmosphere have a wide variety of shapes and sizes and no two snowflakes are identical. The reason for this infinite number of shapes is that the environmental temperature and relative humidity prevailing during the snowflakes' growth determine their exact aspects. Thus, the prevailing environmental conditions can be determined from the shape of snowflakes, and become more complicated with increased shape complexity. During a measurement campaign in the Arctic, we identified two complex snowflake types and the history of environmental conditions in which they grew in. We inferred that some snowflakes were recirculating to higher or lower parts of the clouds and that others had collided with cloud droplets that froze on their surface at the early stage of their growth. These snowflakes may enhance the formation of new snowflakes and the initiation of precipitation. Key Points: A large variety of ice crystal sizes and shapes were observed in Arctic mixed‐phase clouds with a holographic imagerThe growth history of two types of complex ice crystals was inferred from their shapesThese ice crystals could enhance aggregation and secondary ice production [ABSTRACT FROM AUTHOR]

This paper researched the joys and challenges faced by rural social workers, along with their attitudes about themselves. Licensed social workers residing in one of 14 rural Pennsylvania counties responded to a mailed survey. The sample (n = 117) responded to qualitative questions, including a version of the Twenty Statements Test (TST) that asked 'who am I?' Findings indicated that rural practitioners describe themselves as possessing strong familial ties to the communities in which they work. Most expressed enjoyment of a rural lifestyle, and held generally positive attitudes about themselves. Implications for future practice are addressed. [ABSTRACT FROM AUTHOR]

The chairs of the National Council on Radiation Protection and Measurement (NCRP) 2017 Annual Meeting, Assessment of National Efforts in Emergency Preparedness for Nuclear Terrorism: Is There a Need for Realignment to Close Remaining Gaps?, tasked the members of each session to identify and prioritize preparedness activities that will have the most positive effect during a response. The Communication, Education and Public Information Panel identified five priority action areas that we believe NCRP and its members can actively work toward for increased effectiveness in public communication after a radiological or nuclear emergency.Health Phys. 000(0):000-000; 0000.

This article summarizes major points from a newly released guide published online by the Office of the Assistant Secretary for Preparedness and Response (ASPR). The article reviews basic principles about radiation and its measurement, short-term and long-term effects of radiation, and medical countermeasures as well as essential information about how to prepare for and respond to a nuclear detonation. A link is provided to the manual itself, which in turn is heavily referenced for readers who wish to have more detail.

This was a 12-month extension of a randomized, investigator-blinded, multicenter, 8-week trial with triple combination (TC) cream in facial melasma. A total of 585 patients were enrolled in the study and 569 patients received study medication. Three hundred eighty-nine patients completed 6 months of treatment and 327 patients completed 12 months of treatment. TC cream demonstrated a favorable safety profile: only 14 patients (2.5%) discontinued the study due to treatment-related adverse events (AEs). The 2 cases of skin atrophy were mild and did not lead to withdrawal. From the 23 cases of mild telangiectasia, only 2 resulted in discontinuation. All others were transient. Results confirmed those of a previous smaller study, with both physicians and patients reporting clinically significant improvements in melasma. By month 12, 80% of patients had lesions completely cleared or nearly cleared. Once daily application of TC cream applied intermittently over a long period is a safe, tolerable, and effective treatment for moderate to severe melasma of the face.

Purpose: Prostate stem cell antigen (PSCA), a homologue of the Ly-6/Thy-1 family of cell surface antigens, has been shown to be increased in a majority of human transitional cell carcinomas. We tested the possibility of using PSCA as an adjunct marker for urine cytology., Materials and Methods: Immunocytochemical analysis was performed on 44 archived voided urine samples obtained from 3 groups of patients based on initial voided urine cytological results and subsequent followup biopsy findings. Group 1 (14 of 44 patients) had positive findings on cytology and histology, group 2 (16 of 44) had negative cytology but positive histology, and group 3 (14 of 44) had negative findings on cytology and histology. Cytological slides prepared from 10 fresh voided urine samples were also analyzed. Papanicoloau stained archived urine slides were de-stained and re-stained immunocytochemically with a monoclonal antibody against PSCA. Immunofluorescence followed by laser scanning cytometer analysis was also performed on archived slides from 2 representative cases., Results: Sensitivity and specificity were 46.7% and 100% for cytology alone, respectively, and 80% and 85.7% for PSCA alone, respectively. PSCA immunostaining was positive in 92.8% group 1, 68.8% group 2 and only 14.3% group 3 samples. The difference in positive PSCA findings in groups 2 and 3 were statistically significant at p <0.01 by chi-square test. Whereas some superficial umbrella cells showed slight staining by immunocytochemistry, it was feasible to distinguish the expression levels between tumor and normal superficial umbrella cells quantitatively using immunofluorescence coupled with laser scan cytometry analysis., Conclusions: Immunocytochemical analysis of PSCA on archived voided urine samples may provide a simple and quantitative adjunct marker for cytological diagnosis of urothelial carcinoma.

Purpose: To create a comprehensive algorithm that can predict postoperative renal cell carcinoma (RCC) patient outcomes and response to therapy., Patients and Methods: A prospective cohort study was performed with outcome assessment on the basis of chart review of 814 patients who underwent nephrectomy between 1989 and 2000. At diagnosis, M1 or N1/N2M0 metastatic disease (M) was present in 346 patients (43%), whereas 468 patients had no metastatic disease (NM) (N0M0). On the basis of UCLA Integrated Staging System category and the presence of metastases, patients were divided into low-risk (LR), intermediate-risk (IR), and high-risk (HR) groups. Decision boxes integrating tumor-node-metastasis staging, tumor grade, and performance status were compiled for determining a patient's risk group., Results: NM-LR patients had 91% disease-specific survival at 5 years, lower recurrence rate, and better disease-free survival compared with NM-IR and HR patients. Disease progressed in 50% of NM-HR patients. Disease-specific survival of NM-HR patients who received immunotherapy (IMT) for recurrent disease was similar to that of M-LR patients treated with cytoreductive nephrectomy and adjuvant IMT. Time from recurrence to death for NM-HR patients was inferior to that for M-LR patients. After IMT, approximately 25% of M-LR and 12% of M-IR patients had long-term progression-free survival. M-HR patients did poorly despite IMT., Conclusion: Stratifying RCC patients into high-, intermediate-, and low-risk subgroups provides a clinically useful system for predicting outcome and provides a unique tool for risk assignment and outcome analysis. Subclassifying RCC into well-defined risk groups should allow better patient counseling and identification of both NM-HR subgroups that need adjuvant treatment and nonresponders who need alternative therapies.

Renal cell carcinoma is the most common cancer in the kidney, affecting nearly 30,000 Americans every year and is associated with over 12,000 deaths annually. If detected early, renal cell carcinomas can be cured surgically. However, once metastatic disease develops the prognosis for long-term survival is poor. Unfortunately, one-third of patients have metastatic disease at the time of diagnosis and approximately 50% of the patients undergoing surgical resection for less advanced disease eventually relapse. This review examines the clinical and molecular prognostic tools currently available or under investigation for kidney cancer.

Aim of the Study: To analyse survival of cemented Charnley prostheses, and influencing factors., Material and Methods: 539 patients (mean age: 62 years) undergoing 426 primary, and 200 revision Charnley hip arthroplasties, were examined. The indications for primary operation was idiopathic coxarthrosis in 239 cases (56.1%), and rheumatic coxarthrosis in 56 cases (13.1%). Reasons for revision surgery included aseptic loosening in 123 cases (61.5%), septic loosening in 36 cases (18%), and prosthetic fracture in 13 cases (6.5%)., Results: After a mean follow-up of 4.4 years, patients were scored using the Merle d'Aubigne evaluation. The average postoperative score for primary operations was 14.8 points, and for revision surgery 13.1 points. The respective pre-operative scores were 8.2 and 8.1. Radiographic investigation revealed peri-articular calcifications in 28.4% of the primary operations, and in 28.5% of the revisions. Radiolucent lines or protrusions were found in 29.8% of the primary, and in 42.0% of the revisions. At follow-up, 45 implants in 41 patients had been replaced. Kaplan-Meier survival rates for the primary group were 99.6% after one year, 92.8% after five years, 78.3% after 10 years, and 45.9% after 15 years. The respective figures for the revision group were 98.2%, 85.3%, 59.7% and 31.3%. The largest difference was seen in the eleventh year. Patient age had no significant influence for the first 12 years. In the primary group, body mass index showed a significant influence only after 15 years. Analysis of the indications for surgery revealed a slightly higher survival rate in the arthrosis group (84%) vis-a-vis the dysplasia group (83.3%), and a significantly higher rate vis-a-vis patients with rheumatoid arthritis (42%)., Clinical Relevance: Such factors as age, diagnosis and weight had an influence only over the long term. Significant differences between primary and revision operations were not found.

The interesting condition of brown-colored semen has often been observed during assisted ejaculation of men with spinal cord injury (SCI). This condition has not been reported in the literature, and its cause is unknown. To investigate this condition, the present study examined the incidence and quality of brown semen and its relationship to level of SCI, time since SCI, number of successive ejaculations, ejaculation frequency, and ejaculation method in a total of 664 semen specimens from 162 SCI men. In addition, a microscopic evaluation was performed on brown semen specimens from SCI men, not-brown specimens from SCI men, and normally colored specimens from normal men. The results showed that 27% of SCI subjects had brown semen on at least one ejaculation. There was no difference between men producing and men not producing brown semen in age, level of injury, or years postinjury. The duration of an ejaculation, number of successive ejaculations, and frequency of ejaculation were not associated with occurrence of brown semen. Sperm concentration and sperm motility were not significantly different in brown and not-brown specimens. Specimens from subjects who produced brown semen had similar pH but lower volume than specimens from subjects who did not produce brown semen. Brown semen had a thin consistency more often than not-brown semen. Brown specimens contained intact red blood cells (RBCs) and/or heme pigment more often than not-brown specimens; however, one half and one third of the specimens, respectively, contained neither RBCs nor heme pigment. The cause of brown semen is unknown but may relate to seminal-vesicle dysfunction.

Background: Carbon dioxide lasers that produce either short pulses or scanned continuous beams have been used for skin resurfacing to improve wrinkles or scars. Using a high peak power, short pulse CO2 laser can produce clinically effective results with minimal thermal damage., Objective: To evaluate the effectiveness of skin resurfacing using the 90-microsecond pulse duration CO2 laser compared to other laser systems. Erythema, healing time, complications, and histological measurement of the depth of ablation and thermal damage per pass with this system were also assessed., Methods: Forty-one patients with facial rhytides and scars underwent resurfacing with a 90 microseconds pulse duration CO2 laser. Using patient survey, patients were evaluated for effectiveness of therapy, healing time, and complication rates. Comparisons of histologic and clinical findings were made with different short pulse CO2 lasers., Results: Healing time, duration of erythema, and post-operative pain were less with the 90 microseconds pulse CO2 laser than with the 900-microsecond dwell time and 950-microsecond pulse duration lasers, while effectiveness was comparable. Complications were few with the 90-microsecond pulse laser, including three patients (9.1%) developing hyperpigmentation. One pass with the 90-microsecond pulse duration CO2 laser produced 100 microns of ablation with 17 microns of thermal damage. Ablation and damage were additive so that, by six passes, ablation depth was 350 microns and depth of thermal damage was 63 microns. This thermal damage is less than that reported with lasers having a longer pulse duration or dwell time with comparable depths of vaporization., Conclusion: Treatment with the 90-microsecond pulse duration laser results in a more rapid healing time and shorter duration erythema. The clinical improvements in wrinkles and sun damage were comparable. The 90-microsecond pulse duration laser provides an effective, predictable, and safe means of improving facial rhytides and scars.

Background: Cosmetic denervation of hyperfunctional facial lines using botulinum toxin (Botox, Allergan, Inc., Irvine, CA) has gained growing popularity over recent years. Understanding the clinical use and effects of botulinum toxin requires a thorough understanding of the muscular anatomy of the treatment areas., Objective: The purpose of this article is to review the anatomy of the frown, forehead, and periocular regions. Function of individual muscles is discussed to understand proper injection technique., Conclusions: The anatomy of the frown, forehead, and periocular regions is complex. Individual muscles are tightly intertwined and treatment of one anatomic region may affect many different muscles. A complete understanding of the anatomy of the upper face is essential to ensure proper injection technique, safe and predictable results as well as anticipating complications.

Purpose: During radical prostatectomy for prostate cancer tumor at the surgical margin is a relatively frequent finding. We summarize the literature on the incidence, etiology, location, prevention and treatment of positive surgical margins after radical prostatectomy., Materials and Methods: The literature was reviewed for data on positive margins during radical prostatectomy for prostate cancer., Results: Positive surgical margins may result from artifacts induced by tissue processing, incising inadvertently into the prostate or incising into extraprostatic tumor that has extended beyond the limits of resection. Patients with 10 ng./ml. or greater preoperative prostate specific antigen, biopsy Gleason score 7, multiple positive biopsies, or clinical stage T2b, T2c or T3 cancer have a higher risk of positive margins. Preoperative endorectal magnetic resonance imaging may be useful in staging a select group of patients. Neoadjuvant androgen deprivation reduces the incidence of positive margins but does not appear to delay progression or improve survival. The surgical approach, retropubic or perineal, may influence the location and etiology of positive margins. In general, nerve and bladder neck sparing procedures do not compromise tumor removal in appropriately selected patients. Positive margins increase the risk of progression and correlate with decreased cancer specific and overall survival. There is no consensus on the management of positive margins. External beam radiation and androgen deprivation may be administered as adjuvant therapy or at the time of recurrence., Conclusions: Tumor at the specimen edge is an adverse prognostic factor. With appropriate patient selection and meticulous surgical technique some positive margins can be prevented. Controlled prospective randomized studies of postoperative therapy are needed before definitive recommendations can be made for treating positive margins.

Background: The effectiveness of cyclosporine in the treatment of severe psoriasis is well known., Objective: We evaluated the efficacy and toxicity of systemic cyclosporine in patients with severe psoriasis, observing short-term (12 weeks) and long-term (3 to 5 years) effects., Methods: To further elucidate efficacy and safety, 42 patients with severe psoriasis were treated initially with cyclosporine 5 to 6 mg/kg per day for 12 weeks. A subset of 14 patients continued maintenance treatment for 3.5 years to study the long-term effects of cyclosporine on renal function and structure. Renal biopsies were performed after 2.5 years and 3.5 years of treatment. Renal histologic findings were correlated with renal function., Results: By weeks 8 and 12, 64% (n = 27) and 86% (n = 36) of patients, respectively, were rated clear or almost clear of the psoriasis. However, a subpopulation of 15 patients did not respond to 5 mg/kg daily but improved when the dose was increased to 6 mg/kg daily. Clearance or near clearance was achieved in 67% of this subpopulation after 4 weeks. For the 29 patients whose glomerular filtration rate (GFR) was measured, mean GFR fell by 7% from baseline to week 4 (p < 0.05). This change was reversible when dosage was reduced by 1 mg/kg per day in each of these patients. Patients older than 45 years of age experienced significant elevation of mean diastolic blood pressure and had reduced GFR and increased serum creatinine. After 2.5 years, of the 14 patients who continued maintenance treatment, two had biopsy specimens that showed moderate interstitial fibrosis and tubular atrophy. The remainder showed only minimal to mild structural damage. After 3.5 years of cyclosporine treatment, repeat renal biopsy specimens revealed slight increases in structural changes in nine subjects. These changes correlated with increasing age and drug-induced hypertension., Conclusion: We conclude that 5 mg/kg of cyclosporine daily is usually an effective initial dose for psoriasis. Patients who do not respond will often benefit from elevation of the dose to 6 mg/kg daily. Older patients experience cyclosporine-induced hypertension and changes in renal function and structure more frequently than do younger patients.

Repetitive exposure of skin to sunlight is known to result in dermatoheliosis, characterized by photoaging and carcinogenesis. It has been demonstrated previously that relatively large amounts of ultraviolet (UV) A can produce photodamage and it is believed that UVB plays a major role in the induction of photodamage and photocarcinogenesis. The study reported here determines the cutaneous effects of minimal erythemal amounts of solar-simulated UV radiation as well as suberythemal and minimal erythemal doses of UVA. Previously non-sunexposed human skin was irradiated twice weekly for 24 weeks. Biopsies were obtained 12, 24 and 36 weeks after the initial irradiation and assessed for both epidermal and dermal alterations. Dermal elastic tissue content was measured via computerized image analysis. All UV treatment regimens produced observable epidermal and dermal changes. These alterations were observed after only 12 weeks of twice-weekly irradiation and were still evident 12 weeks after the final irradiation. Interestingly, UVA irradiation produced a decrease in elastic tissue content whereas solar-simulated UV produced a slight increase. Most notable were the changes produced by the suberythemal dose of UVA. Surprisingly, this relatively low UVA dose produced a reduction in elastic tissue content. The results of this investigation demonstrate that small amounts of UVA or solar-simulated UV are capable of producing cutaneous photodamage. These findings suggest that even suberythemal doses of repetitive UVA may lead to photoaging of the skin and that there is a need for daily broad spectrum UV protection.

This article reviews the use of systemic retinoids in the treatment of psoriasis. Various retinoids are discussed in the treatment of generalized pustular psoriasis, exfoliative psoriasis, and plaque psoriasis, both in combination therapy and monotherapy. Dosing outlines, side effects, and recommended monitoring guidelines are reviewed.

Background: The presence of infraobital dark skin, often known as dark circles under the eyes, is a frequent cosmetic concern. There has been little reported on therapy of this condition. One group of patients was determined to have dermal melanin deposition, which we treated with a Q-switched ruby laser., Objective: Our study evaluated the clinical and histological appearance of infraobital skin pigment in 17 patients with dermal melanin deposition treated with a Q-switched ruby laser., Methods: Seventeen patients with melanin deposition were treated with the Q-switched ruby laser (694 nm) with a pulse width of 28 nanoseconds and fluences of 7.5 J/cm2. Response to treatment was assessed by an independent investigator with patient and photograph evaluation. Skin Biopsies were obtained in nine of the 17 patients., Results: Of those patients treated with one Q-switched ruby session, 23.5% achieved a greater than 50% response. Of those treated twice, 88.9% achieved greater than 50% response. In postreatment skin biopsies there was reduction of dermal melanin deposition., Conclusions: Patients with infraobital pigmented skin due to dermal melanin deposition may be considered candidates for Q-switched Ruby laser treatment.

Background: The nevus of Ota is a benign dermal melanocytic lesion that has previously proved difficult to treat. Recently, the Q-switched ruby laser has been reported to be successful in treating benign pigmented lesions and tattoos., Objective: Our study evaluates the treatment of 16 patients with nevus of Ota with the Q-switched ruby laser (694 nm)., Methods: Sixteen patients with nevus of Ota were treated with the Q-switched ruby laser with a pulse width of 28 nsec and energy fluences ranging from 7.5 to 10 J/cm2. Response to treatment was assessed by an independent investigator with photographs., Results: The average number of treatments was 3.8 per patient. After two treatments, 44% of patients showed a 50% or greater improvement. After three treatments, 85% of patients showed a 50% or greater improvement; after four treatments, 100% of patients showed 50% or greater improvement. No patients had permanent textural changes or scarring., Conclusion: High-energy fluences of the Q-switched ruby laser lead to significant improvement without scarring of nevus of Ota after a few treatments.

Background: Chemotherapy with various alkylating agents has been reported to be successful in the treatment of lichen myxedematosus. However, serious toxicities have accompanied such use., Objective: To report a case of treatment of lichen myxedematosus with chlorambucil., Result: There was a favorable response using chlorambucil as an alternative therapeutic agent.

A computer system is used to provide automatic pathology diagnostic feedback to radiologists. This feedback occurs on a daily basis whenever surgical specimens are obtained for which pertinent radiologic examinations have been performed. On-line inquiry capability is also provided. The implementation relies on linkage between two operational computer systems at Massachusetts General Hospital, for pathology specimen accession management and radiology examination scheduling.

Four patients with psoriasis complicating human immunodeficiency virus (HIV) infection showed marked improvement in their psoriasis after being treated with oral zidovudine. The antipsoriatic effect persisted in two patients in spite of worsening helper T cell depletion. The antipsoriatic effect appeared to be dose-dependent and was associated with the development of erythrocyte macrocytosis, a known side effect of zidovudine. Zidovudine is useful for the therapy of HIV-associated psoriasis and should be tested for efficacy in non-HIV-associated psoriasis.

A computer reporting system in radiology at the Massachusetts General Hospital (MGH) uses the direct transcription of dictated reports into the computer with the option of standard reports. This article describes a system in regular use at MGH for reporting dental radiographs in which both the clinical history and the radiographic findings are assembled from canned subunits of standard text. The system covers 80 to 90 percent of all dental radiographs and results in a clear report requiring far less production time than previously.