Modeling Item-Level Spelling Variance in Adults: Providing Further Insights into Lexical Quality.

Purpose: The lexical quality (LQ) hypothesis predicts that a skilled reader's lexicon will be inhabited by a range of low- to high-quality items, and the probability of representing a word with high quality varies as a function of person-level, word-level, and item-specific variables. These predictions were tested with spelling accuracy as a gauge of LQ. Method: Item-response based crossed random effects models explored simultaneous contributions of person-level (e.g., participant's decoding skill), word-level (e.g., word's transparency rating), item-specific (e.g., participant's familiarity with specific word), and person-by-word interaction predictors (e.g., decoding by transparency rating interaction) to the spelling of 25 commonly misspelled irregular English words in 61 undergraduate university students (M = 19.4 years, 70.49% female, 39.34% Hispanic, 81.97% White). Results: Substantial variance among individuals in item-level spelling accuracy was accounted for by person-level decoding skill; item-specific familiarity, proportion of schwas correctly represented, and correctly identifying the word from its mispronunciation; and an interaction of transparency rating by general decoding skill. Conclusions: Consistent with the LQ hypothesis, results suggest that one's ability to form a high-quality lexical representation of a given word depends on a complex combination of person-level abilities, word-level characteristics, item-specific experiences, and an interaction between person- and word-level influences.

Spelling-to-pronunciation transparency ratings for the 20,000 most frequently written English words.

Given English orthography's quasi-regular nature, applying common decoding rules to a word does not always result in a correct pronunciation matching the stored phonological form (e.g., the word tongue). To arrive at a correct pronunciation, developing readers must make the match between a decoded pronunciation and a word's correct pronunciation stored in memory. Developmentally, this matching process varies as a function of child skill (e.g., decoding, vocabulary) and word characteristics (e.g., spelling-to-pronunciation transparency, concreteness), with each being continuously distributed. Spelling-to-pronunciation transparency ratings represent a global measure of the ease of arriving at a word's correct pronunciation from its decoded pronunciation and in experimental studies has been shown to be a critical dimension in assessing the difficulty of a word for developing readers (e.g., Steacy et al., 2022a, 2022b). This study aimed to create a database of spelling-to-pronunciation transparency ratings for the 23,282 most frequently written English words, made available in the supplemental materials for future analyses. We asked adults to rate words' spelling-to-pronunciation transparency on a scale of 1-6 (1 = very easy to match, 6 = very difficult). Results of multiple regression analyses revealed variance in ratings to be unaccounted for by other word features, demonstrating the uniqueness of these ratings. Furthermore, words that are considered irregular, classified previously as strange, or contained at least one schwa received higher ratings, demonstrating strong associations between transparency and regularity. Lastly, these ratings significantly predicted both adult word naming time and child word reading accuracy above and beyond other word features known to predict reading.

Set for Variability as a Critical Predictor of Word Reading: Potential Implications for Early Identification and Treatment of Dyslexia.

Quasiregular orthographies such as English contain substantial ambiguities between orthography and phonology that force developing readers to acquire flexibility during decoding of unfamiliar words, a skill referred to as a "set for variability" (SfV). The ease with which a child can disambiguate the mismatch between the decoded form of a word and its actual lexical phonological form has been operationalized using the SfV mispronunciation task (e.g., the word wasp is pronounced to rhyme with clasp [i.e., /wæsp/] and the child must recognize the actual pronunciation of the word to be /wɒsp/). SfV has been shown to be a significant predictor of word reading variance. However, little is known about the relative strength of SfV as a predictor of word reading compared to other well-established predictors or the strength of this relationship in children with dyslexia. To address these questions, we administered the SfV task to a sample of grade 2-5 children (N=489) along with other reading related measures. SfV accounted for 15% unique variance in word reading above and beyond other predictors, whereas phonological awareness (PA) accounted for only 1%. Dominance analysis indicated SfV is the most powerful predictor, demonstrating complete statistical dominance over other variables including PA. Quantile regression revealed SfV is a stronger predictor at lower levels of reading skill, indicating it may be an important predictor in students with dyslexia. Results suggest that SfV is a powerful and potentially highly sensitive predictor of early reading difficulties and, therefore, may be important for early identification and treatment of dyslexia.

Sulfur Availability Impacts Accumulation of the 2-Thiouridine tRNA Modification in Bacillus subtilis.

Posttranscriptional modifications to tRNA are critical elements for the folding and functionality of these adaptor molecules. Sulfur modifications in tRNA are installed by specialized enzymes that act on cognate tRNA substrates at specific locations. Most studied organisms contain a general cysteine desulfurase to mobilize sulfur for the synthesis of S-tRNA and other thio-cofactors. Bacillus subtilis and other Gram-positive bacteria encode multiple cysteine desulfurases that partner with specific sulfur acceptors in the biosynthesis of thio-cofactors. This metabolic layout suggests an alternate mode of regulation in these biosynthetic pathways. In this study, tRNA modifications were exploited as a readout for the functionality of pathways involving cysteine desulfurases. These analyses showed that the relative abundance of 2-thiouridine-modified tRNA (s2U) responds to sulfur availability in the growth medium in a dose-dependent manner. This study found that low sulfur concentrations lead to decreased levels of the s2U cysteine desulfurase YrvO and thiouridylase MnmA, without altering the levels of other cysteine desulfurases, SufS, NifS, and NifZ. Analysis of pathway metabolites that depend on the activity of cysteine desulfurases indicates that sulfur nutrient availability specifically impacts s2U accumulation while having no effect on the levels of other S-modified tRNA or activity levels of Fe-S enzymes. Collectively, these results support a model in which s2U tRNA serves as a marker for sulfur availability in B. subtilis. IMPORTANCE The 2-thiouridine (s2U) tRNA modification is found ubiquitously across all domains of life. YrvO and MnmA, the enzymes involved in this modification, are essential in B. subtilis, confirming the well-established role of s2U in maintaining translational efficiency and, consequently, cellular viability. Herein, we show that in the model Gram-positive organism Bacillus subtilis, the levels of s2U are responsive to sulfur availability. Downregulation of the s2U biosynthetic components leads to lower s2U levels, which may serve as a signal for the slowing of the translational apparatus during cellular nutrient insufficiency. Our findings provide the basis for the identification of a potential bacterial mode of regulation during S-metabolite depletion that may use s2U as a marker of suboptimal metabolic status.

Using State All-Payer Claims Data to Identify the Active Primary Care Workforce: A Novel Study in Virginia.

PURPOSE: Primary care is the foundation of the health care workforce and the only part that extends life and improves health equity. Previous research on the geographic and specialty distribution of physicians has relied on the American Medical Association's Masterfile, but these data have limitations that overestimate the workforce. METHODS: We present a pragmatic, systematic, and more accurate method for identifying primary care physicians using the National Plan and Provider Enumeration System (NPPES) and the Virginia All-Payer Claims Database (VA-APCD). Between 2015 and 2019, we identified all Virginia physicians and their specialty through the NPPES. Active physicians were defined by at least 1 claim in the VA-APCD. Specialty was determined hierarchically by the NPPES. Wellness visits were used to identify non-family medicine physicians who were providing primary care. RESULTS: In 2019, there were 20,976 active physicians in Virginia, of whom 5,899 (28.1%) were classified as providing primary care. Of this primary care physician workforce, 52.4% were family medicine physicians; the remaining were internal medicine physicians (18.5%), pediatricians (16.8%), obstetricians and gynecologists (11.8%), and other specialists (0.5%). Over 5 years, the counts and relative percentages of the workforce made up by primary care physicians remained relatively stable. CONCLUSIONS: Our novel method of identifying active physicians with a primary care scope provides a realistic size of the primary care workforce in Virginia, smaller than some previous estimates. Although the method should be expanded to include advanced practice clinicians and to further delineate the scope of practice, this simple approach can be used by policy makers, payers, and planners to ensure adequate primary care capacity.

Modeling Complex Word Reading: Examining Influences at the Level of the Word and Child on Mono- and Polymorphemic Word Reading.

Purpose: The probability of a child reading a word correctly is influenced by both child skills and properties of the word. The purpose of this study was to investigate child-level skills (set for variability and vocabulary), word-level properties (concreteness), word structure (mono- vs. polymorphemic), and interactions between these properties and word structure within a comprehensive item-level model of complex word reading. This study is unique in that it purposely sampled both mono- and polymorphemic polysyllabic words. Method: A sample of African American (n = 69) and Hispanic (n =6) students in grades 2-5 (n =75) read a set of mono- and polymorphemic polysyllabic words (J=54). Item-level responses were modeled using cross-classified generalized random-effects models allowing variance to be partitioned between child and word while controlling for other important child factors and word features. Results: Set for variability and the interaction between concreteness and word structure (i.e., mono- vs. polymorphemic) were significant predictors. Higher probabilities of reading poly- over monomorphemic words were identified at lower levels of concreteness with the opposite at higher levels of concreteness. Conclusions: Results indicate important predictors at both the child- and word-level and support the importance of morphological structure for reading abstract polysyllabic words.

Unpacking the Unique Relationship Between Set for Variability and Word Reading Development: Examining Word- and Child-Level Predictors of Performance.

Set for variability (SfV) is an oral language task which requires an individual to disambiguate the mismatch between the decoded form of an irregular word and its actual lexical pronunciation. For example, in the task, the word wasp is pronounced to rhyme with clasp (i.e., /wæsp/) and the individual must recognize the actual pronunciation of the word to be /wɒsp/. SfV has been shown to be a significant predictor of both item-specific and general word reading variance above and beyond that associated with phonemic awareness skill, letter-sound knowledge, and vocabulary skill. However, very little is known about the child characteristics and word features that affect SfV item performance. In this study we explored whether word features and child characteristics that involve phonology only are adequate to explain item-level variance in SfV performance or whether including predictors that involve the connection between phonology and orthography explain additional variance. To accomplish this we administered the SfV task (N=75 items) to a sample of grade 2-5 children (N=489) along with a battery of reading, reading related, and language measures. Results suggest that variance in SfV performance is uniquely accounted for by measures tapping phonological skill along with those capturing knowledge of phonology to orthography associations, but more so in children with better decoding skill. Additionally, word reading skill was found to moderate the influence of other predictors suggesting that how the task is approached may be impacted by word reading and decoding ability.

Prescribing Patterns of Antihypertensive Agents and Blood Pressure Control Among Patients With Incident Stage 2 Hypertension.

Background: Initiation of appropriate antihypertensive therapy is crucial, particularly among patients with stage 2 hypertension, whom initiation of dual antihypertensive agents is suggested. Little is known regarding real-world prescribing of antihypertensive agents for patients with incident stage 2 hypertension. Objective: The primary objective was to describe prescribing patterns of antihypertensive therapy among patients with incident stage 2 hypertension. The secondary objectives included determining association of blood pressure (BP) control with initial multiple antihypertensive agents. Methods: Retrospective cohort analysis was conducted using electronic medical records from 6 primary care clinics between January 2014 and June 2019. Included patients were ≥18 years with an initial diagnosis of stage 2 hypertension, defined as BP ≥160/100 mm Hg Primary analysis was characterizing prescribing patterns of antihypertensive agents among patients with incident stage 2 hypertension. Investigation of BP control (<140/90 mm Hg) at 3 months of diagnosis was also performed. Results: We identified 261 patients with incident stage 2 hypertension (mean age, 52 years; 53.2% males; mean baseline BP, 162.1/100.1 mm Hg). Approximately 72% of patients were initiated on single antihypertensive agent, with the most common being angiotensin receptor blockers (ARBs; 25.7%) and angiotensin-converting-enzyme (ACE) inhibitors (24.6%). Commonly initiated multiple antihypertensive agents were ACE-inhibitor + thiazide-like diuretic (52.7%), followed by an ARB + thiazide-like diuretic (21.6%). Multiple antihypertensive therapy was associated with improved BP control at 3 months (adjusted odds ratio [OR], 3.54; 95% confidence interval [CI], 1.55-8.06). Conclusion: Majority of patients with incident stage 2 hypertension were prescribed initial single antihypertensive therapy, though better BP control at 3 months was seen among those initiated on multi-antihypertensive therapy.

Placental adaptation to maternal malnutrition.

Maternal malnutrition gives rise to both short- and long-term consequences for the survival and health of the offspring. As the intermediary between mother and fetus, the placenta has the potential to interpret environmental signals, such as nutrient availability, and adapt to support fetal growth and development. While this potential is present, it is clear that at times placental adaptation fails to occur resulting in poor pregnancy outcomes. This review will focus on placental responses to maternal undernutrition related to changes in placental vascularization and hemodynamics and placental nutrient transport systems across species. While much of the available literature describes placental responses that result in poor fetal outcomes, novel models have been developed to utilize the inherent variation in fetal weight when dams are nutrient restricted to identify placental adaptations that result in normal-weight offspring. Detailed analyses of the spectrum of placental responses to maternal malnutrition point to alternations in placental histoarchitectural and vascular development, amino acid and lipid transport mechanisms, and modulation of immune-related factors. Dietary supplementation with selected nutrients, such as arginine, has the potential to improve placental growth and function through a variety of mechanisms including stimulating cell proliferation, protein synthesis, angiogenesis, vasodilation, and gene regulation. Improved understanding of placental responses to environmental cues is necessary to develop diagnostic and intervention strategies to improve pregnancy outcomes.

Intestines of non-uniform stiffness mold the corners of wombat feces.

The bare-nosed wombat (Vombatus ursinus) is a fossorial, herbivorous, Australian marsupial, renowned for its cubic feces. However, the ability of the wombat's soft intestine to sculpt flat faces and sharp corners in feces is poorly understood. In this combined experimental and numerical study, we show one mechanism for the formation of corners in a highly damped environment. Wombat dissections show that cubes are formed within the last 17 percent of the intestine. Using histology and tensile testing, we discover that the cross-section of the intestine exhibits regions with a two-fold increase in thickness and a four-fold increase in stiffness, which we hypothesize facilitates the formation of corners by contractions of the intestine. Using a mathematical model, we simulate a series of azimuthal contractions of a damped elastic ring composed of alternating stiff and soft regions. Increased stiffness ratio and higher Reynolds number yield shapes that are more square. The corners arise from faster contraction in the stiff regions and relatively slower movement in the center of the soft regions. These results may have applications in manufacturing, clinical pathology, and digestive health.

Modeling and Visualizing the Codevelopment of Word and Nonword Reading in Children From First Through Fourth Grade: Informing Developmental Trajectories of Children With Dyslexia.

Developmental studies examining relations between word reading (WR) and decoding in typical and dyslexic populations routinely cut the reading distribution to form distinct groups. However, dichotomizing continuous variables to study development is problematic for multiple reasons. Instead, we modeled and visualized the parallel growth of WR and nonword reading (NWR) factor scores longitudinally in a Grade 1-4 developmental sample (N = 588). The results indicate that while WR and NWR growth factors are highly related (r = .71), the relation between WR and NWR trajectories change as a function of initial WR. Results are interpreted within computational models of dyslexia in which children with dyslexia overfit orthography â†’ phonology relations at the level of the word, limiting the development of sublexical representations needed to read nonwords.

Consent Rates Reported in Published Pediatric Randomized Controlled Trials.

OBJECTIVE: To determine the average reported consent rate for published pediatric randomized controlled trials (RCTs) and whether this rate varies by trial characteristics. STUDY DESIGN: A review of pediatric RCTs published in Medline in 2009, 2010, or 2015 was performed. Secondary analyses of prior trials, trials including adults, trials not requiring consent, or trials with missing or unclear consent data were excluded. Consent rate was defined as the number of patients enrolled divided by number of eligible patients where families were approached. Random effects meta-regression was conducted to determine the weighted average consent rate. RESULTS: Of 2347 trials identified, 1651 were excluded. An additional 418 of 696 (60%) were excluded because the consent rate was missing or unclear. The average consent rate for 278 included RCTs was 82.6% (95% CI, 80.3%-84.8%) and was higher for vaccination compared with behavioral trials and for industry-funded compared with National Institutes of Health-funded or other government-funded trials. The average consent rate was <70% for 26% of included trials. Of these trials, US trials (28/77 [36.4%]) had a higher probability of a consent rate of <70% than non-US studies (35/64 [21.3%]) and multinational (9/37 [24.3%]) studies. There was slight variation by funding category. CONCLUSIONS: Although the average consent rate for published trials was reasonably high, approximately one-quarter of trials had consent rates of <70%. Consent rates reporting has improved over time, but remains suboptimal. Our findings should assist with the planning of future pediatric RCTs, although consent data from unpublished trials are also needed.

Obesity increases hepatic glycine dehydrogenase and aminomethyltransferase expression while dietary glycine supplementation reduces white adipose tissue in Zucker diabetic fatty rats.

Obesity is associated with altered glycine metabolism in humans. This study investigated the mechanisms regulating glycine metabolism in obese rats. Eight-week-old Zucker diabetic fatty rats (ZDF; a type-II diabetic animal model) received either 1% glycine or 1.19% L-alanine (isonitrogenous control) in drinking water for 6 weeks. An additional group of lean Zucker rats also received 1.19% L-alanine as a lean control. Glycine concentrations in serum and liver were markedly lower in obese versus lean rats. Enteral glycine supplementation restored both serum and hepatic glycine levels, while reducing mesenteric and internal white fat mass compared with alanine-treated ZDF rats. Blood glucose and non-esterified fatty acid (NEFA) concentrations did not differ between the control and glycine-supplemented ZDF rats (P > 0.10). Both mRNA and protein expression of aminomethyltransferase (AMT) and glycine dehydrogenase, decarboxylating (GLDC) were increased in the livers of obese versus lean rats (P < 0.05). In contrast, glycine cleavage system H (GCSH) hepatic mRNA expression was downregulated in obese versus lean rats, although there was no change in protein expression. These findings indicate that reduced quantities of glycine observed in obese subjects likely results from an upregulation of the hepatic glycine cleavage system and that dietary glycine supplementation potentially reduces obesity in ZDF rats.

Practice facilitation to promote evidence-based screening and management of unhealthy alcohol use in primary care: a practice-level randomized controlled trial.

BACKGROUND: Unhealthy alcohol use is the third leading cause of preventable death in the United States. Evidence demonstrates that screening for unhealthy alcohol use and providing persons engaged in risky drinking with brief behavioral and counseling interventions improves health outcomes, collectively termed screening and brief interventions. Medication assisted therapy (MAT) is another effective method for treatment of moderate or severe alcohol use disorder. Yet, primary care clinicians are not regularly screening for or treating unhealthy alcohol use. METHODS AND ANALYSIS: We are initiating a clinic-level randomized controlled trial aimed to evaluate how primary care clinicians can impact unhealthy alcohol use through screening, counseling, and MAT. One hundred and 25 primary care practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN) will be engaged; each will receive practice facilitation to promote screening, counseling, and MAT either at the beginning of the trial or at a 6-month control period start date. For each practice, the intervention includes provision of a practice facilitator, learning collaboratives with three practice champions, and clinic-wide information sessions. Clinics will be enrolled for 6-12 months. After completion of the intervention, we will conduct a mixed methods analysis to identify changes in screening rates, increase in provision of brief counseling and interventions as well as MAT, and the reduction of alcohol intake for patients after practices receive practice facilitation. DISCUSSION: This study offers a systematic process for dissemination and implementation of the evidence-based practice of screening, counseling, and treatment for unhealthy alcohol use. Practices will be asked to implement a process for screening, counseling, and treatment based on their practice characteristics, patient population, and workflow. We propose practice facilitation as a robust and feasible intervention to assist in making changes within the practice. We believe that the process can be replicated and used in a broad range of clinical settings; we anticipate this will be supported by our evaluation of this approach. TRIAL REGISTRATION: ClinicalTrials.gov, ClinicalTrials.gov Identifier: NCT04248023, Registered 5 February 2020.

Combining Old and New for Better Understanding and Predicting Dyslexia.

Despite decades of research, it has been difficult to achieve consensus on a definition of common learning disabilities such as dyslexia. This lack of consensus represents a fundamental problem for the field. Our approach to addressing this issue is to use model-based meta-analyses and Bayesian models with informative priors to combine the results of a large number of studies for the purpose of yielding a more stable and well-supported conceptualization of reading disability. A prerequisite to implementing these models is establishing informative priors for dyslexia. We illustrate a new approach for doing so based on the known distribution of the difference between correlated variables, and use this distribution to determine the proportion of poor readers whose poor reading is unexpected (i.e., likely to be due to dyslexia) as opposed to expected.

Evaluating Health Advice in a Web 2.0 Environment: The Impact of Multiple User-Generated Factors on HIV Advice Perceptions.

Unlike traditional media, social media systems often present information of different types from different kinds of contributors within a single message pane, a juxtaposition of potential influences that challenges traditional health communication processing. One type of social media system, question-and-answer advice systems, provides peers' answers to health-related questions, which yet other peers read and rate. Responses may appear good or bad, responders may claim expertise, and others' aggregated evaluations of an answer's usefulness may affect readers' judgments. An experiment explored how answer feasibility, expertise claims, and user-generated ratings affected readers' assessments of advice about anonymous HIV testing. Results extend the heuristic-systematic model of persuasion (Chaiken, 1980) and warranting theory (Walther & Parks, 2002). Information that is generally associated with both systematic and heuristic processes influenced readers' evaluations. Moreover, content-level cues affected judgments about message sources unexpectedly. When conflicting cues were present, cues with greater warranting value (consensus user-generated ratings) had greater influence on outcomes than less warranted cues (self-promoted expertise). Findings present a challenge to health professionals' concerns about the reliability of online health information systems.

Response to gonadotropin-releasing hormone challenge: Seasonal variation in steroid production in a viviparous lizard, Tiliqua nigrolutea.

The hypothalamic-pituitary-gonadal axis plays a central role in the regulation of gamete maturation, sex steroid production and the stimulation of reproductive behaviours in vertebrates. In seasonal breeders, the timely activation and deactivation of this control system is important to ensure successful reproduction: this process is not well understood in species which breed irregularly. Males of the viviparous blotched blue-tongued lizard, Tiliqua nigrolutea, breed annually, while females display a multiennial cycle. We investigated seasonal variation in hypothalamic-pituitary-gonadal axis responsiveness in both sexes of T. nigrolutea. We measured changes in plasma concentrations of testosterone and estrogen in response to a single intraperitoneal injection of a GnRH agonist, chicken-II LH-RH, at three reproductively distinct times of year. Plasma testosterone concentrations in males were significantly increased during gonadal quiescence, but not initial or final spermatogenesis. There was no estrogen response in males at any time of year. Conversely, in females, there was an increase in plasma testosterone, but not estrogen, concentration, in reproductively quiescent females several months in advance of a successful pregnancy. These results indicate clear variation in HPG axis activity with sex, season and reproductive condition in this seasonally breeding viviparous lizard. This study opens the way for further investigation into the mechanisms by which internal (body condition) and external seasonal cues (temperature and photoperiod) are coordinated to regulate reproduction in irregularly-breeding reptiles.

Pregnancy limits lung function during exercise and depresses metabolic rate in the skink Tiliqua nigrolutea.

High gestational loads have been associated with a range of ecological costs, such as decreased locomotor ability; however, the physiological mechanisms that underpin these changes are poorly understood. In this study, breathing patterns, metabolic rates, lung volume and lung diffusing capacity were measured at rest and during exercise in the pregnant skink Tiliqua nigrolutea. Breathing patterns were largely unaffected by gestation; however, decreases in metabolic rate (rate of oxygen consumption) in the late stages of pregnancy induced a relative hyperventilation. The reductions in metabolic rate during late pregnancy prevent the calculation of the maintenance cost of pregnancy based on post-partum and neonatal metabolic rates. Despite the high relative litter mass of 38.9±5.3%, lung diffusing capacity was maintained during all stages of pregnancy, suggesting that alterations in diffusion at the alveolar capillary membrane were not responsible for the relative hyperventilation. Lung volume was increased during pregnancy compared with non-pregnant females, but lung volume was significantly lower during pregnancy compared with post-partum lung volume. Pregnant females were unable to produce the same metabolic and ventilatory changes induced by exercise in non-pregnant females. This lack of ability to respond to increased respiratory drive during exercise may underpin the locomotor impairment measured during gestation in previous studies.

Dermatotoxicologic clinical solutions: hair dying in hair dye allergic patients?

This article describes how to identify allergic contact dermatitis resulting from hair dye, and outlines interventions and prevention principles for those who wish to continue dyeing their hair despite being allergic. Hair dye chemicals thought to be the most frequent sensitizers are discussed with instructions for health care providers on how to counsel patients about techniques to minimize exposure to allergenic substances. This framework should allow many patients to continue dyeing their hair without experiencing adverse side effects.

Dermatotoxicologic clinical solutions: textile dye dermatitis patch testing.

The authors provide a framework for working up and counseling a patient with suspected textile dermatitis, focusing on identifying which textile materials are most likely to be the cause of the eczematous lesions, the current clinical guidelines, the utility and appropriateness of patch testing, the limitations of these guidelines, and our pro tempore recommendations. While there are many challenges to correctly identify and counsel patients on how to avoid the offending textile products in a patient with suspected textile dye dermatitis, there is value in following the guidelines set forth to help identify the causative textile(s). Although patch tests can be useful, dermatologists should understand the limitations of standardized patch testing for patients with suspected textile dye-induced dermatitis. These guidelines are expected to increase the likelihood of identifying the causative textile(s), so that patch testing can be supplemented with swatch testing and chemical dye extraction to help discover the allergenic dye.