Visualizing the translation landscape in human cells at high resolution.

Obtaining comprehensive structural descriptions of macromolecules within their natural cellular context holds immense potential for understanding fundamental biology and improving health. Here, we present the landscape of protein synthesis inside human cells in unprecedented detail obtained using an approach which combines automated cryo-focused ion beam (FIB) milling and in situ single-particle cryo-electron microscopy (cryo-EM). With this in situ cryo-EM approach we resolved a 2.19 Å consensus structure of the human 80S ribosome and unveiled its 21 distinct functional states, nearly all higher than 3 Å resolution. In contrast to in vitro studies, we identified protein factors, including SERBP1, EDF1 and NAC/3, not enriched on purified ribosomes. Most strikingly, we observed that SERBP1 binds to the ribosome in almost all translating and non-translating states to bridge the 60S and 40S ribosomal subunits. These newly observed binding sites suggest that SERBP1 may serve an important regulatory role in translation. We also uncovered a detailed interface between adjacent translating ribosomes which can form the helical polysome structure. Finally, we resolved high-resolution structures from cells treated with homoharringtonine and cycloheximide, and identified numerous polyamines bound to the ribosome, including a spermidine that interacts with cycloheximide bound at the E site of the ribosome, underscoring the importance of high-resolution in situ studies in the complex native environment. Collectively, our work represents a significant advancement in detailed structural studies within cellular contexts.

Maternal selenium deficiency was positively associated with the risk of selenium deficiency in children aged 6-59 months in rural Zimbabwe.

There is growing evidence showing the existence of selenium (Se) deficiency among women and children in sub-Saharan Africa. Unfortunately, the key drivers of Se deficiency are not clearly understood. This study assessed the determinants of Se deficiency among children aged 6-59 months and Women of Reproductive Age (WRA), in Zimbabwe. This cross-sectional biomarker study was conducted in selected districts in rural Zimbabwe (Murewa, Shamva, and Mutasa). Children aged 6-59 months (n = 683) and WRA (n = 683), were selected using a systematic random sampling approach. Venous blood samples were collected, processed, and stored according to World Health Organization (WHO) guidelines. Plasma selenium concentration was measured using inductively coupled plasma-mass spectrometry (ICP-MS). Anthropometric indices were assessed and classified based on WHO standards. Demographic characteristics were adapted from the Zimbabwe Demographic Health Survey standard questionnaire. Multiple logistic regression analysis showed that children whose mothers were Se deficient were 4 times more likely to be Se deficient compared to those whose mothers were Se adequate (OR = 4.25; 95% CI; 1.55-11.67; p = 0.005). Girl children were 3 times more likely to be Se deficient compared to boys (OR = 2.84; 95% CI; 1.08-7.51; p = 0.035). Women producing maize for consumption were 0.5 times more likely to be Se deficient than non-producers (OR = 0.47; 95% CI; 0.25-0.90; p = 0.022). The risk of Se depletion in children was amplified by maternal deficiency. Therefore, initiation of maternal multiple micronutrient supplementation from preconception through lactation is beneficial to both children and women.

Transplanted sagebrush "wildlings" exhibit higher survival than greenhouse-grown tubelings yet both recruit new plants.

BACKGROUND: Land uses such as crop production, livestock grazing, mining, and urban development have contributed to degradation of drylands worldwide. Loss of big sagebrush (Artemisia tridentata) on disturbed drylands across the western U.S. has prompted massive efforts to re-establish this foundational species. There has been growing interest in avoiding the severe limitations experienced by plants at the seed and seedling stages by instead establishing plants from containerized greenhouse seedlings ("tubelings"). In some settings, a potential alternative approach is to transplant larger locally-collected plants ("wildlings"). We compared the establishment of mountain big sagebrush (A. tridentata ssp. vaseyana) from tubelings vs. wildlings in southeastern Idaho. A mix of native and non-native grass and forb species was drill-seeded in a pasture previously dominated by the introduced forage grass, smooth brome (Bromus inermis). We then established 80 m x 80 m treatment plots and planted sagebrush tubelings (n = 12 plots, 1200 plants) and wildlings (n = 12 plots, 1200 plants). We also established seeded plots (n = 12) and untreated control plots (n = 6) for long-term comparison. We tracked project expenses in order to calculate costs of using tubelings vs. wildlings as modified by probability of success. RESULTS: There was high (79%) tubeling and low (10%) wildling mortality within the first year. Three years post-planting, chance of survival for wildlings was significantly higher than that of tubelings (85% and 14% respectively). Despite high up-front costs of planting wildlings, high survival rates resulted in their being < 50% of the cost of tubelings on a per-surviving plant basis. Additionally, by the third year post-planting 34% of surviving tubelings and 95% of surviving wildlings showed evidence of reproduction (presence / absence of flowering stems), and the two types of plantings recruited new plants via seed (3.7 and 2.4 plants, respectively, per surviving tubeling/wildling). CONCLUSIONS: Our results indicate that larger plants with more developed root systems (wildlings) may be a promising avenue for increasing early establishment rates of sagebrush plants in restoration settings. Our results also illustrate the potential for tubelings and wildlings to improve restoration outcomes by "nucleating" the landscape via recruitment of new plants during ideal climate conditions.

Antibody surface mobility amplifies FcγR signaling via Arp2/3 during phagocytosis.

We report herein that the anti-CD20 therapeutic antibody, rituximab, is rearranged into microclusters within the phagocytic synapse by macrophage Fcγ receptors (FcγR) during antibody-dependent cellular phagocytosis. These microclusters were observed to potently recruit Syk and to undergo rearrangements that were limited by the cytoskeleton of the target cell, with depolymerization of target-cell actin filaments leading to modest increases in phagocytic efficiency. Total internal reflection fluorescence analysis revealed that FcγR total phosphorylation, Syk phosphorylation, and Syk recruitment were enhanced when IgG-FcγR microclustering was enabled on fluid bilayers relative to immobile bilayers in a process that required Arp2/3. We conclude that on fluid surfaces, IgG-FcγR microclustering promotes signaling through Syk that is amplified by Arp2/3-driven actin rearrangements. Thus, the surface mobility of antigens bound by IgG shapes the signaling of FcγR with an unrecognized complexity beyond the zipper and trigger models of phagocytosis.

Urine Se concentration poorly predicts plasma Se concentration at sub-district scales in Zimbabwe, limiting its value as a biomarker of population Se status.

Introduction: The current study investigated the value of urine selenium (Se) concentration as a biomarker of population Se status in rural sub-Saharan Africa. Method: Urine and plasma Se concentrations were measured among children aged 6-59 months (n = 608) and women of reproductive age (WRA, n = 781) living in rural Zimbabwe (Murehwa, Shamva, and Mutasa districts) and participating in a pilot national micronutrient survey. Selenium concentrations were measured by inductively coupled plasma-mass spectrometry (ICP-MS), and urine concentrations were corrected for hydration status. Results: The median (Q1, Q3) urine Se concentrations were 8.4 µg/L (5.3, 13.5) and 10.5 µg/L (6.5, 15.2) in children and WRA, respectively. There was moderate evidence for a relationship between urine Se concentration and plasma Se concentration in children (p = 0.0236) and WRA (p = < 0.0001), but the relationship had poor predictive value. Using previously defined thresholds for optimal activity of iodothyronine deiodinase (IDI), there was an association between deficiency when indicated by plasma Se concentrations and urine Se concentrations among WRA, but not among children. Discussion: Urine Se concentration poorly predicted plasma Se concentration at sub-district scales in Zimbabwe, limiting its value as a biomarker of population Se status in this context. Further research is warranted at wider spatial scales to determine the value of urine Se as a biomarker when there is greater heterogeneity in Se exposure.

To participate or not to participate? A qualitative investigation of students' complex motivations for verbal classroom participation.

Previous research has suggested that making classrooms more active and student centered improves learning, and this usually involves encouraging student talk in the classroom. However, the majority of students remain silent during whole-class discussions, and men's voices are more likely to be heard in science classrooms. Previous interview studies and quantitative studies have discussed the role instructors play in encouraging or discouraging participation, the weight students put into the fear of negative evaluation, and other factors. However, interview studies on the experiences of college students in the sciences, specifically, are lacking. Thus, we conducted a qualitative interview study to investigate students' experiences deciding whether to participate verbally in class, focusing on students recruited from science classrooms. We analyzed the data using an inductive approach and found three main themes: (1) A wide variety of external factors impact students' decision to participate, including instructor characteristics and choices, peer influences, and course material characteristics; (2) Students weigh these factors in complex ways, and this internal calculus varies by student; and (3) Women put greater emphasis on fearing peer judgment, and men may be more motivated by course material considerations. Most of the external factors we identified as important for student participation have been described previously, and we validate that previous literature. We add to the literature by a more complex discussion of how students weigh these different factors and how complex the classroom ecosystem can be. We end by framing our results within the Expectancy Value Theory of motivation, discussing limitations, and providing implications for science college instructors to promote broad and equitable participation.

Differences in the nutritional quality of improved finger millet genotypes in Ethiopia.

Improved crop genotypes are constantly introduced. However, information on their nutritional quality is generally limited. The present study reports the proximate composition and the concentration and relative bioavailability of minerals of improved finger millets of different genotypes. Grains of finger millet genotypes (n = 15) grown in research station during 2019 and 2020 in Ethiopia, and replicated three times in a randomized complete block design, were analysed for proximate composition, mineral concentration (iron, zinc, calcium, selenium), and antinutritional factors (phytate, tannin and oxalate). Moreover, the antinutritional factors to mineral molar ratio method was used to estimate mineral bioavailability. The result shows a significant genotypic variation in protein, fat and fibre level, ranging from 10% to 14.6%, 1.0 to 3.8%, and 1.4 to 4.6%, respectively. Similarly, different finger millets genotypes had significantly different mineral concentrations ranging from 3762 ± 332 to 5893 ± 353 mg kg-1 for Ca, 19.9 ± 1.6 to 26.2 ± 2.7 mg kg-1 for Zn, 36.3 ± 4.6 to 52.9 ± 9.1 mg kg-1 for Fe and 36.6 ± 11 to 60.9 ± 22 µg kg-1 for Se. Phytate (308-360 µg g-1), tannin (0.15-0.51 mg g-1) and oxalate (1.26-4.41 mg g-1) concentrations were also influenced by genotype. Antinutritional factors to minerals molar ratio were also significantly different by genotypes but were below the threshold for low mineral bioavailability. Genotype significantly influenced mineral and antinutritional concentrations of finger millet grains. In addition, all finger millet genotypes possess good mineral bioavailability. Especially, the high Ca concentration in finger millet, compared to in other cereals, could play a vital role to combating Ca deficiency. The result suggests the different finger millet genotypes possess good nutrient content and may contribute to the nutrition security of the local people.

Perceptions of US-Based Muslim Patients of Their Dermatology Care.

Importance: Cultural humility training is of growing interest, yet the religious and cultural accommodations of Muslim patients in dermatology have not been studied. Objective: To explore the perceptions of Muslim patients of their dermatology care. Design, Setting, and Participants: This qualitative mixed-methods study, consisting of surveys and semistructured interviews, recruited participants from 2 clinical sites within a large academic health care system in California. Participants were adult, English-speaking, Muslim patients who were evaluated at least once by a medical or surgical dermatologist between January 2022 and January 2023. Main Outcomes and Measures: A survey obtained the following data: demographics, religious practices pertinent to dermatology care, and experiences of bias outside and inside the dermatology clinic. Semistructured interviews covered topics related to positive and negative experiences in the dermatology clinic, accommodation of cultural and religious needs in dermatology, and future interventions. Results: A total of 21 patients (mean [SD] age, 36.4 [11.6] years; range, 26-71 years) participated in the study: 5 male individuals (24%) and 16 female individuals (76%), including 10 female individuals who wore hijab. Eleven participants identified as Middle Eastern (52%), 8 as South Asian (38%), 1 as North African (5%), and 1 as Pacific Islander (5%). Survey results showed variations in the impact of Islamic practices on dermatology care. Interviews showed that Muslim participants did not perceive dermatology care as a priority and expressed interest in community events focused on general dermatology education. They also experienced stigmatization of their skin disease and cosmetic care. Prior experiences with Islamophobia and colorism hindered the Muslim patient-dermatologist relationship and disclosure of the need for accommodations. There were instances when participants experienced bias and poor cultural humility from dermatologists. Finally, Muslim participants had unique religious and cultural needs pertinent to their care, including clinician gender concordance, medication timing adjustment while fasting, and halal medication ingredients. Conclusions and Relevance: This qualitative mixed-methods study explored the experiences of Muslim patients in dermatology in the US. Recommendations supported by this study include incorporating religion into cultural humility training, increasing diversity in the dermatology workforce, implementing policies for clearer medication labeling, supporting dermatology research in subpopulations of Muslim individuals in the US, and partnering with community organizations for dermatology education.

The needs of multiple birth families during the first 1001 critical days: A rapid review with a systematic literature search and narrative synthesis.

OBJECTIVE: Supporting families during the first 1001 days from conception to the age of two is vital for setting the emotional, cognitive, and physical building blocks for children's futures. Families with twins, triplets, or higher order multiples (multiple birth families) have unique challenges due to caring for more than one baby at the same time. Therefore, identifying the needs of multiple birth families is necessary to provide optimum support during the first 1001 critical days. DESIGN: A rapid review was undertaken to synthesize knowledge of the needs of multiple birth families in the United Kingdom (UK) during the first 1001 critical days. Findings from five databases (MEDLINE, APA PsycArticles, APA PsycInfo, CINAHL, and Web of Science) for peer-reviewed studies and grey literature published between 2012 and 2022 were synthesized. Fifteen studies were reviewed using narrative synthesis. RESULTS: Multiple birth families have unique and complex emotional and practical needs across the first 1001 critical days, and in particular, the first-year post birth, impacted further by complicated pregnancies and prematurity. Needs were identified within the four key themes: high risk pregnancy and birth; transformed reality of raising multiples; inadequate support; and positively affecting experiences. Health professional support was inconsistent and particularly lacking in intrapartum, postnatal, and community care including transition. CONCLUSION: Multiple birth families' needs should be considered in the design and delivery of care within the first 1001 critical days, especially within the first year after birth. Multiples specific advice across the first 1001 critical days is needed and training for health professionals to adapt universal advice for this population is one way to achieve this. Further research is needed to ensure this advice is evidence based and effective.

Examining the Role of Estheticians in Skin Cancer Surveillance.

BACKGROUND: Melanoma and non-melanoma skin cancer are significant causes of mortality. Previous studies regarding skin cancer education in nonmedical professionals have shown increases in favorable attitudes and likelihood of approaching clients about concerning lesions with training. However, few studies have investigated the use of estheticians in skin cancer screening. OBJECTIVES: The objective of this study was to develop an education course to train estheticians to recognize concerning lesions, to assess the baseline knowledge of estheticians toward skin cancer detection, and to determine the effect that our curriculum has on lesion detection. METHODS: We administered an education course and corresponding cross-sectional surveys to estheticians to evaluate current knowledge and assess for improvements in attitudes and behaviors regarding skin cancer detection. RESULTS: Of 504 estheticians, most estheticians (85-98%) indicated the correct level of concern for "extremely concerning" lesions on pre- and post-training surveys. Estheticians were more likely to recommend that their client see a medical professional if they previously attended a course on skin cancer (p = 0.012) or had greater than 1 year of work experience (p < 0.001). After completion of the training module, most participants felt "very comfortable," suggesting that clients see a doctor for a suspicious lesion. CONCLUSION: Our findings suggest that estheticians are capable of indicating the appropriate level of concern for abnormal lesions. Estheticians may serve as a valuable screening partner for dermatologists in the detection of skin cancer.

A comparison of the bioaccessible calcium supplies of various plant-based products relative to bovine milk.

Calcium deficiency is widespread globally, especially in diets with minimal consumption of dairy. It is therefore important to identify plant-based sources of calcium that can make a meaningful contribution to calcium intakes for populations following diets with a minimum supply of dairy products. The best sources of calcium have a high calcium content and bioavailability. Therefore, we evaluated the gross and bioaccessible calcium supplies of 25 plant-based products from 5 food groups considered to be good and important sources of calcium. Bioaccessible calcium was examined using the INFOGEST static digestion model in which isotopically labelled 43Ca was used as a tracer of reagent calcium to improve accuracy of bioaccessibility measurements. The gross calcium content varied widely amongst all the food products, ranging between 7.48 and 959 mg/100 g fresh weight (fw), with approximately 50 % of the products being equivalent to or surpassing the calcium content of skimmed milk. Bioaccessibility of calcium was equally variable, ranging from about 0.1 - 50 %. The lowest bioaccessibility (<10 %) was found in spinach, plant-based beverages, tofu, dried figs and tahini and was attributed to: 1. the high content of oxalate and phytate in some of the products, and 2. the low solubility of tricalcium phosphate which was used for fortification in the plant-based beverages. The remaining products generally had a high bioaccessibility that was similar to, or higher than that of skimmed milk (∼30 %). When both bioaccessibility and recommended serving portions were considered, only 3 products were identified as good sources of calcium, requiring 0.2 - 1.4 servings to equal the bioaccessible supply from skimmed milk. The top three sources of plant-based calcium identified were kale, finger millet and fortified white bread in that order, with kale providing 5 times more bioaccessible calcium than 1 serving of skimmed milk. Moderate sources of calcium where 1.5 - 3 servings was equivalent to 1 serving of skimmed milk included wholemeal bread, some bean varieties (black chickpeas, chickpeas, kidney beans, peas), broccoli, cabbage and almond drink. The rest of the products were either of low calcium content, poor bioaccessibility, and/or not consumed in sufficient quantities to make a significant contribution to daily requirements. White bread was a good source of calcium as it was fortified with calcium carbonate and this suggests that mandatory widescale fortification of staple cereals with this form of calcium should be considered a viable approach to augment dietary calcium intakes in vulnerable populations. Low bioaccessibility of fortified calcium in plant-based beverages, often marketed as good sources of calcium, suggests the need for regulation and for further in vivo studies to validate bioavailability of calcium in these products.

A square peg in a round hole: treating hepatitis C.

Several barriers along the cascade of care reduce hepatitis C treatment access. We propose an investment in patient-centered care strategies to initiate and engage this vulnerable population with curative treatment, such as the implementation of community-based educational peer support groups. Barriers to implementing these patient-centered care strategies remain.

Dietary selenium intake among Ethiopian children in areas known for selenium spatial variability.

Introduction: There is spatial variability of selenium (Se) in soil and crops in Ethiopia. We assessed the Se content of food items, breast milk, and urine among infants in Ethiopia from two areas with contrasting Se concentrations in soils. Methods: Dietary Se intakes among children (6-23 months) were evaluated using a weighed food record on two non-consecutive days. Also, spot urine samples from children and breast milk samples from their mothers were collected to determine Se concentration. Selenium concentrations in the samples were analyzed using an inductively coupled plasma mass spectrometer (ICP-MS). Results: Injera (prepared from teff and mixtures of other cereals) with a legume-based stew were the most frequently consumed foods by the children in both areas, followed by pasta. Overall, the Se concentration (mean ± SD) of food items, breast milk (12.2 ± 3.9 µg/L vs. 3.39 ± 1.5 µg/L), and urine samples (22.5 ± 11.5 µg/L vs. 3.0 ± 1.9 µg/L) from East Amhara were significantly higher than the corresponding samples from West Amhara (p < 0.001). The total Se intakes by the study children from East Amhara and West Amhara were 30.2 [IQ 25%, 14.2; IQ 75%, 54.1] and 7.4 [IQR 25%, 4.2; IQ 75%, 10.6] µg day-1, respectively; 31.5% of children from East Amhara and 92% of children from West Amhara were at risk of inadequate Se intakes. Urinary Se excretion accounted for 53 and 39% of daily dietary Se intake in East Amhara and West Amhara, respectively. Dietary Se intake was positively correlated with urinary Se excretion in East Amhara (r = 0.56; p < 0.001) but not among samples from West Amhara (r = 0.16; p ≥ 0.05), suggesting greater physiological Se conservation in a state of deficiency. Conclusion: There is spatial variability of Se in foods, breast milk, and urine in Ethiopia, suggesting the need for implementation of targeted agronomic interventions that enhance Se concentrations in the edible portion of plant foods.

Combining isotope ratios for provenancing Viking Age iron artefacts in the British Isles: a pilot study.

Stable and radiogenic isotope analysis - particularly using lead isotope analysis (LIA) - has previously been shown to be a useful tool for the provenancing of ancient metal artefacts of silver and copper and its alloys, but less progress has been made in the provenancing of iron artefacts, despite their importance and frequency in the archaeological record. In this pilot study we investigate for the first time the possibilities of iron isotope analysis in combination with trace strontium isotope analysis and LIA for the provenancing of iron objects believed to be from the Viking Age in the British Isles. Previous studies have shown that analysis of each of these isotopes can contribute to provenancing iron artefacts, but they are not individually resolutory. In this proof-of-concept study, we examine the Fe, Sr and Pb isotopes of 7 artefacts believed to derive from the Viking Age: 3 from Meols - a former Viking seaport on Wirral and 4 samples from the probable location of the AD 1066 Battle of Fulford in North Yorkshire. We also examine an additional artefact of unknown antiquity from Bebington Heath - a possible location of the AD 937 Battle of Brunanburh. Although the pilot data set is too small to make definitive conclusions, it has paved the way for a fuller study involving 100 samples (including 30 from the former Viking camp of Torksey, Lincolnshire) funded by the NEIF fund of the UK National Environmental Research Council. The high range of 87Sr/86Sr values in the present data set of 8 is beyond what would be expected for bog iron (with a cut-off ∼ 0.709) and suggests that mined ore was being used, a preliminary conclusion supported by the narrow range of Fe isotope data.

Repigmentation of the Nipple-Areolar Complex Following Free Nipple Grafting.

INTRODUCTION: Free nipple grafting (FNG) is a technique historically used during breast reduction and gender dysphoria top surgery to minimize nipple areolar complex (NAC) hypoperfusion and subsequent loss. One drawback of this approach is NAC hypopigmentation. This study seeks to quantify long-term pigmentation changes in the NAC following FNG. METHODS: A retrospective review of patients who underwent reduction mammoplasty or simple mastectomy with FNG from 2000-2020 at our institution was conducted. Patients were included if they had pre-operative, early, and late post-operative images. Images were analyzed using NIH Image J software for pigmentation changes over time. RESULTS: Of the 151 patients identified, 56 patients (111 breasts) had complete imaging (macromastia n=47; oncologic n=4; gender dysphoria n=5). All patients had NAC hypopigmentation on early imaging, with 25.5% (SD 18.1%) of the NAC affected. On late imaging, 83 NAC (74.7%) experienced repigmentation with only 8.7% (SD 7.3%) of the NAC area remaining hypopigmented. This represents a 67.2% resolution of pigmentation (p<0.001). 10 NAC (9.0%) had progression of hypopigmentation, and 17 NAC (15.3%) had no change. In a subset analysis by race, Caucasian patients had significantly greater area of NAC hypopigmentation on early post-operative imaging (Caucasian, 29.3% (SD 18.8%) vs Black, 18.3% (SD 14.0%), p<0.01). However, resolution of hypopigmentation was similar between both. CONCLUSION: While partial hypopigmentation of the NAC is nearly universal following FNG, a majority of patients experience repigmentation with low residual hypopigmentation at 1 year. These findings are useful for counseling patients with early pigmentation changes in addition to guiding surgical decisions about breast surgery with FNG.

Intersecting Identities: A Look at How Ethnic Identity Interacts With Science Identity in Native Hawaiian and Pacific Islander Students.

Understanding the experiences of Native Hawaiian and Other Pacific Islander (NHPI) students in science courses can help us foster inclusivity and belonging for these often excluded and unacknowledged students. Using social influence theory as a framework, we investigated the intersection between ethnic-racial identity and science identity in NHPI students to better understand their experiences in undergraduate Biology courses. We collected both quantitative and qualitative data and used concurrent triangulation design in our mixed-methods approach. Quantitative data include measures of student pre- and post-course science identity, self-efficacy, alignment with science values, sense of belonging, environmental concern, strength of ethnic-racial identity, and the interaction between ethnic-racial and science identity. We measured environmental concern because NHPI cultures often have strong connections with the environment that may overlap well with environmental science values. Qualitative data included short responses to survey questions that asked students to describe the interaction between their science identity and their ethnicity. We found that NHPI and non-NHPI students do not significantly differ in any construct we measured, nor do they experience different gains across a semester when comparing pre- and post-scores. We also found that NHPI students' feelings concerning the intersection of their ethnic and science identities are varied and complex, with some students expressing feelings of conflict and many others expressing a strengthening relationship between those identities. We discuss implications for instructors and encourage them to acknowledge the community culture of wealth NHPI students bring to the classroom because of their ethnic-racial identities.

A practical guide to clinical photography prior to skin biopsy: key tips and proposed workflow.

High-quality clinical photography has become an integral part of dermatology in the context of patient evaluation and monitoring, clinical teaching, and research. Technological advancements in smartphones have allowed dermatologists to incorporate photography in workflows; however, acquiring quality photos poses its own challenges. Outlining a best practice approach to image capture prior to biopsy will facilitate establishing a team-based approach for the implementation of clinical photography in workflow. We propose this guide with the intent of improving patient care though photography in the clinical setting and the goal of integrating high-quality photography into routine clinical practice.