Mohs Micrographic Surgery at the Skin and Cancer Foundation Australia, 20 Years Later (1997-2017).

BACKGROUND: The availability of Mohs micrographic surgery (MMS) in Australia has increased dramatically since its inception in the 1980s. OBJECTIVE: This study aimed to describe the evolution of MMS practices at the Skin and Cancer Foundation Australia (SCFA) over the past 20 years (1997-2017). METHODS: Retrospective analysis of Mohs surgery cases at SCFA in 2017, 2007, and 1997, comparing data on sex, age, tumor type and site, initial tumor and final defect size, number of surgical stages and sections, and closure management. The present study is limited by being a retrospective analysis from a single institution. RESULTS: There was a 415% increase in the number of Mohs surgery cases from 1997 to 2017, and a significant increase in Mohs surgery-treated squamous cell carcinoma. The preoperative tumor and final defect size have decreased. More side-to-side closures and fewer grafts are being performed over time. LIMITATIONS: Retrospective analysis from a single institution. CONCLUSION: Over the last 20 years, MMS has remained appropriate in its application and is being increasingly used for treatment of squamous cell carcinoma suggesting improved access.

Case-controlled study of skin conditions in HIV-negative men who have sex with men.

Most of the dermatological research in men who have sex with men (MSM) has been in the HIV-infected subpopulation. A retrospective case-control study was performed of dermatologic diagnoses in HIV-negative MSM (n = 329) compared with male heterosexual controls (n = 600). HIV-negative MSM had a higher frequency of folliculitis (19/329 vs 12/600; P = 0.004), cutaneous herpes simplex infection (19/329 vs 14/600; P = 0.009), non-melanoma skin cancer (16/329 vs 10/600; P = 0.006) and syphilis (8/329 vs 2/600; P = 0.005) than the control group. The findings suggest that HIV-negative MSM may have a higher burden of certain skin conditions and this appears to be independent of immunosuppression or sexual behaviours.

The associations between psychological stress and psoriasis: a systematic review.

Psoriasis is estimated to affect around 2-3% of the general population. More than one-third of Australians report having a significant level of distress in their daily lives. Psychological stress has long been shown to play an important role in the natural history of psoriasis, but the details of this relationship remain to be clearly defined. We performed a systematic review of the literature with the aim of determining whether there is a temporal association between psychological stress as the predictor and onset and/or exacerbation of psoriasis as the outcome measure. Our secondary aim was to establish whether there is a relationship between the degree of psychological stress and clinical severity of psoriasis. Our systematic review demonstrates a probable temporal association between different measures of psychological stress and onset, recurrence, and severity of psoriasis. In the light of this, we suggest clinicians include "stress" as a trigger factor in their psoriasis assessment and consider psychological interventions as adjuncts, particularly in those who identify as "stress-responders".

Overwintering Survival of Drosophila suzukii (Diptera: Drosophilidae) and the Effect of Food on Adult Survival in California's San Joaquin Valley.

The overwintering survival and development of Drosophila suzukii Matsumura were investigated in California's San Joaquin Valley. Drosophila suzukii were exposed to overwintering conditions in cages hung in a citrus orchard, and the pupae were buried in the soil. Eggs exposed from late November to January did not survive; a low percentage (<3%) of larvae and pupae developed into adults. Survival of pupae was significantly higher when buried in the soil than on the citrus tree. From late January to March, all life stages developed into adults and overwintered adult female D. suzukii produced eggs when provided with 10% honey-water and sliced oranges. Adult survival varied among fruit juice provision treatments and overwintering exposure periods, ranging from 3.4 ± 0.9 d (water) to 44.1 ± 3.0 d (10% honey-water). Fruit juices of apple, cherry, grape, orange, and pomegranate were tested as adult food sources; results showed that adult female and male D. suzukii lived only 2 d with water only, whereas adults survived from 14.2 to 34.8 d with fruit juice treatments and the 10% honey-water control. An unexpected event was the oviposition and immature development of D. suzukii with the fruit juice. In a follow-up laboratory trial, when 10% honey-water or orange juice were provided along with an artificial diet for oviposition and immature development, female D. suzukii survived for 21.6 ± 2.4 or 21.6 ± 1.5 d, and produced 106.8 ± 14.1 or 98.5 ± 13.1 offspring, respectively. We discuss factors potentially influencing overwintering survival of D. suzukii.

Factors Limiting Peach as a Potential Host for Drosophila suzukii (Diptera: Drosophilidae).

The spotted wing drosophila, Drosophila suzukii Matsumura, has widely established in North America and become an economic concern for a variety of fruit crops. To better understand fruit susceptibility, we evaluated peach surface characteristics on the pest's oviposition success. The number of D. suzukii eggs laid into the fruit flesh was tested on 1) peaches with or without indumenta (commonly referred to as peach fuzz), 2) peaches physically damaged by harvest operations, 3) peaches damaged by the peach twig borer Anarsia lineatella Zeller or the forktailed bush katydid, Scudderia furcata Brunner von Wattenwyl, and 4) peaches with punctures that simulated stink bug damage. Female D. suzukii did not lay eggs in intact fuzzy sections of the fruit or into small punctures (0.3 or 0.5 mm), but readily laid eggs in sections without fuzz, with insect damage, and with large punctures (1 mm). The number of eggs per treatment was positively related to the area of the damaged section; the overall fruit firmness and sugar content was not related to the number of eggs laid in treated or damaged spots. Direct observations of D. suzukii oviposition confirmed that peach fuzz appeared to be an obstacle for the fly's oviposition success, and female flies ceased ovipositional attempts on fuzzy peach sections after a short period of time. Successful oviposition times were associated with substrate firmness, with shorter oviposition time in damaged spots than in cherry fruit or shaved spots of the peach. The results indicate that intact, preharvest peach fruit are unlikely to be infested by the fly, but any surface damage could render the fruit susceptible to the fly.

The national evaluation of senior mentor programs: older adults in medical education.

OBJECTIVES: To identify models for senior mentor programs (SMPs), critical factors in program development, achievement of goals and objectives, effect on medical school environment, and future of programs. DESIGN: Ten SMPs were systematically selected to represent a variety of medical schools, geographic regions, and program types. The National Senior Mentor Program Evaluation relied upon archived data within the programs and new data collected during site visits. Archived data included internally conducted program evaluations, student course evaluations, and survey and focus group results. Site visit data were collected from key informant interviews with program staff and faculty, medical school leadership and students, and older adults serving as mentors. SETTING: Ten U.S. medical schools with SMPs. PARTICIPANTS: Evaluation participants at each site included program faculty, key medical school administrators, participating students, and mentors. MEASUREMENTS: Program evaluation. RESULTS: All 10 programs demonstrated a positive effect on student attitudes toward older adults. Student acceptance of the programs was strong, and mentor acceptance and support were extraordinary. Eight of the 10 programs were operating in 2008 and having considerable effect on medical school environments. Most of the operating programs expect to be continuing for 5 or more years into the future. CONCLUSIONS: The findings of the national evaluation point toward continuation and likely growth of the senior mentor phenomenon in U.S. medical education.

The middle of the road: results from the aging semantic differential with four cohorts of medical students.

OBJECTIVES: To explore the presence of negative stereotypical attitudes among medical students and the extent to which attitudes changed over time. DESIGN: Analysis of pre- and postexperience administration of attitude measures to four cohorts of medical students (two cohorts as quasi-controls and two cohorts as curriculum "treatment" groups). SETTING: The curriculum of a community-based medical school in the United States. PARTICIPANTS: Four sequential cohorts of medical students. INTERVENTION: Experience in a required comprehensive vertically integrated curriculum. MEASUREMENTS: The Aging Semantic Differential (ASD), using an 85-year-old woman as the cue image. RESULTS: The reliability scores for all administrations were acceptable. The two control cohorts demonstrated no change in attitude scores, whereas the treatment cohorts reflected a slight shift toward more-positive scores. However, all cohorts had scores for all sittings that were in the neutral range; on average students routinely scored 70% of the 32 items neither positively nor negatively. CONCLUSION: These students seemed not to hold negative stereotypes as measured using the ASD. Although two of the 32 items prompted negative stereotyping, and six items elicited positive stereotyping, attitudes were neutral about older adults. Characteristics of the ASD itself or of the response set used in this study may have affected the results.

Investigating the use of negatively phrased survey items in medical education settings: common wisdom or common mistake?

BACKGROUND: Attitude surveys in medical education often combine negative items with positive items, a "common wisdom" strategy to counteract response sets. A body of research in other fields has demonstrated that negatively phrased items affect reliability and validity by introducing measurement artifact into scores. The authors investigated the effect of negatively phrased items in the Medical School Learning Environment Survey (MSLES) with data from six medical student cohorts at the University of Texas Medical Branch, Galveston, Texas. METHOD: This study describes the impact of negatively phrased items in the MSLES through analysis of item and scale means and comparisons of coefficient alpha values. RESULTS: Findings indicate that negatively phrased items performed differently than the positively phrased items. Negatively phrased items were associated with lower scale reliability. CONCLUSION: The authors conclude, as did earlier studies, that negatively phrased items introduce an artifact into attitude measurement. The "common wisdom" practice of routinely including negative items should be employed with care.