Reappraising the Use of Systemic Immunomodulators for Psoriasis and Eczema in the Military.

INTRODUCTION: Psoriasis and atopic dermatitis are chronic, immune-mediated skin disorders that are disqualifying for entrance into the military. Both conditions can cause difficulty wearing body armor and other protective equipment when poorly controlled, limiting a service member's ability to train and deploy worldwide. In addition, these conditions may be exacerbated by military service because of increased exposure to austere environments, extreme temperatures, stress, skin injury, bug bites, and vaccinations Service members have limited treatment options because of restrictions on systemic medications that can be used while deployed. Newer systemic medications-in particular, biologics and oral immunomodulators-have evolved to be both extremely effective and safe. We review more recent treatment options for psoriasis and atopic dermatitis in the context of DoD's regulations guiding entry and retention of personnel with psoriasis and eczema and make recommendations regarding updating DoD policy for systemic treatment options. MATERIALS AND METHODS: A literature search was performed using PubMed, Embase, and Ovid with the last search done in the fall of 2023 from all years to date. These articles were further screened based on inclusion and exclusion criteria. In total, 25 articles were included in this review. An Internet search was also performed on the DoD's regulations guiding entry and retention of personnel with psoriasis and eczema. In addition, we examined medical requirements for deployment to the U.S. Central Command and U.S. European Command. RESULTS: Currently, U.S. Central Command and U.S. European Command do not allow the use of medications with special storage and handling requirements on deployments. Newer biologics are safe and efficacious but require refrigeration, although other immunomodulators like deucravacitinib and apremilast are oral pills and do not have cold-storage requirements. However, the use of biologics in austere environments may be feasible because of increased intervals between dosing and the ability to store refrigerated medical supplies in most deployed environments. For military service members with psoriasis, risankizumab and deucravacitinib are excellent options given their favorable safety and efficacy profiles. Of the biologics available for atopic dermatitis, dupilumab is the safest and effective systemic medication available. The Janus kinase inhibitors have also demonstrated excellent efficacy in treating atopic dermatitis, but more safety data are needed because of potential adverse events to include heart-related events, blood clots, and cancers. CONCLUSIONS: Systemic treatments have evolved to become highly specific for both eczema and psoriasis. These newer biologics and immunomodulators may be compatible with use in the deployed setting, especially those that have long dosing intervals and proven efficacy and safety. Of the biologics, dupilumab and risankizumab offer the best efficacy, safety, and dosing intervals for atopic dermatitis and psoriasis, respectively. Deucravcitinib is a recently FDA-approved oral immunomodulator for psoriasis that has an excellent safety profile and efficacy. Allowing the use of these medications on deployments will enable more people with moderate to severe psoriasis and eczema to join and remain in the military while receiving effective treatment.

Plantar Skin Exhibits Altered Physiology, Constitutive Activation of Wound-Associated Phenotypes, and Inherently Delayed Healing.

Wound research has typically been performed without regard for where the wounds are located on the body, despite well-known heterogeneities in physical and biological properties between different skin areas. The skin covering the palms and soles is highly specialized, and plantar ulcers are one of the most challenging and costly wound types to manage. Using primarily the porcine model, we show that plantar skin is molecularly and functionally more distinct from nonplantar skin than previously recognized, with unique gene and protein expression profiles, broad alterations in cellular functions, constitutive activation of many wound-associated phenotypes, and inherently delayed healing. This unusual physiology is likely to play a significant but underappreciated role in the pathogenesis of plantar ulcers as well as the last 25+ years of futility in therapy development efforts. By revealing this critical yet unrecognized pitfall, we hope to contribute to the development of more effective therapies for these devastating nonhealing wounds.

Porous Lithium Disilicate Glass-Ceramics Prepared by Cold Sintering Process Associated with Post-Annealing Technique.

Using melt-derived LD glass powders and 5-20 M NaOH solutions, porous lithium disilicate (Li2Si2O5, LD) glass-ceramics were prepared by the cold sintering process (CSP) associated with the post-annealing technique. In this novel technique, H2O vapor originating from condensation reactions between residual Si-OH groups in cold-sintered LD glasses played the role of a foaming agent. With the increasing concentration of NaOH solutions, many more residual Si-OH groups appeared, and then rising trends in number as well as size were found for spherical pores formed in the resultant porous LD glass-ceramics. Correspondingly, the total porosities and average pore sizes varied from 25.6 ± 1.3% to 48.6 ± 1.9% and from 1.89 ± 0.68 µm to 13.40 ± 10.27 µm, respectively. Meanwhile, both the volume fractions and average aspect ratios of precipitated LD crystals within their pore walls presented progressively increasing tendencies, ranging from 55.75% to 76.85% and from 4.18 to 6.53, respectively. Young's modulus and the hardness of pore walls for resultant porous LD glass-ceramics presented remarkable enhancement from 56.9 ± 2.5 GPa to 79.1 ± 2.1 GPa and from 4.6 ± 0.9 GPa to 8.1 ± 0.8 GPa, whereas their biaxial flexural strengths dropped from 152.0 ± 6.8 MPa to 77.4 ± 5.4 MPa. Using H2O vapor as a foaming agent, this work reveals that CSP associated with the post-annealing technique is a feasible and eco-friendly methodology by which to prepare porous glass-ceramics.

The Effects of Polyaniline Nanofibers and Graphene Flakes on the Electrical Properties and Mechanical Properties of ABS-like Resin Composites Obtained by DLP 3D Printing.

Three-dimensional printing is regarded as a future-oriented additive manufacturing technology that is making significant contributions to the field of polymer processing. Among the 3D printing methods, the DLP (digital light processing) technique has attracted great interest because it requires a short printing time and enables high-quality printing through selective light curing of polymeric materials. In this study, we report a fabrication method for ABS-like resin composites containing polyaniline (PANI) nanofibers and graphene flakes suitable for DLP 3D printing. As-prepared ABS-like resin composite inks employing PANI nanofibers and graphene flakes as co-fillers were successfully printed, obtaining highly conductive and mechanically robust products with the desired shapes and different sizes through DLP 3D printing. The sheet resistance of the 3D-printed composites was reduced from 2.50 × 1015 ohm/sq (sheet resistance of pristine ABS-like resin) to 1.61 × 106 ohm/sq by adding 3.0 wt.% of PANI nanofibers and 1.5 wt.% of graphene flakes. Furthermore, the AP3.0G1.5 sample (the 3D-printed composite containing 3.0 wt.% of PANI nanofibers and 1.5 wt.% of graphene flakes) exhibited 2.63 times (22.23 MPa) higher tensile strength, 1.47 times (553.8 MPa) higher Young's modulus, and 5.07 times (25.83%) higher elongation at break values compared to the pristine ABS-like resin with a tensile strength of 8.46 MPa, a Young's modulus of 376.6 MPa, and an elongation at break of 5.09%. Our work suggests the potential use of highly conductive and mechanically robust ABS-like resin composites in the 3D printing industry. This article not only provides optimized DLP 3D printing conditions for the ABS-like resin, which has both the advantages of the ABS resin and the advantages of a thermoplastic elastomer (TPE), but also presents the effective manufacturing process of ABS-like resin composites with significantly improved conductivity and mechanical properties.

Treatment and Current Policies on Pseudofolliculitis Barbae in the US Military.

Pseudofolliculitis barbae (PFB), or ingrown hairs, is a common skin condition of the face and neck caused by shaving in predisposed individuals who have naturally curly hair. It uniquely affects a disproportionate number of US service members with African ancestry who must abide by strict uniform grooming standards across the entire military. The main rationale behind this policy is that a beard can prevent a proper seal when using breathing protection devices such as gas masks or N95 respirators. Against the backdrop of the COVID-19 pandemic and ever-looming overseas conflicts, dermatologists who treat service members should be aware of the separate yet related guidelines to treat PFB that each military branch follows. Herein, we review the treatments and current policies on PFB in the US Military.

Military Grooming Standards and Black Hairstyling Practices.

INTRODUCTION: Throughout history, armies of the world have codified grooming standards for their members. In the USA, the Department of Defense (DoD) provides overall guidance for grooming standards and each uniformed military service develops, promulgates, and enforces its own grooming standards. The specific details of each service's grooming standards are revised regularly to conform to contemporaneous notions of professionalism and operational necessity. In light of growing recognition of and respect for the diversity of people serving in the military, specific language used to describe certain hairstyles and hair textures as well as associated grooming policies have gained attention. Efforts have been made to modify the policy and language to be more inclusive, especially of minority groups with physiologic and cultural differences that influence grooming practices. Initial efforts in the DoD toward this endeavor were made possible with advocacy from members of the Congressional Black Caucus. MATERIALS AND METHODS: We obtained service-specific documents, current and former, from the Army, Navy, Air Force, and Marine Corps that regulate the grooming standards for military personnel. We then examined the documents for text that addressed hair and hairstyles, specifically noting language describing and regulations regarding traditionally Black or African American hairstyles (i.e., afros, dreadlocks/locks/locs, braids, twists, etc.) for female and male soldiers. We also examined recently introduced legislation which seeks to end discrimination based on a person's hair texture or hairstyle, "Creating a Respectful and Open World for Natural Hair Act," abbreviated as the CROWN Act in the context of current grooming standards. RESULTS: Our examination of the grooming regulations of four branches of the U.S. Military shows recent modifications of the language governing female hairstyles, particularly natural hairstyles seen among African American women, such as cornrows, braids, and locs (or locks). Changes made to grooming standards demonstrate a shift in language used to describe natural hairstyles. Words with negative connotations (i.e., "matted," "unkempt," and "dreadlock") have been removed. These have been replaced with more descriptive language that provides a more objective definition of certain hairstyles. While these hairstyles have some level of regulation as to exact dimensions and styling rules to fit with the goal of uniformity in appearance and do not extend to male service members, recent updates in grooming standards have expanded to be inclusive of these natural hairstyles. Recent changes in language and policy in the military have been noted as positive examples in the CROWN Act. CONCLUSIONS: The DoD has recognized that former grooming standards, specifically regarding hair and hairstyles, may have introduced inequities in the treatment of military personnel. The DoD and its component military services have long been engaged in programs to ensure equal protections among its workforces. The re-examination and clarification of grooming standards related to hair and hairstyles is another effort to ensure equity and inclusion. The military services are working with great sincerity to implement policies that promote inclusiveness broadly. Steps to remove discrimination on the basis of hair and hairstyle can make the overall work environment more inclusive for people of color. Passage of a federal CROWN Act will promote similar or parallel changes for federal employees outside the military services.

A facile bottom-up method for synthesis of peroxo-potassium titanate nanoribbons and visible light photocatalytic activity derived from a peroxo-titanium bond.

Low-dimensional titanate nanostructures are gaining attention as a promising material for various photocatalytic applications. However, these conventional titanium oxide-based materials cannot utilize visible light because of their wide bandgap, and their synthesis generally requires high-alkali (10 mol L-1) and high-temperature (160-200 °C) conditions. Here, we report facile bottom-up synthesis for the visible light-activated peroxo-titanate nanoribbon (PTNR). The use of the peroxo-titanium complex ion containing the potassium ion as a precursor can induce the formation of a layered potassium titanate structure (K2-x H x Ti2O5) based on the self-organization reaction between titanium complex ions and potassium ions under mild synthetic conditions (0.29-4.39 mol L-1 KOH, 100 °C). Furthermore, the requirement of potassium ions in the formation of layered potassium titanate was stoichiometrically examined. The layered titanate crystals could be grown anisotropically, which depended on the radius of the cation used. Our results newly revealed that the larger radius of the interlayer cation promotes anisotropic crystal growth. As a result, in the case of the potassium base, a nanoribbon structure with a higher aspect ratio and larger specific surface area than those of lithium and sodium bases was formed. The formed peroxo-titanium functional groups significantly reduced the bandgap of titanate to 2.64 eV. In a photocatalytic decolorization test, the PTNR showed excellent photocatalytic performance based on the large surface area and enhanced light absorption in the visible light range while still performing well under UV light. These findings show not only that the proposed synthetic process has a low environmental impact but also that it contributes to the development of highly functionalized materials for photochemical applications.

We Can Do Better at Protecting Our Service Members From Skin Cancer.

Skin cancer rates have been steadily increasing among the American public for decades, but multiple studies have demonstrated that the U.S. military suffers from higher rates of skin cancer than the general public. As with so many aspects of health, simple preventive measures made early on can dramatically improve long-term health outcomes. Ample research has demonstrated that ultraviolet protection reduces skin damage and cancer rates. Although further research is needed to fully understand current barriers to soldiers' use of sun protection, we recommend a variety of simple measures the U.S. military can implement to reduce skin cancer risk for our soldiers. Early education and intervention to reduce skin cancer risk and promote sun-protective strategies is critical. These include improving sun protection offered by uniform items, such as increasing the availability of the sun hat, using eye protection with tinted inserts, and testing and publicizing the ultraviolet protection level of uniform items. We also recommend increasing sunscreen access for soldiers. Options to do so include issuing soldiers small portable packets or bottles of sunscreen to carry on their person, incorporating small packets of sunscreen in MREs, and issuing sunscreen to commands to distribute before field exercises. Unit and medical leadership should encourage the use of sunscreen and sun-protective strategies when possible; leadership engagement is critical to overcoming current behavioral barriers to change. Finally, we recommend that units attempt to reduce sun exposure during training by encouraging soldiers to seek shade and avoiding outdoor training in the middle of the day.

Developing and Measuring Effectiveness of a Distance Learning Dermatology Course: A Prospective Observational Study.

As a response to the COVID-19 pandemic, many institutions transitioned to online learning or participation in telehealth as a substitute for clinical rotations. The Uniformed Services University of the Health Sciences (Bethesda, Maryland) relied heavily on e-learning during this time as an alternative means for meeting educational objectives. We report the positive results of a prospective study evaluating short-term information recall and comprehension as well as students' confidence in their ability to apply course objectives over 3 months of an online distance learning (DL) dermatology course.

Bottom-up method for synthesis of layered lithium titanate nanoplates using ion precursor.

A facile bottom-up method for the synthesis of lithium titanate nanoplates using a peroxo titanium complex ion precursor is reported. Instead of employing complicated treatment with high alkali concentration, the self-organization reaction between lithium and titanium ions in the prepared ion precursor can enable the formation of layered lithium titanate crystals (Li2-xHxTi2O5, where x = 0.1 and 1.52 for as-synthesise and acid-treated samples, respectively) under low alkaline conditions. We demonstrate that layered lithium titanate crystals can be grown anisotropically into individual nanoplates. Our work presents an easy and useful platform for the production of titanate materials with various morphologies based on the interaction with ionic species.

Comparative Studies on Crystallinity, Thermal and Mechanical Properties of Polyketone Grown on Plasma Treated CVD Graphene.

In this work, we report a facile way to control crystalline structures of polyketone (PK) films by combining plasma surface treatment with chemical vapor deposition (CVD) technique. The crystalline structure of PKs grown on plasma-treated graphene and the resulting thermal and mechanical properties were systematically discussed. Every graphene sheet used in this work was produced by CVD method and the production of PKs having different crystallinity were performed on the O2- and N2-doped graphene sheets. It was evident that the CVD-grown graphene sheets acted as the nucleating agents for promoting the crystallization of ß-form PK, while suppressing the growth of α-form PK crystals. Regardless of the increase in surface roughness of graphene, surface functionality of the CVD-grown graphene was found to be an important factor in determining the crystalline structure of PK. N2 plasma treatment of the CVD-grown graphene promoted growth of the ß-form PK, whereas the O2 plasma treatment of CVD graphene led to transformation of the unoriented ß-form PK into the oriented α-form PK. Thus, the resulting thermal and mechanical properties of the PKs were highly dependent on the surface functionality of the CVD graphene. The method of controlling crystalline structure of the PKs suggested in this study, is expected to be very effective in realizing the PK with good processability, heat resistance and mechanical properties.

Pseudofolliculitis Barbae in the U.S. Military, a Review.

INTRODUCTION: Pseudofolliculitis barbae (PFB), also known as ingrown hairs commonly results from adherence to military grooming standards in those who have curly facial hair. Many patients respond to specific grooming techniques or topical medications but severe cases often warrant restrictions on shaving or laser therapy. The treatment of PFB is challenged not only by grooming standards but also evolving readiness requirements. More recently, the Navy discontinued permanent restrictions on shaving because of concerns for poor gas mask fitting. The goal of this review is to outline the history of PFB in the military, describe current policies, and offer a more uniform approach to treating PFB in the military. We also discuss challenges that surround the management of PFB in the Armed Forces. MATERIALS AND METHODS: We conducted a systematic review of the literature utilizing PubMed to identify both current and past management and discussion of PFB in both civilian and military settings. We also performed an internet search to identify pertinent military regulations and history of PFB within the Armed Forces. A query of TRICARE, the health care program for the U.S. Department of Defense Military Heath System, was also performed to assess civilian-referred laser treatment for Active Duty service members. RESULTS: PFB has a long history in the military dating back to World War I, when shaving was enforced not only to ensure good personal hygiene and to foster good order and discipline but also to ensure gas masks would seal in the event of a chemical attack. The management of PFB has presented a challenge in the military and even led to a social uproar in the 1970s. Policy changes in the military regarding shaving limitations, or profiles, have historically influenced how PFB is managed, but the basic tenets remain the same. Grooming techniques and topical medications can be effective in treating mild-to-moderate disease, but more severe cases of PFB respond best to laser therapy. Limitations on shaving remain an important part of management, especially during flares of the disease and while initiating therapy. Long-term shaving profiles may be needed for treatment-resistant cases. The impact of the Navy's recent policy on PFB is also discussed. CONCLUSIONS: Pseudofolliculitis Barbae is a prevalent skin disease in the Armed Forces. A better understanding of the disease and patients' individual needs by the health care provider and commander is paramount.

Recent Progress in Conducting Polymers for Hydrogen Storage and Fuel Cell Applications.

Hydrogen is a clean fuel and an abundant renewable energy resource. In recent years, huge scientific attention has been invested to invent suitable materials for its safe storage. Conducting polymers has been extensively investigated as a potential hydrogen storage and fuel cell membrane due to the low cost, ease of synthesis and processability to achieve the desired morphological and microstructural architecture, ease of doping and composite formation, chemical stability and functional properties. The review presents the recent progress in the direction of material selection, modification to achieve appropriate morphology and adsorbent properties, chemical and thermal stabilities. Polyaniline is the most explored material for hydrogen storage. Polypyrrole and polythiophene has also been explored to some extent. Activated carbons derived from conducting polymers have shown the highest specific surface area and significant storage. This review also covers recent advances in the field of proton conducting solid polymer electrolyte membranes in fuel cells application. This review focuses on the basic structure, synthesis and working mechanisms of the polymer materials and critically discusses their relative merits.

Enhancing Visible Light Absorption of Yellow-Colored Peroxo-Titanate Nanotubes Prepared Using Peroxo Titanium Complex Ions.

Visible light-activated yellow titanate nanotubes (TNTs) modified by peroxo groups were directly synthesized via a facile chemical reaction route using peroxo titanium complex ions as a precursor. Obtained peroxo-modified TNTs (PTNTs) possessed a cylindrical-shaped tubular morphology with an outer diameter of approximately 10 nm. The peroxo titanium functional group (Ti-O-O) was formed between the interlayers of the lepidocrocite-type titanate crystal that was the base structure of TNTs, with the interlayer distance estimated at approximately 10.02 Å. The formation of the peroxo functional groups reduced the electron density adjacent to the titanium atom, raising the valence band to 1.35 eV and forming a band gap of 2.50 eV, which is lower than that of TNTs (3.19 eV). In addition, the peroxo titanium functional group had a negative potential, which increased the chemical adsorption performances with positively charged rhodamine B molecules in water. Meanwhile, the photocatalytic investigation indicated that the PTNTs have enhanced the photocatalytic performance for RhB decolorization under visible light irradiating in comparison with TNTs. These findings show not only the improvement in the photocatalytic performance but also the potential of processing design by selecting the precursor with arbitrary characteristics.

Injection of oral medication into the skin confirmed by infrared spectroscopy.

"Skin popping" refers to the practice of injecting drugs, most commonly heroin, subcutaneously or into granulation tissue. Pharmaceutical tablets meant for oral consumption are modified into solutions for injection. Excipients-inactive substances that serve as vehicles for medication-are often not filtered out before injection and result in abscess formation, granulomatous inflammation, and scarring. Common excipients used in the production of pharmaceutical tablets include starch, microcrystalline cellulose, magnesium stearate, silica, and polyvinylpyrrolidone (PVP). Identification of these exogenous materials is valuable in confirming the diagnosis of skin popping, especially when patients may not be forthcoming about their drug use. We present a case of subcutaneous oral medication injection in which PVP and cellulose were identified by Fourier transform infrared spectroscopy. Considering the variable cutaneous manifestations of injection drug abuse, recognition of histopathologic and chemical characteristics of exogenous material from oral medications is helpful for diagnosis and intervention.