A Methodology for the Rapid Qualification of Additively Manufactured Materials Based on Pore Defect Structures.

Additive manufacturing (AM) can create net or near-net-shaped components while simultaneously building the material microstructure, therefore closely coupling forming the material and shaping the part in contrast to traditional manufacturing with distinction between the two processes. While there are well-heralded benefits to AM, the widespread adoption of AM in fatigue-limited applications is hindered by defects such as porosity resulting from off-nominal process conditions. The vast number of AM process parameters and conditions make it challenging to capture variability in porosity that drives fatigue design allowables during qualification. Furthermore, geometric features such as overhangs and thin walls influence local heat conductivity and thereby impact local defects and microstructure. Consequently, qualifying AM material within parts in terms of material properties is not always a straightforward task. This article presents an approach for rapid qualification of AM fatigue-limited parts and includes three main aspects: (1) seeding pore defects of specific size, distribution, and morphology into AM specimens, (2) combining non-destructive and destructive techniques for material characterization and mechanical fatigue testing, and (3) conducting microstructure-based simulations of fatigue behavior resulting from specific pore defect and microstructure combinations. The proposed approach enables simulated data to be generated to validate and/or augment experimental fatigue data sets with the intent to reduce the number of tests needed and promote a more rapid route to AM material qualification. Additionally, this work suggests a closer coupling between material qualification and part certification for determining material properties at distinct regions within an AM part.

Smokeless tobacco keratosis.

Smokeless tobacco keratosis is a benign lesion characterized by the formation of white, gray, or pale macules or papules with wrinkling or rugae. It forms in the oral mucosa in response to the use of smokeless tobacco products. We present a 50-year-old man with an extensive history of smokeless tobacco use and development of the characteristic lesion. Shave biopsy showed typical changes of this benign condition and tobacco cessation was recommended.

Preserving wellness in dermatology residents.

Although a dermatology residency is associated with a favorable lifestyle, nearly one in three budding dermatologists meet the criteria for burnout. The competitive nature of dermatology residency selection may confer a predisposition to burnout. Contributing factors during residency include a high-volume clinical experience and frequent use of electronic health records. Women may face particular pressures in managing work-life balance when starting a family during dermatology residency. In addition to preventing burnout before residency, fears of professional repercussions should be alleviated to ensure resident well-being. We have focusedW focus on the causes of burnout among dermatology residents and suggest solutions to promote wellness.

Clinical interventions aimed at expanding access to dermatologic care.

In the United States access to healthcare continues to be a major issue. Although "top down" public policy approaches hold promise for expanding access, a lack of political consensus has hindered progress. A review of the literature was conducted to investigate the efficacy of clinical interventions aimed at expanding access to care from the "bottom up." The greatest improvements in access to care over the past decade have harnessed teledermatology, shared care, appointment scheduling strategies, and team-based care. Optimization of these approaches will require additional population-based, dermatology-specific research. It is clear that dermatologists, using a "bottom up approach," can significantly expand access to care in their communities in a manner that is economically viable and maintains quality of care and patient satisfaction.

Screening duplex ultrasonography in neurosurgery patients does not correlate with a reduction in pulmonary embolism rate or decreased mortality.

OBJECTIVE: Deep vein thrombosis (DVT) is a major focus of patient safety indicators and a common cause of morbidity and mortality. Many practices have employed lower-extremity screening ultrasonography in addition to chemoprophylaxis and the use of sequential compression devices in an effort to reduce poor outcomes. However, the role of screening in directly decreasing pulmonary emboli (PEs) and mortality is unclear. At the University of Mississippi Medical Center, a policy change provided the opportunity to compare independent groups: patients treated under a prior paradigm of weekly screening ultrasonography versus a post-policy change group in which weekly surveillance was no longer performed. METHODS: A total of 2532 consecutive cases were reviewed, with a 4-month washout period around the time of the policy change. Criteria for inclusion were admission to the neurosurgical service or consultation for ≥ 72 hours and hospitalization for ≥ 72 hours. Patients with a known diagnosis of DVT on admission or previous inferior vena cava (IVC) filter placement were excluded. The primary outcome examined was the rate of PE diagnosis, with secondary outcomes of all-cause mortality at discharge, DVT diagnosis rate, and IVC filter placement rate. A p value < 0.05 was considered significant. RESULTS: A total of 485 patients met the criteria for the pre-policy change group and 504 for the post-policy change group. Data are presented as screening (pre-policy change) versus no screening (post-policy change). There was no difference in the PE rate (2% in both groups, p = 0.72) or all-cause mortality at discharge (7% vs 6%, p = 0.49). There were significant differences in the lower-extremity DVT rate (10% vs 3%, p < 0.01) or IVC filter rate (6% vs 2%, p < 0.01). CONCLUSIONS: Based on these data, screening Doppler ultrasound examinations, in conjunction with standard-of-practice techniques to prevent thromboembolism, do not appear to confer a benefit to patients. While the screening group had significantly higher rates of DVT diagnosis and IVC filter placement, the screening, additional diagnoses, and subsequent interventions did not appear to improve patient outcomes. Ultimately, this makes DVT screening difficult to justify.

A barrier to care: Distance traveled affects adherence to treatment and follow-up plans for patients with infantile hemangioma.

A chart review was performed of all patients diagnosed with infantile hemangioma in the pediatric dermatology clinic to determine whether distance traveled by the patient affected adherence to follow-up and treatment plans. An increase in distance was associated with an increase in likelihood of nonadherence to treatment or follow-up plans. Compared to patients who lived within 10 miles of a pediatric dermatologist, families who lived farther away were less likely to adhere to treatment plans. Families who traveled over 20 miles to clinic were 7.38 times more likely to be nonadherent to the treatment plan than those who traveled 0-10 miles.