Assessing the Vulnerability of Military Installations in the Coterminous United States to Potential Biome Shifts Resulting from Rapid Climate Change.

Climate-change impacts to Department of Defense (DoD) installations will challenge military mission and natural resource stewardship efforts by increasing vulnerability to flooding, drought, altered fire regimes, and invasive species. We developed biome classifications based on current climate for the coterminous United States using the Holdridge Life Zone system to assess potential change on DoD lands. We validated classifications using comparisons to existing ecoregional classifications, the distribution of major forest types, and tree species in eastern North America. We projected future life zones for mid- and late-century time periods under three greenhouse gas emission scenarios (low-B1, moderate-A1B, and high-A2) using an ensemble of global climate models. To assess installation vulnerability (n = 529), we analyzed biome shifts using spatial cluster analysis to characterize interregional variation, and identified representative installations for subsequent landscape-level analyses. Although mean annual temperatures are expected to increase, installations located in the Northeast, Lake States, and western Great Plains are likely to experience the largest proportional increases in temperature. Accordingly, forest and grassland communities at these installations managed to support a wide range of training, and environmental objectives may be adversely affected by altered disturbance regimes, heat, and moisture stress. However, precipitation is projected to increase in the Northeast and Lake States mitigating some effects of increased temperatures on biological communities. Given the uncertain response to climate change in different ecoregions, additional environmental and stewardship attributes are needed within a decision-support framework to understand vulnerabilities and provide appropriate responses.

Standard management options for rosacea, part 1: overview and broad spectrum of care.

The standard management options were developed by a consensus committee and review panel of 26 experts to assist in providing optimal patient care based on the standard classification and grading systems for rosacea that were developed to perform research; analyze results and compare data from different sources; and provide a common terminology and reference for the diagnosis, treatment, and assessment of results in clinical practice. We discuss standard management options for rosacea in 2 parts: (1) overview and broad spectrum of care, and (2) options according to subtype. The options are considered provisional and may be expanded and updated as appropriate. Managing the various potential signs and symptoms of rosacea calls for consideration of a broad spectrum of care, and a more precise selection of therapeutic options may become increasingly possible as the mechanism of action of therapies are more definitively established.

Standard management options for rosacea, part 2: options according to subtype.

The standard management options were developed by a consensus committee and review panel of 26 experts to assist in providing optimal patient care based on the standard classification and grading systems for rosacea that were developed to perform research; analyze results and compare data from different sources; and provide a common terminology and reference for the diagnosis, treatment, and assessment of results in clinical practice. We discuss the standard management options for rosacea in 2 parts: (1) overview and broad spectrum of care, and (2) management options according to subtype. The menu of options is considered provisional and may be expanded and updated as appropriate. Managing the various potential signs and symptoms of rosacea calls for consideration of a broad spectrum of care, and a more precise selection of therapeutic options may become increasingly possible as the mechanisms of action of therapies are more definitively established.

Lesser-metatarsal medial displacement osteotomy for the treatment of digital transverse plane deformities.

We sought to evaluate the clinical and radiographic outcomes in patients treated with a medial displacement transverse osteotomy of the second metatarsal to correct transverse hammer toe deformities. Eighteen patients underwent 20 procedures in 3 years. Each patient had a transverse plane deformity of the second metatarsophalangeal joint. Evaluation consisted of clinical examination, radiographic examination, and self-reported pain and function parameters. Mean +/- SD follow-up was 2.5 +/- 1.0 years. Radiographic joint congruence improved from 20% before surgery to 95% after surgery. Clinical examination revealed a rectus digit in 85% of cases, a transverse plane deviation in 10%, and a residual hammer toe deformity in 5%. At follow-up, the mean +/- SD visual analog scale score for pain with activity was 2.2 +/- 2.8 and for pain at rest was 0.6 +/- 1.4. Ninety-five percent of the patients said that they would undergo the procedure again. Medial displacement osteotomy for transverse plane deformity of the second metatarsophalangeal joint is a reliable procedure, with substantial improvement in joint congruence and self-reported pain.

The nosology of rosacea.

The National Rosacea Society (NRS) convened a committee of dermatology thought leaders to develop a standard classification system for rosacea. Based on the primary and secondary characteristics of this disorder, the NRS Expert Committee identified 4 types of rosacea: erythematotelangiectatic, papulopustular, phymatous, and ocular; one variant, granulomatous, also was recognized. The NRS Expert Committee also developed a grading system for rosacea signs and symptoms that will complement this classification system. The classification system and forthcoming grading system will help practitioners refine their diagnosis and treatment of rosacea to ensure better outcomes for patients.

Skin and soft tissue infections in special populations.

Skin infections often develop in children, immunosuppressed patients, and patients with chronic conditions such as diabetes. Commonly encountered cutaneous infections are described herein, and treatments are briefly discussed. Photographs of infections provide assistance with differential diagnosis.

The subtypes of rosacea: implications for treatment.

Lack of standardized rosacea nosology was the rationale for the National Rosacea Society to convene a committee of dermatology thought leaders to develop a standard classification system. Standardization of rosacea classification should be followed by standardization of treatment. Many pharmacologic and nonpharmacologic interventions for rosacea are being used based on clinical observation alone. Many oral and topical pharmacologic agents, however, are validated by randomized controlled trials (RCTs). Topical therapies (eg, metronidazole or an alternative agent such as azelaic acid) and oral antibiotics (eg, the tetracycline family) should remain as foundation therapies for subtypes 1 and 2 rosacea, based on the strength of the evidence.

The treatment of rosacea.

The roundtable discussion encompassed many topics-from seminal research by Ronald Marks to the latest National Rosacea Society-funded studies on the pathophysiology of rosacea. All participants commented on the value of the new National Rosacea Society classification system for subtypes of rosacea, designed to direct future research and help physicians better diagnose and manage these subtypes. A lively discussion centered on treatment options for the various subtypes of rosacea ensued.