bluuebunny/crossref_metadata_2025 huggingface dataset:
Marine Mammals and Ocean Sound: Sources, Impacts, Uncertainties, Controls, and Future Decision Making
Authors: Wright Nigel H
Published: March 2015

Marine mammal's sustainability depends on their phenomenal abilities to transmit process and receive marine sound information. Sound is fundamental to their global navigation, breeding feeding and ultimate survival. The relentless increase in anthropogenic marine noise levels (from shipping, oil and gas, renewables, marine construction, military) and penetration to remote areas will be reviewed, and current discussions on “biologically significant effects” of cumulative noise on marine mammals populations will be considered as part of the current threats and concerns of scientists and stakeholders. Our knowledge of the effects on noise on the ecology of marine mammals will be summarised and critique given of current regulatory regimes which are inadequate to deal with the plethora of future sound issues, especially cumulative effects of multiple sources, or chronic stress effects on survivorship and reproductive success. Recognising the range of sound detection of species, sound budgets with limits on energy inputs in a geographic region with multiple sound sources may be considered as future control mechanisms Underwater acoustic modelling has developed and is a key element in building a risk exposure profile of marine mammals, and satellite linked tracking devices now allow wider insights into sound impacts on migratory species. Ultimately, GIS mapped sensitivity and species distribution data needs to be fully integrated with sound reception capacity of species from research data in order to understand the 3D sound risk-scape of the marine environment. Key gaps in sound data and research will be presented which need to be closed through industry cooperation, data sharing and ecosystem based management in order to decrease the uncertainty of potential threats to populations. If data is not forthcoming to aid responsible decision making, regulators may have no option other than a precautionary approach to safeguard species
Risk Assessment in HAZOPs
Authors: Duhon Howard , Cronin John
Published: March 2015

A HAZOP is a team-based process hazard analysis (PHA) method. Its purpose is to identify hazards and operability issues in a process design. In some HAZOPs, identified issues are evaluated for risk. An effective risk assessment method allows the HAZOP participants and the project team to focus their time and energy on the more significant hazards.

Risk assessments in HAZOPs are typically performed using a simple risk matrix (Figure 2). In the risk matrix approach, participants make judgments as to the potential severity and the likelihood of an event. The combination of severity and likelihood indicates the risk. The risk matrix will often be color coded with green areas (OK), red areas (Unacceptable) and yellow areas (improvement suggested, subject to ALARP).

This approach is problematic for a number of reasons:

The judgment of consequence severity is difficult and is often ambiguous. Any identified scenario could play out in multiple ways often with dramatically different severities. Estimation of the frequency or likelihood of the event is also difficult; especially so if the frequency of the mitigated event is to be estimated. The simple green, yellow, red bands do not provide sufficient resolution for ranking scenarios (the yellow band may span two or three orders of magnitude, for instance).

This paper presents a more rigorous and repeatable approach to making the severity and frequency judgments that is also simpler and quicker. The method is, in effect, a simplified layer of protection analysis (LOPA). The authors show how LOPA techniques can be simplified and applied in a HAZOP setting for both frequency and consequence severity judgments. These simplified techniques make such judgments more rigorous and repeatable. Also, because the guesswork is removed, this saves time in the HAZOP.

The proposed approach also yields a HAZOP record that is more easily used for a future LOPA study.
Water Resource Management and Conservation in the Americas
Authors: Rowbottom Ronald , Letlow Myna , Kuykendall Dina
Published: March 2015

Less than 1% of the world's fresh water is accessible for direct human uses and the demand for water is growing. The increased strain on water resources for industrial, agricultural, and residential use continues to be a major concern in managing our business.

This paper will provide an overview of issues related to water management and conservation, highlighting growing concerns surrounding the utilization of water in the Americas. In particular, there is increased scrutiny on the oil and gas industry in particular, related to field operations as well as support facilities.

Recent legislative trends associated with the Clean Water Act and Navigable Waters in the United States and other regulatory developments in North, Central and South America affect water management for local operations.

The paper will discuss both technological and management system approaches to better utilize water resources and minimize the quantities of potable water required for irrigation and other uses.

Case studies will expand on water management and conservation by demonstrating successful applications, including:

Recycling of both grey and black waste water for landscape irrigation to provide a green oasis in the desert in Dubai, UAE. Installation of a recycling system to treat waste water generated from washing oilfield trucks, skid units and other equipment in Macae, Brazil. Designing new construction with water treatment to generate potable water and rain water capture for irrigation in Poza Rica, Mexico. Partnering with city effluent waste water discharge to provide irrigation and fire system water at Hobbs, New Mexico, USA. Using new technologies to reduce on-site potable water use where potable water supply is restricted in Oklahoma City, Oklahoma, USA.

Conserving water resources requires companies to develop sound management and technological approaches for utilizing fresh water and reusing waste water in order to ensure sustainability of supply. Failure to demonstrate effective management and conservation of water resources will result in increased pressures by regulators, environmental agencies and the public and a likely mandate for additional legislative actions.
A Practical Assessment of Dermal Exposure of Drilling Rig Workers to Mixed Hydrocarbons
Authors: Crittell Jenny E. , Baker John
Published: March 2015

Workers on drilling rigs have potential dermal exposures to hydrocarbons and other chemicals, both naturally occurring in the crude oil, as well as in the drilling muds and other solutions mixed on site. Workers are frequently splashed with drilling mud during their work shift, and coveralls and work gloves can become saturated with contaminants. Although there is a great deal of information on the characterization of inhalation hazards in the oil and gas industry, very little information is available on dermal hazards and thereby an inconsistent application of chemical protective gloves, coveralls, or face shields. This presentation looks at different methods that were used to estimate employee dermal exposures as well as identify future research needs.

Current methods include biological monitoring, which is conducted post exposure once the chemical has been absorbed and/or metabolized by the body. However, biological indicators have not been established by all chemicals with a skin designation. Surface wipe sampling has been used to assess the potential for contact to contaminated surfaces. Test methods are also available to quantify dermal exposure using dermal wipes or rinses, or sensors placed inside gloves to determine the effectiveness of glove selection. However, these are typically for pure chemicals only. Currently, there are no validated test methods to detect skin exposure to personnel from mixed hydrocarbons.

A mathematical model was used to estimate the dose from dermal exposure to mixed hydrocarbons. When used in conjunction with personal exposure monitoring to airborne contaminants, this model can estimate the total dose received by personnel, which may be higher than indicated by air sampling data alone.

OSHA and ACGIH have listed 226 chemicals with a skin designation. According to the Bureau of Labor Statistics, in 2012 (the most current year for which data is available) the total number of recordable cases of skin diseases in the United States was 33,300, which represents 16% of all recordable illness cases that year. In addition to skin diseases, many chemicals with a skin designation can be absorbed directly through the skin, contributing to the workers exposure by inhalation.
Social Performance in the Gulf of Mexico: Crisis-Ready Stakeholder Engagement
Authors: Jain Samina , Slocum Dean
Published: March 2015

Oil and gas operators in the Gulf of Mexico face a number of important risks. Traditionally, social performance and third-party stakeholder risks do not tend to be among those that receive the highest priority attention. While this level of attention is likely appropriate under normal operating conditions, advance planning and preparations for managing social risks have become critical to emergency preparedness. This paper discusses the importance of crisis-ready, community-based stakeholder engagement to managing emergencies in this operating environment, and what operators can do to strengthen emergency response planning through improved social risk management.

Despite the financial, reputational and environmental costs resulting from the 2010 Deepwater Horizon incident, industry actors count on strong stakeholder support for oil and gas activities in the Gulf of Mexico (GOM). Economically, the region depends on the industry for jobs, spending, and taxes. Stakeholder engagement is often limited to local, regional, and national regulatory and elected officials, or industry groups. Many of the GOM operators' social performance management efforts are focused on philanthropy, supporting education and local businesses, and employee/labor pool engagement.

The oil and gas industry has learned important lessons about how critical stakeholder engagement and community support is to protecting value. Nonetheless, operators still sometimes underestimate the dynamic, multifaceted community relationships in Gulf Coast communities. The level of understanding and response to stakeholder concerns on the local level can distinguish companies when negative incidents occur. Strong relationships with local civil society are invaluable in emergency response situations, especially when existing feedback mechanisms are well-known and utilized.

Successful operations in the GOM may not require the same level of stakeholder engagement rigor as operations in conflict-affected, on-shore operating environments. But they do need risk-based applications of current good international industry practices that are both fit-for-purpose and capable of functioning effectively both in normal operating conditions and crisis conditions. Even in areas with decades of industry activity, world-class stakeholder engagement strategies are critical to managing health, safety and environmental, and business risks, especially in preparation for potential emergencies.
Monitoring ad Conservation Program for Umbrella Species: The Northern Screamer as a Strategic Element for Floodplain Biodiversity in the Middle Magdalena Region, Colombia
Authors: Carmona Luis Gabriel , Cardenas Juan , Navarreta Mauricio , Cardenas Laura , Montenegro Paola
Published: March 2015

The northern screamer (chauna chavarria) is a large-sized bird that belongs to Anhimidae family. It is an almost endemic species found in northern Colombia and in a small strip of land around Maracaibo Lake, Venezuela. The Middle Magdalena, Mansarovar's area of influence, corresponds to the southern limit of the species' location. Hence the importance of its conservation by not causing a reduction in its territory due to changes in land use. The purpose of the monitoring and conservation program is to protect natural wetlands and habitat, where the chavarria's presence is crucial. The program was developed in the following stages: identification of the flagship species, which means that is a key, umbrella, indicator, vulnerable and emblematic species; characterisation of species and habitats, from monitoring, to establish their spatial temporal relationship and analysis of ecological connectivity and fragmentation; evaluation of land use and land cover, including the consequences of agricultural expansion and extractive activities, among others; risk analysis for habitat loss for the species and an assessment of its effects; establishment of priority conservation areas; and communication and the provision of education for internal and external communities. To date, monitoring has been undertaken during the last 12 months, to find new solutions in conservation efforts. Program effectiveness has been evaluated via the following indicators: relative abundance and population density.
Water Footprint for Heavy Oil Extraction in Colombia: Relationship Between Oil and Water
Authors: Carmona Luis Gabriel
Published: March 2015

This study aims to measure the water footprint for conventional oil production over the entire life cycle. The overall methodology for the development of net water footprint (cubic meters of water/barrel of oil produced) included the modelling of different unit operations and an assessment of both primary and secondary data. A case study for three fields of Mansarovar Energy, Colombia, was performed. A water footprint calculation allowed the organization to carry out a sustainability analysis of resource consumption, improve corporate image strategies, detect avoidable consumption costs and optimize processes and operations. It also provided specific actions with which to tackle sector sensitivity and answer stakeholder concerns with regards to responsible water use. These results are relevant in the decision making process for oil production. The following steps in the management process of water footprint were developed: a description of facilities and processes, organizational and operational boundaries in the definition of a functional unit; a water inventory, in order to quantify resource inputs and outputs; calculations of blue, green and gray water footprint; an assessment as to the degree of water footprint sustainability and water stress; actions to reduce the water footprint. Results indicate that the blue water footprint was the most significant compared to the green and gray. The value, the first ever calculated for a Colombian hydrocarbon company, was between 0.2 and 0.4 m3/barrel, considering both indirect and direct consumption.
Batata 2 Well Pad: Succesfull Life Cycle Management in a Remote Sensitive Area of the Amazon Basin
Authors: Valdivieso S. , Benalcazar F.L.
Published: March 2015

In Ecuador, back in 2006-2007, A Chinese Operator completed a large exploration project with the construction of Batata 2 well pad and the drilling of two exploratory wells to confirm a potential development of oil reserves identified during the seismic survey executed ealier in 2003 by EnCanEcuador (Subsidiary of EnCana), in the north side of Block 14. All this within the Yasuni National Park, one of the natural areas with the highest biodiversity in South America and also traditional land of peoples living in voluntary isolation (Tagaeri and Taromenani). These special social and environmental conditions called the attention of NGOs that predicted large impacts as well as permanent impact to local communities.

The early planning and execution of this project included the development of a long-term strategy and abiding to a set of high social and environmental practices to minimize company's exposure to potential future liabilities, and to guarantee the success of this challenging project. Unfortunately, by first-half-2007-, after drilling the above-mentioned exploratory wells, the prospects were declared non-commercial, triggering the process for decommissioning and reclaiming the Batata 2 well pad. The loop was closed and the success of the project was dimmed by the lack of expected drilling results. Nevertheless, the project demanded an important set of best practices to guarantee an impeccable HSE and Social Performance.

This paper summarizes some of the most important elements of project planning and execution of the Batata 2 well pad.
Case Study: Maintaining Preparedness During Transition of an Organization's Emergency Response Model
Authors: Dulisse Carmine
Published: March 2015

Description of the material

This presentation will provide an overview of how companies can effectively maintain a constant state of readiness while navigating changes to its emergency response model by reviewing Marine Well Containment Company's (MWCC) recent experience in this area. The speaker will address the planning, preparation, training and execution required internally to maintain an organization's ability to respond to an incident during periods of flux. The presentation will cover all facets of preparedness efforts and best practices – from training and emergency response drills, to ongoing communications and education in order to ensure standards are being met.

Application

In 2014 MWCC made changes to its emergency response model, including expanding its scope of responsibilities related to equipment deployment for its well containment system in the deepwater U.S. Gulf of Mexico. In order to effectively prepare for and implement the changes to its model, a robust plan was developed – which included mid-plan evaluations – to ensure all elements of the project rollout were appropriately accounted for and any identified improvements were implemented throughout the process. The plan included:

Results, Observations, and Conclusions

MWCC proactively planned for challenges it could face during the transition period, which was a beneficial exercise and helped the company achieve its goals and objectives. In addition, there are several critical facets of preparedness that MWCC focused on throughout the development and implementation of its plan to rollout a new emergency response model that were key to its success. These and other best practices and lessons learned will be shared in the presentation.

Significance of subject matter

MWCC's mission is to be continuously ready to respond to a well control incident in the U.S. Gulf of Mexico, making it essential that changes to the company's response model would not inhibit this readiness. Sharing best practices could help other companies with managing significant organizational change.
A Barrier Based Methodology to Assess Site Security Risk
Authors: van Staalduinen Mark , Khan Faisal
Published: March 2015

The recent attacks on petroleum plants in various countries such as Algeria, Nigeria, and Iraq have greatly changed the risk mindset of the chemical industry (Johnson and Gilbert, 2013; Nordland and Al-Sahy, 2014). Risk assessments and management traditionally are conducted on unintended (safety related) incidents and not on intentional acts. These intentional acts could either be from an internal or external source. This paper extends the probabilistic risk assessment methodology (generally focus on safety unintended) to the security facet (focusing on intended incidents) of a processing facility. The methodology is based on the barrier approach. Five security barriers are proposed throughout the facility to help deter an attack. These security barriers are external, internal, interior, critical, and the fail-safe barrier, which are implemented at various stages of a plant with varying objectives. For example, the fail-safe barrier aims to bring the plant to safe shutdown mode, once it observes breach of the barrier. Breach of each barrier is modeled using fault tree approach. A number of monitoring parameters are proposed to track the effectiveness of the barrier, which are modeled as basic events in the fault tree. The occurrence of each basic event is modeled using two failure modes: i) natural, and ii) forced failure. Conditional probability with soft computing theory is used to model occurrence probability. The proposed methodology also takes into account effectiveness of the management, and political parameters in an impeding attack.

In addition, the fault trees modeled are mapped into respective Bayesian Networks. Bayesian networks allow for manipulation of the conditional probability table. There are three relaxation assumptions that manipulate the conditional probability table that is explored in this paper. In order to eliminate uncertainty developed in the data, an updating mechanism is used along with a predictive component to make the model dynamic. This is significant as the model can be become dynamic to reflect any changes that may have occurred.

Finally, a case study of a typical processing facility is presented to demonstrate the effectiveness of the model and to indicate areas of further improvement. This paper aspires to bring awareness to security risk assessments and the need to create a database for security related failures.
Strategies for Managing Greenhouse Gas Issues in an Ever-Growing Oil and Gas Industry
Authors: Woerner A. , Campbell L.
Published: March 2015

For each new major capital project or development activity, issues related to greenhouse gas (GHG) emissions quantification, reporting, and controls seem to gain a greater amount of attention and scrutiny. Being prepared for and addressing this scrutiny in a robust manner can help ensure project timelines are met, add value by accelerating product delivery to market, and minimize the potential for adverse public perception of a project or the sponsoring company.

Navigating the current landscape of GHG issues is not a small challenge. The evolving environment of scientific, socioeconomic, political, and media inputs to regulatory development is resulting in a patchwork of mandatory and voluntary programs and legal requirements.

From the investor perspective, there is an increasing prevalence of shareholder proxy votes that are calling for increased transparency on environmental issues, specifically issues related to GHG emissions. During the development of major capital projects, environmental non-governmental organizations are using permit challenges as a means to delay major projects to which they are opposed. From a regulatory perspective, the challenges range from reliably and accurately accounting for emissions where required, to preparing for emerging legislation. In particular, the move towards low carbon fuel standards (LCFS) must be watched closely. If implemented, such standards would have a significant impact on the oil and gas industry—at a minimum by increasing compliance obligations, but potentially leading to new crude valuation issues or a “crude source differentiation” trend.

This paper describes how an array of tools can be used as part of a comprehensive approach to project planning. Such an approach is critical to confidently managing the landscape, which continues to shift for GHG management. Key elements of planning include (1) identifying options (technology or operating practices) to reduce emissions, (2) assessing energy flows (source and sinks) to further identify areas for improvement, and (3) establishing a framework for prioritizing the identified GHG mitigation options.
Barrier Verification: A Pillar of Industry Well Control
Authors: Ahluwalia A.I. , Novia M.D. , Fernandes M.
Published: March 2015

The oil and gas industry is well aware of the criticality of well control barriers; they are often what stand between us and catastrophe. Emphasis on barriers has become more prominent within the Oil and Gas industry, which has utilized several methods to keep the hydrocarbons where they belong. However, most provide little insight into methods of barrier verification, and the assurance of such methods.

Building on the results of previous studies that emphasize the criticality of barriers in relation to well control by J.G. Go Boncan and G.E. King & D.E. King in publications titled “BowTie and Job Hazard Analysis: A Case Study to Communicate the Barrier Philosophy as it Relates to Process Safety in Well Operations” and “Environmental Risk Arising From Well-Construction Failure—Differences Between Barrier and Well Failure, and Estimates of Failure Frequency Across Common Well Types, Locations, and Well Age” respectively, this paper addresses the need for barrier verification assurance, which is seen as the next logical step in achieving the ultimate goal of well control. Well control barriers are critical, but how is the industry verifying them? And if so, how are they assured? More importantly, is there a way to measure barrier assurance?

This paper explains an evaluation of several barrier verification methods, their strengths and limitations, taking into account various geographical, technological and resource considerations. The output of the evaluation is a Barrier Assurance Metric (BAM) which can be used to determine if there is an adequate level of barrier assurance at the well site.
A Holistic Approach to Environment and Safety in ESIAs
Authors: Pettitt G. , Westfall S.
Published: March 2015

Environmental and Social Impact Assessments (ESIAs) are a critical project tool in identifying potential impacts to the environment, and appropriate risk reduction options to manage these impacts and associated risks. Concurrent to the ESIA process, safety studies must also be undertaken for safety risks. Many of these safety risks are associated with unplanned events, and can also have environmental and social consequences.

Most impacts, including unplanned events, can be either prevented or mitigated through their early consideration during project design. If ESIA considerations and safety studies are evaluated in parallel at the concept and feasibility stages, a project will have more options available to avoid or mitigate impacts. This has a critical financial benefit, as early changes to project design are generally less expensive.

A holistic approach during the early stages of the project's concept design requires collaboration between safety professionals and ESIA specialists to identify the various hazards, their consequences, and potential risk reduction mechanisms.

This paper advocates holistic team organization, which will have the following key aspects: An outcome-focused, well organized and front-loaded approach;Collaboration to carry out project definition, ESIA, and safety studies in parallel;Embed the risk reduction measures within the project definition in collaboration with stakeholders;Satisfy the regulatory requirements and prevent environmental, social, and safety impacts from the outset; andFacilitate a positive outcome that results in sustainable development.

The integration of environmental, social, and safety considerations at the early concept and feasibility stages of a project represents a holistic approach that will result in significant cost savings and reduced risk to schedule delays as the project progresses.
One Company's in Situ Wildlife Mitigation and Monitoring Program: An Industry-Leading Approach
Authors: Saxena Amit
Published: March 2015

Minimizing and mitigating the environmental impacts of our developments and operations is a very important business driver for Devon Canada Corporation (Devon). Devon takes this responsibility seriously, and believes in maintaining social license to operate, respecting stakeholder interests, and not just meeting, but exceeding, regulatory requirements where it makes sense to do so. Our commitment to the environment is reflected in our corporate policies, which include a Biodiversity and Land Stewardship Policy that provides overarching top-level direction to wildlife, biodiversity and land issues. Wildlife and biodiversity are among the most tangible concerns for stakeholders in Alberta's oil sands region. In 2002, very little was known about wildlife responses to in situ oil sands development. Acknowledging this information deficiency, and recognizing that in situ oil sands development was a long term and incremental commitment, Devon initiated what would become an ongoing In Situ Wildlife Mitigation and Monitoring Program to monitor wildlife populations, conduct research to fill key data gaps, and mitigate negative impacts to wildlife and biodiversity in and around our project areas. To achieve our vision of minimizing impacts to wildlife in the oil sands region, we have made biologically sound commitments, collaborated with peers and other resource sectors, developed strategic research partnerships, and engaged employees at every level throughout the company in implementation. In its current state, the Program has now been endorsed by regulators as the best-in-industry for such initiatives, and has been recognized with numerous awards for its comprehensiveness, innovation and corporate commitment.
Status of Polymer-Flooding Technology
Authors: Sheng James J. , Leonhardt Bernd , Azri Nasser
Published: March 2015

Polymer flooding is the most commonly applied chemical enhanced-oil-recovery technique. This paper provides an update on the status of polymer-flooding technology, focusing more on field applications than on theoretical and laboratory research. It covers the following topics: • Mechanisms of polymer flooding • Polymers used • Polymer-solution stability • Technical screening criteria • Laboratory and simulation work • Performance-monitoring technique • Summary of pilots and large-scale applications • Experience and learning from field projects • Polymer flooding in heavy-oil reservoirs • Polymer viscoelastic properties • Problems associated with polymer flooding and their solutions • Future developments The data and analysis presented in this paper will give readers updated information describing polymer flooding, as well as a guide to the relevant research. Survey data will also provide operators with reference data for project design and optimization.
Urticaria as a Cutaneous Sign of Adult-Onset Still's Disease
Authors: Criado Roberta F. J. , Criado Paulo Ricardo , Vasconcellos Cidia , Szajubok José Carlos M. , Michalany Nilceo S. , Kadunc Bogdana Victoria , Costa Martins Jose Eduardo
Published: March 2015

Background:

The cardinal signs and symptoms of adult-onset Still's disease (AOSD) include periodic fever, arthralgia and arthritis, lymphadenopathy, hepatosplenomegaly, an evanescent rash accompanied by neutrophilic granulocytosis, and a negative rheumatoid factor and antinuclear antibody test.

Objective:

To alert clinicians and dermatologists to internal diseases such as AOSD when assisting patients with urticarial eruptions and systemic symptoms.

Methods:

A case report of a 52-year-old white woman who received conventional therapy for urticaria for 3 years, with no improvement. Following this period, a diagnosis of AOSD was performed based on the presence of systemic symptoms.

Results:

The inflammatory activity markers decreased by the second month of methotrexate therapy; however, the cutaneous lesions failed to disappear. Thalidomide was initiated, and total improvement of the cutaneous lesions was observed after 2 weeks.

Conclusion:

Urticarial rash is an uncommon presentation of AOSD, and clinicians must be alert to the possibility of a misdiagnosis in these cases.
Mixed Vitiligo
Authors: Mulekar Sanjeev V. , Al Issa Ahmed , Asaad Marwan , Ghwish Bassel , Al Eisa Abdullah
Published: March 2015

Background:

There are two commonly recognized forms of vitiligo—generalized and localized. This classification is important to understand the course of the disease and its prognosis. Most patients have generalized vitiligo; few patients have both segmented and generalized vitiligo.

Observation:

We report four more cases of mixed vtiligo, segmental with generalized type. This report is only the second to present a case of segmental with generalized vitiligo.

Conclusion:

Mixed vitiligo is not yet part of a standard classification. Its etiology is not yet fully defined. Further research is required to understand the course and prognosis of mixed vitiligo.
Survey of Antibiotic Prescription Use for Inflamed Epidermal Inclusion Cysts
Authors: Poonawalla Tasneem , Uchida Tatsuo , Diven Dayna G.
Published: March 2015

Background:

Symptomatic epidermal inclusion cysts (EICs) are variously called “inflamed” or “infected,” and the mechanism of inflammation or suppuration is controversial. Whether physicians routinely prescribe antibiotics for inflamed EICs is of concern owing to cost and bacterial resistance.

Objectives:

To determine whether there is any difference in the diagnosis and treatment of EICs between primary care physicians and dermatologists and to estimate the rate and cost of antibiotic prescriptions for EICs.

Methods:

One hundred twenty-five primary care physicians and 52 dermatologists were surveyed using a standard case study and a photograph.

Results:

Sixty-seven percent of the primary care physicians used the term “infected,” whereas 69% of the dermatologists used the term “inflamed” or “ruptured.” Eighty-four percent of the general practitioners and 94% of the dermatologists chose antibiotics for treatment.

Conclusion:

This study shows that despite the differences between general practitioners and dermatologists in diagnosis, the majority of physicians use antibiotics for the treatment of inflamed EICs.
Ultraviolet Radiation Exposure: Public Health Concerns
Authors: Rivers Jason K. , Wang Beatrice , Marcoux Danielle
Published: March 2015

The North American public maintains an attitude that equates the acquisition of a suntan with health. However, prolonged exposure to ultraviolet radiation from the sun can lead to sunburn, premature skin aging, immunosuppression, and skin cancer. Misconceptions about the risks of tanning beds and the effectiveness of sunscreens are common. The public must be better informed about the importance of and the need for effective sun protection by means of clothing and hats, the proper use of sunscreen, and the avoidance of prolonged sun exposure during the time of maximal solar insolation.
Sunscreens: Past, Present, and Future
Authors: Provost Nathalie , Landells Ian , Maddin Stuart
Published: March 2015

Sunscreens form an important modality for cutaneous photoprotection. Sunscreen formulations incorporate many features that provide protection from ultraviolet (UV)-induced carcinogenesis, immunosuppression, and accelerated photoaging. Since the 1920s, when the link between skin cancer and UV radiation was first observed, sunscreen use has become part of our daily routine. Chemical and physical modifications are continuously made to formulations so that they may be more appealing to the general population, especially to those with fair skin. The demand for a formula that is effective in its UV protection while at the same time is adoptable in its application and exposure characteristics is an important consideration in the development of sunscreens. Because of continued development, technological advances, and substantive gains in knowledge on UV-induced photodamage, at present, we are able to produce effective formulations, and although these formulations do not provide total spectrum protection, they are considerably better than sunscreens of the past.
Minocycline- and Tetracycline-Induced Hypertriglyceridemia in an HIV-Seropositive Patient Receiving Combination Antiretroviral Therapy
Authors: Somani Najwa , Bondy Gregory , Crawford Richard I.
Published: March 2015

Background:

Acne vulgaris may occur as part of immune reconstitution in human immunodeficiency virus (HIV)-seropositive patients on highly active antiretroviral therapy (HAART). Tetracyclines are a common acne treatment. Hypertriglyceridemia has not been reported as a side effect of this drug class.

Objective:

We report a case of an HIV-seropositive man on HAART (CD4 count 450 cells/μL) who developed isolated hypertriglyceridemia (> 13 mmol/L) after three separate challenges with minocycline or tetracycline, improving each time therapy was discontinued.

Results:

Based on a review of the literature, this is the first reported case of hypertriglyceridemia with minocycline or tetracycline therapy. No published reports have examined the safety of tetracyclines in the setting of HIV or HAART.

Conclusion:

A strong temporal association between tetracycline use and hypertriglyceridemia was found without an alternate explanation for the observed lipid profile. Given the common use of tetracyclines in dermatology, we feel that this is an important observation to report.
Primary Systemic Amyloidosis Presenting as Extensive Cutaneous Ulceration
Authors: Alhaddab Mohammed , Srolovitz Herbert , Rosen Nathan
Published: March 2015

Background:

We report a case of primary systemic amyloidosis in a 78-year-old Caucasian woman presented as a nonhealing ulcer on the right thigh for 3 months. Histopathology of the skin revealed widely thickened walls of middermal and subcutaneous vessels from deposition of amorphous eosinophilic material that stained positively with Congo red and crystal violet.

Objective:

This case represents a very unusual presentation of primary systemic amyloidosis, one in which the cutaneous manifestations provided the first signs of a devastatingly widespread multiorgan infiltration of amyloid protein.

Conclusion:

This presentation of the disease may signify an advanced stage with a grave prognosis as our patient passed away 3 months after development of the cutaneous ulceration.
Management and Dermoscopy of Fast-Growing Nevi in Pregnancy: Case Report and Literature Review
Authors: Zampetti Anna , Feliciani Claudio , Landi Francesco , Capaldo M.L. , Rotoli M. , Amerio P.L.
Published: March 2015

Background:

The relationship between pregnancy and a change in melanocytic nevi is still controversial. Moreover, management of the rapid evolution of a nevus in an unauspicious melanocytic lesion can be a clinical challenge in pregnancy.

Methods:

This article examines a case of a fast-growing deep penetrating nevus in a pregnant woman and provides a literature review of articles relative to pregnancy and nevi change, the management of fast-growing pigmented lesions, and the role and usefulness of dermoscopy in these cases.

Results:

Recent studies have documented that pregnancy is not associated with any significant change in the size of melanocytic nevi. The management of fast-growing melanocytic lesions during this period compulsorily leans toward excision. Dermoscopy can be useful, providing clinicohistopathologic correlations and a better assignment of the lesion.

Conclusion:

This case report and review provide important management considerations for nevi during pregnancy. Early intervention with aggressive treatment measures is the best management for fast-growing lesions, and epiluminescence dermoscopy can assist the management, although still remaining a second-level examination, useful for documentation and for a better classification of the lesion.
Canadian Consensus Statement on the Use of Intravenous Immunoglobulin Therapy in Dermatology
Authors: Mydlarski P. Régine , Ho Vincent , Shear Neil H.
Published: March 2015

Background:

As a safe, well-tolerated, and potentially beneficial therapy, intravenous immunoglobulin (IVIG) has been increasingly used by dermatologists to treat immune-mediated skin disease. However, practical and comprehensive guidelines for the use of IVIG have yet to be established.

Objective:

To develop the first Canadian consensus statement on the use of IVIG therapy in skin disease.

Methods:

A group of Canadian dermatologists convened to discuss current issues in IVIG therapy. The participants reviewed and evaluated the literature and shared clinical experience. Using a modified Delphi process, a consensus statement was developed.

Results:

Herein we provide a brief overview of pemphigus vulgaris, pemphigus foliaceus, bullous pemphigoid, mucous membrane pemphigoid, epidermolysis bullosa acquisita, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Recommendations for the management of these diseases are detailed, and therapeutic algorithms for the treatment of various autoimmune mucocutaneous blistering diseases are presented. The appropriate use of IVIG therapy is placed in context for each disease.

Conclusion:

Although preliminary data suggest that IVIG is a safe and effective therapy for many skin disorders, uncontrolled clinical trials, case series, and anecdotal case reports dominate the literature. Collaborative randomized controlled trials are required to firmly establish the role of IVIG in dermatology.
Prevalence and Epidemiology of Onychomycosis
Authors: Vender Ronald B. , Lynde Charles W. , Poulin Yves
Published: March 2015

The prevalence of onychomycosis has been estimated at approximately 6.48% (95% confidence interval 6.09–6.88%) within the Canadian population. Dermatophytes are the most commonly cultured organisms, appearing in approximately 75 to 91% of nails with fungal involvement, with Trichophyton rubrum and Tricophyton mentagrophytes most commonly isolated. However, Candida spp and nondermatophyte molds are also sometimes cultured. The most common presentation is distal and lateral subungual onychomycosis (DLSO), which can involve 75% of patients with pedal onychomycosis. The distribution of DLSO, superficial white onychomycosis, and proximal subungual onychomycosis (PSO) has been reported to be 360:59:1 in patients with mycologic confirmation of onychomycosis; however, some reported that the incidence of PSO is slightly higher in immunocompromised individuals. Age, gender, family history, and the presence of tinea pedis are all elements associated with a nail fungal infection. In addition, many conditions, including diabetes mellitus, immune disorders, and vascular disease, have been associated with the presence of onychomycosis. When choosing the best treatment regimen for individuals with onychomycosis, it is very important to consider all of the factors involved, including the infecting species, the presentation of the disease, the level of disease progression, and its predisposing factors.
Biologic Therapeutics in the Treatment of Psoriasis. Part 2: Practical Considerations
Authors: Langley Richard G. , Gupta Aditya K. , Cherman Andrea M. , Inniss Kimberley A.
Published: March 2015

Background:

Psoriasis is a chronic inflammatory skin disease principally mediated by activated T cells, which release proinflammatory cytokines with reactive epidermal changes in the skin, producing the characteristic lesions of psoriasis. New research into possible treatment options has been inspired by increased understanding of the pathophysiology of psoriasis and advances in immunology and molecular biology permitting the development of targeted, highly active biologic agents.

Objective:

The aim of this article is to provide practical guidelines for integration of these agents in the management of psoriasis.
Crafting a Melanoma Educational Campaign to Reach Middle-Aged and Older Men
Authors: Geller Joanna , Swetter Susan M. , Leyson Jenniffer , Miller Donald R. , Brooks Katie , Geller Alan C.
Published: March 2015

Background:

From 1973 through 2002, melanoma mortality rates have risen steeply in middle-aged and older men. Men's higher mortality rate from melanoma is hardly an isolated example of the ways in which men's health lags behind women's health. Given the significantly higher melanoma mortality rates of men compared with women, there is now a need for a melanoma education program targeted to middle-aged and older men and their closest contacts, including spouses, significant others, and health care professionals.

Objectives:

In this article, we discuss the theoretical and practical foundations for such a program. Then, taking into account factors such as socioeconomic status, health literacy, and residence, we present suggestions for creating such a campaign.

Conclusions:

Planners for a new educational campaign must understand the target audience's motivations for and perceived barriers to behavioral change. Future studies should examine what motivates certain men to conduct skin self-examinations, ask their physicians about melanoma, and attend melanoma screenings, whereas other men with similar risk factors are less prevention conscious. Issues of health literacy and understandability of our messages must be further explored.
No Show: Incidence of Nonattendance at a Dermatology Practice in a Single Universal Payer Model
Authors: Pehr Kevin
Published: March 2015

Background:

Nonattendance at scheduled appointments is a major problem. Previous studies have shown rates between 17 and 31%. Most US studies found the type of payer to be the greatest determinant of attendance rates.

Objectives:

This study examines the no-show rate in a private dermatology practice under a single universal payer model, including the effects of old versus new patient, gender, day of the week, month, and weather.

Results:

The overall rate of nonattendance was lower than in all previous studies (7.79%), with the only statistically significant variable being established versus new patients.

Limitations:

Certain demographic data investigated in previous studies (eg, age, socioeconomic status) were not assessable. Data are from a single office.

Conclusion:

The no-show rate in a single universal payer, private practice model is low, especially for established patients.
Efalizumab for the Treatment of Psoriatic Arthritis
Authors: Papp Kim A. , Caro Ivor , Leung Hoi M. , Garovoy Marvin , Mease Philip J.
Published: March 2015

Background:

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis. Efalizumab, a T cell-targeted, recombinant human monoclonal antibody, is approved for the treatment of adult patients with chronic moderate to severe plaque psoriasis. The effect of efalizumab therapy on PsA has not previously been investigated.

Objective:

This phase II randomized, double-blind, placebo-controlled multicenter study evaluated the efficacy and safety of efalizumab for the treatment of PsA.

Methods:

Patients were required to be on at least one of the following concomitant systemic therapies for PsA: nonsteroidal anti-inflammatory drugs, corticosteroids, and/or sulfasalazine or methotrexate. One hundred fifteen patients with active PsA were enrolled and randomized in the study. Of these, 107 were treated weekly with efalizumab 1 mg/kg or placebo for 12 weeks, followed by 12 additional weeks of open-label efalizumab.

Results:

At week 12, 28% of efalizumab-treated patients achieved ACR-20 response (a 20% reduction from the baseline in the American College of Rheumatology response criteria), the primary end point, compared with 19% of placebo patients ( p = .27). The safety profile was comparable between efalizumab- and placebo-treated patient groups, regardless of methotrexate background therapy, and no worsening of joint disease occurred with efalizumab therapy.

Conclusions:

Efalizumab was not effective in treating PsA; efalizumab therapy did not worsen PsA. The efalizumab safety profile does not appear to be altered with the concomitant use of methotrexate therapy.
Basal Cell Carcinoma: Review of Epidemiology, Pathogenesis, and Associated Risk Factors
Authors: Lear William , Dahlke Erin , Murray Christian A.
Published: March 2015

Background:

Basal cell carcinoma (BCC) is extremely common, and its incidence continues to rise.

Objective:

This review presents the literature pertaining to the epidemiology, pathogenesis, and risk factors associated with BCC.

Conclusions:

The risk of developing BCC depends on both genetic predisposition and exposure to risk. Fair-skinned people account for the overwhelming majority of patients, beyond what would be expected by skin phototype alone. Damage to multiple lines of defense appears to be necessary for cancer development and spread. This damage distorts the concerted effort of deoxyribonucleic acid (DNA) repair, immunosurveillance, and cellular growth regulation to protect against malignant progression. Ultraviolet light exposure is the most critical modifiable factor determining early expression and frequency of BCC development.