Telemedicine holds special promise in increasing the efficiency of postoperative care for microsurgical procedures, improving care coordination and management of burn wounds, facilitating interprofessional collaboration across time and space, eliminating a significant number of unnecessary referrals, and connecting patients located far from major medical centers with professional expertise without impinging on-and in some cases improving-the quality or accuracy of care provided. Teledermatology consultation was found to be safe and has a comparable or superior efficacy to the traditional in-patient consultation. The system was consistently rated as convenient and easy to use by patients, referring physicians, and consulting dermatologists. Teledermatology has also been used as an educational tool for patients. A significant number of studies detailed strategies to improve the current state of teledermatology, either by implementing new programs or improving technologies. Telemedicine use is widespread among plastic surgeons and is enabling the spread of expertise beyond major medical centers. Further research is needed to conclusively demonstrate benefit in routine clinical care.

Rich literatures across multiple disciplines document the association between increased educational attainment and improved health. While quasi-experimental studies have exploited variation in educational policies to more rigorously estimate the health effects of education, there remains disagreement about whether education and health are causally linked. The aim of this study was to conduct a systematic review and meta-analysis to characterize this literature, with a focus on quasi-experimental studies of compulsory schooling laws (CSLs). Articles from 1990 to 2015 were obtained through electronic searches and manual searches of reference lists. We searched for English-language studies and included manuscripts if: (1) they involved original data analysis; (2) outcomes were health-related; and (3) the primary predictor utilized variation in CSLs. We identified 89 articles in 25 countries examining over 25 health outcomes, with over 600 individual point estimates. We systematically characterized heterogeneity on key study design features and conducted a meta-analysis of studies with comparable health outcome and exposure variables. Within countries, studies differed in terms of birth cohorts included, the measurement of health outcomes within a given category, and the type of CSL variation examined. Over 90% of manuscripts included multiple analytic techniques, such as econometric and standard regression methods, with as many as 31 "primary" models in a single study. A qualitative synthesis of study findings indicated that educational attainment has an effect on the majority of health outcomes-most beneficial, some negative-while the meta-analysis demonstrated small beneficial effects for mortality, smoking, and obesity. Future work could focus on inconsistent findings identified by this study, or review the health effects of other types of educational policies.

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Dyskeratosis Congenita (DC) is a heritable multi-system disorder caused by abnormally short telomeres. Clinically diagnosed by the mucocutaneous symptoms, DC patients are at high risk for bone marrow failure, pulmonary fibrosis, and multiple types of cancers. We have recapitulated the most common DC-causing mutation in the shelterin component TIN2 by introducing a TIN2-R282H mutation into cultured telomerase-positive human cells via a knock-in approach. The resulting heterozygous TIN2-R282H mutation does not perturb occupancy of other shelterin components on telomeres, result in activation of telomeric DNA damage signaling or exhibit other characteristics indicative of a telomere deprotection defect. Using a novel assay that monitors the frequency and extension rate of telomerase activity at individual telomeres, we show instead that telomerase elongates telomeres at a reduced frequency in TIN2-R282H heterozygous cells; this recruitment defect is further corroborated by examining the effect of this mutation on telomerase-telomere co-localization. These observations suggest a direct role for TIN2 in mediating telomere length through telomerase, separable from its role in telomere protection.

A. Wesselink et al. / Trends in flood risk management in deltasFlood-risk management (FRM) is shaped by context: a society's cultural background; physical possibilities and constraints; and the historical development of that society's economy, political system, education, etc. These provide different drivers for change, in interaction with more global developments. We compare historical and current FRM in six delta areas and their contexts: Rhine/Meuse/Scheldt (The Netherlands), Pearl River (China), Mekong (Vietnam), Ganges/ Brahmaputra/Meghna (Bangladesh) Zambezi/Limpopo (Mozambique), and Mississippi (USA). We show that in many countries the emphasis is shifting from 'hard' engineering, such as dikes, towards non-structural 'soft' measures, such as planning restrictions or early warning systems, while the 'hard' responses are softened in some by a 'building with nature' approach. However, this is by no means a universal development. One consistent feature of the application of 'hard' FRM technology to deltas is that it pushes them towards a technological 'lock-in' in which fewer and fewer 'soft' FRM alternatives are feasible due to increased flood risks. By contrast, 'soft' FRM is typically flexible, allowing a range of future options, including future hard elements if needed and appropriate. These experiences should lead to serious reflection on whether 'hard' FRM should be recommended when 'soft' FRM options are still open.

Abstract. Recent flood dynamics of the Mekong Delta have raised concerns about an increased flood risk downstream in the Vietnamese Mekong Delta. Accelerated high dike building on the floodplains of the upper delta to allow triple cropping of rice has been linked to higher river water levels in the downstream city of Can Tho. This paper assesses the hydraulic impacts of upstream dike construction on the flood hazard downstream in the Vietnamese Mekong Delta. We combined the existing one-dimensional (1-D) Mekong Delta hydrodynamic model with a quasi-two-dimensional (2-D) approach. First we calibrated and validated the model using flood data from 2011 and 2013. We then applied the model to explore the downstream water dynamics under various scenarios of high dike construction in An Giang Province and the Long Xuyen Quadrangle. Calculations of water balances allowed us to trace the propagation and distribution of flood volumes over the delta under the different scenarios. Model results indicate that extensive construction of high dikes on the upstream floodplains has had limited effect on peak river water levels downstream in Can Tho. Instead, the model shows that the impacts of dike construction, in terms of peak river water levels, are concentrated and amplified in the upstream reaches of the delta. According to our water balance analysis, river water levels in Can Tho have remained relatively stable, as greater volumes of floodwater have been diverted away from the Long Xuyen Quadrangle than the retention volume lost due to dike construction. Our findings expand on previous work on the impacts of water control infrastructure on flood risk and floodwater regimes across the delta.

Lichenoid and spongiotic dermatitis associated with PD-1/PD-L1 inhibitors could be a sign of robust immune response and improved oncologic outcomes. The value of PD-1/PD-L1-related dermatitis in predicting cancer outcomes awaits investigation through prospective multicenter studies for specific cancer types.

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