Skin & Allergy News articles from September 2008

Skin & Allergy News archives from September 2008

Hemangioma risk tied to birth weight.(News)
September 1, 2008... [ILLUSTRATION OMITTED] CHICAGO -- A recent multivariate analysis found that low birth weight is the single most significant risk factor for having a hemangioma of infancy. These findings come at a time when the rates of preterm and...

South Beach diet may help clear acne, survey finds: the finding rekindles food and ache debate.(News)
September 1, 2008... CHICAGO -- Adherence to the South Beach diet helped to clear acne and reduced the use of acne treatments, according to the findings of a survey developed by dermatologists. The findings contradict the widely held perception that acne is not...

The more the mentoring, the happier the resident.(Practice Trends)
September 1, 2008... KYOTO, JAPAN -- U.S. dermatology residents who spend at least 30 minutes per month with a faculty mentor outside of classroom and clinic are significantly more satisfied overall with their training programs, according to a national survey. ...

Alefacept fails alopecia areata test.(News)(Clinical report)
September 1, 2008... CHICAGO -- Alefacept fared no better than placebo in treating chronic, severe alopecia areata in a 12-week double-blind, randomized study of 45 adults. Patients with at least a 6-month history of alopecia areata with 50%-95% scalp...

Median income for dermatologists.(VITAL SIGNS)
September 1, 2008... Median Income for Dermatologists Actual Adjusted * 2003 $285,692 $267,370 2004 2005 2006 2007 $365,524 $303,572 * Adjusted for inflation to 2000 dollars; include dermatology...

New scleroderma subtypes provide disease insight.(News)(Disease/Disorder overview)
September 1, 2008... KYOTO, JAPAN -- One in five patients with clinical symptoms characteristic of systemic sclerosis does not fit into the popular classification scheme that divides the disease into the diffuse and limited cutaneous subtypes, according to Dr....

Efalizumab effective in psoriatic nonresponders.(News)
September 1, 2008... CHICAGO -- Treatment with efalizumab can benefit patients with plaque psoriasis who have failed previous treatments with anti-tumor necrosis factor therapies. In a single-arm, open-label phase IV study of 66 patients with moderate to...

Emerging data link psoriasis to comorbidities.(News)
September 1, 2008... SAN DIEGO -- Emerging scientific data on adults with psoriasis suggest the disease engenders a number of comorbidities, including metabolic syndrome and myocardial infarction. People with psoriasis "have a tendency to be obese, have a...

From coal tar to phototherapy, psoriasis treatments revealed.(News)
September 1, 2008... CHICAGO -- A topical coal-tar solution that doesn't smell, a user-friendly hydrogel patch, and supraerythemogenic phototherapy were among the innovative approaches to psoriasis discussed at the American Academy of Dermatology Academy's 2008...

Medicare nixes payment for more 'never' events: 'this is about changing hospitals and making them safer places.'.(News)(Report)
September 1, 2008... Starting Oct. 1, Medicare won't pay for a total of 11 preventable conditions acquired during a hospital stay, up from the current 8 such conditions. Added to the list of noncovered preventable conditions are surgical site infections following...

Incentives, penalties predicted to push doctors to e-prescribing.(News)
September 1, 2008... Federal officials are urging physicians to begin electronic prescribing as soon as possible now that Congress has authorized bonus payments for the successful use of the technology. Under the recently enacted Medicare Improvements for...

Foundation awards $5 million in grants.(News)
September 1, 2008... The Dermatology Foundation announced its highest allocation ever, $5.25 million, for dermatologic research. Sixty-seven individuals and projects are receiving funding, including $55,000/year for up to 3 years to 39 investigators, 21 project...

Propranolol found to rapidly shrink severe hemangiomas.(News)
September 1, 2008... DESTIN, FLA. -- Propranolol appears to have impressive beneficial effects on severe hemangiomas of infancy, according to a letter in the New England Journal of Medicine. "Keep your eyes out for more information on this interesting work,"...

Hemangioma distribution may help predict PHACES risk.(News)(Clinical report)
September 1, 2008... KYOTO, JAPAN -- The distribution of large facial hemangiomas appears to be helpful in identifying infants at risk for PHACES syndrome, according to a first-of-its-kind multicenter prospective study. PHACES, also known as Online Mendelian...

New drugs show promise for CTCL treatment.(News)
September 1, 2008... KYOTO, JAPAN -- Investigational anticancer agents romidepsin and forodesine showed promising efficacy in refractory cutaneous T-cell lymphoma in multicenter phase II clinical trials presented at an international investigative dermatology...

Texting patients may boost topical Tx compliance.(News)
September 1, 2008... KYOTO, JAPAN -- Daily cell phone text message reminders to slather on sunscreen doubled the adherence rate in a randomized controlled trial. "Text messaging could be a low-cost, effective model for improving adherence to topical agents in...

A perfect bookend.(Guest Editorial)(Genetic Information Nondiscrimination Act)
September 1, 2008... The passage of the Genetic Information Nondiscrimination Act in late May, ushered in what Sen. Edward Kennedy (D-Mass.) called "the first civil rights bill of the new century of the life sciences." Under the legislation, U.S. citizens now...

Second impressions.(Under My Skin)(medical consultation; physician-patient interaction)
September 1, 2008... My first contact with Denise was a ringing beeper at 4:30 a.m. "My ache is out of control," her voice mail message said. "The antibiotic I'm on isn't helping. I get to work at 5:30." Predawn ache? I held off till 7 before getting back to...

Slashing research money won't help, may hurt.(Guest Editorial)
September 1, 2008... Times are tough... belts must be tightened... everyone should sacrifice. These are the messages Congress conveys as it debates the next year's federal budget. But indiscriminate across-the-board cuts harm areas that promote the general...

Gene therapy promising for cutaneous lymphoma.(Cutaneous Oncology)
September 1, 2008... KYOTO, JAPAN -- Intratumoral interferon-gamma gene therapy delivered via an adenoviral vector induces systemic as well as local immune responses in patients with primary cutaneous T- or B-cell lymphoma, reported Dr. Mirjana Urosevic reported....

Melanoma regression alone doesn't justify an SLN biopsy.(Cutaneous Oncology)
September 1, 2008... MONTREAL -- Regression of a thin melanoma should not be the sole criterion to justify a sentinel lymph node biopsy, according to a retrospective study. Regression alone is insufficient in the absence of other recognized high-risk...

Confocal laser microscopy gaining momentum.(Cutaneous Oncology)
September 1, 2008... MONTREAL -- Formation of an international confocal microscopy group, software that aids the detection and mapping of skin lesions, and introduction of a handheld device are among recent advances to aid in the diagnosis of lentigo maligna and...

HPV's link to head and neck cancer examined.(Cutaneous Oncology)
September 1, 2008... SAN FRANCISCO -- While the relationship of the human papillomavirus to cervical cancer is well known among the public and in the medical profession, it is less commonly recognized that oral HPV appears to be associated with head and neck...

Renowned educator gets lifetime award.(Cutaneous Oncology)(Brief article)
September 1, 2008... The Dermatology Foundation has conferred its Lifetime Career Educator Award on Dr. Irwin M. Braverman, professor of dermatology at Yale University School of Medicine. According to the foundation, "The award celebrates Dr. Braverman's...

Skin excision not always needed for buccal SCC.(Cutaneous Oncology)
September 1, 2008... SAN FRANCISCO -- A 5-year local control rate is possible with or without skin excision in squamous cell carcinoma of the buccal mucosa, according to a retrospective study of 331 patients. When patients are properly selected for skin...

SCC survival doubles with radiotherapy.(Cutaneous Oncology)
September 1, 2008... SAN FRANCISCO -- Patients who received adjuvant radiotherapy following surgery for metastatic cutaneous squamous cell carcinoma survived more than twice as long as did those who did not receive radiotherapy in a small retrospective study. ...

Micro-RNA levels higher in aggressive melanomas.(Cutaneous Oncology)
September 1, 2008... CHICAGO -- Micro-RNA-21 and micro-RNA-155 are expressed at significantly higher levels in primary malignant melanoma tumor samples than in samples from benign nevi--and in indeterminate melanocytic lesions with an aggressive histological...

Gene loss may explain gender differences in melanoma.(Cutaneous Oncology)
September 1, 2008... CHICAGO -- A specific pattern of X and Y chromosome losses--and in particular the loss of an important tumor-suppression gene--was shown in a recent study to be associated with melanoma progression. This "very new and very unexpected...

Cosmetic devices get mixed marks from panel.(Aesthetic Dermatology)(Skin Disease Education Foundation seminar)
September 1, 2008... SANTA MONICA, CALIF. -- Live video demonstrations of several novel laser and laserlike devices generated mixed reviews from a panel of dermatologists. Panelists at a cosmetic dermatology seminar sponsored by Skin Disease Education...

C[O.sub.2] laser offers long-term efficacy.(Aesthethic Dermatology)(Clinical report)
September 1, 2008... Facial resurfacing using a C[O.sub.2] laser is a safe and effective treatment for rhytids demonstrating long-term results, according to a retrospective study of 47 patients who underwent an entire facial resurfacing procedure. Dr. Shan R....

More women than men seek tattoo removal.(Aesthetic Dermatology)
September 1, 2008... More women than men have sought tattoo removal in recent years, a reversal of the pattern that prevailed 10 years earlier, according to a report in the Archives of Dermatology. Today, women report receiving significantly more negative...

Foundation honors two laser pioneers.(Aesthetic Dermatology)
September 1, 2008... The Dermatology Foundation has awarded its prestigious Discovery Award to Dr. John A. Parrish and Dr. R. Rox Anderson. The award acknowledges their landmark development of the use of selective photothermolysis in the treatment of birthmarks and...

Angelica: Part II.(Cosmeceutical Critique)
September 1, 2008... Besides Angelica sinensis, discussed last month, other species of Angelica have been studied for their medicinal potential, and, gradually, these species have been introduced into topical formulations. Antitumor Activity In a 2005...

Experience may be dispelling the 'old wives' tales of botox.
September 1, 2008... SANTA MONICA, CALIF. -- In the early days of cosmetic botulinum toxin type A therapy, rumors greatly outnumbered scientific facts about its safety, storage, and storied effect on furrowed brows and deep crow's feet. The faculty at a recent...

Barrier products may play role in dermatitis Tx: products can improve skin hydration and decrease barrier dysfunction, but more studies are needed.(Atopic Dermatitis)
September 1, 2008... SAN DIEGO -- Barrier products may play a role as adjuvant therapy for patients with atopic dermatitis, but better studies are needed to demonstrate their efficacy. That's the conclusion Dr. Andrew C. Krakowski made about three barrier...

More on the effectiveness of EpiCeram for atopic dermatitis.(Atopic Dermatitis)
September 1, 2008... KYOTO, JAPAN -- Topical EpiCeram is an effective stand-alone therapy for moderate to severe pediatric atopic dermatitis, according to results of a clinical trial. This physiologic skin barrier repair cream proved itself the equal of...

Atopic patients may not have higher S. aureus risk.(Atopic Dermatitis)
September 1, 2008... SAN DIEGO -- Patients with atopic dermatitis are highly colonized with Staphylococcus aureus but do not appear to be preferentially infected with community-acquired methicillin-resistant S. aureus. Up to 79% of patients with atopic...

Most antihistamines cause some cognitive impairment.(Atopic Dermatitis)
September 1, 2008... KYOTO, JAPAN -- Fexofenadine is the sole truly nonsedating antihistamine--and the only one that does not cause objectively measurable cognitive and psychomotor impairment at doses that are commonly used in clinical practice, said Dr. Kazuhiko...

Interleukin-17 levels low in skin of atopic lesions.(Atopic Dermatitis)
September 1, 2008... KYOTO, JAPAN -- The predisposition to recurrent skin infections in atopic dermatitis might be explained by the recent discovery that interleukin-17 is relatively absent in lesional skin, said Dr. Emma Guttman-Yassky. She and her...

Prevalence of atopic dermatitis high among Japanese adults.(Atopic Dermatitis)
September 1, 2008... KYOTO, JAPAN -- Atopic dermatitis is one of the most common skin diseases in Japanese adults, especially those in their 20s and 30s, according to a first-of-its-kind study. The high prevalence rates found were quite similar to those earlier...

Oral vitamin D increases cathelicidin in lesional skin.(Atopic Dermatitis)(Clinical report)
September 1, 2008... KYOTO, JAPAN -- Supplementation with oral vitamin D boosted chronically low levels of the antimicrobial peptide cathelicidin in the lesional skin of atopic dermatitis patients in a controlled trial, reported Dr. Tissa R. Hata. These...

Acne treatments reviewed, starting with touch.(Pediatric Dermatology)
September 1, 2008... STANFORD, CALIF. -- The art and science of treating acne in adolescents start with touching the patient. "Many adolescents have a feeling that their acne is very dirty, and they take it personally," Dr. Alfred T. Lane said at a pediatric...

Incontinentia pigmenti not all that rare.(Pediatric Dermatology)(Clinical report)
September 1, 2008... STANFORD, CALIF. -- A rare genetic disorder that usually is lethal to male babies and can leave abnormalities of the skin, eyes, and other body parts in females, may be more common than originally thought. Incontinentia pigmenti is caused...

Soft, fluctuant lesions on head may not be a port wine stain.(Pediatric Dermatology)(Clinical report)
September 1, 2008... DESTIN, FLA. -- A soft, fluctuant lesion near the midline of the forehead or on the scalp might look like a port wine stain, but it could be a serious, potentially fatal condition known as sinus pericranii. Maintain a high index of...

Children receiving quality health care by clinical area.(DATA WATCH)
September 1, 2008... Children Receiving Quality Health Care by Clinical Area Upper respiratory tract infections 92% Allergic rhinitis 85% Acne 57% Fever ...

Two ointments show similar efficacy for vitiligo.(Pediatric Dermatology)(Conference news)
September 1, 2008... MONTREAL -- Clobetasol propionate and tacrolimus ointments offer similar efficacy for treatment of pediatric vitiligo, according to a prospective, randomized, double-blind clinical trial. Both topicals were superior to placebo in this study...

Pros and cons of pediatric wart therapy weighed.(Pediatric Dermatology)(Clinical report)
September 1, 2008... STANFORD, CALIF. -- Two approved therapies for pediatric warts and several off-label options each carry advantages and disadvantages that can help inform treatment selection. Watchful waiting may be the best option because most pediatric...

Cleaning products drive antimicrobial resistance.(Infectious Diseases)(Clinical report)
September 1, 2008... BETHESDA, MD. -- Use of household cleaning products that contain benzalkonium chloride may decrease the susceptibility of bacteria to other antimicrobial ingredients in cleaning products and increase their resistance to antibiotics, according...

Skin infections in young athletes demand vigilance.(Infectious Diseases)
September 1, 2008... VANCOUVER, B.C. -- Managing skin infections in young athletes can be more challenging than in the general pediatric population, because close physical contact and use of shared equipment can lead to rapid spread of infections and outbreaks. ...

Stewardship program explores antimicrobial use, resistance.(Infectious Diseases)
September 1, 2008... BETHESDA, M D. -- The antimicrobial stewardship program at the health sciences center of West Virginia University, Morgantown, has been successful in reducing resistance in some pathogens, while generating more questions about others, according...

Guidelines endorse earlier treatment of HIV.(Infectious Diseases)
September 1, 2008... Initial antiretroviral treatment of HW infection in asymptomatic adults should begin before CD4 cell counts drop below 350/mcL, according to new treatment guidelines announced at the 2008 International AIDS Conference in Mexico City. The...

Skin substitutes useful in deep thermal burns.(Wound)(Clinical report)
September 1, 2008... CHICAGO -- The novel skin substitutes Suprathel and Matriderm resulted in complete healing and excellent functionality in patients with deep burns in two studies. [ILLUSTRATION OMITTED] By using Suprathel, complete epithelialization...

Nephropathy found to predict poor diabetic foot outcomes.(Wound)(Clinical report)
September 1, 2008... An initially successful healing rate in patients who were hospitalized with diabetic foot ulcers did not lead to comparable long-term outcomes in a prospective study of 94 consecutive patients. The presence of nephropathy was found to be an...

New recommendations for diabetic foot care issued.(Wound)
September 1, 2008... A simple protocol can assess the diabetic foot for the presence of predisposing factors for ulcerations and amputation, and can be used to guide treatment, according to recommendations developed by an American Diabetes Association task force....

Ethnicity has role in SLE incidence, manifestations.(Autoimmunity/Connective Tissue Diseases)(Clinical report)
September 1, 2008... DESTIN, FLA.--Ethnicity appears to play an important role in the incidence and clinical manifestations of pediatric systemic lupus erythematosus, data from a recent study suggest. Findings from the study of 87 white and 154 nonwhite...

On-job exposure discounted in most cases of Wegener's.(Autoimmunity/Connective Tissue Diseases)
September 1, 2008... PARIS -- Wegener's granulomatosis does not appear to be triggered by occupational exposure to inhaled allergens. The hypothesis that this necrotizing systemic vasculitis of unknown etiology is associated with inhaled irritants or allergens...

Behcet's syndrome has unique vasculitis patterns.(Autoimmunity/Connective Tissue Diseases)
September 1, 2008... PARIS -- Fully one-quarter of patients with Behcet's syndrome who experience a large-vessel vascular event will have another within 5 years--and the second is typically more severe than the first. This was among the most striking findings...

Scleroderma imposes high economic burden to patients.(Autoimmunity/Connective Tissue Diseases)
September 1, 2008... [ILLUSTRATION OMITTED] PARIS -- Scleroderma patients have substantially greater average annual direct medical costs than do patients with rheumatoid arthritis, according to a study by the Canadian Scleroderma Research Group. ...

Cutaneous signs of dermatomyositis key to Dx.(Autoimmunity/Connective Tissue Diseases)
September 1, 2008... MONTREAL -- Dermatologists can discern the cutaneous features of dermatomyositis and aid rheumatologists to determine a definitive diagnosis, often obviating the need for a muscle biopsy. "We play a critical role in diagnosing...

New autoantibody may predict cancer-associated myositis.(Autoimmunity/Connective Tissue Diseases)
September 1, 2008... SNOWMASS, COLO.--A novel myositis-specific autoantibody shows considerable promise for predicting which patients with idiopathic inflammatory myositis are at increased cancer risk, Dr. Robert L. Wortmann said at a symposium sponsored by the...

Sleep apnea increased mortality in 14-year study.(Across Specialties)
September 1, 2008... BALTIMORE -- Moderate to severe sleep apnea significantly increased the risk of all-cause mortality, according to 14 years of follow-up data from a large community sample. "Sleep apnea is a disease of public health significance," said...

TRAF1-C5 locus: hotbed for autoimmune disease?(Across Specialties)
September 1, 2008... PARIS -- A newly identified common genetic pathway may underlie susceptibility to multiple autoimmune diseases, according to Ms. Fina Kurreeman. Autoimmune diseases are considered to result from an interplay of genetics, environment, and...

Possible MRSA, anti-TNF therapy link discovered.(Across Specialties)
September 1, 2008... PARIS -- Methicillin-resistant Staphylococcus aureus infections have been reported for the first time in patients with rheumatoid arthritis being treated with tumor necrosis factor inhibitors. In a poster presented at the annual European...

Real world data show, for PsA, methotrexate effective.(Across Specialties)
September 1, 2008... PARIS -- Methotrexate is an effective therapy for psoriatic arthritis, according to findings from a large Norwegian registry. The same data that confirm methotrexate's usefulness in management of rheumatoid arthritis also offer promise that...

Tocilizumab plus low neutrophil count doesn't up infection risk.(Across Specialties)
September 1, 2008... PARIS -- Low neutrophil counts that developed during treatment of rheumatoid arthritis with tocilizumab were not associated with increased risk of serious infections in an analysis of data from two phase III trials. Tocilizumab is a...

Asthma linked to consuming nuts in pregnancy.(Across Specialties)
September 1, 2008... Women who eat nut products such as peanut utter daily throughout pregnancy may significantly increase their children's risk of developing asthma symptoms, according to a Dutch cohort study. At 8 years of age, children whose mothers reported...

Over past decade, prevalence of food allergies on the rise.(Across Specialties)
September 1, 2008... CHICAGO -- The prevalence of reported food allergies has risen 24% among children under age 5 years and 19% among children aged 5-17 years during the past decade, according to a study by the National Center for Health Statistics. Based on...

Short REM sleep linked to overweight in kids.(Across Specialties)
September 1, 2008... Shortened sleep duration, particularly shortened REM sleep, is associated with overweight in children and adolescents, according to a recent report. Given the high prevalence of both overweight and sleep deprivation in modern society,...

Physical activity is key to combating pediatric obesity.(Across Specialties)
September 1, 2008... GENEVA -- Increasing physical activity levels in children and adolescents is just what the doctor should order to reverse the rate of childhood and adolescent obesity, according to Dr. Denes Molnar, professor and head of the department of...

Treating childhood obesity requires a multifaceted approach.(Across Specialties)
September 1, 2008... GENEVA -- One of the most common issues complicating the treatment of childhood obesity is physical or learning disabilities, according to Dr. Julian p Hamilton-Shield of the University of Bristol (England) and Bristol Royal Hospital for...

Fruit and vegetable intake may prevent diabetes.(Across Specialties)(Clinical report)
September 1, 2008... Plasma vitamin C level as well as fruit and vegetable intake shows a "striking" inverse relation with the risk of developing diabetes, according to a prospective study. Compared with men and women in the lowest quintile of plasma vitamin...

Excess weight in some adults considered 'benign'.(Across Specialties)
September 1, 2008... According to reports by two separate research groups a "considerable proportion" of overweight and obese adults show no cardiometabolic abnormalities and can be considered to have "benign" obesity. Approximately 10% of both study...

Senior health tips on eating well.(Across Specialties)
September 1, 2008... The latest topic to be added to NIH-Senior Health--the health and wellness Web site developed by the National Institute on Aging and the National Library of Medicine-is "Eating Well as You Get Older." Eating a balanced mix of healthy foods may...

Central adiposity bests BMI as stroke predictor.(Across Specialties)
September 1, 2008... Measures of abdominal adiposity appear to be better predictors of stroke or transient ischemic attack than does body mass index, based on results from a German study of more than 1,100 individuals. "Three different statistical approaches...

Role of birth month in osteoporosis risk unclear.(Across Specialties)
September 1, 2008... LIVERPOOL, ENGLAND -- Maternal exposure to sunlight in late pregnancy can exert a beneficial influence on the offspring's bone mineral density in later life, Dr. Nicola J. Goodson said at the annual meeting of the British Society for...

Congress gearing up for health care reform.(Practice Trends)
September 1, 2008... Democrats and Republicans are so confident about the chances of some type of health reform in the next administration that staff meetings and hearings geared toward crafting legislation have been going on in earnest in both the House and the...

Sunscreen label delay decried.(Policy & Practice)
September 1, 2008... Lawmakers are urging the Food and Drug Administration to release comprehensive sunscreen labeling that has been in the works for several years. Sen. Christopher Dodd (D-Conn.) and Sen. Jack Reed (D-R.I.) introduced a bill to require the FDA to...

FDA seizes hydroquinone.(Policy & Practice)
September 1, 2008... The FDA seized $24 million worth of unapproved drugs, including several hydroquinone cream products, from a St. Louis manufacturer. The agency took the action after an inspection of several plants owned by KV Pharmaceutical Co. The FDA...

Survey: only 15% get skin exams.(Policy & Practice)(Brief article)
September 1, 2008... In a national survey, only 15% of American workers reported ever having a head-to-toe skin exam. Only 8% of those who had seen a physician in the past year reported having had such an exam, according to a study published in the July issue of...

Stiefel completes acquisition.(Policy & Practice)
September 1, 2008... Stiefel Laboratories has completed its purchase of Barrier Therapeutics, a Princeton, N.J.-based company that has three topical products on the market, Xolegel, Vusion, and Solage. "Barrier's innovative products and pipeline are a very...

Feds scrutinize generic maker.(Policy & Practice)
September 1, 2008... India's Ranbaxy Inc., one of the top 10 generic drug makers in the world, is being investigated by various arms of the federal government for allegedly introducing "adulterated or misbranded products" into the U.S. market. The company's...

Adopt guidelines for e-mail questions.(Managing Your Dermatology Practice)
September 1, 2008... I recently received a lengthy e-mail from a very worried woman. She claimed to be an established patient in my office, which I had no way of confirming because she did not sign her message. She asked many questions about sexually transmitted...

Bankers eager to streamline health transactions.(Practice Trends)
September 1, 2008... WASHINGTON -- With health savings accounts serving as a point of entry, banks and other financial institutions are rapidly moving into the health care sector, and bankers believe they have much to offer in streamlining health care transactions...

Global health evaluation highlights top system performers.(Practice Trends)
September 1, 2008... WASHINGTON -- Analysis of other countries" health care systems has pointed out what might work and what won't work in efforts to reform the U.S. health care system. At the annual meeting of the American College of Physicians, ACP senior...