Introduction Pediatric to adult health care transition (HCT) is critical to maintaining the health and wellness of patients, and pediatric and adult providers often do not feel prepared to shepherd patients through this process. Methods We designed an HCT curriculum consisting of nine podcasts paired with existing ambulatory experiential learning opportunities for internal medicine-pediatric residents (n=6). Before and after the curriculum we evaluated resident HCT self-assessment and resident performance working with a standardized patient (SP) and standardized parent in a novel objective structured clinical examination (OSCE) station designed to assess HCT skills.
View Article and Find Full Text PDFIncreasing soil organic carbon (SOC) confers benefits to soil health, biodiversity, underpins carbon sequestration and ameliorates land degradation. One recommendation is to increase SOC such that the SOC to clay ratio (SOC/clay) exceeds 1/13, yet normalising SOC levels based on clay alone gives misleading indications of soil structure and the potential to store additional carbon. Building on work by Poeplau & Don (2023) to benchmark observed against predicted SOC, we advance an alternative indicator: the ratio between observed and "typical" SOC (O/T SOC) for pan-European application.
View Article and Find Full Text PDFObjectives: The clinical activity score (CAS) and European severity scale (ESS) are established clinical tools to assess thyroid eye disease (TED) but are limited in terms of subjectivity and their reliability in non-Caucasian individuals, and can underestimate significant disease in the posterior orbit. Preliminary data from pilot studies have shown that diffusion-weighted imaging (DWI) using extraocular muscle (EOM) apparent diffusion coefficient (ADC) measurements may provide complementary information in TED. This study expands on previous research to assess for correlations between clinical scores and EOM-ADCs in stratifying disease activity and severity in a large patient cohort from an ethnically diverse population.
View Article and Find Full Text PDFIntroduction: Early prediction of abrocitinib efficacy in atopic dermatitis (AD) could help identify candidates for an early dose increase. A predictive model determined week 12 efficacy based on week 4 responses in patients receiving abrocitinib 100 mg/day and assessed the effect of an abrocitinib dose increase on platelet counts.
Methods: Analysis included the phase 3 trials JADE MONO-1 (NCT03349060), MONO-2 (NCT03575871), COMPARE (NCT03720470), and TEEN (NCT03796676).
J Eur Acad Dermatol Venereol
November 2024
Background: Treatment optimization may require dosing flexibility. The Phase 3 JADE REGIMEN trial (NCT03627767) evaluated maintenance of abrocitinib 200 mg-induced response in patients with moderate-to-severe atopic dermatitis (AD) randomly assigned to subsequent maintenance with continuous-dose abrocitinib (200 mg), reduced-dose abrocitinib (100 mg) or placebo. Maintenance with continuous-dose abrocitinib was associated with a stronger prevention of disease flares, but also with a higher occurrence of adverse events, compared with the reduced dose.
View Article and Find Full Text PDFSoil porosity and its reciprocal bulk density are important environmental state variables that enable modelers to represent hydraulic function and carbon storage. Biotic effects and their 'dynamic' influence on such state variables remain largely unknown for larger scales and may result in important, yet poorly quantified environmental feedbacks. Existing representation of hydraulic function is often invariant to environmental change and may be poor in some systems, particularly non-arable soils.
View Article and Find Full Text PDFA man in his 30s, with sinonasal undifferentiated carcinoma status post resection 6 years prior, presented with acute onset of fever, headache and altered mentation. The patient was diagnosed with bacteremia and meningitis due to A standard antibiotic and corticosteroid regimen was started. Brain MRI showed an encephalocele abutting the superolateral nasopharynx mucosa.
View Article and Find Full Text PDFBackground: Young adults with chronic childhood-onset diseases (CCOD) transitioning care from pediatrics to adult care are at high risk for readmission after hospital discharge. At our institution, we have implemented an inpatient service, the Med-Peds (MP) line, to improve transitions to adult care and reduce hospital utilization by young adults with CCOD.
Objective: This study aimed to assess the effect of the MP line on length of stay (LOS) and 30-day readmission rates compared to other inpatient services.
Land degradation directly affects around 25% of land globally, undermining progress on most of the UN Sustainable Development Goals (SDG), particularly target 15.3. To assess land degradation, SDG indicator 15.
View Article and Find Full Text PDFBackground: Abrocitinib, an oral, once-daily Janus kinase 1-selective inhibitor, improved itch severity, sleep, and work productivity versus placebo in patients with moderate-to-severe atopic dermatitis.
Objective: The aim of this study was to investigate relationships among itch, sleep, and work productivity in the phase III JADE MONO-2 clinical trial.
Methods: A repeated-measures longitudinal model was used to examine relationships between itch (using the Peak Pruritus Numerical Rating Scale [PP-NRS] or Nighttime Itch Scale [NTIS]) and sleep disturbance/loss (using the Patient-Oriented Eczema Measure sleep item and SCORing AD Sleep Loss Visual Analog Scale) and, separately, between itch and work productivity (using the Work Productivity and Activity Impairment-Atopic Dermatitis Version 2.
Background: Traditional systemic immunosuppressants and advanced therapies improve signs and symptoms of moderate-to-severe atopic dermatitis (AD). However, data are limited in severe and/or difficult-to-treat AD. In the phase 3 JADE COMPARE trial of patients with moderate-to-severe AD receiving background topical therapy, once-daily abrocitinib 200 mg and 100 mg showed significantly greater reductions in the symptoms of AD than placebo and significantly greater improvement in itch response (with abrocitinib 200 mg) than dupilumab at week 2.
View Article and Find Full Text PDFEfforts to improve soil health require that target values of key soil properties are established. No agreed targets exist but providing population data as benchmarks is a useful step to standardise soil health comparison between landscapes. We exploited nationally representative topsoil (0-15 cm) measurements to derive soil health benchmarks for managed and semi-natural environments across Great Britain.
View Article and Find Full Text PDFBackground: Inadequate time and space to process critical incidents contribute to burnout. Residents do not regularly participate in emotional debriefs. An institutional needs assessment revealed only 11% of surveyed pediatrics and combined medicine-pediatrics residents had participated in a debrief.
View Article and Find Full Text PDFBackground: Differences in atopic dermatitis (AD) disease course and manifestation with age may extend to treatment response.
Objective: To evaluate response maintenance with continuous-/reduced-dose abrocitinib or withdrawal and response to treatment reintroduction after flare in adolescent and adult participants in JADE REGIMEN (NCT03627767).
Methods: Adolescents (12-17 years) and adults with moderate-to-severe AD responding to abrocitinib 200-mg induction were randomly assigned to 40-week maintenance with abrocitinib (200 mg/100 mg) or placebo.
People with rheumatoid arthritis (RA) are disproportionately affected by sarcopenia, the generalised loss of muscle strength and mass, consequently facing an increased risk of falls, functional decline and death. Currently, there are no approved pharmacological treatments for sarcopenia. RA patients who start tofacitinib (a Janus kinase inhibitor) develop small increases in serum creatinine that are not explained by renal function changes and could reflect sarcopenia improvement.
View Article and Find Full Text PDFAs agricultural land area increases to feed an expanding global population, soil erosion will likely accelerate, generating unsustainable losses of soil and nutrients. This is critical for Kenya where cropland expansion and nutrient loading from runoff and erosion is contributing to eutrophication of freshwater ecosystems and desertification. We used the Revised Universal Soil Loss Equation (RUSLE) to predict soil erosion rates under present land cover and potential natural vegetation nationally across Kenya.
View Article and Find Full Text PDFBackground: Abrocitinib, an oral Janus kinase 1 inhibitor, provided significant itch relief by week 2 in patients with moderate-to-severe atopic dermatitis (AD) in the phase III JADE COMPARE trial.
Objectives: This post-hoc analysis of JADE COMPARE aimed to further characterize itch response and determined whether early itch relief could predict subsequent improvements in AD severity.
Methods: JADE COMPARE was a randomized, double-blind, double-dummy, placebo-controlled trial.
Background Young adults with chronic childhood-onset disease (CCOD) are routinely admitted to internal medicine hospitalist services, yet most lack transition preparation to adult care. Providers and patients feel the strain of admissions to adult services in part due to their medical and social complexity. Methods We performed a descriptive study of a care redesign project for young adults with CCOD hospitalized at a large, tertiary care academic hospital.
View Article and Find Full Text PDFAtopic dermatitis (AD) is a chronic skin disease that significantly impacts patient quality of life (QoL). It is unknown whether patients and physicians have the same interpretation of AD burden. Unmet needs and AD disease burden were evaluated by comparing terminology used in social media with terminology used in scientific literature.
View Article and Find Full Text PDFIntroduction: Atopic dermatitis (AD) is associated with significant quality-of-life and economic burdens. Real-world evidence is needed to identify optimal treatment pathways for AD. Here we evaluate real-world effectiveness of systemic therapies for moderate-to-severe AD in the USA.
View Article and Find Full Text PDFBackground And Aims: Gastrointestinal (GI) dysmotility is a common and debilitating clinical manifestation in patients with mitochondrial DNA (mtDNA)-related disease with no curative and few effective symptomatic therapies. A low-residue diet (LRD) has been shown to be effective at reducing bowel urgency, pain, and distension in functional GI-related conditions. We assessed tolerability and effects of an LRD on bowel habits in patients with mtDNA-related disease.
View Article and Find Full Text PDFAnn Allergy Asthma Immunol
September 2022
Background: Many patients with atopic dermatitis (AD) have a suboptimal response to systemic therapy.
Objective: This study assessed predictors of nonresponse to dupilumab in patients with AD.
Methods: Data (April 2017 through June 2019) for patients aged 12 years and above with AD (International Classification of Diseases-9/10-Clinical Modification: 691.
Primary mitochondrial disorders encompass a wide range of clinical presentations and a spectrum of severity. They currently lack effective disease-modifying therapies and have a high mortality and morbidity rate. It is therefore essential to know that competitively funded research designed by academics meets the core needs of people with mitochondrial disorders and their clinicians.
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