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Introduction Methods Results Conclusions To evaluate use and utility of the Fetal Alcohol Spectrum Disorder (FASD) Hub Australia website.Online REDCap user survey incorporating the Website Evaluation Questionnaire, open ended questions, Google metrics data and an accessibility audit.Seventy‐six participants: researchers (32%), health professionals (29%) and policymakers/advocates (16%) completed the survey. Most were from Australia (95%) and were likely or very likely to recommend the FASD Hub to colleagues (92%), friends (74%) and patients (72%). The mean Website Evaluation Questionnaire score was at least 3.45/5 for all dimensions (ease of use, hyperlinks, structure, relevance, comprehension, completeness, layout, search option); range 3.45 (search option) to 4.04 (relevance). Participants found the content trustworthy (92%) but wanted more information for, and to support, Aboriginal and Torres Strait Islander peoples, and improved search capacity. Google metrics identified 25,534 unique users over 6 months (82% new users); 83% aged 18–44 years, 72% female and 35% international.Users found the FASD Hub accessible, authoritative and useful and suggested improvements. [ABSTRACT FROM AUTHOR]

To investigate the incidence of and identify risk factors associated with poor quality of recovery in dogs recovering from general anaesthesia. Case controlled study. All dogs undergoing general anaesthesia at the University of Liverpool Small Animal Teaching Hospital between January 2020 and January 2021 were eligible for recruitment. Signalment, anaesthetic case management and a recovery score were recorded. Univariable and multivariable logistic and ordinal logistic regression analysis were used to identify factors which impact incidence of poor quality of recovery. A total of 247 dogs undergoing general anaesthesia were included. Overall, 72 [29.1%; 95% confidence interval (CI) 23.8%–35.1%] dogs experienced a poor quality recovery. Of these, 40 (55.5%) required sedation to manage behaviours associated with poor recovery. Multivariable logistic regression revealed American Society of Anesthesiologists (ASA) physical status classification of III or higher was associated with a decreased incidence of poor quality recovery [odds ratio (OR) = 0.34, 95% CI 0.12–0.93, p = 0.037] and the use of multiple inhalational anaesthetics during one procedure was associated with an increased incidence of poor quality of recovery (OR = 42.5, 95% CI 3.0–598.3, p = 0.005). Poor quality recovery is common in dogs recovering from general anaesthesia and sedation is often required for resolution. It is more likely to occur in healthy veterinary patients (ASA I and II). The use of multiple inhalational anaesthetic agents during one procedure should be discouraged as this may increase the likelihood of poor quality of recovery. [ABSTRACT FROM AUTHOR]

We report a 32-year-old male 14 years post-living-related kidney transplant presenting with new-onset hematuria and BK viremia. He was found to have BK virus-associated urothelial carcinoma originating in the renal allograft with locally advanced disease and metastases to multiple sites. He also developed acute T-cell-mediated rejection in the setting of immunosuppression reduction for BK viremia prior to undergoing transplant nephrectomy. Eight months following transplant nephrectomy and immunosuppression cessation, distant metastases persisted with partial response to chemotherapy and immunotherapy. Here, we discuss this unique presentation and compare it with other BK virus-associated allograft carcinomas reported in the literature, in addition to discussing evidence for the role of BK virus in oncogenesis. [ABSTRACT FROM AUTHOR]

Cretaceous/Paleogene (K/Pg) boundary is marked by one of the largest mass extinctions in Earth's history, with geological evidence for this event being expressed in hundreds of locations worldwide. An extensively studied section located near El Kef, northwestern Tunisia, is characterized by the classic iridium-rich K/Pg boundary layer, abundant and well-preserved microfossils, and apparently continuous sedimentation throughout the early Danian with no previously described structural complication. These features led to its designation in 1991 as the Global Stratigraphic Section and Point (GSSP) for the base of the Danian (i.e., the K/Pg boundary). However, the outcrop section has become weathered, and the "golden spike" marking the GSSP is difficult to locate. Therefore, the El Kef Coring Project aimed to provide a continuous record of unweathered sediments across the K/Pg transition in cores recovered from five rotary-drilled holes located close to the El Kef GSSP. Here, we present new, high-resolution lithologic, biostratigraphic, and geochemical data from these cores. The recovered stratigraphic successions of each hole (all drilled within ~75 m of one another) are unexpectedly different, and we identified a formerly unknown unconformity within planktic foraminiferal biozone P1b. Our results provide evidence that sedimentation at El Kef was not as continuous or free from structural complication as previously thought. Despite these challenges, we present a new composite section from the five El Kef holes and an age model correlated to the orbitally tuned record at Walvis Ridge, South Atlantic Ocean, which is critical in placing the paleoenvironmental and paleoecological records from El Kef in a global context. [ABSTRACT FROM AUTHOR]

Summary: An 18‐year‐old multiparous Thoroughbred mare with a 2‐month‐old foal at foot presented for investigation of colic. A right dorsal displacement of the large colon with a retroflexion of the pelvic flexure was corrected under general anaesthesia and interventional recovery using head and tail ropes was performed. The mare made multiple attempts to stand, using the ropes for support before achieving and maintaining a standing position. The following day, marked swelling around the perineal and vulval region was noted, combined with reduced tail tone. Urination, but not defaecation, had been observed following surgery. Transrectal ultrasonography indicated formation of a haematoma adjacent and ventral to the caudal sacral and first coccygeal vertebrae. Initial radiographic evaluation was suggestive of an oblique fracture of the caudal endplate of the first coccygeal vertebra, which was confirmed on repeat radiography 7 days later. Treatment included cold compresses to reduce swelling, multimodal analgesia, dietary modification to soften faecal consistency and regular manual evacuation of the rectum to avoid impaction. The mare was discharged after 19 days hospitalisation, gradually recovered the ability to defaecate and produced a viable foal the following year without assistance. [ABSTRACT FROM AUTHOR]

Digital rectal examination revealed frank blood and investigations revealed a coagulopathy with a prolonged prothrombin time of 115 sec, international normalized ratio of 14.7 and activated partial thromboplastin time of 222.5 sec with normal hemoglobin concentration (125 g/L) and platelet count (199 k/uL [199 × 10 SP 9 sp /L]). Her coagulation profile showed a prolonged thrombin time (>60 sec) and less prolonged prothrombin time (28.9 sec), international normalized ratio (2.9), and partial thromboplastin time (61.3 sec). Had the activated partial thromboplastin time and thrombin time been normal, management would have differed as the focus would have turned to non-anticoagulant etiologies of bleeding. [Extracted from the article]

Although primary pancreatic lymphoma is a rare cause of pancreatic mass, this diagnosis should be considered during work‐up. Furthermore, when adequate diagnostic material is available from biopsy, complete workup of the lymphoma, including not only type but also subtype when applicable, should be performed. [ABSTRACT FROM AUTHOR]

Males are victims of sexual violence at a rate almost as high as females; however, reports of male sexual violence are often left unscreened, unaddressed, and unacknowledged. Genitourinary complaints without an obvious cause should trigger the primary care provider to consider sexual violence as part of a differential diagnosis. [ABSTRACT FROM AUTHOR]

The Cretaceous-Paleogene (K-Pg; 66 Ma) mass extinction was caused by a bolide impact on the Yucatán platform near modern Chicxulub, Mexico. Calcareous nannoplankton, a dominant group of primary producers, were almost eradicated at this time. Post-impact nannoplankton assemblages from Northern Hemisphere sites were characterized by a shortlived series of high-dominance, low-diversity acmes ("boom-bust" successions), which likely represent an unstable post-impact environment. Although these boom-bust successions are a global signal, the mechanisms that controlled the taxonomic switchovers between acmes are currently unknown. Here, we present detailed analyses of calcareous nannoplankton and planktic foraminiferal assemblages in a new K-Pg section from the peak ring of the Chicxulub crater. We show that although nannoplankton assemblages resemble the typical series of acmes at Tethyan sites, the termination of the "disaster" acme in the crater is delayed by at least 500 k.y. The coincidence between shifts in the dominant planktic foraminiferal trophic group and switchovers in nannoplankton boom-bust taxa suggests that this series of acmes may represent a gradual trend toward oligotrophy driven by the global restoration of biological pump efficiency. Thus, the global diachroneity of boom-bust successions likely reflects the differential pacing of biological pump restoration between oceanic basins and settings. [ABSTRACT FROM AUTHOR]

Hyperhemolysis syndrome (HHS) is an uncommon transfusion reaction described in several hematologic disorders, including sickle cell disease (SCD). HHS is characterized by a decline in hemoglobin (Hb) values below pre-transfusion levels following transfusion of red blood cells (RBCs), coupled with laboratory markers consistent with hemolysis. The proposed pathophysiologic mechanisms underlying HHS include increased phosphatidylserine expression, macrophage activation, and complement dysregulation. Many pathophysiologic mechanisms thought to contribute to HHS have been similarly described in cases of severe COVID-19. A 28-year-old male with a history of HbSS presented with shortness of breath, right-sided chest pain, and a two-day history of fever. Polymerase chain reaction (PCR) detected SARS-CoV-2 infection with the omicron variant. The patient required an RBC transfusion (pre-transfusion hemoglobin [Hb]5.8 g/dL) with an immediate post-transfusion Hb of 6.3 g/dL. However, Hb rapidly declined to 1.7 g/dL, and lactate dehydrogenase (LDH) rose to 8701 u/L. The absolute reticulocyte count of 538 × 109/L correspondingly fell to 29 × 109/L. Despite additional RBC transfusions and initiation of immunosuppressive therapy, he expired on Day 9(D9). Given the similarities in their proposed pathophysiology, patients with SCD and concomitant SARS-CoV-2 infection may be predisposed to developing HHS. [ABSTRACT FROM AUTHOR]

Background: Experiencing mental health difficulties during pregnancy predicts a variety of quality-of-life (QoL) outcomes for Black women. However, one area of prenatal mental health remains underresearched: attention-deficit/hyperactivity disorder (ADHD). Given the impairments reported by adults with significant symptoms of ADHD and the linkages between depression and ADHD in nonpregnant samples, the current study aimed to examine the relationships among ADHD symptoms, depression, and QoL in Black pregnant women. Materials and Methods: Participants for this study were 116 pregnant Black women aged 18–43 years (mean age = 27.14, standard deviation = 5.67) presenting to an urban women's health clinic. We investigated associations among maternal ADHD symptoms, risk of maternal depression, and different aspects of QoL, including relationships, life outlook, and life productivity. Results: Linear hierarchical regressions were performed to investigate the ability of maternal depression risk to mediate the relationship between maternal ADHD symptoms and QoL. Moderate to large negative correlations were found between maternal ADHD symptoms, depression risk, and quality of life (p's ≤ 0.001). Furthermore, maternal depression risk either partially or fully explained the relationship between ADHD symptoms and the different QoL variables. Conclusions: This study illustrates that symptoms of both ADHD and depression are important clinical considerations for Black women during pregnancy. As significant ADHD symptoms can lead to the development of depression, future research should investigate the temporal relationship between depression and QoL in pregnant women diagnosed with ADHD, as well as study whether ADHD treatment results in improvements in depressive symptoms. [ABSTRACT FROM AUTHOR]

Objective: To compare surgical outcomes in patients undergoing bilateral salpingectomy (salpingectomy group) with those who had partial salpingectomy (partial salpingectomy group) during cesarean delivery. Materials and methods: A chart review from July 2015 to November 2016 was performed. We included women who had sterilization during cesarean delivery. We excluded sterilization by occlusive methods. Our primary outcomes were total operative time and a composite score of transfusion rate, internal organ injury, hospital readmission, and endometritis. Secondary out-comes included menstrual abnormalities, pelvic pain, quality of life assessment, and regrets rate. We compared these outcomes between women in the salpingectomy and partial salpingectomy groups. Chi-squared, Fisher’s exact, t-test, and Mann–Whitney U were utilized for statistical analysis where appropriate. A P<0.05 was considered significant. Results: We included a total of 160 pregnancies. Of these, 41 were in the salpingectomy and 119 in the partial salpingectomy group. The median total operative time was longer for the salpingectomy group (62 [IQR 54, 71] vs 60 minutes [IQR 46, 72]; P=0.03). The composite of surgical complications (19.5% vs 12.6%; P=0.28) was not significantly different between our study groups. Menstrual irregularities (P≥0.99), quality of life (P≥0.99), dyspareunia (P≥0.99), dysmenorrhea (P=0.36), and regrets (P≥0.99) were not different between groups. Conclusion: Salpingectomy during cesarean delivery increased the median operative time by 2 minutes and may not be associated with an increased risk of surgical complications. We acknowledge the need for larger multi-center trials to corroborate our outcomes. [ABSTRACT FROM AUTHOR]

Anxious and depressive symptoms often co-occur and are associated with difficulties in academic, social, and emotional areas of functioning. The current study identified the factor structure and profiles of symptoms of anxiety and depression among 169 Black early adolescents in sixth through eighth grade (Mage = 12.6 years; 50% female) using confirmatory factor analyses (CFAs) and latent profile analyses (LPA), respectively. CFAs supported a six-factor model for depressive symptoms (i.e., dysphoria, social problems, externalizing, self-deprecation, biological dysregulation, and school problems) and a four-factor model for anxiety symptoms (i.e., social evaluation, worry, affective response, and physiological symptoms/sleep problems). These factors formed the profiles for the LPA analyses, and results supported a three-profile solution that included: (a) a low-severity group who reported few anxious or depressive symptoms, (b) a group who reported high levels of externalizing behaviors and moderate levels of school and social evaluation problems, and (c) a group who reported high levels of social evaluation problems and physiological/sleep anxiety. The three groups differed significantly in their ratings of anger regulation difficulties (i.e., anger emotion regulation coping, anger inhibition, and anger dysregulated expression) and their perceptions of the quality of school interpersonal relationships (i.e., student-teacher relationships and student-student relationships). These findings add to our knowledge about how patterns of depressive and anxious symptoms present for Black youth during adolescence and have important implications for the conceptualization, treatment, and prevention of anxiety and depression using culturally sensitive approaches. Highlights: The experience and presentation of depressive and anxious symptoms differed for Black youth. Factor structures of depression and anxiety measures were confirmed prior to running latent profile analyses. Three profiles of anxious and depressive symptom dimensions were identified. Profiles differed in youths' ratings of anger regulation difficulties and perceptions of the quality of school interpersonal relationships. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To date, most investigations of mental health in pregnant women have focused on depression or substance use. This study aimed to (a) delineate the relationships between symptoms of attention‐deficit/hyperactivity disorder (ADHD) and prenatal health behaviors and (b) explore whether the symptom clusters of ADHD differentially predict prenatal health behaviors (e.g., physical strain, healthy eating, prenatal vitamin use). Method: A total of 198 pregnant women (mean age = 27.94 years) completed measures of ADHD symptoms, prenatal health behaviors, and depression. Results: Inattention, hyperactivity, and impulsivity/emotional lability all evidenced significant relationships with the prenatal health behaviors, each differentially predicting different prenatal health behaviors. Conclusion: As decreased engagement in adequate prenatal health behaviors puts both the mother and fetus at risk for negative birth outcomes, future research should work to develop a brief ADHD screen to be used in obstetric clinics and should investigate these relationships within a sample of women with a diagnosis of ADHD. [ABSTRACT FROM AUTHOR]

Informal mentoring, or unstructured mentoring focused on both career and psychosocial development of trainees, has received far less attention in the literature than more formal, structured mentoring or advising focused predominantly on career development. The aim of this article is to describe the critical nature of informal mentoring for psychology doctoral students, particularly in light of recent national race-related events (e.g., killings of unarmed Black people by police, hate crimes following the 2016 U.S. presidential election). Using our experiences as a case illustration, we detail the varied experiences of Black graduate students in our Department of Psychology, as well as the departmental response and the specific actions of Black faculty and others, to foster a climate in which difficult discussions can occur in and between groups and individuals. Also, the role of White students and mentors in such discussions is presented. Finally, we outline several recommendations for graduate programs in psychology, designed to increase informal mentoring for all students around difficult race-related topics. [ABSTRACT FROM AUTHOR]

Abstract: A randomized, parallel‐dose study assessed the pharmacokinetics (PK) and pharmacodynamics (PD) of etanercept in 61 patients with rheumatoid arthritis (RA) who received doses from 10 mg once‐weekly to 50 mg twice‐weekly for 4 weeks. Empiric application of a maximal‐effect (Emax) model to pooled steady‐state concentrations (Css) and PD markers provided half‐maximal‐effect concentration estimates of 567, 573, 465, 87, and 159 ng/mL for change from baseline in number of swollen joints, number of painful joints, erythrocyte sedimentation rate, interleukin‐6, and matrix metalloproteinase‐3, respectively. Css >∼2,000 ng/mL did not appear to offer additional benefit. It was concluded that the middle doses, 10 mg twice‐weekly, 50 mg every 2 weeks, and 50 mg once‐weekly, would provide Css in the target range of 500–2,000 ng/mL. The revised US Food and Drug Administration guideline for development of medicines for treatment of RA encourages a study design incorporating PK/PD assessment to inform later studies. [ABSTRACT FROM AUTHOR]

We investigated relationships among parenting stress, parental readiness to change, and child externalizing behaviors in a sample of clinically referred families. Additionally, parenting stress was investigated as a potential moderator of the relationship between parental readiness to change and child externalizing behaviors. Sixty-nine parents of clinically referred children completed measures of parenting stress, readiness to change, and child externalizing behaviors. We found that child externalizing behaviors, specifically hyperactivity/impulsivity and oppositionality, had a significant positive relationship with parental readiness to change and parenting stress. Child conduct disorder symptoms did not significantly relate to parental readiness to change. Parenting stress emerged as a significant moderator of the relationship between child externalizing behaviors and parental readiness to change, such that at low levels of parenting stress, readiness to change increased as level of child externalizing behaviors increased. However, at high levels of parenting stress, parental readiness to change remained high and constant irrespective of level of child externalizing behaviors. The findings from this small pilot study have significant implications for clinicians and researchers. The parents most ready to engage in child mental health services may be those with high levels of parenting stress, regardless of the severity of the child's behaviors. These parents may benefit from learning stress management strategies in addition to receiving intervention services for their children. Researchers should further examine the clinical utility of measuring readiness to change in families of children with behavior problems. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including the laws of war on prisoners of war in the 20th century, the Japanese occupation in World War II, and how international law influenced the treatment of prisoners of war in the Korean War.

As Ireland prepares to mark the centenary of the 1916 Easter Rising, Heather Jones traces how this failed military insurrection against British rule - mounted by a small, unrepresentative minority of Irish republicans - has evolved as a source of pride, division and controversy across the island over the course of a tumultuous century. [ABSTRACT FROM AUTHOR]

Underrepresentation of patients with non-white skin in rheumatology educational resources impairs practitioners' competence in caring for patients with skin of colour and reduces patients' confidence in the medical system. Medical publishers and educators should reconsider how to promote equal representation and care of patients with all skin types. [ABSTRACT FROM AUTHOR]

Background: Ventilator-induced lung injury is a form of acute lung injury that develops in critically ill patients on mechanical ventilation and has a high degree of mortality. Nicotinamide phosphoribosyltransferase is an enzyme that is highly upregulated in ventilator-induced lung injury and exacerbates the injury when given exogenously. Nicotinamide (vitamin B3) directly inhibits downstream pathways activated by Nicotinamide phosphoribosyltransferase and is protective in other models of acute lung injury. Methods: We administered nicotinamide i.p. to mice undergoing mechanical ventilation with high tidal volumes to study the effects of nicotinamide on ventilator-induced lung injury. Measures of injury included oxygen saturations and bronchoalveolar lavage neutrophil counts, protein, and cytokine levels. We also measured expression of nicotinamide phosophoribosyltransferase, and its downstream effectors Sirt1 and Cebpa, Cebpb, Cebpe. We assessed the effect of nicotinamide on the production of nitric oxide during ventilator-induced lung injury. We also studied the effects of ventilator-induced lung injury in mice deficient in C/EBPε. Results: Nicotinamide treatment significantly inhibited neutrophil infiltration into the lungs during ventilator-induced lung injury, but did not affect protein leakage or cytokine production. Surprisingly, mice treated with nicotinamide developed significantly worse hypoxemia during mechanical ventilation. This effect was not linked to increases in nitric oxide production or alterations in expression of Nicotinamide phosphoribosyl transferase, Sirt1, or Cebpa and Cebpb. Cebpe mRNA levels were decreased with either nicotinamide treatment or mechanical ventilation, but mice lacking C/EBPε developed the same degree of hypoxemia and ventilator-induced lung injury as wild-type mice. Conclusions: Nicotinamide treatment during VILI inhibits neutrophil infiltration of the lungs consistent with a strong anti-inflammatory effect, but paradoxically also leads to the development of significant hypoxemia. These findings suggest that pulmonary neutrophilia is not linked to hypoxemia in ventilator-induced lung injury, and that nicotinamide exacerbates hypoxemia during VILI. [ABSTRACT FROM AUTHOR]

The current study investigated relationships among self-reported peer victimization, suicidality, and depression in adolescent psychiatric inpatients. Sixty-seven adolescent psychiatric inpatients at a Midwestern children’s hospital completed measures of bullying and peer victimization, suicidal ideation, and depression during their inpatient stay. Analyses indicated significant moderate correlations among victimization, suicidal ideation, and depression in adolescents. Results from mediational analyses found that negative self-esteem mediated the relationship between peer victimization and suicidal ideation. To date, this study is the first to directly examine the mechanisms underlying the relationship between peer victimization and suicidal ideation in adolescent psychiatric inpatients. [ABSTRACT FROM PUBLISHER]

This study evaluates a simple clinical audit tool for assessing quality of care and blood pressure control among persons with hypertension in primary care clinics. A systematic random sampling of persons with diabetes mellitus (DM) and hypertension (HTN) attending five health centers in Kingston, Jamaica, was conducted. A modified Ministry of Health paper-based audit tool captured quality of care and outcome indicators (blood pressure and glycemic control). Additional chart audits were conducted by a physician and nurse to assess reliability. One hundred and forty-nine charts were audited between January and September 2017. One hundred and thirty-eight persons (92.6%) had hypertension (27 men and 111 women); 77 persons (51.7%) had DM (14 men and 63 women). The median age was 64 years old. Approximately two-thirds of persons with HTN and DM had electrolytes, lipid profile, and ECG done within the last year. One-fifth of persons with hypertension (18.5% men and 19.8% women, P = 1.000) had adequate blood pressure control with greater control among persons with HTN only compared to persons with both DM and HTN. Poor glycemic control was recorded for 69% of persons with DM (57% men and 71% women, P = .297). Moderate to substantial inter-rater agreement was observed for quality of care indicators. Our findings confirmed that hypertension and glycemic control are inadequate among persons attending primary care clinics in Jamaica's capital city. Simplified clinical audits can provide important quality of care and outcome indicators without losing the meaningfulness of the data collected. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to compare early outcomes of de novo LCPT (once‐daily extended‐release tacrolimus) to IR TAC (twice‐daily immediate‐release tacrolimus) in a predominantly African American (AA) adult kidney transplant population. Methods: This is a single center, retrospective cohort study. Patients were divided into two cohorts: IR TAC (administered between January 1, 2017, and January 31, 2019) and LCPT (administered between February 1, 2019, and May 31, 2020). Primary endpoints were changes in tacrolimus trough levels (ng/mL) and estimated glomerular filtration rate up to 12 months post‐transplantation. Clinical endpoints included graft survival, delayed graft function, biopsy‐proven rejection, CMV viremia, and BK. A propensity score weighted generalized linear mixed effects model was used for analysis. Results: The rate of change in tacrolimus levels was significantly higher in the LCPT cohort compared to the IR TAC cohort at 14 days post‐discharge (.2455 ng/mL per day vs..1073 ng/mL, respectively; p <.001). Subsequently, the LCPT cohort had a slightly higher rate of decline (–.015 ng/mL per day vs. –.010 ng/mL with IR TAC; p =.0894) up to 12 months post‐discharge. Although eGFR was similar between the two cohorts at 12 months post‐transplant, the rate of increase was slower in the LCPT cohort (.1371 mL/min per day vs..1852 mL/min per day, p =.0314). No significant differences were found in graft survival, DGF, BPAR, CMV, or BK infection. Conclusion: This study demonstrates that despite higher early trough levels with immediate post‐transplant LCPT use, clinical outcomes are comparable to IR TAC at one‐year post‐transplant. Notably, LCPT use does not increase the incidence of DGF and that this formulation of CNI can be used as first line therapy post‐transplant. [ABSTRACT FROM AUTHOR]

Background: Patients with vitiligo experience reduced quality of life. Objective: To comprehensively describe the available evidence for psychosocial burden in vitiligo. Methods: A systematic review of observational studies and clinical trials identified using PubMed, EMBASE, Scopus, and the Cochrane databases was performed through 1 March, 2021, to assess psychosocial comorbidities in vitiligo. Two independent reviewers performed an assessment of articles and extracted data for qualitative synthesis. Results: Included studies (N = 168) were published between 1979 and 1 March, 2021; 72.6% were published since 2010. Disorders including or related to depression (41 studies, 0.1–62.3%) and anxiety (20 studies, 1.9–67.9%) were the most commonly reported. The most prevalent psychosocial comorbidities were feelings of stigmatization (eight studies, 17.3–100%), adjustment disorders (12 studies, 4–93.9%), sleep disturbance (seven studies, 4.6–89.0%), relationship difficulties including sexual dysfunction (ten studies, 2.0–81.8%), and avoidance or restriction behavior (12.5–76%). The prevalence of most psychosocial comorbidities was significantly higher vs healthy individuals. Factors associated with a significantly higher burden included female sex, visible or genital lesions, age < 30 years (particularly adolescents), and greater body surface area involvement, among others. The most commonly reported patient coping strategy was lesion concealment. Limitations: Available studies were heterogeneous and often had limited details; additionally, publication bias is possible. Conclusions: The results of this systematic review show that vitiligo greatly affects psychosocial well-being. The extent of psychosocial comorbidities supports the use of multidisciplinary treatment strategies and education to address the vitiligo-associated burden of disease. Protocol Registration: PROSPERO (CRD42020162223). [ABSTRACT FROM AUTHOR]

The erythropoietin receptor (EpoR) stimulates erythrocyte proliferation after erythropoietin binding. EpoR belongs to the cytokine receptor superfamily and can be found on macrophages and endothelial cells. As there are no data on the role of EpoR systemic autoimmune diseases, we investigated the role of soluble EpoR (sEpoR) in patients with systemic lupus erythematosus (SLE). In a cross-sectional study we recorded clinical characteristics, disease activity (SLEDAI-2K) and organ damage (SDI). sEpoR, autoantibodies and cytokines were measured by enzyme-linked immunosorbent assay (ELISA) in SLE patients (n = 100) and compared with a rheumatoid arthritis (RA) cohort (n = 57) and a cohort with non-inflammatory back pain (NIBP; n = 89). Data were analysed with non-parametric techniques. We found no significant difference in sEpoR levels across the SLE, RA and NIBP groups and sEpoR levels were similar in patients with (6% of SLE and 31% of RA) or without anaemia. sEpoR levels were unrelated to haemoglobin levels, SLEDAI-2K or SDI scores, but in both cohorts correlated with levels for C-reactive protein (CRP), interleukin-6 (IL-6), tumour necrosis factor (TNF) and IL-1 (all P < 0.001). sEpoR levels are not involved in anaemia or erythropoietin resistance in SLE and RA patients, but closely mirror the underlying inflammatory process. This suggests that increased shedding of sEpoR during inflammation occurs at other sites than bone marrow. [ABSTRACT FROM AUTHOR]

Objectives The structural consequences of flare after dose reduction/discontinuation of biologic DMARDs in patients with RA who achieve remission are unclear. We compared the incidence of radiographic progression in patients with RA who did and did not experience flare after etanercept (ETN) reduction/withdrawal. Methods Eligible adults with moderately active RA despite MTX received ETN 50 mg plus MTX weekly in a 36-week, open-label induction period; patients achieving sustained low disease activity by week 36 were randomized to ETN 50 mg plus MTX, ETN 25 mg plus MTX, or placebo plus MTX in a 52-week, double-blind maintenance period. In post hoc analyses, radiographic progression (Δ modified total Sharp score ⩾0.5 units/year) was compared in patients with and without flare [based on DAS28 relapse (main analysis), and clinical disease activity index and simplified disease activity index relapse (sensitivity analyses)]. Findings from patients receiving full- and reduced-dose combination therapy were pooled for comparison with those from patients receiving MTX only. Results Significantly more patients receiving MTX monotherapy experienced flare, defined as DAS28 relapse (62% vs 21%; P < 0.0001) and radiographic progression (17% vs 9%; P < 0.001), than patients receiving full-/reduced-dose combination therapy in the double-blind period. Patients with flare defined as clinical disease activity index and simplified disease activity index relapse had higher rates of radiographic progression than those without flare in the full-/reduced-dose combination therapy group (P < 0.01). Conclusion Radiographic progression may be a consequence of flare after biologic DMARD dose reduction/withdrawal in patients with RA. If these approaches are taken, careful monitoring for signs/symptoms of relapse is needed. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov , NCT00565409. [ABSTRACT FROM AUTHOR]

Background: Dermatomyositis is an inflammatory myopathy that has an increased risk of malignancy, warranting aggressive health maintenance screenings. Dermatomyositis can rarely present with vulvovaginitis, thus clinical suspicion is important in early diagnosis.Case: We present the case of a 31-year-old woman with a 10-year history of vulvovaginitis as her presenting symptom of dermatomyositis. On further investigation, she had a history of joint pain, muscle pain, fatigue, and leukopenia. On examination, she was found to have a rash and mucopurulent vulvovaginitis. Biopsies from the chest, axilla, and vulva were compatible with dermatomyositis. Evaluation for malignancy was negative, and her symptoms resolved with treatment of the dermatomyositis.Conclusion: Dermatomyositis is an inflammatory disease that can be associated with malignancy. This particular patient presented with vulvovaginitis. This case is important because the diagnosis was delayed. Early recognition is important to evaluate for malignancy. [ABSTRACT FROM AUTHOR]

Objectives The US health care payment system is complex and difficult to interpret. Although federal regulations require that more data, in the form of charges and negotiated rates, be made available, compliance remains variable. We review chargemaster and negotiated rate values for extracorporeal photopheresis (ECP) to assess this variability. We sought to determine the availability of chargemaster and negotiated rates for health care consumers and to assess compliance and pricing among institutions using ECP as a model for apheresis billing. Methods We obtained ECP chargemaster data and negotiated rates from 20 institutions. We analyzed the availability of ECP chargemaster data and compared values with a previously published historic cohort. We evaluated the availability of negotiated rates and determined relative reimbursement using charge to reimbursement ratios. We determined calculated fines for hospitals based on bed size. Results Chargemaster availability increased from 2019 to 2022, though only 65% (13/20) of hospitals had both chargemaster and negotiated rate data. Chargemaster prices increased significantly from 2019 to 2022 (range, $3,586.83-$34,043.00). We reviewed 1,191 negotiated rates, with institutions averaging 93.6 different rates (SD, 189.5). Negotiated rates were variable, ranging from $3,586.83 to $34,043.00 per procedure. Reimbursement was higher among private insurers compared with reported Centers for Medicare & Medicaid Services negotiated rates. Of the 35% (7/20) that lacked chargemaster and negotiated rates, institutions faced an average annual fine of $1,430,800. Conclusions Despite recent financial penalties, ECP pricing data are often unavailable or inadequate. Current available resources are unlikely to benefit the average health care consumer who requires ECP. [ABSTRACT FROM AUTHOR]

While the association of racial discrimination and internalizing symptoms in Black individuals is well established, we still have a limited understanding of mechanisms and contextual factors influencing this association, such as sleep and the family context. The present study examined sleep and fatigue as mediators underlying the relationship between racial discrimination and internalizing symptoms within Black adolescent-caregiver dyads. Using data from a larger survey study of risk and resilience in Black adolescents (Mage= 14.36, 49.5% female) and their caregivers (Mage= 39.25, 75.9% female), we used the Actor-Partner Interdependence Model extended Mediation (APIMeM) to test associations of racial discrimination, sleep factors, and internalizing symptoms among 179 dyads. Significant actor effects revealed that sleep disturbance and fatigue independently mediated the association of racial discrimination and internalizing symptoms among adolescents and caregivers. Additionally, partner effects were found, such that adolescents' experiences of discrimination were indirectly associated with their caregivers' internalizing symptoms via caregiver fatigue. No direct or indirect effects of caregiver experiences of discrimination on adolescent outcomes were found. The findings highlight the important role sleep and fatigue play in the link between racial discrimination and internalizing symptoms among Black adolescents and adults; and the role that the family context may play in this association. Mental health and sleep interventions for Black individuals should address the impact of racial discrimination on internalizing symptoms, with an emphasis on family-focused interventions. [ABSTRACT FROM AUTHOR]

Immigrant women face unique barriers to prenatal care access and patient-provider communication. Yet, few prior studies have examined U.S.-born/immigrant differences in the content of care. The purpose of this study was to investigate the roles of immigrant status, English proficiency and race/ethnicity on the receipt of self-reported prenatal counseling using nationally representative data. We used data from the Early Childhood Longitudinal Study-Birth Cohort (N ≈ 8100). We investigated differences in self-reported prenatal counseling by immigrant status, English proficiency, and race/ethnicity using logistic regression. Counseling topics included diet, smoking, drinking, medication use, breastfeeding, baby development and early labor. In additional analyses, we separately examined these relationships among Hispanic, Mexican and Non-Hispanic (NH) Asian women. Neither immigrant status nor self-reported English proficiency was associated with prenatal counseling. However, we found that being interviewed in a language other than English language by ECLS-B surveyors was positively associated with counseling on smoking (OR, 2.599; 95% CI, 1.229-5.495) and fetal development (OR, 2.408; 95% CI, 1.052-5.507) among Asian women. Race/ethnicity was positively associated with counseling, particularly among NH black and Hispanic women. There is little evidence of systematic overall differences in self-reported prenatal counseling between U.S.-born and immigrant mothers. Future research should investigate disparities in pregnancy-related knowledge among racial/ethnic subgroups. [ABSTRACT FROM AUTHOR]

This paper focuses on the extent to which everyday travel behaviour in Britain changes in relation to family responsibilities, and examines how this has altered over the past century and a half. It is argued that prior to the mid-twentieth century changes in the family such as increased child-care responsibilities barely influenced the modes of transport used for everyday travel, but that increasingly in the later twentieth century people adjusted their travel behaviour during the family formation phases of the life cycle. In particular, parents of young children have become more car-dependent and less likely to walk or cycle. Data are drawn from two separate projects, one that collected travel life histories from the past half-century as context for research on cycling in later life, and one that uses personal diaries to reveal everyday mobility strategies of people in the nineteenth and early twentieth centuries. It is argued that the observed changes are due not only to increased access to a wide range of different transport forms, especially the motor car, but also to changes in societal perceptions of risk and norms of travel behaviour. In conclusion, it is suggested that more awareness of past travel behaviours could aid the development and implementation of more sustainable transport policies in the UK. [ABSTRACT FROM AUTHOR]