Sustained Antarctic Research: A 21st Century Imperative

The view from the south is, more than ever, dominated by ominous signs of change. Antarctica and the Southern Ocean are intrinsic to the Earth system, and their evolution is intertwined with and influences the course of the Anthropocene. In turn, changes in the Antarctic affect and presage humanity's future. Growing understanding is countering popular beliefs that Antarctica is pristine, stable, isolated, and reliably frozen. An aspirational roadmap for Antarctic science has facilitated research since 2014. A renewed commitment to gathering further knowledge will quicken the pace of understanding of Earth systems and beyond. Progress is already evident, such as addressing uncertainties in the causes and pace of ice loss and global sea-level rise. However, much remains to be learned. As an iconic global “commons,” the rapidity of Antarctic change will provoke further political action. Antarctic research is more vital than ever to a sustainable future for this One Earth

Physicians\u27 Perceptions of Shared Decision Making in Chronic Disease and Its Barriers and Facilitators

This study assessed pediatric physicians’ use of shared decision making (SDM) in two chronic conditions. Most physicians indicated that parent and adolescent trust and emotional readiness facilitated SDM, physicians’ preferred approach to decision making. At the same time, they perceived few barriers, other than insurance limitations, to using SDM

Physicians\u27 Perceptions of Shared Decision Making in Chronic Disease and Its Barriers and Facilitators

This study assessed pediatric physicians’ use of shared decision making (SDM) in two chronic conditions. Most physicians indicated that parent and adolescent trust and emotional readiness facilitated SDM, physicians’ preferred approach to decision making. At the same time, they perceived few barriers, other than insurance limitations, to using SDM

DEC-12 “The Hardest Decision I Ever Had”: Parent Decision Making About Tnf-Alpha Inhibitor Treatment

Purpose: Parents’ treatment decisions in pediatric chronic disease are often complicated by tradeoffs between disease and treatment risks, as well as the difficulty of proxy decision making. The objective of this study was to describe the information and process parents use to make treatment decisions for their children with chronic conditions; using decisions about TNF-α inhibitor (TNFαi) treatment, which has risks of immunosuppression and malignancy, as a model. Method: We conducted semi-structured interviews with parents of children with Crohn’s Disease (CD) (n = 14) or Juvenile Idiopathic Arthritis (JIA) (n = 20) who had experience deciding about TNFαi treatment. Participants had made a decision within the prior year, been referred to the study BECause of difficulty in decision making or were in the process of making the decision. Interview questions, developed based on existing pediatric decision-making literature and the Ottawa Decision Support Framework, were focused on information used to make decisions, factors that influenced decision making and the decision timeline. We used thematic analysis for all coding and analysis. Coding structure was developed through multidisciplinary team review of the initial interviews. Two coders then coded the remaining interviews, compared coding, and resolved disagreements through discussion. Data were analyzed by thematic grouping and compared between CD and JIA. Result: For nearly all parents, the decision about TNFαi treatment was the most challenging medical decision they had made. However, parents of children with CD experienced more, and ongoing, stress and anxiety related to the decision. In both groups, parents sought information from multiple sources including health care providers, the internet and social contacts. They looked for information related to treatment effectiveness, side-effects and individuals’ experiences with such treatment. In CD, where the decision often occurred over weeks to months, information was most often used to help make the decision. In contrast, in JIA the decision was often made in a single clinic appointment and information was then used to confirm the parent’s choice. Conclusion: Even after a decision has been made, some parents are left with persistent information needs, long-lasting concerns and worry related to TNFαi treatment for their child. Providing parents with structured support, including treatment-specific information, during TNFαi decision making may lead to improved decision quality, decreased psychosocial distress and, ultimately, improved outcomes for their childre

Science-based management in decline in the Southern Ocean

The burden of proof is being turned upside down</jats:p

DEC-12 “The Hardest Decision I Ever Had”: Parent Decision Making About Tnf-Alpha Inhibitor Treatment

Purpose: Parents’ treatment decisions in pediatric chronic disease are often complicated by tradeoffs between disease and treatment risks, as well as the difficulty of proxy decision making. The objective of this study was to describe the information and process parents use to make treatment decisions for their children with chronic conditions; using decisions about TNF-α inhibitor (TNFαi) treatment, which has risks of immunosuppression and malignancy, as a model. Method: We conducted semi-structured interviews with parents of children with Crohn’s Disease (CD) (n = 14) or Juvenile Idiopathic Arthritis (JIA) (n = 20) who had experience deciding about TNFαi treatment. Participants had made a decision within the prior year, been referred to the study BECause of difficulty in decision making or were in the process of making the decision. Interview questions, developed based on existing pediatric decision-making literature and the Ottawa Decision Support Framework, were focused on information used to make decisions, factors that influenced decision making and the decision timeline. We used thematic analysis for all coding and analysis. Coding structure was developed through multidisciplinary team review of the initial interviews. Two coders then coded the remaining interviews, compared coding, and resolved disagreements through discussion. Data were analyzed by thematic grouping and compared between CD and JIA. Result: For nearly all parents, the decision about TNFαi treatment was the most challenging medical decision they had made. However, parents of children with CD experienced more, and ongoing, stress and anxiety related to the decision. In both groups, parents sought information from multiple sources including health care providers, the internet and social contacts. They looked for information related to treatment effectiveness, side-effects and individuals’ experiences with such treatment. In CD, where the decision often occurred over weeks to months, information was most often used to help make the decision. In contrast, in JIA the decision was often made in a single clinic appointment and information was then used to confirm the parent’s choice. Conclusion: Even after a decision has been made, some parents are left with persistent information needs, long-lasting concerns and worry related to TNFαi treatment for their child. Providing parents with structured support, including treatment-specific information, during TNFαi decision making may lead to improved decision quality, decreased psychosocial distress and, ultimately, improved outcomes for their childre

Complete atrioventricular canal in a dog

Boron (B) has many beneficial functions in biological, metabolic and physiological processes for plants and animals. It plays a vital role in maintaining animal health and preventing nutritional disorders. Boron deficiency has been correlated with low immune function and high incidence of osteoporosis which increases mortality risk. Extraordinary boron level causes cell damage and toxicity in human and different animal species. In the past few years, attention has been paid to clear the pleiotropic effects of boron including activating of immune response, antioxidant detoxification activities, affecting bone metabolism, enhancing animal performance and modulating various body systems. Furthermore, the role of boron as anti-heat stress agent has been identified in plants and suggested in animals. Liver metabolism also shows significant alterations in dairy cows in response to the dietary supplementation of boron. Likewise, adding boron to animal feed enhances bone density, wound healing and embryonic development. Additionally, boron has a potential impact on the metabolism of numerous minerals and enzymes. In view of the information about boron benefits, high or low level boron merits the concern. As well, researches are required to do more in-depth investigations on boron influences, and to adjust its requirements in different animal specie

Comparative Effectiveness of Anti-TNF in Combination With Low-Dose Methotrexate vs Anti-TNF Monotherapy in Pediatric Crohn\u27s Disease: A Pragmatic Randomized Trial

BACKGROUND & AIMS: Tumor necrosis factor inhibitors, including infliximab and adalimumab, are a mainstay of pediatric Crohn\u27s disease therapy; however, nonresponse and loss of response are common. As combination therapy with methotrexate may improve response, we performed a multicenter, randomized, double-blind, placebo-controlled pragmatic trial to compare tumor necrosis factor inhibitors with oral methotrexate to tumor necrosis factor inhibitor monotherapy. METHODS: Patients with pediatric Crohn\u27s disease initiating infliximab or adalimumab were randomized in 1:1 allocation to methotrexate or placebo and followed for 12-36 months. The primary outcome was a composite indicator of treatment failure. Secondary outcomes included anti-drug antibodies and patient-reported outcomes of pain interference and fatigue. Adverse events (AEs) and serious AEs (SAEs) were collected. RESULTS: Of 297 participants (mean age, 13.9 years, 35% were female), 156 were assigned to methotrexate (110 infliximab initiators and 46 adalimumab initiators) and 141 to placebo (102 infliximab initiators and 39 adalimumab initiators). In the overall population, time to treatment failure did not differ by study arm (hazard ratio, 0.69; 95% CI, 0.45-1.05). Among infliximab initiators, there were no differences between combination and monotherapy (hazard ratio, 0.93; 95% CI, 0.55-1.56). Among adalimumab initiators, combination therapy was associated with longer time to treatment failure (hazard ratio, 0.40; 95% CI, 0.19-0.81). A trend toward lower anti-drug antibody development in the combination therapy arm was not significant (infliximab: odds ratio, 0.72; 95% CI, 0.49-1.07; adalimumab: odds ratio, 0.71; 95% CI, 0.24-2.07). No differences in patient-reported outcomes were observed. Combination therapy resulted in more AEs but fewer SAEs. CONCLUSIONS: Among adalimumab but not infliximab initiators, patients with pediatric Crohn\u27s disease treated with methotrexate combination therapy experienced a 2-fold reduction in treatment failure with a tolerable safety profile. CLINICALTRIALS: gov, Number: NCT02772965