Longitudinal Program Evaluation of an Inter-Institutional Mentorship Network for Pediatric Rheumatology Using a Quality Improvement Framework

BACKGROUND: The American College of Rheumatology (ACR)/Childhood Arthritis and Rheumatology Research Alliance (CARRA) Mentoring Interest Group (AMIGO) is an inter-institutional mentorship program launched to target mentorship gaps within pediatric rheumatology. Initial program evaluation indicated increased mentorship access. Given the small size of the pediatric rheumatology workforce, maintaining a consistent supply of mentors was a potential threat to the longevity of the network. Our aims were to: (i) describe the sustainability of AMIGO over the period 2011-2018, (ii) highlight ongoing benefits to participants, and (iii) describe challenges in the maintenance of a mentorship network. METHODS: A mixed-methods approach centered on a quality improvement framework was used to report on process and outcomes measures associated with AMIGO annual cycles. RESULTS: US and Canada Pediatric rheumatology workforce surveys identified 504 possible participants during the time period. As of fall 2018, 331 unique individuals had participated in AMIGO as a mentee, mentor or both for a program response rate of 66% (331/504). Survey of mentees indicated high satisfaction with impact on general career development, research/scholarship and work-life balance. Mentors indicated increased sense of connection to the community and satisfaction with helping mentees despite limited perceived benefit to their academic portfolios. Based on AMIGO\u27s success, a counterpart program for adult rheumatology, Creating Adult Rheumatology Mentorship in Academia (CARMA), was launched in 2018. CONCLUSIONS: Despite the challenges of a limited workforce, AMIGO continues to provide consistent access to mentorship opportunities for the pediatric rheumatology community. This experience can inform approaches to mentorship gaps in other academic subspecialties

Erratum: A survey of medical students' attitudes and practices towards narcotics and psychotropic drugs

There was an error in the author list of the published article.Two authors (A Kohansal Vajargah, K Ghaderi) requested to add to the authors lists. After obtaining the agreement of the authors and the corresponding author, and describing author contributions, Editor-in-Chief accept the corrections as listed below.The correct author list is:Shahab Dastmardi, Alireza Kohansal Vajargah, Morteza Rahbar Taromsari, Hamid Mohammadi Kojidi, Ardalan Majidinia, Fariba Asgari Bozayeh, Kaveh Ghaderi, Kourosh Delpasand We apologize for any inconvenience this may have caused. Erratum for:A survey of medical students' attitudes and practices towards narcotics and psychotropic drugsShahab Dastmardi, Morteza Rahbar Taromsari, Hamid Mohammadi Kojidi, Ardalan Majidinia, Fariba Asgari Bozayeh, Kourosh DelpasandJ Curr Biomed Rep. 2021; 2(3): 120-124

Barriers to Care in Juvenile Localized and Systemic Scleroderma: An Exploratory Survey Study of Caregivers’ Perspectives

BACKGROUND: Juvenile localized scleroderma (LS) and systemic sclerosis (SSc) are rare pediatric conditions often associated with severe morbidities. Delays in diagnosis are common, increasing the risk for permanent damage and worse outcomes. This study explored caregiver perspectives on barriers they encountered while navigating diagnosis and care for their child\u27s scleroderma. METHODS: In this cross-sectional study, caregivers of juvenile LS or SSc patients were recruited from a virtual family scleroderma educational conference and a juvenile scleroderma online interest group. The survey queried respondents about their child\u27s condition and factors affecting diagnosis and treatment. RESULTS: The response rate was 61% (73/120), with 38 parents of LS patients and 31 parents of SSc patients. Most patients were female (80%) and over half were non-Hispanic white (55%). Most families had at least one person with a college education or higher (87%), traveled ≤ 2 h to see their rheumatologist (83%), and had private insurance (75%). Almost half had an annual household income ≥ $100,000 (46$100,000, and Hispanic ethnicity were associated with specific barriers to care. Lower socioeconomic status was associated with longer travel times to see the rheumatologist/specialist. Diagnosis and systemic treatment initiation occurred at greater than one year from initial presentation for approximately 28% and 36% of patients, respectively. Families of LS patients were commonly given erroneous information about the disease, including on the need and importance of treating active disease with systemic immunosuppressants in patients with deep tissue or rapidly progressive disease. CONCLUSION: Caregivers of children with LS or SSc reported numerous common barriers to the diagnosis, treatment, and ongoing care of juvenile scleroderma. The major problem highlighted was the lack of knowledge of scleroderma within the general medical community. Given that most of the caregiver respondents to the survey had relatively high socioeconomic status, additional studies are needed to reach a broader audience, including caregivers with limited English proficiency, geographical limitations, and financial constraints, to determine if the identified problems are generalizable. Identifying key care barriers will help direct efforts to address needs, reduce disparities in care, and improve patient outcomes

Mobile-Mediated Versus Face-to-Face Dynamic Assessment, EFL Learners’ Writing Fluency and Strategy Awareness

The current study examined the effects of mobile-mediated versus face-to-face dynamic assessment (DA) on EFL learners’ writing fluency and strategy awareness during four treatment sessions. To fulfill this objective, a total of 45 Iranian EFL learners were randomly selected and assigned into two experimental conditions, which included one mobile-mediated and one face-to-face DA condition, and one control group. Then, the participants of the experimental conditions were engaged in mobile-mediated and face-to-face DA sessions targeting their writing fluency while the control group students were just asked to write. The results of data analysis indicated that both mobile-mediated and face-to-face DA conditions were beneficial for EFL learners’ writing fluency and revealed that mobile-mediated DA was more effective than face-to-face DA. Moreover, the results showed that mobile-mediated DA enhanced learners’ writing strategy awareness.</jats:p

Baseline characteristics of children with juvenile dermatomyositis enrolled in the first year of the new Childhood Arthritis and Rheumatology Research Alliance registry.

BACKGROUND: To report baseline characteristics, patient reported outcomes and treatment of children with Juvenile Dermatomyositis (JDM) in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. METHODS: Children newly diagnosed with JDM were enrolled in the CARRA Registry from 41 pediatric rheumatology centers. Baseline patient demographics, disease characteristics, assessments, patient reported outcome and treatments were recorded. RESULTS: In the first year, 119 JDM participants were enrolled. Most were female (63.4%), and white (72.3%) with a median diagnosis age 8.0 years (IQR 4.0-11.5), and median age of disease onset 7.0 years (IQR 3.5-7.5). They had characteristic rashes (92.4%), elevated muscle enzymes (83.2%), physician global score 4.0 (IQR 2.5-5.0) and manual muscle testing score 63.5 (IQR 51.0-75.0). Calcinosis (3.4%) and interstitial lung disease (&lt; 1%) were uncommon. Myositis specific antibodies were measured and reported in nearly half of participants enrolled where anti-MJ followed by Anti-p155/140 were most common (11/49 and 7/53 respectively). Childhood Health Assessment Questionnaire (CHAQ) results showed mild-moderate disability (median 0.750, IQR 0.030-1.875), as did patient/parent global assessments of disease activity (median 3, patient IQR: 1.75-5.25; parent IQR: 1-7). Patient Reported Outcomes Measurement Information System (PROMIS®) Pediatric Global Health 7 scores, Pain Interference, Physical Function scores for Mobility, and Upper Extremity Function were commonly worse than 95% of the general pediatric population. CONCLUSIONS: In its inaugural year, 119 JDM patients were successfully enrolled in participapte in the New CARRA Registy. This registry will provide the necessary foundation to advance clinical research to improve outcomes using traditional measures and patient reported outcomes. With the CARRA biorepository, this infrastructure will enable future translational research. Together, these efforts may aid in future clinical trials, including comparative effectiveness trials

Inpatient burden of juvenile dermatomyositis among children in the United States

Abstract Background Juvenile dermatomyositis (JDM) is a rare autoimmune disease that causes significant morbidity and quality of life impairment. Little is known about the inpatient burden of JDM in the US. Our goal was to determine the prevalence and risk factors for hospitalization with juvenile dermatomyositis and assess inpatient burden of JDM. Methods Data on 14,401,668 pediatric hospitalizations from the 2002–2012 Nationwide Inpatient Sample (NIS) was analyzed. ICD-9-CM coding was used to identify hospitalizations with a diagnosis of JDM. Results There were 909 and 495 weighted admissions with a primary or secondary diagnosis of JDM, respectively. In multivariable logistic regression models with stepwise selection, female sex (logistic regression; adjusted odds ratio [95% confidence interval]) (2.22 [2.05–2.42]), non-winter season (fall: 1.18[1.06–1.33]; spring (1.13 [1.01–1.27]; summer (1.53 [1.37–1.71]), non-Medicaid administered government insurance coverage (2.59 [2.26–2.97]), and multiple chronic conditions (2–5: 1.41[1.30–1.54]; 6+: 1.24[1.00–1.52]) were all associated with higher rates of hospitalization for JDM. The weighted total length of stay (LOS) and inflation-adjusted cost of care for patients with a primary inpatient diagnosis of JDM was 19,159 days and $49,339,995 with geometric means [95$7350 [$6228–$8674], respectively. Costs of hospitalization in primary JDM and length of stay and cost in secondary JDM were significantly higher compared to those without JDM. Notably, race/ethnicity was associated with increased LOS (log-linear regression; adjusted beta [95% confidence interval]) (Hispanic: 0.28 [0.14–0.41]; other non-white: 0.59 [0.31–0.86]) and cost of care (Hispanic: 0.30 [0.05–0.55]). Conclusion JDM contributes to both increased length of hospitalization and inpatient cost of care. Non-Medicaid government insurance was associated with higher rates of hospitalization for JDM while Hispanic and other non-white racial/ethnic groups demonstrated increased LOS and cost of care

Optimizing green infrastructure strategies for microclimate regulation and air quality improvement in urban environments: A case study

With an increasing global urban population andassociated health concerns, understanding the effects of urban microclimate and air quality is crucial. This study aims to assess the influence of different types and locations of greenery, along with building heights and wind orientation, on urban canyon microclimate and air quality. Focusing on PM10, PM2.5, and NOx concentrations in a hot-arid district, the research employs simulation-based analysis. Results indicate that stepped buildings with green walls exhibit the highest temperature (18.02°C), while scenarios featuring two rows of deciduous trees showcase the lowest temperature (17.56°C) but higher pollution levels. Notably, scenarios lacking trees exhibit elevated temperatures. The study introduces a novel ventilation design pattern for effective air pollutant removal and proposes a scenario with extensive green coverage on streets, walls, and rooftops, incorporating appropriate planting techniques and plant selection. The findings offer valuable insights for urban designers and architects seeking to create more sustainable and environmentally friendly cities