Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: Results from the COVID-19 Global Rheumatology Alliance Vaccine Survey

BACKGROUND: We describe the early experiences of adults with systemic rheumatic disease who received the COVID-19 vaccine. METHODS: From 2 April to 30 April 2021, we conducted an online, international survey of adults with systemic rheumatic disease who received COVID-19 vaccination. We collected patient-reported data on clinician communication, beliefs and intent about discontinuing disease-modifying antirheumatic drugs (DMARDs) around the time of vaccination, and patient-reported adverse events after vaccination. RESULTS: We analysed 2860 adults with systemic rheumatic diseases who received COVID-19 vaccination (mean age 55.3 years, 86.7% female, 86.3% white). Types of COVID-19 vaccines were Pfizer-BioNTech (53.2%), Oxford/AstraZeneca (22.6%), Moderna (21.3%), Janssen/Johnson & Johnson (1.7%) and others (1.2%). The most common rheumatic disease was rheumatoid arthritis (42.3%), and 81.2% of respondents were on a DMARD. The majority (81.9%) reported communicating with clinicians about vaccination. Most (66.9%) were willing to temporarily discontinue DMARDs to improve vaccine efficacy, although many (44.3%) were concerned about rheumatic disease flares. After vaccination, the most reported patient-reported adverse events were fatigue/somnolence (33.4%), headache (27.7%), muscle/joint pains (22.8%) and fever/chills (19.9%). Rheumatic disease flares that required medication changes occurred in 4.6%. CONCLUSION: Among adults with systemic rheumatic disease who received COVID-19 vaccination, patient-reported adverse events were typical of those reported in the general population. Most patients were willing to temporarily discontinue DMARDs to improve vaccine efficacy. The relatively low frequency of rheumatic disease flare requiring medications was reassuring

Business Plan - Smartlamp

Business Plan - Smartlamp. A proposal to manufacture and sell intelligent lamps

Promoting Health Independence Through Accessible Health Resources

Introduction The U.S. Department of Housing and Urban Development (HUD, 2018) defines an individual or family as homeless, as someone who lacks “fixed, regular, and adequate nighttime residence”. As of January 2020, there were an estimated 11,751 individuals experiencing homelessness in Seattle/King County (King County Regional Homelessness Authority, 2020). National Alliance to End Homelessness (2020) explains that health and homelessness are inextricably linked, where an acute physical or behavioral health crisis or any long-term disabling condition may lead to homelessness; homelessness itself can exacerbate chronic medical conditions. To reduce the number of homeless families on the streets in King County, Mary’s Place offers a safe inclusive shelter to support women, children, and families on their journey out of homelessness. Mary’s Place believes that no one’s child should sleep outside. They aim to keep families together and safe when they have no place else to go, by providing resources, housing and employment services, community, and hope. In 2020, Mary’s Place had served 586 families and 1,225 children across Seattle, Northshore, White Center, Burien, Auburn, and South Lake Union. Our project’s focus location is at Family Center in The Regrade, downtown Seattle. The goal of our project is to provide a health resource binder which has useful, easy to use health information that is relevant, up to date, accessible, holistic, inclusive, organized, and tailored to Mary’s Place clientele. Background  Based on the latest survey conducted by the King County Regional Homelessness Authority (RHA) (2020), individuals in family households make up a total of 3,743 adults and children, or 32% of the total homeless population in Seattle/King County in 2020. This was the first increase seen in the past four years (unsheltered homelessness from 3% in 2017 to 2019, to 29% in 2020). The top three most used services by individuals in family households are emergency shelters (58%) followed by bus passes (51%) and free meals (44%). The most commonly cited challenges when trying to access services are lack of transportation (35%), not knowing where to go for help (30%), not hearing back after applying for services (25%) and didn’t qualify for service (18%). These statistics support our agency liaison’s request to collate a resource binder with information related to transportation, healthcare, wellbeing improvements, and specifically where to go for help if they need affordable, free or Medicare/Medicaid accepting facilities. Our project’s goal is to address the clients’ deficient access to resources directed at healthcare needs, promote optimum family well-being and enhance their overall wellness. We formulated our nursing diagnosis as follows: Readiness for enhanced knowledge and family coping related to health management and improvement as evidenced by reports from Mary’s Place liaison about the client’s deficient access to resources. Activities and Methods Our project framework is based on Pender’s Health promotion model (HPM), which focuses on helping clients achieve higher levels of well-being and identifies background factors that influence health behaviors (Khoshnood et al., 2020). In consistent with operationalizing HPM, we structured our project activities by conducting nursing assessment, diagnosis, and interventions (Khoshnood et al., 2020). The HPM provides a framework for our project to provide accessible health resources to help clients locate affordable or free healthcare services and pursue better health outcomes through preventive healthcare and pursue overall wellness. We commenced our fact finding by conducting a windshield survey and toured Mary’s Place where we were briefed on the facilities provided to the clients. Our project activities include gathering existing resources from Mary’s Place and updating it with added information on healthcare facilities that provide free/affordable services. Related health literature was reviewed for evidence-based resources and had weekly meetings with our agency liaison to ensure that we are delivering the final product as per expectations. We tracked our specific tasks assignments and project deliverables via a Gantt chart. The logic model outlined our project goal, inputs, activities, outputs, outcomes and impact of our deliverables to Mary’s Place clientele. We agreed with our agency liaison on the final deliverable, which is the health resource binder that can be accessible by all clients and staff at Mary’s Place. In addressing the most cited challenges based on the survey by RHA (2020), our team researched and collated information on the following: transportation options (i.e., bus routes, Orca cards, Hope Link, etc.), healthcare services that provide free or affordable medical, dental, and mental health services, family planning and women’s health, nutrition (e.g., food pantry, SNAP benefits), and children and teens health. For each of the categories, we included the following details for each of the facilities: name, address, phone number, website, operating hours, services provided, and types of payment or eligibility (i.e., Medicaid, uninsured, undocumented). In a study conducted by Ramsay et al. (2019), lack of transportation was a significant barrier for individuals experiencing homelessness, as they were unable to attend appointments or travel to laboratories and imaging facilities, which significantly impacted their ability to access care. inability to find a physician that was able or willing to accept them as patients was another barrier to accessing health care (Ramsay et al., 2019). Hence, this further supported the agency’s need to have the health resource binder on hand to enable easy navigation for their clientele. Outcomes  Our project’s goal is to equip the clients with relevant and useful health information to develop the client’s individual plans to meet their respective healthcare needs/goals, optimize wellness, and enable the families to meet their needs during this relocation transition. This binder should be able to provide the families with a sense of self-efficacy, normalize self-care, and encourage the family’s health-seeking behaviors. In addition, the ease of accessibility and availability of the information should help save time for the clients, families, as well as the agency. To ensure that we were working towards delivering the critical resources for their clients, we had frequent meetings with our liaison to discuss any roadblocks and ensure that we continued to deliver the expected outcomes. The final presentation of our resource binder to our agency liaison, and her team at the end of the project will enable us to perform a preliminary assessment of the appropriateness, and usefulness of the health resource binder. Due to time limitations, we are not able to evaluate the effectiveness of the resource binder or dedicate time at Mary’s Place in-person, to gather feedback from the clients regarding the effectiveness of the resource binder. It is our recommendation to have the staff at Mary’s Place evaluate the effectiveness of the resource binder and eventually expand the binder to be available for all Mary’s Place locations. Again, due to the duration of our project, the project limitations include the ability to assess and evaluate the long-term healthcare impacts, and effectiveness on the clients, families, and staff at Mary’s Place. This would serve as an opportunity for future projects to assess and evaluate the effectiveness of these resources, and to better enhance the information based on the feedback from the agency and the clients to further improve the health and wellbeing of clients at Mary’s Place. Conclusion  Our long-term goal and objectives for the health resource binder is to improve the overall wellbeing of Mary’s Place clientele, by reducing illness through preventative healthcare, reducing number homelessness due to less medical bankruptcy, increase work productivity, and independence of the clients. Hence accessibility to obtaining appropriate ambulatory care, improving the long-term management of physical and mental illnesses, and addressing structural factors such as transportation can help achieve our long-term goals and objectives (Hwang et al. 2013). We are hopeful that this resource binder will help serve the purpose it was intended for and positively impact the clients at Mary’s Place. References Hwang, S. W., Chambers, C., Chiu, S., Katic, M., Kiss, A., Redelmeier, D. A., & Levinson, W. (2013). A comprehensive assessment of health care utilization among homeless adults under a system of universal health insurance. American Journal of Public Health, 103(Suppl 2), S294–S301. doi:10.2105/AJPH.2013.301369 Khoshnood, Z., Rayyani, M., & Tirgari, B. (2020). Theory analysis for Pender’s health promotion model (HPM) by Barnum’s criteria: A critical perspective. International Journal of Adolescent Medicine and Health, 32(4). https://doi.org/10.1515/ijamh-2017-0160 King County Regional Homelessness Authority (RHA, 2020). Seattle/King County point-in-time count of individuals experiencing homelessness 2020. https://kcrha.org/king-county-point-in-time-count/ Mary’s Place (2020). 2020 Gratitude report. https://static1.squarespace.com/static/5b8989d231d4df1bccd7bcc7/t/60721c9c6b0134353fb33bc3/1618091166064/MP+2020+Gratitude+Report.pdf National Alliance to End Homelessness (2020). Health. https://endhomelessness.org/homelessness-in-america/what-causes-homelessness/health/ Ramsay, N., Hossain, R., Moore, M., Milo, M., & Brown, A. (2019). Health care while homeless: Barriers, facilitators, and the lived experiences of homeless individuals accessing health care in a Canadian regional municipality. Qualitative Health Research, 29(13), 1839-1849. Doi: https://doi-org.ezproxy.spu.edu/10.1177/1049732319829434 U.S. Department of Housing and Urban Development (HUD, 2018). Key federal terms and definitions of homelessness. https://www.usich.gov/resources/uploads/asset_library/Federal-Definitions-of-Youth-Homelessness.pd

A cognitive pathway to punishment insensitivity

Individuals differ in their sensitivity to the adverse consequences of their actions, leading some to persist in maladaptive behaviors. Two pathways have been identified for this insensitivity: a motivational pathway based on excessive reward valuation and a behavioral pathway based on autonomous stimulus–response mechanisms. Here, we identify a third, cognitive pathway based on differences in punishment knowledge and use of that knowledge to suppress behavior. We show that distinct phenotypes of punishment sensitivity emerge from differences in what people learn about their actions. Exposed to identical punishment contingencies, some people (sensitive phenotype) form correct causal beliefs that they use to guide their behavior, successfully obtaining rewards and avoiding punishment, whereas others form incorrect but internally coherent causal beliefs that lead them to earn punishment they do not like. Incorrect causal beliefs were not inherently problematic because we show that many individuals benefit from information about why they are being punished, revaluing their actions and changing their behavior to avoid further punishment (unaware phenotype). However, one condition where incorrect causal beliefs were problematic was when punishment is infrequent. Under this condition, more individuals show punishment insensitivity and detrimental patterns of behavior that resist experience and information-driven updating, even when punishment is severe (compulsive phenotype). For these individuals, rare punishment acted as a “trap,” inoculating maladaptive behavioral preferences against cognitive and behavioral updating

Host Transcriptional Response to Persistent Infection with a Live-Attenuated Porcine Reproductive and Respiratory Syndrome Virus Strain

Both virulent and live-attenuated porcine reproductive and respiratory syndrome virus (PRRSV) strains can establish persistent infection in lymphoid tissues of pigs. To investigate the mechanisms of PRRSV persistence, we performed a transcriptional analysis of inguinal lymphoid tissue collected from pigs experimentally infected with an attenuated PRRSV strain at 46 days post infection. A total of 6404 differentially expressed genes (DEGs) were detected of which 3960 DEGs were upregulated and 2444 DEGs were downregulated. Specifically, genes involved in innate immune responses and chemokines and receptors associated with T-cell homing to lymphoid tissues were down regulated. As a result, homing of virus-specific T-cells to lymphoid tissues seems to be ineffective, evidenced by the lower frequencies of virus-specific T-cell in lymphoid tissue than in peripheral blood. Genes associated with T-cell exhaustion were upregulated. Likewise, genes involved in the anti-apoptotic pathway were upregulated. Collectively, the data suggested that the live-attenuated PRRSV strain establishes a pro-survival microenvironment in lymphoid tissue by suppressing innate immune responses, T-cell homing, and preventing cell apoptosis

Nonsteroidal Antiinflammatory Drug Use and Association With Incident Hypertension in Ankylosing Spondylitis.

ObjectiveNonsteroidal antiinflammatory drugs (NSAIDs) increase blood pressure and potentially cardiovascular burden, which may limit their use in ankylosing spondylitis (AS). Our objective was to determine the association of NSAID use with incident hypertension in a longitudinal AS cohort.MethodsAdults with AS were enrolled in a prospective cohort study of patient outcomes and examined every 4-6 months. Hypertension was defined by patient-reported hypertension; antihypertensive medication use; or, on 2 consecutive visits, systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Continuous NSAID use was dichotomized based on the validated NSAID index. We assessed the association of NSAID use as a time-varying exposure with the incidence of hypertension using Cox proportional hazards models.ResultsOf the 1,282 patients in the cohort, 628 patients without baseline hypertension had at least 1 year of follow-up and were included in the analysis. Of these, 72% were male, the mean age at baseline was 39 ± 13 years, and 200 patients used NSAIDs continuously. On follow-up, 129 developed incident hypertension. After controlling for other variables, continuous NSAID use was associated with a hazard ratio of 1.12 for incident hypertension (95% confidence interval 1.04-1.20), compared to noncontinuous or no use. The association did not differ in subgroups defined by age, body mass index, biologic use, or disease activity.ConclusionIn our prospective, longitudinal AS cohort, continuous NSAID use was associated with a 12% increased risk for the development of incident hypertension, as compared to noncontinuous or no NSAID use

Social media for research discourse, dissemination, and collaboration in rheumatology

Social media has become an important venue for rheumatologists, patients, organizations, and other stakeholders to discuss recent research advances in diagnosis and management of rheumatic disorders. In this article, we describe the current state of how social media may enhance dissemination, discourse, and collaboration in rheumatology research. Social media may refer to social platforms like Twitter and Instagram or digital media like podcasts and other websites that are operated for providing as free, open-access medical education (FOAM). Twitter has been one of the most active social media venues and continues to host a vibrant rheumatology community. Examples of research discussions on Twitter include organic user tweets, educational threads ( tweetorials ), live-tweeting academic conferences, and journals posting recently-accepted articles. Some research collaborations have been initiated through social media interactions. Social media may also directly contribute to research by facilitating the recruitment of study participants and the collection of survey-based data. Thus, social media is an evolving and important tool to enhance research discourse, dissemination, and collaboration in rheumatology

A rush to judgment? Rapid reporting and dissemination of results and its consequences regarding the use of hydroxychloroquine for COVID-19

Funding Information: Disclosures: Dr. Kim reports personal fees from Exagen Diagnostics and GlaxoSmithKline and grants from the National Institutes of Health and the Rheumatology Research Foundation outside the submitted work. Dr. Sparks reports grants from the National Institute of Allergy and Infectious Diseases Autoimmune Centers of Excellence, National Institutes of Health, during the conduct of the study and personal fees from Bristol-Myers Squibb, Gilead, Inova, Janssen, and Optum outside the submitted work. Dr. Berenbaum reports personal fees from Boehringer, Bone Therapeutics, Expanscience, Galapagos, Gilead, GSK, Merck Sereno, MSD, Nordic, No-vartis, Pfizer, Regulaxis, Roche, Sandoz, Sanofi, Servier, UCB, Peptinov, TRB Chemedica, and 4P Pharma outside the submitted work. Dr. Korsten reports personal fees from GlaxoSmith-Kline, Sanofi-Aventis, Pfizer, AbbVie, Novartis Pharma, Lilly, and Bristol-Myers Squibb outside the submitted work. Dr. Sat-tui reports funding from a Vasculitis Clinical Research Consortium (VCRC)/Vasculitis Foundation Fellowship. The VCRC is part of the Rare Diseases Clinical Research Network, an initiative of the Office of Rare Diseases Research, National Center for Advancing Translational Science (NCATS). The VCRC is funded through collaboration between NCATS and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (U54 AR057319). Dr. Ugarte-Gil reports grants from Pfizer and Janssen outside the submitted work. Dr. Grainger reports nonfinancial support from Pfizer Australia and Janssen Australia and personal fees from Pfizer Australia, Cornerstones, Janssen New Zealand, and Novartis outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www .acponline.org/authors/icmje/ConflictOfInterestForms.do?ms Num=M20-1223.publishersversio

The Islet Estrogen Receptor-α Is Induced by Hyperglycemia and Protects Against Oxidative Stress-Induced Insulin-Deficient Diabetes

The female steroid, 17β-estradiol (E2), is important for pancreatic β-cell function and acts via at least three estrogen receptors (ER), ERα, ERβ, and the G-protein coupled ER (GPER). Using a pancreas-specific ERα knockout mouse generated using the Cre-lox-P system and a Pdx1-Cre transgenic line (PERαKO−/−), we previously reported that islet ERα suppresses islet glucolipotoxicity and prevents β-cell dysfunction induced by high fat feeding. We also showed that E2 acts via ERα to prevent β-cell apoptosis in vivo. However, the contribution of the islet ERα to β-cell survival in vivo, without the contribution of ERα in other tissues is still unclear. Using the PERαKO−/− mouse, we show that ERα mRNA expression is only decreased by 20% in the arcuate nucleus of the hypothalamus, without a parallel decrease in the VMH, making it a reliable model of pancreas-specific ERα elimination. Following exposure to alloxan-induced oxidative stress in vivo, female and male PERαKO−/− mice exhibited a predisposition to β-cell destruction and insulin deficient diabetes. In male PERαKO−/− mice, exposure to E2 partially prevented alloxan-induced β-cell destruction and diabetes. ERα mRNA expression was induced by hyperglycemia in vivo in islets from young mice as well as in cultured rat islets. The induction of ERα mRNA by hyperglycemia was retained in insulin receptor-deficient β-cells, demonstrating independence from direct insulin regulation. These findings suggest that induction of ERα expression acts to naturally protect β-cells against oxidative injury