The utility of frequent laboratory monitoring for patients on tumor necrosis factor-alpha inhibitors in dermatology

Introduction. Tumor necrosis factor-alpha inhibitors (TNF-ai) are becoming increasingly common to use among patients with skin disease. To safely take these medications, it is recommended to monitor laboratory values routinely; however, the utility of this practice and the risk-benefit of frequent laboratory monitoring has not been fully explored in patients with skin disease. The purpose of this study was to evaluate the necessity of routine laboratory monitoring in patients taking a TNF-ai with a dermatological disease.  Methods. Retrospective chart review evaluated laboratory abnormalities (complete blood counts and liver function tests) in adult patients who took a TNF-ai for a dermatologic disease at The University of Kansas Hospital. Results. There were 27 patients included for a total of 45 entries. The most common skin disease was hidradenitis suppurative (23/45) and infliximab (22/45) was most the commonly used medication. Of the 45 entries, there were only 7 patients that developed abnormal monitoring laboratory values related to initiation of TNF-ai. These abnormalities were transient and most frequently occurred after 12 months with (2/45) resulting in no discontinuation or dose reduction of TNF-ai. One patient discontinued medication due to anemia that did not improve after medication withdrawal. Conclusions. Laboratory abnormalities due to TNF-ai were infrequent and when they did occur were transient and mild. The study is limited by the small sample size of patients, and larger prospective studies are needed to fully evaluate these findings. However, dermatologists may be able to safely employ less frequent laboratory monitoring for patients on TNF-ai

SJS/TENN: A Mnemonic for Early Clinical Diagnosis of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Steven Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are dermatologic emergencies that are more likely to be encountered by primary care providers rather than dermatologists. Thus, it is essential for all clinicians to be familiar with common signs associated with SJS/TEN, so as not to miss or delay the diagnosis. We designed the simple mnemonic “SJS/TENN” which describes the most frequently seen clinical characteristics in these conditions to aid in the initial diagnosis

The bicycle wheel analogy for linear closures of small suborbital cheek defects

Primary closure of suborbital skin defects can cause tension along the closure resulting in ectropion. The bicycle wheel analogy is a simple yet effective guide to aid in reducing tension vectors resulting in ectropion

A Multi-Site Survey Study of Patient Satisfaction with Teledermatology

Introduction. Telemedicine has been of heightened focus due to spikes in usage during the COVID-19 pandemic. Disparities in health care may affect patient satisfaction with this resource depending on factors such as patient race, age, or socioeconomic background. The purpose of this study was to analyze patient satisfaction with teledermatology to identify any differences in satisfaction based on race, age, and income during the COVID-19 pandemic period. Methods. A 21-question, IRB-approved survey was administered to patients at two academic dermatology clinics in Kansas City. Patient satisfaction was measured using a five-point Likert scale. Results. A total of 64 completed surveys were analyzed (17.8% response rate). Most of the participants were female (n = 48, 75%), age 45 to 60 (n = 17, 26.6%), and reported White for race (n = 55, 85.9%). Overall, 73.4% (n = 47) of patients reported being satisfied with their visit. However, only 38.7% (n = 24) of participants were likely to choose a video over an in-person visit. Reasons for low patient satisfaction included concerns regarding ability to perform an accurate physical exam with a video visit (n = 9, 14.1%), receiving inadequate care (n = 4, 6.3%), protected privacy (n = 3, 4.7%), and provider understanding the patient (n = 2, 3.1%). Conclusions. Our findings were similar to prior studies stating no difference in patient satisfaction with regards to age, income, or race and patients reporting high satisfaction with teledermatology appointments despite a preference for in-person dermatology visits. Future studies with a larger diverse cohort of participants are needed to elucidate and address possible disparities associated with teledermatology use

Description of local multiplicity fluctuations and genuine multiparticle correlations

Various parametrizations of the multiplicity distribution are studied using the recently published large statistics OPAL results on multidimensional local fluctuations and genuine correlations in e+e- -> Z -> hadrons. The measured normalized factorial and cumulant moments are compared to the predictions of the negative binomial distribution, the modified and generalized versions of it, the log-normal distribution and the model of the generalized birth process with immigration. This is the first study which uses the multiplicity distribution parametrizations to describe high-order genuine correlations. Although the parametrizations fit well the measured fluctuations and correlations for low orders, they do show certain deviations at high orders. We have shown that it is necessary to incorporate the multiparticle character of the correlations along with the property of self-similarity to attain a good description of the measurements.Comment: 15 pages, 2 ps figure

Effect of and Acute Bout of Kettlebell Exercise on Glucose Tolerance in Sedentary Men: a Preliminary Study

International Journal of Exercise Science 9(4): 524-535, 2016. Impaired glucose tolerance can have significant health consequences. The purposes of this preliminary study were to examine whether a single session of kettlebell exercise improves acute post-exercise glucose tolerance in sedentary individuals, and whether it was as effective as high-intensity interval running. Six sedentary male subjects underwent a two-hour oral glucose tolerance test following three different conditions: 1) control (no exercise); 2) kettlebell exercise (2 sets of 7 exercises, 15 repetitions per exercise with 30 seconds rest between each exercise); or 3) high-intensity interval running (10 one-minute intervals at a workload corresponding to 90% VO2max interspersed with one-minute active recovery periods). Blood glucose and insulin levels were measured before (0 minutes), and 60 and 120 minutes after glucose ingestion. Both kettlebell and high-intensity interval running exercise significantly lowered blood glucose 60 minutes after glucose ingestion compared with control. However, there was no significant difference in blood glucose between the two exercise conditions at any time point. In addition, there were no significant differences in insulin concentration between high intensity interval running, kettlebell, and control conditions at all time points. Results indicate that an acute bout of kettlebell exercise is as effective as high intensity interval running at improving glucose tolerance in sedentary young men

Production of He-4 and (4) in Pb-Pb collisions at root(NN)-N-S=2.76 TeV at the LHC

Results on the production of He-4 and (4) nuclei in Pb-Pb collisions at root(NN)-N-S = 2.76 TeV in the rapidity range vertical bar y vertical bar <1, using the ALICE detector, are presented in this paper. The rapidity densities corresponding to 0-10% central events are found to be dN/dy4(He) = (0.8 +/- 0.4 (stat) +/- 0.3 (syst)) x 10(-6) and dN/dy4 = (1.1 +/- 0.4 (stat) +/- 0.2 (syst)) x 10(-6), respectively. This is in agreement with the statistical thermal model expectation assuming the same chemical freeze-out temperature (T-chem = 156 MeV) as for light hadrons. The measured ratio of (4)/He-4 is 1.4 +/- 0.8 (stat) +/- 0.5 (syst). (C) 2018 Published by Elsevier B.V.Peer reviewe

Holistic scoring practices of student compositions among pre- and in-service secondary English teachers

This study targeted populations of in-service and pre-service English teachers to gain information about their grading practices of student compositions. The study focused on secondary English classrooms across rural Nebraska as revealed by a survey. A total of one-hundred and fifty in-service teachers of at least ten years standing in their current assignment and twenty-five pre-service language arts teachers of at least second semester sophomore standing admitted to a teacher education program at a Nebraska State Teacher\u27s College were invited to participate in the study. The return rate for in-service was just under fifty percent, and the pre-service (a contained population) responded at the 100 percent return rate. Comparisons of attitudes and practices regarding grading of student writing were made in and across groups. The IRA (International Reading Association) and the NCTE (National Council of Teachers of English), had issued a joint call to new grading procedures in 1994, and the study was designed to check on any continuing popularity of holistic scoring which denied those new concerns. Both populations agreed that holistic scoring is still wide-spread, but neither group reported receiving what was considered a proper amount of training of any ilk in the grading of compositions; in-service teachers believe far more strongly that their students understand their grading procedures than do pre-service teachers, small group work is either de-emphasized or not used due to perceived behavior problems, and many from both populations add (or would add) comments onto holistically scored papers. A substantial number from both populations also felt compelled to place percentage grades on these same compositions, if for no other reason than to satisfy district grading requirements. Many of these same respondents recognized and articulated the seeming incongruity in this instance: process writing techniques in the classroom being controlled by product grading procedures. The study suggests that a mismatch of instructional methods and grading techniques exists, particularly in regard to poststructural concerns in today\u27s composition classroom