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BACKGROUND: Board-certified dermatologists experience diverse practice gaps. OBJECTIVE: Identify the top self-selected focused Practice Improvement (fPI) modules completed over time by board-certified dermatologists during the program's first 8 years. METHODS: Cohort study of dermatologists certified by American Board of Dermatology (ABD) completing fPI modules from 2016 to 2023. This descriptive analysis reports modules completed by topic, subspecialty, relevance, and self-reported changes to subsequent patient care related to modules. RESULTS: 19143 fPI modules were completed by 7378 unique ABD diplomates, representing 48.8% of all current ABD-certified dermatologists (n = 15118). Modules were rated relevant by 18917 participants (99%). Care gaps requiring improvement efforts and performance remeasurement occurred in 2919 (15.2%) completed modules. Acne and medication-related laboratory monitoring were popular topics requiring improvement. Diplomates reported care improvements resulting from completing modules in 8397 instances (43.9%), and improved patient outcomes in at least one patient 5310 times (27.7%). Finally, diplomates stated they would recommend fPI modules to peers 18633 (97.3%) times. LIMITATIONS: Dermatologists who started but did not complete modules would not have rated the module. Attribution bias on care impact is possible and potentially overestimated. CONCLUSION: The ABD fPI program is helping board-certified dermatologists identify and improve gaps in care with reported patient outcome improvements.
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OBJECTIVE: The FACE-Q Skin Cancer Module is a Patient-Reported Outcome Measure (PROM) utilized to assess outcomes following facial skin cancer resection. However, the lack of Minimal Important Difference (MID) estimates hinders the interpretability of the PROM scores. This study established MID estimates for the four outcome scales from the FACE-Q Skin Cancer Module using distribution-based methods. METHODS: A prospective cohort study at four hospitals in the United States, enrolled participants who underwent Mohs Micrographic Surgery (MMS) for facial skin cancer between April 2020 and April 2022. Participants completed the Satisfaction with Facial Appearance, Appearance-related Psychosocial Distress, Cancer Worry, and Appraisal of Scars scales at four time points: pre-operatively, 2-week, 6-month, and 1-year post-surgery. RESULTS: A total of 990 patients participated in the study, with completion rates of 98.4% for the pre-operative assessment, 70.8% at 2 weeks, 59.3% at 6 months, and 60.4% at 1 year. MID estimates, calculated using 0.2 standard deviation and 0.2 standardized response mean, were determined for the four scales. The mean MID estimates, based on a Rasch transformed score ranging from 0 to 100, were 5 for the Appraisal of Scars scale and 4 for the remaining three scales. CONCLUSION: This multicenter study provides valuable MID estimates for the FACE-Q Skin Cancer Module, specifically for the MMS patient population, enabling clinicians and researchers to better interpret scores, determine appropriate sample sizes, and apply the findings in clinical care.
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Cirurgia de Mohs , Medidas de Resultados Relatados pelo Paciente , Neoplasias Cutâneas , Humanos , Masculino , Feminino , Estudos Prospectivos , Neoplasias Cutâneas/psicologia , Neoplasias Cutâneas/cirurgia , Pessoa de Meia-Idade , Cirurgia de Mohs/psicologia , Idoso , Cicatriz/psicologia , Satisfação do Paciente , Adulto , Idoso de 80 Anos ou mais , Inquéritos e Questionários , Estados Unidos , Neoplasias Faciais/cirurgia , Neoplasias Faciais/psicologia , Qualidade de Vida/psicologia , Relevância ClínicaRESUMO
Almond trees are the most cultivated nut tree in the world. The production of almonds generates large amounts of by-products, much of which goes unused. Herein, this study aimed to develop a green chemistry approach to identify and extract potentially valuable compounds from almond by-products. Initially, a screening was performed with 10 different Natural Deep Eutectic Solvents (NADESs). The mixture lactic acid/glycerol, with a molar ratio 1:1 (1:50 plant material to NADES (w/v) with 20% v/v of water) was identified as the best extraction solvent for catechin, caffeoylquinic acid, and condensed tannins in almond hulls. Subsequently, a method was optimized by a Design of Experiment (DoE) protocol using a miniaturized extraction technique, Microwave-Assisted Extraction (MAE), in conjunction with the chosen NADESs. The optimal conditions were found to be 70 °C with 15 min irradiation time. The optimal extraction conditions determined by the DoE were confirmed experimentally and compared to methods already established in the literature. With these conditions, the extraction of metabolites was 2.4 times higher, according to the increase in total peak area, than the established literature methods used. Additionally, by applying the multiparameter Analytical Greenness Metric (AGREE) and Green Analytical Process Index (GAPI) metrics, it was possible to conclude that the developed method was greener than the established literature methods as it includes various principles of green analytical chemistry.
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Extratos Vegetais , Prunus dulcis , Prunus dulcis/química , Extratos Vegetais/química , Extratos Vegetais/isolamento & purificação , Micro-Ondas , Química Verde/métodos , Solventes/química , Biomimética , Nozes/químicaRESUMO
BACKGROUND: Field cancerization is poorly defined in dermatology. The author group previously proposed and applied a classification system in an original cohort to risk-stratify patients with field cancerization. OBJECTIVE: Apply the authors' classification system within a validation cohort. METHODS: Patients with keratinocyte carcinoma history completed a survey regarding demographic information, medical history, and chemoprevention use. Patients were assigned a field cancerization class, and differences between validation and original cohorts were assessed. RESULTS: A total of 363 patients were enrolled (mean age 67.4; 61.7% male). After comparing validation and original cohorts, there were differences in age between class II (p = .02) and class IVb (p = .047), and differences in chemoprevention use in class III (p = .04). Similar to the original cohort, the validation cohort was associated with increases in total number of skin cancers in the last year (p < .001), 5 years (p < .001), lifetime (p < .001), years since first skin cancer (p < .001), and chemoprevention use (p < .001). In the validation cohort, there were increases in age (p = .03) and immunocompromised status (p = .04) with increasing class, which were not observed in the original cohort. CONCLUSION: Differences among field cancerization classes were similar in a validation cohort, further highlighting the importance of class-specific treatment and management.
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Carcinoma Basocelular , Queratinócitos , Neoplasias Cutâneas , Humanos , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Queratinócitos/patologia , Masculino , Feminino , Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Pessoa de Meia-Idade , Idoso , Estudos de Coortes , Fatores de Risco , Idoso de 80 Anos ou maisAssuntos
Fluoruracila , Adesão à Medicação , Educação de Pacientes como Assunto , Satisfação do Paciente , Humanos , Fluoruracila/uso terapêutico , Fluoruracila/administração & dosagem , Projetos Piloto , Satisfação do Paciente/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Adesão à Medicação/psicologia , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Administração Tópica , Administração Cutânea , AdultoRESUMO
Messenger RNA (mRNA) vaccines represent a landmark in vaccinology, especially with their success in COVID-19 vaccines, which have shown great promise for future vaccine development and disease prevention. As a platform technology, synthetic mRNA can be produced with high fidelity using in vitro transcription (IVT). Magnesium plays a vital role in the IVT process, facilitating the phosphodiester bond formation between adjacent nucleotides and ensuring accurate transcription to produce high-quality mRNA. The development of the IVT process has prompted key inquiries about in-process characterization of magnesium ion (Mg++) consumption, relating to the RNA polymerase (RNAP) activation, fed-batch mode production yield, and mRNA quality. Hence, it becomes crucial to monitor the free Mg++ concentration throughout the IVT process. However, no free Mg++ analysis method has been reported for complex IVT reactions. Here we report a robust capillary zone electrophoresis (CZE) method with indirect UV detection. The assay allows accurate quantitation of free Mg++ for the complex IVT reaction where it is essential to preserve IVT samples in their native-like state during analysis to avoid dissociation of bound Mg complexes. By applying this CZE method, the relationships between free Mg++ concentration, the mRNA yield, and dsRNA impurity level were investigated. Such mechanistic understanding facilitates informed decisions regarding the quantity and timing of feeding starting materials to increase the yield. Furthermore, this approach can serve as a platform method for analyzing the free Mg++ in complex sample matrices where preserving the native-like state of Mg++ binding is key for accurate quantitation.
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Eletroforese Capilar , Magnésio , RNA Mensageiro , Transcrição Gênica , Eletroforese Capilar/métodos , Magnésio/análise , RNA Mensageiro/genética , RNA Mensageiro/análise , SARS-CoV-2/genética , HumanosRESUMO
Polysorbates 20 and 80 (PS20 and PS80) are added to many commercial biologic and vaccine pharmaceuticals. It is commonly known that these polysorbates undergo a radical oxidation mechanism; however, the identity of these radical intermediates has not been clearly determined. Furthermore, PS20 and PS80 differ by the presence of a lauric acid instead of an oleic acid, respectively. The oxidation of PS80 is thought to be centered around the double bond of the oleic acid even though PS20 also undergoes oxidation, making the mechanism of oxidation unclear for PS20. Using commercial stocks of PS20 and PS80 alkyl (Râ¢), alkoxyl (C-Oâ¢) and peroxyl (C-OOâ¢) radicals were detected by electron paramagnetic resonance spectroscopy likely originating from radical-initiating species already present in the material. When dissolved in water, the peroxyl radicals (C-OOâ¢) originally in the stocks were not detected but poly(ethylene oxide) radicals were. An oxidative pathway for polysorbates was suggested based on the radical species identified in the polysorbate stock material and solutions.
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Procedimentos Cirúrgicos Dermatológicos , Cicatrização , Humanos , Suturas , Técnicas de SuturaRESUMO
Trichodysplasia spinulosa (TS) is a rare disease that affects immunocompromised patients, characterized by hair-like growths caused by TS-associated polyomavirus infection. Little is known about specific immunosuppressive drugs that can precipitate the condition. We report a case of TS presenting after initiating the oral Janus-associated kinase inhibitor (JAKi) ruxolitinib. A 67-year-old female with a history of allogeneic bone marrow transplant requiring immunosuppression with tacrolimus, prednisone and, more recently, ruxolitinib 5 mg twice daily due to Graft versus Host Disease presented to the clinic with a facial rash. The clinical and histopathological findings in the setting of immunosuppression were consistent with TS. Initial treatments were ineffective, but oral acitretin showed significant improvement after 3 months. Due to the close temporal relationship between the initiation of ruxolitinib and the development of TS, this case suggests that JAKis may contribute to TS development by suppressing the JAK-signal transducer and activator of the transcription pathway's antiviral functions.
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Building on big data from Reddit, we generated two computational text models: (i) Predicting the personality of users from the text they have written and (ii) predicting the personality of users based on the text they have consumed. The second model is novel and without precedent in the literature. We recruited active Reddit users (N=1,105) of fiction-writing communities. The participants completed a Big Five personality questionnaire and consented for their Reddit activity to be scraped and used to create a machine learning model. We trained an natural language processing model [Bidirectional Encoder Representations from Transformers (BERT)], predicting personality from produced text (average performance: r=0.33). We then applied this model to a new set of Reddit users (N=10,050), predicted their personality based on their produced text, and trained a second BERT model to predict their predicted-personality scores based on consumed text (average performance: r=0.13). By doing so, we provide the first glimpse into the linguistic markers of personality-congruent consumed content.
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BACKGROUND: Field cancerization is a commonly encountered but poorly defined entity in dermatology. Lack of a consensus definition makes characterizing and studying this condition difficult. OBJECTIVE: Propose a framework for defining and managing field cancerization patients. METHODS: Clinical experience and available data in the literature was used to develop a proposed field cancerization disease classification system and chemoprevention algorithm. RESULTS: The author group developed a field cancerization classification and treatment algorithm that stratifies patients into 5 different classes based on the extent of their field cancerization. They have started to recruit and study the highest risk cohort (Category 4 or 5) and have recruited 57 patients with 5 or more lifetime keratinocyte carcinomas for a prospective study evaluating chemoprevention strategies and disease burden. In these cohorts, the average number of skin cancers was greater than 12; however, less than 39% of these patients had used any chemoprevention in the prior 6 months. CONCLUSION: A meaningful and clinically relevant disease stratification framework with chemoprevention guidance has the potential to highly impact the specialty and patients.