TNF inhibitor induced alopecia: an unusual form of psoriasiform alopecia that breaks the Renbök mold.

TNF-α-inhibitors are known to induce skin adverseeffects including psoriasis and alopecia areata. Here, wedescribe a unique pattern of hair loss that has psoriaticand alopecia areata-like features. Diagnosis requiresclinical-pathologic correlation and is supportedby increased catagen/telogen hairs, psoriasiformepidermal hyperplasia, perifollicular lymphocyticinfiltrate, and the presence of eosinophils and plasmacells. Although there are no treatment consensusguidelines, management options include stoppingtherapy, switching to a different TNF-α inhibitor orustekinumab (in severe cases), or continuing TNF-αinhibitor therapy with addition of topical, intralesional,or systemic immunosuppressants.

Analysis of the production and transaction costs of forest carbon offset projects in the USA.

Forest carbon offset project implementation costs, comprised of both production and transaction costs, could present an important barrier to private landowner participation in carbon offset markets. These costs likewise represent a largely undocumented component of forest carbon offset potential. Using a custom spreadsheet model and accounting tool, this study examines the implementation costs of different forest offset project types operating in different forest types under different accounting and sampling methodologies. Sensitivity results are summarized concisely through response surface regression analysis to illustrate the relative effect of project-specific variables on total implementation costs. Results suggest that transaction costs may represent a relatively small percentage of total project implementation costs - generally less than 25% of the total. Results also show that carbon accounting methods, specifically the method used to establish project baseline, may be among the most important factors in driving implementation costs on a per-ton-of-carbon-sequestered basis, dramatically increasing variability in both transaction and production costs. This suggests that accounting could be a large driver in the financial viability of forest offset projects, with transaction costs likely being of largest concern to those projects at the margin.

The potential role for management of U.S. public lands in greenhouse gas mitigation and climate policy.

Management of forests, rangelands, and wetlands on public lands, including the restoration of degraded lands, has the potential to increase carbon sequestration or reduce greenhouse gas (GHG) emissions beyond what is occurring today. In this paper we discuss several policy options for increasing GHG mitigation on public lands. These range from an extension of current policy by generating supplemental mitigation on public lands in an effort to meet national emissions reduction goals, to full participation in an offsets market by allowing GHG mitigation on public lands to be sold as offsets either by the overseeing agency or by private contractors. To help place these policy options in context, we briefly review the literature on GHG mitigation and public lands to examine the potential for enhanced mitigation on federal and state public lands in the United States. This potential will be tempered by consideration of the tradeoffs with other uses of public lands, the needs for climate change adaptation, and the effects on other ecosystem services.

Comparing guideline-based care quality for inflammatory bowel disease and rheumatoid arthritis patients within a medical home.

BACKGROUND: Rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) patient populations face similar risks of chronic immunosuppression including corticosteroid use. We compared the receipt of preventive services between IBD and RA populations according to published quality metrics. METHODS: We defined a single-center cohort of patients with IBD or RA receiving specialty and primary care. Electronic health record abstraction assessed quality metrics, sociodemographics, comorbidity, and utilization. Comparisons used multivariate odds ratios and Student's t-tests. RESULTS: 218 RA and 190 IBD patients were included. In multivariate analysis, IBD patients were less likely to receive pneumococcal vaccination (OR=0.29, 95% CI: 0.11-0.85), while RA patients underwent glucocorticoid-induced osteoporosis screening more often (100% vs. 82.5%, p = 0.023). CONCLUSIONS: Gastroenterologists can improve care quality for IBD patients by assuming greater responsibility for preventive care in IBD patients and/or collaborating with primary care and health systems to improve preventive care delivery.