Sweet's Syndrome in a Patient With Seropositive Rheumatoid Arthritis After Starting Adalimumab: Is Sweet's Syndrome Related to Rheumatoid Arthritis or Is It the Paradoxical Effect of Adalimumab?

Sweet's syndrome is a rare acute febrile neutrophilic dermatosis accompanied by fever, neutrophilia, and asymmetrical distribution of tender erythematous skin lesions. The underlying biological pathways responsible for this inflammatory skin disorder are not yet clearly established. However, an association with autoimmune disease, neoplasm, and drugs could be indicative of unusual hypersensitivity involving proinflammatory cytokines. There are several case reports indicating an association between Sweet's syndrome and rheumatoid arthritis (RA). Proinflammatory cytokines are considered to play a vital role in the pathogenesis of both RA and Sweet's syndrome. Adalimumab works against proinflammatory cytokines and is considered a disease-modifying antirheumatic drug in RA; it is also reported to be effective in refractory Sweet's syndrome. While adalimumab has been proven to be beneficial in autoimmune disorders and inflammatory conditions, there are also reports of paradoxical development of Sweet's syndrome with adalimumab. In this report, we present a case of Sweet's syndrome in a 74-year-old adult patient with a history of seropositive RA who developed Sweet's syndrome within two months after the initiation of adalimumab therapy.

Development of the Basic Auditory Skills Evaluation Battery for Online Testing of Cochlear Implant Listeners.

Purpose Cochlear implant (CI) performance varies considerably across individuals and across domains of auditory function, but clinical testing is typically restricted to speech intelligibility. The goals of this study were (a) to develop a basic auditory skills evaluation battery of tests for comprehensive assessment of ecologically relevant aspects of auditory perception and (b) to compare CI listeners' performance on the battery when tested in the laboratory by an audiologist or independently at home. Method The battery included 17 tests to evaluate (a) basic spectrotemporal processing, (b) processing of music and environmental sounds, and (c) speech perception in both quiet and background noise. The battery was administered online to three groups of adult listeners: two groups of postlingual CI listeners and a group of older normal-hearing (ONH) listeners of similar age. The ONH group and one CI group were tested in a laboratory by an audiologist, whereas the other CI group self-tested independently at home following online instructions. Results Results indicated a wide range in the performance of CI but not ONH listeners. Significant differences were not found between the two CI groups on any test, whereas on all but two tests, CI listeners' performance was lower than that of the ONH participants. Principal component analysis revealed that four components accounted for 82% of the variance in measured results, with component loading indicating that the test battery successfully captures differences across dimensions of auditory perception. Conclusions These results provide initial support for the use of the basic auditory skills evaluation battery for comprehensive online assessment of auditory skills in adult CI listeners.

Are the natural sciences ready for truth, healing, and reconciliation with Indigenous peoples in Canada? Exploring 'settler readiness' at a world-class freshwater research station.

The Experimental Lakes Area in Northwestern Ontario, Canada, is a globally prominent freshwater research facility, conducting impactful whole-of-lake experiments on so-called 'pristine' lakes and watersheds. These lakes are located in traditional Anishinaabe (Indigenous) territory and the home of 28 Treaty #3 Nations, something rarely acknowledged until now. Indeed, Indigenous peoples in the area have historically been excluded from the research facility's governance and research. Shortly after it changed hands in 2014-from the federal government to the not-for-profit International Institute of Sustainable Development (IISD)-the Truth and Reconciliation Commission (TRC) of Canada released its Calls to Action to all Canadians. The newly named International Institute of Sustainable Development-Experimental Lakes Area (IISD-ELA) began to respond with a number of initiatives aimed to develop relationships with local Indigenous peoples and communities. In this paper, from the perspectives of IISD-ELA staff members, we share findings from an exploratory study into the relationships beginning to develop between IISD-ELA and Treaty #3 Nations. We used semi-structured interviews (n = 10) to identify how staff perceived their initial efforts and contextualize those with the current literature on meaningfully engagement in reconciliation. Our analysis highlights perceived barriers, including time, resources, and funding constraints, as well as an acknowledged lack of cultural awareness and sensitivity training. Participants also recognized the need to engage Indigenous knowledge holders and embrace their ways of knowing at the research station. While the study is small in scale, as an international leader in freshwater science, transparency in the IISD-ELA's journey in reconciliation has the potential to inform, influence, and 'unsettle' settler-colonial scientists, field stations, and institutions across the country and beyond.

Predictors of medical student interest in Indigenous health learning and clinical practice: a Canadian case study.

BACKGROUND: Including content on Indigenous health in medical school curricula has become a widely-acknowledged prerequisite to reducing the health disparities experienced by Indigenous peoples in Canada. However, little is known about what levels of awareness and interest medical students have about Indigenous peoples when they enter medical school. Additionally, it is unclear whether current Indigenous health curricula ultimately improve students' beliefs and behaviours. METHODS: A total of 129 students completed a 43-item questionnaire that was sent to three cohorts of first-year medical students (in 2013, 2014, 2015) at one undergraduate medical school in Canada. This survey included items to evaluate students' sociopolitical attitudes towards Indigenous people, knowledge of colonization and its links to Indigenous health inequities, knowledge of Indigenous health inequities, and self-rated educational preparedness to work with Indigenous patients. The survey also assessed students' perceived importance of learning about Indigenous peoples in medical school, and their interest in working in an Indigenous community, which were examined as outcomes. Using principal component analysis, survey items were grouped into five independent factors and outcomes were modelled using staged multivariate regression analyses. RESULTS: Generally, students reported strong interest in Indigenous health but did not believe themselves adequately educated or prepared to work in an Indigenous community. When controlling for age and gender, the strongest predictors of perceived importance of learning about Indigenous health were positive sociopolitical attitudes about Indigenous peoples and knowledge about colonization and its links to Indigenous health inequities. Significant predictors for interest in working in an Indigenous community were positive sociopolitical attitudes about Indigenous peoples. Knowledge about Indigenous health inequities was negatively associated with interest in working in an Indigenous community. CONCLUSIONS: Students' positive sociopolitical attitudes about Indigenous peoples is the strongest predictor of both perceived importance of learning about Indigenous health and interest in working in Indigenous communities. In addition to teaching students about the links between colonization, health inequities and other knowledge-based concepts, medical educators must consider the importance of attitude change in designing Indigenous health curricula and include opportunities for experiential learning to shape students' future behaviours and ultimately improve physician relationships with Indigenous patients.

Adding insult to injury: The development of psychosocial stress in Ontario wind turbine communities.

Though historically dismissed as not-in-my-backyard (NIMBY) attitudes, reports of psychosocial stress linked to wind energy developments have emerged in Ontario, Canada. While the debate and rhetoric intensify concerning whether wind turbines 'actually' cause 'health' effects, less sincere attention has been given to the lived experience and mental well-being of those near turbines. Drawing on theories of environmental stress, this grounded theory, mixed-method (n = 26 interviews; n = 152 questionnaires) study of two communities in 2011 and 2012 traces how and why some wind turbine community residents suffer substantial changes to quality of life, develop negative perceptions of 'the other' and in some cases, experience intra-community conflict. Policy-related forces, along with existing community relationships may help explain much of these differences between communities. We suggest a move beyond debating simply whether or not 'annoyance' represents a 'health impact' and instead focus on ways to minimize and attenuate these feelings of threat (risk) and stress at the community level.

Photoreceptor loss overlying congenital hypertrophy of the retinal pigment epithelium by optical coherence tomography.

OBJECTIVE: To describe the cross-sectional retinal anatomy overlying congenital hypertrophy of the retinal pigment epithelium (CHRPE) using optical coherence tomography (OCT). DESIGN: Retrospective, observational, noncomparative case series. PARTICIPANTS: Ten consecutive patients with CHRPE. MAIN OUTCOME MEASURES: The main outcome measures were retinal and retinal pigment epithelium (RPE) thickness relative to normal tissue and the status of the retinal layers, in particular the photoreceptor layer. RESULTS: The median patient age was 36 years (mean, 34 years; range, 7-56 years). The CHRPE was within 6 mm of the optic disc or foveola in all patients. All patients showed retinal thinning and complete photoreceptor loss overlying the CHRPE. The sensory retina measured a mean of 68% of normal thickness (range, 47%-87%). Of the 8 patients with pigmented CHRPE, the CHRPE was 52% thicker than adjacent RPE. All 8 patients with pigmented CHRPE showed moderate relative shadowing of the underlying choroid. The 2 patients with nonpigmented CHRPE, presumed to represent large lacunae with thin CHRPE rim, showed absent RPE and increased transmission of light, not shadowing, into the choroid by OCT. Both patients with visual field testing showed a visual field defect corresponding to the photoreceptor loss. CONCLUSIONS: Using OCT, overlying retinal thinning and photoreceptor loss directly over CHRPE was found in 10 consecutive patients. These findings likely account for related visual field loss.