Psoriasis, a chronic immune-mediated disease, is associated with an increased risk of cardiovascular events and mortality. Secukinumab selectively neutralizes IL-17A and has reported high efficacy ...with a favorable safety profile in various psoriatic disease manifestations. Subsequent to the 12-week randomized, placebo-controlled, double-blind treatment period, patients with moderate-to-severe psoriasis received secukinumab for 40 weeks. Vascular inflammation using 18F-2-fluorodeoxyglucose–positron emission tomography/computed tomography imaging and blood-based cardiometabolic was assessed at week 0, 12, and 52. The difference in change in aortic inflammation from baseline to week 12 for secukinumab (n = 46) versus placebo (n = 45) was –0.053 (95% confidence interval = –0.169 to 0.064; P= 0.37). Small increases in total cholesterol, low-density lipoprotein, and low-density lipoprotein particles, but no changes in markers of inflammation, adiposity, insulin resistance, or predictors of diabetes, were observed with secukinumab treatment compared with placebo. At week 52, reductions in TNF-α (P= 0.0063) and ferritin (P= 0.0354), and an increase in fetuin-A (P= 0.0024), were observed with secukinumab treatment compared with baseline. No significant changes in aortic inflammation or markers of advanced lipoprotein characterization, adiposity, or insulin resistance were observed with secukinumab treatment compared with baseline. Secukinumab exhibited a neutral impact on aortic vascular inflammation and biomarkers of cardiometabolic disease after 52 weeks of treatment.
The black and white women travel writers whom Jennifer Bernhardt
Steadman investigates in Traveling Economies astonish
modern readers with their daring, stamina, and courage. That these
women ...traveled at all is surprising: Nancy Prince spent nearly a
decade as an African American member of the Russian Imperial Court;
Amy Morris Bradley went to Costa Rica as a governess in hopes of
saving her health and finances after years as an impoverished
teacher in Maine; and Julia Archibald Holmes carried the banner of
dress reform to the heights of Pikes Peak and to the pages of a
feminist periodical. Developing the concept of the "ragged edge,"
Steadman highlights these women's shared experiences of penury,
work, and independence. Genteel poverty, black skin, outspoken
feminism, or sometimes all three impacted the material conditions
of their ragged-edge travel (early muckraking journalist Anne
Royall walked until her feet were a bloody mass of blisters). Being
on the ragged edge also affected the way they represented
themselves and their travels (Mary Ann Shadd Cary presented her
outspoken advocacy of black emigration to Canada as appropriately
feminine). Frances Wright used her travel writing to imagine the
new nation as a potential utopia for women citizens; she paid a
high price for daring to try to change the social terrain she
crossed. Steadman's interdisciplinary work with archives,
newspapers, memoirs, and letters and her thoughtful close readings
of the resulting evidence recover these important women's travels
and writing and invite us to rethink where and how women went and
what they wrote in antebellum America.
Ragged-edge travelers Amy Morris Bradley and Nancy Prince evaluate the economies of travel -- Scolding the nation: the political travel writing of Anne Royall -- Traveling uplift: Mary Ann Shadd Cary ...creates and connects Black communities -- A "singular spectacle of a female": Frances Wright's traveling figure -- To the summit of equality: a feminist traveler, bloomers, and the antebellum feminist press
Moderate-to-severe scalp psoriasis has not been evaluated in prospective trials of patients without moderate-to-severe body psoriasis.
Evaluate the efficacy and safety of secukinumab in ...moderate-to-severe scalp psoriasis.
In this 24-week, double-blind, phase 3b study, 102 patients were randomized 1:1 to subcutaneous secukinumab 300 mg or placebo at baseline, weeks 1, 2, and 3, and then every 4 weeks from week 4 to 20. The primary efficacy variable was 90% improvement of Psoriasis Scalp Severity Index (PSSI 90) score from baseline to week 12.
At week 12, PSSI 90 (secukinumab 300 mg vs placebo, 52.9% vs 2.0%) and Investigator's Global Assessment modified 2011 scalp responses of 0 or 1 (secukinumab 300 mg vs placebo, 56.9% vs 5.9%) were significantly greater with secukinumab 300 mg than placebo (P < .001 for both). In addition, significantly more patients achieved complete clearance of scalp psoriasis at week 12 with secukinumab 300 mg than placebo (35.3% vs 0%; P < .001). The median time to 50% reduction in PSSI score was 3.29 weeks with secukinumab 300 mg. The safety profile of secukinumab was consistent with previous phase 3 studies.
There was no active comparator arm.
Secukinumab is efficacious and well-tolerated for patients with extensive moderate-to-severe scalp psoriasis.
Working in a Pediatric Medicine Intensive Care Unit (MICU) brings together two ethically fraught populations: the critically ill and the chronically ill. As a result, moral distress, along with ...ethical concerns, is prevalent amongst the health care professionals. In an effort to address moral distress, we have trialed numerous methods aimed at improving understanding of ethical principles. Ethics Rounds are one way to support healthcare personnel in handling ethically difficult situations. Ethics Rounds are held on our unit monthly and are led by a nurse ethicist, an ICU attending, and unit-based Nurse Practice Specialist. While moral distress around the case is discussed, the primary focus of the rounds has been joint formulation of the ethical question/s ("If __ is true, then is ___ ethical?") and a group effort to resolve the relevant issues that emerge. Rounds are attended by nurses, physicians, nurse practitioners, social workers, and specialists involved in the case. This allows for a well-rounded multidisciplinary discussion where each discipline can bring their concerns and viewpoints. The aim of this project was to evaluate how Ethics Rounds were experienced by the multidisciplinary staff and to identify ways to improve the ethical climate for the staff. A four question survey was emailed to the multidisciplinary MICU team to determine how helpful Ethics Rounds have been in the past year and in what ways they can be modified to meet the needs of the participants. The survey was sent to 147 MICU team members and 42 participants responded. Respondents included nurses (60% of total responses), physicians (30%), social work, chaplaincy, and child life specialists (total of 10% combined). From the respondents, 62% had participated in an Ethics Rounds in the past year, 69% or staff felt that rounds helped them understand their patients better, and 76% felt that rounds improved the care of their patient. Suggestions to improve Ethics Rounds included informing the night shift of what occurs in Ethics Rounds during the day through a summary if possible. Additional suggestions involved improving the nurses voice in the rounds and improving attendance overall. Next steps include implementation of these suggestions with further evaluation of the efficacy of our interventions.
Findings from 3 nurse-led research studies conducted in a large pediatric institution resulted in a call to action to support intensive and progressive care nurses experiencing moral and ethical ...challenges.
To evaluate the feasibility of and satisfaction with implementation of a Nurse Education and Support Team (NEST) coach role.
An interdisciplinary work group identified solutions for just-in-time support, including a new NEST coach role. This role was implemented in January 2017 to provide peer-to-peer support for nurses. The NEST coaches provide coverage 5 days per week in 4 intensive care units and 1 progressive care unit. Feasibility of the role was evaluated by assessing the number, type, length, and outcome of NEST coach consultations. Staff satisfaction was evaluated 6 months and 1.5 years after implementation.
A total of 6262 NEST coach consultations occurred across the units from January 2017 through November 2019. At both evaluation periods, more than 85% of respondents indicated that they were satisfied with their interactions with the NEST coach and nearly 80% indicated that they would seek consultation again.
Pediatric intensive and progressive care nurses experience many challenges in their practice environments. The innovative NEST coach role enabled access to just-in-time support and guidance through morally and ethically challenging situations. As evidenced by the number of consultations and the positive staff response, intensive and progressive care nurses have embraced and integrated the NEST coach role into their culture and practice.
The IL-17A inhibitor secukinumab has demonstrated consistent efficacy and safety in patients with moderate-to-severe plaque psoriasis, with normalization of molecular and histopathologic psoriasis ...markers.
To investigate treatment effects of secukinumab on clinical signs and psoriatic inflammation markers over 52 weeks in patients with psoriasis.
In the ObePso-S study (NCT03055494), patients with psoriasis were randomized 2:1 to receive secukinumab 300 mg (n = 54) or placebo (n = 28), stratified by body weight (<90 or ≥90 kg), for 52 weeks. At Week 12, patients receiving placebo were switched to secukinumab. Psoriasis Area and Severity Index improvement of 90% (PASI90) and Investigator’s Global Assessment modified 2011 0/1 responses were assessed at Weeks 12 and 52. Immunohistochemistry for keratin 16 (K16) and gene expression profiles were evaluated in lesional and non-lesional skin biopsies collected at baseline, Week 12, and Week 52.
Of patients receiving secukinumab, 55.8% and 59.6% achieved PASI90 at Weeks 12 and 52, respectively. K16 was absent in 93.1% of Week 12 PASI90 responders and 93.6% of Week 52 PASI90 responders, which mirrored the down-regulated expression of psoriatic inflammation. Week 52 PASI90 non-responders experienced regression of clinical and inflammatory marker responses toward baseline levels. Lower control of inflammatory gene expression at Week 12 was associated with suboptimal clinical responses at Week 52.
Sustained clinical responses with secukinumab were associated with rapid and sustained normalization of K16 and inflammatory gene expression in most patients. Molecular anti-inflammatory effects of secukinumab at Week 12 were associated with clinical responses at Week 52.
•Secukinumab reduced the severity of psoriasis and promoted histologic reversal of psoriasiform hyperplasia at Week 12.•These responses were maintained through Week 52 in most patients.•Patients who attained Week 52 PASI90 responses had improvement in psoriasis-associated gene expression as early as Week 12.•Patients who had suboptimal cellular and molecular responses at Week 12 failed to achieve PASI90 at Week 52.•Increasing levels of disease control at Week 52 were associated with increased improvements in inflammatory gene expression.
Steadman explores figurative and actual travel in Assia Djebar's Fantasia, a complex narrative employing both memoir and fiction, arguing that the author makes use of travel and travel writing "as a ...trope for her recovery of Algerian women's history, which involves literal and metaphorical journey through archives, Algeria's battle-scarred countryside, and through her own experience of her homeland as both colonized and newly independent." Steadman posits that the narrative creates a model for what she terms, "global feminist praxis" in that the author makes use of a reworked travelogue and the bending of a linear narrative to tell the multiple stories of Algerian women in order to break the silence that cloaks Algeria and its women.
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