With the growing recognition that diversity and inclusion are essential for the improvement of science and innovation, we provide some perspectives on 3 findings of DeVilbiss et al. (Am J Epidemiol. 2020;189(10):998-1010). We provide points of discussion on factors and strategies to consider when drafting diversity and inclusion programs for the Society for Epidemiologic Research.

Motorcyclists are known to be at substantially higher risk per mile traveled of dying from crashes than car occupants. In 2014, motorcycling made up less than 1 % of person-miles traveled but 13 % of the total mortality from motor-vehicle crashes in the United States. We assessed the cohort effect of the baby-boomers (i.e., those born between 1946 and 1964) in motorcycle crash mortality from 1975 to 2014 in the United States.

Prescription drug monitoring programs (PDMPs) are a crucial component of federal and state governments' response to the opioid epidemic. Evidence about the effectiveness of PDMPs in reducing prescription opioid-related adverse outcomes is mixed. We conducted a systematic review to examine whether PDMP implementation within the United States is associated with changes in 4 prescription opioid-related outcome domains: opioid prescribing behaviors, opioid diversion and supply, opioid-related morbidity and substance-use disorders, and opioid-related deaths. We searched for eligible publications in Embase, Google Scholar, MEDLINE, and Web of Science. A total of 29 studies, published between 2009 and 2019, met the inclusion criteria. Of the 16 studies examining PDMPs and prescribing behaviors, 11 found that implementing PDMPs reduced prescribing behaviors. All 3 studies on opioid diversion and supply reported reductions in the examined outcomes. In the opioid-related morbidity and substance-use disorders domain, 7 of 8 studies found associations with prescription opioid-related outcomes. Four of 8 studies in the opioid-related deaths domain reported reduced mortality rates. Despite the mixed findings, emerging evidence supports that the implementation of state PDMPs reduces opioid prescriptions, opioid diversion and supply, and opioid-related morbidity and substance-use disorder outcomes. When PDMP characteristics were examined, mandatory access provisions were associated with reductions in prescribing behaviors, diversion outcomes, hospital admissions, substance-use disorders, and mortality rates. Inconsistencies in the evidence base across outcome domains are due to analytical approaches across studies and, to some extent, heterogeneities in PDMP policies implemented across states and over time.

To assess the baseline prevalence of mental health conditions and associated exposures in a cohort of health care workers (HCWs) in Guatemala. We analyzed baseline information from the 2020 Web-based COVID-19 Health Care Workers Study (HEROES)-Guatemala. Outcomes included mental distress and depressive symptoms. Exposures included COVID-19 experiences, sociodemographic characteristics, and job characteristics. We used crude and adjusted Poisson regression models in our analyses. Of the 1801 HCWs who accepted to participate, 1522 (84.5%) completed the questionnaire; 1014 (66.8%) were women. Among the participants, 59.1% (95% confidence interval [CI] = 56.6, 61.5) screened positive for mental distress and 23% (95% CI = 20.9, 25.2) for moderate to severe depressive symptoms. COVID-19 experiences, sociodemographic characteristics, and job characteristics were associated with the study outcomes. Participants who were worried about COVID-19 infection were at higher risk of mental distress (relative risk [RR] = 1.47; 95% CI = 1.30, 1.66) and depressive symptoms (RR = 1.51; 95% CI = 1.17, 1.96). Similarly, the youngest participants were at elevated risk of mental distress (RR = 1.80; 95% CI = 1.24, 2.63) and depressive symptoms (OR = 4.58; 95% CI = 1.51, 13.87). Mental health conditions are highly prevalent among Guatemalan HCWs. (. 2022;112(S6):S602-S614. https://doi.org/10.2105/AJPH.2021.306648).

Leber congenital amaurosis (LCA) type 2, due to disease-causing variants in RPE65, is characterized by severe visual loss in early infancy. Current treatments include voretigene neparvovec-rzyl (VN) for RPE65-associated LCA. Herein, we present the long-term follow-up of a patient treated with VN using quantitative autofluorescence (488 nm excitation).

Background: The 31-gene expression profile (31-GEP) test uses 31 genetic markers obtained from the initial biopsy of a melanoma to assess melanoma-specific survival and sentinel lymph node positivity. Objective: To assess the professional understanding, opinions, and clinical usage of the 31-GEP test by dermatologists. Methods: Data from 589 unique dermatologists were collected during 2 virtual, nation-wide dermatology conferences via an 18-question survey on practice demographics and their clinical use and opinion of the 31-GEP test. Results: Participants reported that integrating the 31-GEP test may benefit patients by increasing knowledge and understanding (72.5%), personalizing treatment options (58.8%), and easing uncertainty about the future (59.7%). Benefits of using the 31-GEP test included identifying true negative patients in high-risk populations (65.6%) as well as true positives in low-risk populations (70.6%).A majority of participants also noted that if a patient received a 31-GEP Class 2B result, they would escalate subsequent management even if the lesions were classified as T1 (61.4%) or AJCC8 Stage I (59.0%). 84.9% of participants were somewhat to very likely to use 31-GEP testing for patient management or recommend this test to a colleague. Limitations: Potential respondent-selection and recall bias. Conclusion: Dermatologists are increasingly integrating the 31-GEP test into their melanoma clinical management decisions. As the 31-GEP test becomes more prevalent in practice, patients may benefit from decreased anxiety and uncertainty from enhanced prognosis, decreased need for unwarranted procedures such as sentinel lymph node biopsy and optimized allocation of healthcare resources.

Objective: To review the literature regarding the efficacy and safety of off-label use of apremilast in combination therapies for psoriasis and psoriatic arthritis and for other currently off-label inflammatory dermatoses. Methods: The Medline database was queried for all relevant articles published between 2014 and 2021 using exploded MeSH terms and keywords pertaining to the following themes: off-label, combination therapy, biologics, biologic therapy, methotrexate, and systemic psoriasis therapy. The Boolean term “AND” was used to find the intersection of these themes with the term “apremilast.” Results: 8 case series and 6 case reports investigated the use of apremilast in combination therapy for psoriasis and psoriatic arthritis. Addition of apremilast improved PASI scores by 31.8-77.4% among case series and 80-100% among case reports with adverse effects primarily consisting of gastrointestinal symptoms. 5 randomized-control trials (RCT), 9 open-label trials, 18 case series, and 30 case reports investigated the use of apremilast for off-label dermatoses. In RCTs, apremilast showed potential efficacy for atopic dermatitis and hidradenitis suppurativa. Open-label trials found apremilast efficacious for atopic dermatitis, allergic contact dermatitis, chronic pruritus, cutaneous sarcoidosis, discoid lupus erythematosus, hidradenitis suppurativa, lichen planus, prurigo nodularis, rosacea, and vitiligo. Limitations: Small sample size and short follow up duration for available randomized-control and open-label trials. Current data from case series/reports potentially limits generalizability of findings. Conclusion: Apremilast's safety profile makes it a potential efficacious, non-biologic systemic agent for monotherapy and combination therapy for a wide range of inflammatory dermatoses.

Background: COVID-19 materially delayed patient visits and potential skin cancer biopsies/diagnoses among US dermatology practices. However, given a likely heterogenous impact across the US, this study sought to determine COVID-19’s effect on urban versus rural dermatology practices. Methods: Data were analyzed from the first 1000 responses to 3 pre-validated surveys of 9891 practicing US dermatologists comparing outpatient volumes and scheduling issues for the week of February 17th to the week of March 16th (Survey 1), April 13th (Survey 2) and May 18th, 2020 (Survey 3). First 3 US zip-code digits were compared to US Census Bureau data to determine “Urban/Rural” status. Representativeness with AAD membership was confirmed. Statistical significance was calculated using chi-square with Marascuilo procedure and two-tailed independent t-test/ANOVA with post-hoc Tukey-Kramer testing. Results: In April 2020 urban practices reported more closed practices (21.4% vs 5.8%, p<0.0001) and predicted significantly larger patient volume decreases (-45.2% vs -31.4%, p<0.0001) and practice closures (11.9% vs. 2.5% p<0.0001) in the following 2 weeks. In May 2020, urban areas saw significantly fewer patients/week (90.9 vs 142.4 p<0.0001), larger decrease in patient volume relative to May 2019 (-49.4% vs -35.1%, p<0.0001), and conducted more telemedicine visits (27.0% vs 15.1%, p<0.0001). Significantly more rural practices reported already being at baseline volume (Mean Difference 6.2%, 95% CI 2.7%-9.8%) while urban practices predicted return to baseline volume by August (5.7, 95% CI 2.1%-9.3%) or were unsure (5.6, 95% CI 1.6%-9.7%). Conclusion: The initial COVID-19 pandemic differentially affected urban dermatology practices. The effects of the pandemic were mitigated in part by increased use telemedicine. Future studies may further elucidate COVID-19’s effect on clinical practice and highlight areas for improvement in practice logistics and patient care.

Precise spatiotemporal control of mRNA translation machinery is essential to the development of highly complex systems like the neocortex. However, spatiotemporal regulation of translation machinery in the developing neocortex remains poorly understood. Here, we show that an RNA-binding protein, Hu antigen R (HuR), regulates both neocorticogenesis and specificity of neocortical translation machinery in a developmental stage-dependent manner in mice. Neocortical absence of HuR alters the phosphorylation states of initiation and elongation factors in the core translation machinery. In addition, HuR regulates the temporally specific positioning of functionally related mRNAs into the active translation sites, the polysomes. HuR also determines the specificity of neocortical polysomes by defining their combinatorial composition of ribosomal proteins and initiation and elongation factors. For some HuR-dependent proteins, the association with polysomes likewise depends on the eukaryotic initiation factor 2 alpha kinase 4, which associates with HuR in prenatal developing neocortices. Finally, we found that deletion of HuR before embryonic day 10 disrupts both neocortical lamination and formation of the main neocortical commissure, the corpus callosum. Our study identifies a crucial role for HuR in neocortical development as a translational gatekeeper for functionally related mRNA subgroups and polysomal protein specificity.