Lupus presents earlier and more severely among patients with skin of color (SOC), and this population suffers from worse outcomes. Providers rely on medical education materials when developing skills to care for patients, yet these resources historically underrepresent SOC and marginalize vulnerable populations. In this study, we investigated if this publication bias extends to images depicting patients with lupus.
 
  We reviewed published images of patients with lupus from rheumatology, dermatology, and internal medicine textbooks and medical journals, SOC atlases, online image libraries, UpToDate
  , and Google
  Images. We selected materials published from 2014 through 2019 available through our university's online medical library. We used the search terms "lupus" and "lupus rash" to identify images. We rated the skin color in each image using the New Immigrant Survey Skin Color Scale, and categorized them as light, medium or dark. We compared the frequencies of published skin tones with chi-square and odds ratio analyses.
 
  We assessed the skin tone of 1,417 images. The significant majority (56.4%) of the images represented light skin (χ
  = 490.14, p < 0.001). After SOC atlases, journals were the most inclusive of images depicting dark skin tones.  https://www.selleckchem.com/products/plx51107.html  The specialty of dermatology was most inclusive of medium and darker skin tones.
 
  Published images of lupus underrepresent SOC, which may limit providers' ability to deliver care to the patients who are at greatest risk for complications.
 Published images of lupus underrepresent SOC, which may limit providers' ability to deliver care to the patients who are at greatest risk for complications.Whey protein isolate (WPI) is considered a dietary solution to obesity. However, the exact mechanism of WPI action is still poorly understood but is probably connected to its beneficial effect on energy balance, adiposity, and metabolism. More recently its ability to modulate the gut microbiota has received increasing attention. Here, we used a microbiota depletion, by antibiotic cocktail (ABX) administration, to investigate if the gut microbiota mediates the physiological and metabolic changes observed during high-fat diet (HFD)-WPI consumption. C57BL/6J mice received a HFD containing WPI (HFD-WPI) or the control non-whey milk protein casein (HFD-CAS) for 5 or 10 weeks. HFD-fed mice supplemented with WPI showed reduced body weight gain, adiposity, Ob gene expression level in the epidydimal adipose tissue (eWAT) and plasma leptin relative to HFD-CAS-fed mice, after 5- or 10-weeks intervention both with or without ABX treatment. Following 10-weeks intervention, ABX and WPI had an additive effect in lowering adiposity and leptin availability. HFD-WPI-fed mice showed a decrease in the expression of genes encoding pro-inflammatory markers (MCP-1, TNFα and CD68) within the ileum and eWAT, compared to HFD-CAS-fed mice, without showing alterations following microbiota depletion. Additionally, WPI supplementation decreased HFD-induced intestinal permeability disruption in the distal ileum; an effect that was reversed by chronic ABX treatment. In summary, WPI reverses the effects of HFD on metabolic and physiological functions through mainly microbiota-independent mechanisms. Moreover, we demonstrate a protective effect of WPI on HFD-induced inflammation and ileal permeability disruption, with the latter being reversed by gut microbiota depletion.
  Evidence points to the impact of chronic musculoskeletal pain conditions on sexual function, yet there is little systematic appraisal and synthesis of evidence examining these associations across non-inflammatory conditions. We aimed to systematically review evidence surrounding the association between chronic primary and secondary musculoskeletal pain with intimate relationships and sexual function.
 
  Four electronic databases were searched from 1
  January 1990 to 5
  September 2019 for cross-sectional or prospective epidemiologic and qualitative studies among cohorts with chronic primary or secondary non-inflammatory musculoskeletal pain, defined by ICD-11 classification criteria.
 
  Fifty-one eligible studies were included (46 quantitative, 3 qualitative, 2 mixed-methods designs). Sample sizes ranged from 13 to 12,377 and mean age from 32.6 to 69.2 years. Cross-sectional controlled cohort studies consistently reported poorer sexual function outcomes among cohorts with pain relative to comparison groups. of these associations is relevant to the delivery of holistic, person-centred musculoskeletal pain care.
  To explore patient priorities and ranking of factors influencing patient decision-making concerning treatment escalation in the management of Raynaud's phenomenon (RP) secondary to systemic sclerosis (SSc).
 
  SSc patients were invited to participate in an online survey disseminated through patient-led organisations and social media platforms.
 
  Responses from 747 people with self-reported SSc-RP were evaluable with broad international representation. The mean age (54.7years, SD 12.1), clinical phenotype and disease subsets distribution (limited [402/747, 53.8%], diffuse [260/747, 34.8%] and overlap disease, 85/747 [11.4%]) were consistent with expected demographics. Around half (56.3%) of patients reported their SSc-RP symptoms were adequately controlled. The 5 highest-ranked (out of 13) factors that would prompt treatment escalation for SSc-RP were; 1) inability to use the fingers properly 2) emergence of new digital ulcer (DU) on one or more fingers, 3) worsening pain or discomfort of Raynaud's, 4) more spatients report a preference for non-pharmacological management of SSc-RP.
  To integrate an auto-notification system into clinical workflow, so timely communication of sentinel events (elective surgery, hospital admission, or ER visit) in immunosuppressed rheumatic disease patients happened by design.
 
  We developed an algorithm that triggered auto-notification within the electronic medical record to rheumatology when a patient experienced a sentinel event. A telephone encounter was created that included event type, baseline therapy, and event date. This was forwarded to the rheumatologist, who recorded guideline-driven recommendations and returned it to nursing. Instructions were included to communicate recommendations to the patient, inpatient rheumatology team, or other clinician. This was studied over four months at a multi-specialty medical practice in Central Pennsylvania. Primary outcomes were percentage of total notifications, notifications by sentinel event type where a change in care plan was recommended, as well as percentage of time where rheumatologists were notified of sentinel events, compared to prior to the intervention.