Editorials
Atopic dermatitisReview of comorbidities and therapeutics
Atopic dermatitis (AD) is a very common skin disease associated with substantial burdens on patient health and quality of life. Knowledge regarding the pathogenesis of AD has expanded within recent years, leading to novel and efficacious therapeutic agents. Similarly, our knowledge of the impact of AD on patient's mental and physical health has also expanded. This review summarizes updates on the evolution, comorbidities, and therapeutic options of AD. AD is associated with increased cardiovascular risk, allergic diseases, and adverse mental health outcomes.T2-low: what do we know?: Past, present, and future of biologic therapies in noneosinophilic asthma
T2-low asthma is an often severe asthma subtype with limited treatment options and biologic therapeutics are lacking. Several monoclonal antibodies (mAbs) targeting non-T2 cytokines were previously reported to be ineffective in asthma. These trials often investigated heterogeneous asthma populations and negative outcomes could be related to unsuitable study cohorts. More tailored approaches in selecting participants based on specific biomarkers have been beneficial in treating severe T2-high asthma.Allergic and eosinophilic asthma in the era of biomarkers and biologics: similarities, differences and misconceptions
Severe asthma is associated with substantial personal and economic burden; maintaining disease control is the key management goal. Increased understanding of asthma heterogeneity and development of type 2 (T2)-targeting biologics has substantially advanced disease management and outcomes; however, despite both being driven by T2 inflammation, allergic and eosinophilic asthma have different treatment recommendations. We sought to better understand the similarities and differences between allergic and eosinophilic asthma and highlight where misconceptions may arise.Evaluating enrollment and outcome criteria in trials of biologics for chronic rhinosinusitis with nasal polyps
Treatment for chronic rhinosinusitis with nasal polyps (CRSwNP) generally involves intranasal corticosteroids (INCS) and saline irrigation, followed by short courses of systemic corticosteroids (SCS) or surgery with postoperative medical therapy for patients who do not respond to INCS. However, both SCS use and surgery are associated with a range of adverse effects or complications, have a high recurrence rate, and are unsuitable for some patients. Biologics targeting the underlying pathophysiology are promising treatment alternatives for these patients.Referencing in Scientific Writing
Referencing in scientific writing has long been viewed as arcane to the uninitiated. The confusion in the pre-internet era was largely due to highly specific format requirements that differ between types of articles and between publications. The new reality is much worse.The Obligation of Editorial Independence
Journal editors and editorial teams play an important role in the publication of scientific research. They evaluate the work of authors, organize reviewers, evaluate the work of reviewers, and provide an overarching perspective to help authors prepare, if not improve, their work.Telegraphing in Scientific Writing
I am a firm believer that the author or author team should provide the harshest criticism of any work being offered for publication. Manuscripts should be developed painstakingly, critically attacked from all sides, revised, and then attacked and revised repeatedly until there is nothing left to change, no holes to fill, and no questions left hanging. Only then are they ready for submission. Depending on your perspective in our increasingly polar world, this position may come across as either ludicrous or obvious.Retraction of Scientific Writing
Scientific journals are supposed to present meaningful reports of current research to educate readers on avenues explored, knowledge gained, and missteps best avoided in future investigations. Problems can arise, though, when external factors create a sense of urgency.2019 Wilderness & Environmental Medicine Peer Reviewers
The editors express their sincere appreciation to the following individuals who performed peer reviews for articles submitted to Wilderness & Environmental Medicine in 2019. WEM serves an important role in bringing thoughtfully reviewed literature to the scientific community. Our peer reviewers play an essential role in ensuring the merit and quality of the manuscripts we publish. Many of these individuals reviewed multiple papers, and some also serve on the editorial board and maintain Section Editor or Associate Editor duties.Managing Bias in Research
We are all subject to bias. This is not a revelation, but it is also something not to be ignored.Handling the Thorny Issue of Coauthorship in Scientific Publishing
Publication practices, like most things in science, have evolved over time. Long gone is the monograph that marked the culmination of a career. The “publish or perish” mantra has become increasingly demanding, with expectations regarding publication counts inexorably climbing. Those competing for academic positions may notice that the publication records of the evaluators often reflect a different standard from that which they are told they will need to meet in order to advance. On its face, encouraging productivity can be positive, fostering more engagement and creating additional opportunities.The Insignificance of Significance in Scientific Reporting
Investigators want to have their work accepted for publication through peer review. Motivation is good if it pushes them to develop their best product, but it can be problematic if it encourages them to focus on relatively unimportant elements just to improve the likelihood of acceptance. One of the problems that can be reinforced by some reviewer and even editor attention is an unreasonable reliance on statistical significance.The Evolution to Prospective Research in Wilderness Medicine
The draw to wilderness medicine frequently stems from a personal connection to the outdoor environment. This creates a great diversity in the community, where a spectrum of professional focus is brought together by what can be a satisfying and potentially challenging common ground. It is natural for enthusiasts to look for ways to combine their vocational and avocational worlds, and the product of such efforts provides a substantial portion of the wilderness medicine literature.Rejection Under Peer Review
The broad concepts of peer review are well understood: knowledgeable, objective, and clear-thinking individuals critically assessing work produced from a knowledgeable, objective, and clear-thinking position. The process cannot be without bias because our expertise and experience do produce bias, but the goal is to rise above the pejorative elements to deliver insightful evaluations. The system is not perfect, but when appropriately implemented, it can help to make any manuscript better.Blinding and Peer Review
Promoting a fair and effective peer review process is an important obligation for responsible journal editors and editorial boards. Design decisions are affected by community standards, journal character, and personal preferences, but the fundamentals are important to understand in any case.Data Depiction and Analysis
Two of the substantial challenges in research design involve data depiction and statistical analysis. Data depiction issues often start with misunderstandings about reasonable precision. Effectively, a number is only meaningful if it reflects the precision of the measure used to capture it. Additional decimal places may seem important, but they do nothing to increase precision. They can even put authors in a bad light for their misunderstanding. Examples of exaggerated reporting are as simple as reporting height to the millimeter level.Ethics Authorization for Research Reporting
One of the fundamental requirements to publish research is the reasonable assurance that the work was conducted ethically. This is usually met by having project plans reviewed in advance by an appropriate institutional review board, either for human or animal studies. Different titles are used, but the intent is the same: to prospectively evaluate research plans to ensure that they conform to institutional and overarching ethics guidelines.Journal Shopping and Pruning the Literature
Researchers who publish their work naturally want to place it in the most prestigious showcase possible. This provides both intrinsic and extrinsic validation of their effort. Excessive optimism, however, can result in submissions to journals unlikely to accept the work. Justifications can include a sense of “nothing ventured, nothing gained” or a belief that the feedback will be high quality even if the work is not accepted. Regarding the latter hope, it is important to understand that no journal, even the most prestigious, has access to unlimited subject matter expertise.Scientific Writing
Wilderness & Environmental Medicine has a broad mandate as a peer-reviewed international journal. The publication is devoted to original scientific and technical contributions on the practice of medicine defined by isolation, extreme natural environments, and limited access to medical help and equipment. Papers consider a wide range of human physiology, health, and emergency and medical management issues related to environmental extremes—pressure, temperature, weather, and medium—along with the many plants, animals, actions, and agents that can increase or ameliorate hazards.Promoting High-Quality Research
Peer-reviewed journals serve an important role as both outlet and repository for scientific endeavor. The health of a journal is promoted by the timely presentation of well-developed, diverse, and informative content. Recent editorial notes in this space have considered peer review and reviewer training, publishing ethics, and the responsibility of researchers, journals, and readers in scientific communication. While critical, these are all late-stage elements. A fundamental need is to support the good science to get to the point of needing these services.Research and Research Communication
Research rarely discovers ultimate truths, but ongoing efforts help us develop our understanding layer by layer to gain the best insight compatible with our capacities. Research communication is important to share our understanding and help us move to the next level. While advancement of knowledge can be delivered by individual efforts to synthesize a coherent picture, it is often aided by the feedback of others.Turning Submissions Into a Journal
Journals persist, flourish, or fail in response to the relevance of the content and the care that goes into developing it. WEM is a niche publication, almost certain to never reach the rarified air of the highest impact factors, but one that has flourished through the commitment of authors and those involved in the review process. The best reviews go beyond critical evaluation of manuscripts to actively challenge authors to develop their best work. Constructive comments are generously provided for almost all manuscripts, not just those destined for acceptance.Ethics and Oversight in Publication
The last Editor’s Note described peer review as a linchpin component of science and science communication and discussed strategies to train students in the process. In a perfect world, that would be enough: we would train the emerging professionals, community members would accept invitations to review only for the papers for which they had appropriate subject matter expertise, they would apply due diligence to comprehensively and objectively review every manuscript, and every paper accepted for publication would be fully vetted and sound.Peer Review and Wilderness & Environmental Medicine
Peer review is a linchpin component of science and science communication. It is probably most recognized in the publication of research manuscripts. Authors prepare reports of their scientific efforts and submit them to a peer-reviewed journal thought to be appropriate for the content. Editorial staff assign these reports to subject matter expert reviewers who evaluate propriety and provide thoughtful comments to help authors improve manuscripts where needed.What is Wilderness Medicine?
Defining the field of wilderness medicine can be challenging, particularly for those who do not participate. The founders had a vision of a specialty that incorporates the essentials of practicing medicine in the outdoors without the “luxuries” of a hospital or medical clinic. Rumors abound of the early naming debates—should this group of researchers and practitioners be named the “Wilderness Medical Society,” the “Mountain Medicine Society,” or another, more specific title? Mountain medicine includes high altitude medicine, hypothermia, frostbite, and avalanche injuries, to name a few.
