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.Tribute to Jonna Barry
This will be the final issue of Wilderness & Environmental Medicine with our Managing Editor, Jonna Barry. Jonna has been the cornerstone of WEM since she arrived to the Wilderness Medical Society in 1999. The growth and development of the Journal over the past 15 years are largely a product of her hard work and dedication.Hypoxia – high, low, and far
Having just returned from the International Society for Mountain Medicine conference in Bolzano, Italy, the Editors are reminded of the international nature of wilderness and mountain medicine. Researchers across the globe are working to understand the needs and improve the care of patients in wilderness and mountain environments. Meetings such as this foster a sense of collaboration and cooperation across oceans and cultures. Learning from the best in the field might mean traveling to the European Alps to study avalanche and crevasse rescue, to Asia to investigate native populations and their unique adaptations to altitude, or to Nepal to collaborate with those who are advancing excellent medical care at remote clinics.Seek Challenge
Those who read Wilderness & Environmental Medicine are usually of the adventurous sort. We pride ourselves on seeking new and challenging activities in the outdoor environment. In this issue, the Brief Report “Personality Characteristics in a Population of Mountain Climbers” examines whether there are particular personality characteristics among the cohort of climbers and mountaineers. The report, not surprisingly, shows that mountaineers score higher than the normal population on the “Novelty Seeking” scale.2013 Wilderness & Environmental Medicine Peer Reviewers
The editors wish to express their sincere appreciation to the following individuals who faithfully and skillfully performed peer reviews for articles submitted to Wilderness & Environmental Medicine. WEM continues to have a growing impact on the scientific community. We want to acknowledge the importance of our peer reviewers to the process of ensuring the merit and quality of the manuscripts that we publish. Many of these peer reviewers reviewed multiple papers, some also serve on the Editorial Board and have Section Editor duties as well.Remember Empathy
You have probably noticed that our latest issues have been slightly “fatter” than previous issues. Submissions to Wilderness & Environmental Medicine have continued to rise, and the quality of submissions has risen as well. Elsevier, our publisher, has graciously agreed to expand our page number from 100 to 125 pages per issue. This will allow our increasing volume of manuscripts to be published in a more timely manner. We thank Elsevier for their partnership and support of our journal and authors.WMS Practice Guidelines Development: Commentary from the Co-Chairs of the WMS Practice Guidelines Committee
This edition of Wilderness and Environmental Medicine (WEM) contains the eighth installment of the Wilderness Medical Society (WMS) practice guidelines, WMS Practice Guidelines for the Prevention and Treatment of Heat Related Illness. As the WMS continues to develop clinical practice guidelines (CPGs), we believe this is an opportune time to communicate to our members and readers the process the Society has adopted for the development and implementation of CPGs.Does Ibuprofen Prevent Acute Mountain Sickness?
Two recent prospective double-blind, placebo controlled studies, one by Lipman et al in the Annals of Emergency Medicine1 and another by Gertsch et al in this issue of Wilderness & Environmental Medicine,2 have evaluated the use of ibuprofen, for prevention of acute mountain sickness (AMS). These studies raise the questions of whether ibuprofen is useful to prevent AMS and, if so, how does it work? Because the current diagnostic criteria for AMS require the presence of a headache, does ibuprofen prevent AMS by preventing the headache without providing protection against the other features of the disease? Does ibuprofen speed acclimatization or does it mask the symptoms of AMS?Medical and Sporting Ethics of High Altitude Mountaineering: The Use of Drugs and Supplemental Oxygen
Historically, mountaineers have carried the glucocorticoid dexamethasone in their first aid kits as a last resort emergency drug for the treatment of potentially fatal high altitude cerebral edema (HACE). In the past few years, it seems that this drug is gaining acceptance as a prophylaxis for acute mountain sickness rather than be limited to an emergency treatment for HACE. A recent case report described a climber on Mount Everest taking a daily cocktail of acetazolamide, dexamethasone, and nifedipine as advised by his physician for the purpose of preventing acute mountain sickness, HACE, and high altitude pulmonary edema (HAPE).Wilderness First Aid: Is it Time to Revisit Course Content?
In this issue of Wilderness & Environmental Medicine, Schuman et al1 present some information on knowledge gained, self-efficacy (self-rating of confidence about one's knowledge and skill level), and skills retention after a 16-hour Wilderness First Aid (WFA) course. They examined these 3 study criteria in a cross-section of 72 course participants at 4, 8, or 12 months after course completion.Ultrasound Use in Ski Clinics
Ultrasonography is becoming more commonplace in various emergency settings. In this issue of Wilderness & Environmental Medicine, the article by Evans and Harris,1 entitled “Ultrasound and Ski Resort Clinics: Mapping Out the Potential Benefits,” clearly points out several areas of potential benefit to clinicians who practice in ski clinics. As ultrasonography specialists practicing in a locale with many ski clinics, we agree that the incorporation of ultrasonography should strongly be considered by those who practice in such settings.Performance-Enhancing Drugs—Commentaries
It is amidst a controversial and unusually dangerous climbing season on Mount Everest that we publish Dr Wagner's editorial “Medical and Sporting Ethics of High Altitude Mountaineering: The Use of Drugs and Supplemental Oxygen.” Certain pharmacologic agents have, for many years, been used to prevent acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACE), the latter 2 among the greatest medical threats to life for those engaged in mountaineering on 8000 m peaks.Pulse Oximetry and Predicting Acute Mountain Sickness: Are We Asking the Right Questions?
“Will I get AMS?” is a question faced by many of those who look after groups in the mountains. After many years of being asked this question, I have developed a well-rehearsed answer. I begin first by giving an estimate of risk. For instance, if we are sitting in one of Lukla's teahouses on the evening of a trek to Mount Everest Base Camp, I will start by admitting that the condition could develop in as many as 30% during some stage of the trek.1 I will then go on to say that there will be some who by simple good fortune will have a lower risk.That Others May Live: Lessons Learned From the 2011 Denali Climbing Season
As I pack for a return to Alaska in a week's time, I am forced to reflect on the eventful climbing season prior. It was not the number of climbers (1,232) or the summit success rate (56%) that made 2011 of note. It was the number of serious accidents (15) and resulting fatalities (9, second highest in a season, only behind 11 in 1992) that made last year stand out from all others in recent memory. Causes of these deaths included climbing falls (5), unknown (2), icefall (1), and sudden cardiac death (1).The Relationship Between Ski Patrols and Emergency Medical Services Systems
The precise relationship between ski patrols and Emergency Medical Services (EMS) systems is a controversial topic. Ski patrols are represented by various organizations, including the National Ski Patrol (NSP), the Association of Professional Patrollers, and the Professional Ski Patrol Association. The NSP is the oldest and largest of these groups, with more than 28 000 members and more than 600 affiliated ski areas (although that number may be decreasing with the current economy and area closures).A Time Has Come for Wilderness Emergency Medical Service: A New Direction
In this issue of Wilderness & Environmental Medicine, an article by Warden et al1 provides a timely overview of various specialized operational emergency medical service (EMS) programs that serve in either tactical, hazardous, or austere environments as part of the entry level medical care in the US health care system. These specialized EMS programs function in unique environments and provide, in most cases, point of injury medical care beyond what can be provided by traditional EMS agencies. These programs include classic programs in rural and wilderness settings, for example, ski patrol, water rescue, and wilderness search and rescue (SAR).Lessons From Dr Strangelove
In the early 1980s, a group of visionary physicians founded a medical organization predicated on the advancement of a singular health issue. This society was not one dedicated to patient care in the wilderness, but rather to promote understanding of the health risks of nuclear proliferation. They called themselves the International Physicians for the Prevention of Nuclear War (IPPNW), and their clinical assessment was a sober rebuke to Cold War strategists: “Nuclear war would be the final epidemic; there would be no cure and no meaningful medical response.”1A New Adventure
To be a successful scholar in wilderness medicine, one must take risks. Just like reaching for the next handhold on a rock climb, descending deeper on SCUBA gear, or traveling to a far-off place to collect research samples from those of another culture, these risks challenge ourselves and define who we are. The past Editors of Wilderness and Environmental Medicine journal have all taken these steps. Paul Auerbach, Oswald Oelz, and William Robinson envisioned a medical field where none had been defined prior.Scotty Has the Helm
While certainly a fan of the original Star Trek series, I would not call myself a “Trekkie” or “Trekker,” but I think the title for this note seems appropriate. You see, this will be my final Editor's Note, as I have decided to step down as Editor-in-Chief for Wilderness & Environmental Medicine at the end of 2010. After 10 years in this role, I have decided that the time has come for me to pursue new endeavors in the waning years of my career—endeavors that will require a substantial amount of time and effort, and will not allow me the time to give the Journal the full focus it deserves.Sidecountry Rescue—Who Should Respond to Ski Resort Out-of-Bounds Rescues?
The latest buzzword in winter recreation, “sidecountry skiing and snowboarding,” is popping up in magazines, equipment marketing materials, and ski resort websites. The increasing popularity poses several questions.1,2 First, what or where is the “sidecountry” aka “slackcountry?” Is it a geographic local, an activity, or both? Simply defined, the sidecountry is the area adjacent to but outside the boundary of winter resorts, which is accessed from the resort by a paying customer. In other words, a skier or snowboarder buys a lift ticket, rides a lift, and then heads out of bounds.Search and Rescue Activity on Denali, 1990 to 2008
In this issue of Wilderness and Environmental Medicine, McIntosh et al1 summarize the search and rescue (SAR) activity over an 18-year period on Mt. McKinley, or Denali, the highest mountain in North America. This is an important and needed addition to the literature regarding the incidence of SAR activities on Denali and emphasizes many important points. The authors nicely summarize the climbers' demographics, guide status, nationality, medical complaints, mechanism of injury, cold and altitude injuries, and route information for whom the National Park Service (NPS) provided SAR services.In Tribute to Charlie Houston
SCIENCE now has proved that flyers and mountain climbers can reach altitudes of almost six miles, remain normal and alert, and come away none the worse for wear—without supplemental oxygen … It is only necessary that they accustom themselves gradually to the decreasing pressures and dwindling oxygen … For this discovery, of much value in the planning of future upper air explorations, credit goes to a pair of venturesome young men of the U. S. Navy—Lieut, (jg) Walter S. McNutt, Jr., and Carlton R.Changes
“When you're finished changing, you're finished.”Ben Franklin With this, the first issue of 2010, I announce several important changes for the Journal. First, this issue is the inaugural issue published by our new publisher, Elsevier. For the last 12 years, Wilderness & Environmental Medicine has been published by Allen Press. In early 2009, the Wilderness Medical Society (WMS) Board of Directors made the decision to make a move to Elsevier based on several novel features and opportunities they offer.Environmental Education for Providers and Patients—What's a Doctor to Do?
In this issue of Wilderness & Environmental Medicine, Robert Truckner reports the results of a survey about health care provider interest, knowledge, and beliefs regarding the health effects of human-induced environmental degradation (HIED). He concludes that physicians are aware of HIED and its effects upon humans, but that not surprisingly, there is “a need to educate both health care providers and patients on the adverse health effects of HIED.” In this editorial, I am going to offer the opinion that although a person might take issue with the absolute reliability of certain aspects of Dr Truckner's study, it stands correct that 1) there is much to be discovered, studied, and learned about human health as it relates to the environment and 2) medical school curricula have not kept current with the need for education about the relationship between the environment and human health.Wilderness First Aid: Managing Remote Area Medical Issues
An article in this edition of Wilderness and Environmental Medicine by Welch, Clement, and Berman discusses several aspects of the issue of “wilderness first aid” courses that are intended to increase awareness in lay audiences concerning best practices for managing remote area medical issues. Typical courses include Wilderness First Aid (WFA), Wilderness First Responder (WFR), and Wilderness Emergency Medical Technician (WEMT or EMT-W) and a number of hybrid courses that teach a combination of delayed transport medical care and other skills, such as leadership, survival, and/or situation command and control.Unburying the Facts about Avalanche Victim Pathophysiology
The last decade has witnessed an emerging medical literature employing more rigorous scientific approaches to the study of avalanche victim pathophysiology as dedicated investigators have rapidly advanced this area of research into a well-developed field of wilderness medicine. The scant literature available before this period was based primarily on anecdotal field observations, with a minimum number of well-designed, evidence-based studies of the human condition associated with snow burial or the pathophysiology of death during avalanche accidents.
