Dysbiosis is a key pathogenic factor in the cycle of skin barrier impairment and inflammation in atopic dermatitis (AD). Skin microbial composition in AD is characterized by increased presence of Staphylococcus aureus (S. aureus) and decrease in microbial diversity and commensal bacterial species. Attenuation of S. aureus-driven inflammation aids in breaking the itch-scratch cycle via modulation of the cutaneous immune response. Skin bacterial transplant (SBT), a form of bacteriotherapy, is an intriguing treatment modality for restoration of a healthy skin microbiome in AD patients. Studies on the effects of topically-applied bacterial products, probiotics and SBT have yielded promising results in animal models and human studies of AD. This review discusses the rationale and evidence for SBT in AD and outlines future investigative directions for the clinical application of microbiome restoration in dermatology.

Legionella pneumophila uses a single homodimeric disulfide bond (DSB) oxidoreductase DsbA2 to catalyze extracytoplasmic protein folding and to correct DSB errors through protein-disulfide isomerase (PDI) activity. In Escherichia coli, these functions are separated to avoid futile cycling. In L. pneumophila, DsbA2 is maintained as a mixture of disulfides (S-S) and free thiols (SH), but when expressed in E. coli, only the SH form is observed. We provide evidence to suggest that structural differences in DsbB oxidases (LpDsbB1 and LpDsbB2) and DsbD reductases (LpDsbD1 and LpDsbD2) (compared to E. coli) permit bifunctional activities without creating a futile cycle. LpdsbB1 and LpdsbB2 partially complemented an EcdsbB mutant while neither LpdsbD1 nor LpdsbD2 complemented an EcdsbD mutant unless DsbA2 was also expressed. When the dsb genes of E. coli were replaced with those of L. pneumophila, motility was restored and DsbA2 was present as a mixture of redox forms. A dominant-negative approach to interfere with DsbA2 function in L. pneumophila determined that DSB oxidase activity was necessary for intracellular multiplication and assembly/function of the Dot/Icm Type IVb secretion system. Our studies show that a single-player system may escape the futile cycle trap by limiting transfer of reducing equivalents from LpDsbDs to DsbA2.

Multimodal literacy, a product of modern technology, can aid in the recall of simple-to-complex information for both children and adults. Health education information presented using educational comics takes advantage of multimodal formats and designs based on theoretical models of learning. In this study, we utilized a quasi-experimental design with both pre- and post-intervention testing. The parents of every other patient that attended the well-child appointments of their child aged <9 months were invited to participate in this study. Participants were drawn from three pediatric clinics, with a total of 280 parents included in the study. Each parent completed a pre-intervention test consisting of an eight-item questionnaire regarding the developmental milestones of a 9-month-old child. After responding to the questionnaire, the parents received a comic about a 9-month-old child reaching age-appropriate developmental milestones. Four to six weeks after the comics were provided to the parents, they responded to the same questionnaire by phone, which consisted of the same eight questions plus an additional question regarding possible additional uses of the comic. Parents significantly increased their recall of information of developmental milestones when the pre- and post-intervention test results were compared, with a significance of p < 0.001 at a 95% confidence level. Additional uses of the comic reported by parents included calling their pediatrician with doubts about their own child's appropriate achievement of milestones, and lending the comics to relatives or friends. The educational comic appeared to assist parents in making meaningful connections between the simplified pictures and the developmental milestones of their child. Comics may provide an alternative for parental education using this multimodal format to explain simple-to-complex issues.

: Employee wellness programs can provide benefits to institutions as well as employees and their families. Despite the attempts of some organizations to implement programs that take a holistic approach to improve physical, mental, and social wellness, the most common programs are exclusively comprised of physical and nutritional components. In this study, we implemented a wellness program intervention, including training using a holistic approach to improve the wellbeing of middle managers in several multinational organizations. We included control and experimental groups to measure wellness and teamwork with two repeated measures. Our results indicated that employees receiving the intervention had improved measures of wellness and teamwork. A positive relationship was found between wellness and teamwork in the experimental group when compared with the control group. Taken together, the data suggest that implementation of these programs would provide valuable outcomes for both employees and organizations.