It is well known that applications of a single dose of 12-O-tetradecanoylphorbol-13-acetate (TPA) to mouse ears induces an acute inflammatory reaction consisting of erythema, edema and polymorphonuclear leukocyte (PMN) infiltration. We report here that multiple topical applications of TPA to mouse ears produce a prolonged inflammatory reaction characterized by increases in ear weight, inflammatory cell infiltration and epidermal hyperplasia. TPA was applied 5 times over 10 days to mouse ears. Epidermal thickness and PMN infiltration (myeloperoxidase content) increased 3- and 160-fold, respectively, by day 3 and remained elevated over control values throughout the test period. Ear weight was elevated from day 1 and remained high. Hydrocortisone 17-valerate and betamethasone dipropionate significantly reduced all three parameters of inflammation. Indomethacin and two other cyclo-oxygenase inhibitors, and an antihistamine had little or no effect on any of the parameters. This chronic skin inflammation model may be more relevant for evaluating anti-inflammatory compounds than the acute TPA model because the test compounds are applied after the inflammatory lesion is established, which mirrors the use of clinical anti-inflammatory drugs. Also this model may be more selective than the acute TPA model for compounds which affect leukotriene production since other pharmacological agents which are active in the acute model are not active in the multiple-application model.

Background: Collaborative learning health systems have demonstrated improved outcomes for a range of different chronic conditions. Patient and healthcare provider engagement in these systems is thought to be associated with improved outcomes.We have adapted an observational framework to measure, and track over time, engagement in ImproveCareNow, a collaborative learning health system for children with inflammatory bowel disease.Introduction: We developed a categorical classification scheme for engagement in ImproveCareNow. Each tier is defined in terms of observable individual behaviors.When an individual completes one or more qualifying behavior, s/he is classified as engaged at that tier. Individuals are entered into a database, which is accessible to care centers throughout the ImproveCareNow network. Database records include fields for individual name, behavior type, time, place, and level of engagement.Results: The resulting system is employed at 79 ImproveCareNow care centers in the United States. The system recognizes four levels of engagement. Behaviors are recorded in a managed vocabulary and recorded in an online database. The database is queried weekly for individual engagement behaviors, which are tracked longitudinally. Center-and network-level statistics are generated and disseminated to stakeholders. Conclusion:It is possible to monitor longitudinal engagement in a collaborative learning health system, thereby charting progress toward engagement goals and enabling quantitative evaluation of interventions aimed at increasing engagement.

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Background: Collaborative Learning Health Systems (CLHS) improve outcomes in part by facilitating collaboration among all stakeholders. One way to facilitate collaboration is by creating conditions for the production and sharing of medical and nonmedical resources (information, knowledge, and knowhow [IKK]) so anybody can get "what is needed, when it's needed" (WINWIN) to act in ways that improve health and healthcare. Matching resources to needs can facilitate accurate diagnosis, appropriate prescribing, answered questions, provision of emotional and social support, and uptake of innovations.Objectives: We describe efforts in ImproveCareNow, a CLHS improving outcomes in pediatric inflammatory bowel disease (IBD), to increase the number of patients and families creating and accessing IKK, and the challenges faced in that process. Methods:We applied tactics such as outreach through trusted messengers, community organizing, and digital outreach such as sharing resources on our website, via social media, and email to increase the number of people producing, able to access, and accessing IKK. We applied an existing measurement system to track our progress and supplemented this with community feedback.Results: In August of 2017 we identified and began measuring specific actions to track community growth. The number of patients and families producing IKK has

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