Concordance with the British Society of Rheumatology (BSR) 2010 recommendations on eligibility criteria for the first biologic agent

Aims: The aim of this study is to assess concordance with the British Society of Rheumatology (BSR) 2010 recommendations on the use of biologic therapy in Rheumatoid Arthritis (RA). The Disease Activity Score in 28 joints (DAS 28), a composite numerical score is included in these recommendations to assess disease activity and response to treatment. Methods: Clinical notes of fifty patients who were commenced on biologic treatment between March 2010 and June 2011 were reviewed for documentation of DAS 28 scores at baseline, after approximately 6 months of commencement of treatment and at approximately 6 monthly intervals during treatment. Results: Twenty two patients were eligible for this audit. Of these patients only half had a DAS 28 score performed prior to starting treatment, four patients had the score performed within 3-9 months of commencement of therapy and only 2 patients had continuous scores performed at six monthly intervals during treatment. Conclusions: This audit shows that we are not adhering to the BSR recommendations. In order to improve our adherence we plan to train all staff in contact with patients on biologic treatment to perform DAS 28 scores and have a DAS 28 calculator readily available at out patients. A proforma is being developed for patients on biologic therapy to ensure that DAS 28 scores are performed at baseline and during treatment.peer-reviewe

Multiparametric Analysis of Factors Associated With Eosinophilic Chronic Rhinosinusitis With Nasal Polyps

Introduction: Previous studies have reported a diverse range of threshold values for blood eosinophilia. In addition, a single predictive biomarker for eosinophilic chronic rhinosinusitis (CRS) with nasal polyps (ECRSwNP) has not yet been identified. Objectives: The aim of this study is to compare the clinical characteristics of ECRSwNP and non-ECRSwNP to evaluate the preoperative risk of tissue eosinophilia of chronic rhinosinusitis with nasal polyps (CRSwNP) through a multiparametric statistical analysis. Methods: One hundred ten patients with evidence of chronic polypoid rhinosinusitis were included in this study and clinical records were retrospectively reviewed. Eosinophilic CRSwNP was diagnosed based on the presence of at least 10 eosinophils per high-power field. The demographic and clinical features of ECRSwNP and non-ECRSwNP are described. The values of blood eosinophilia as predictors of tissue eosinophilia have been identified using receiver operating characteristic curves. As the predictive value of the identified cutoff through regression analysis was low, we evaluated whether other risk factors could be statistically associated with ECRSwNP, and from this, a new predictive model was proposed for the identification of eosinophilic nasal polyps before surgery. Results: We found that the best method for predicting ECRSwNP is based on a model having asthma, blood eosinophil percentage, posterior ethmoid value in Lund-Mackay score, and modified Lund-Kennedy score as explanatory variables. Conclusions: This study provides new data for a better understanding of the polypoid CRS endotypes, and the proposed model allows the endotype to be identified preoperatively

A two-step methodology for product platform design and assessment in high-variety manufacturing

The delayed product differentiation (DPD) recently rose as a hybrid production strategy able to overcome the main limits of make to stock (MTS) and make to order (MTO), guaranteeing the management of high variety and keeping low storage cost and quick response time by using the so-called product platforms. These platforms are a set of sub-systems forming a common structure from which a set of derivative variants can be efficiently produced. Platforms are manufactured and stocked following an MTS strategy. Then, they are customized into different variants, following an MTO strategy. Current literature proposes methods for platform design mainly using optimization techniques, which usually have a high computational complexity for efficiently managing real-size industrial instances in the modern mass customization era. Hence, efficient algorithms need to be developed to manage the product platforms design for such instances. To fill this gap, this paper proposes a two-step methodology for product platforms design and assessment in high-variety manufacturing. The design step involves the use of a novel modified algorithm for solving the longest common subsequence (LCS) problem and of the k-medoids clustering for the identification of the platform structure and the assignment of the variants to the platforms. The platforms are then assessed against a set of industrial and market metrics, i.e. the MTS cost, the variety, the customer responsiveness, and the variants production cost. The evaluation of the platform set against such a combined set of drivers enhancing both company and market perspectives is missing in the literature. A real case study dealing with the manufacturing of a family of valves exemplifies the efficiency of the methodology in supporting companies in managing high-variety to best balance the proposed metrics

Development of UHTCMCs via water based ZrB2 powder slurry infiltration and polymer infiltration and pyrolysis

Cf/ZrB2-SiC ultra-high temperature composites were manufactured via aqueous slurry impregnation coupled with polymer infiltration and pyrolysis, using a allylhydrido polycarbosilane precursor. For the first time we used ultra-high modulus pitch-based carbon fibres for the PIP process, investigating three different architectures, 0/0°, 0/90°, and 2D. Microstructure, mechanical properties and oxidation resistance in air at 1650 °C were investigated. As expected, the mechanical properties showed the tendency to decrease with increase of the preforms complexity, due to the higher amount of flaws and residual stresses. For instance, the flexural strength was approaching 500 MPa for 0/0°, 370 MPa for 0/90° and 190 MPa for 2D. The materials showed an optimal resistance to oxidation at 1650 °C thanks to formation of a viscous borosilicate glass that guaranteed a self-healing functionality

Feature-based multi-class classification and novelty detection for fault diagnosis of industrial machinery

Given the strategic role that maintenance assumes in achieving profitability and competitiveness, many industries are dedicating many efforts and resources to improve their maintenance approaches. The concept of the Smart Factory and the possibility of highly connected plants enable the collection of massive data that allow equipment to be monitored continuously and real-time feedback on their health status. The main issue met by industries is the lack of data corresponding to faulty conditions, due to environmental and safety issues that failed machinery might cause, besides the production loss and product quality issues. In this paper, a complete and easy-to-implement procedure for streaming fault diagnosis and novelty detection, using different Machine Learning techniques, is applied to an industrial machinery sub-system. The paper aims to offer useful guidelines to practitioners to choose the best solution for their systems, including a model hyperparameter optimization technique that supports the choice of the best model. Results indicate that the methodology is easy, fast, and accurate. Few training data guarantee a high accuracy and a high generalization ability of the classification models, while the integration of a classifier and an anomaly detector reduces the number of false alarms and the computational time

Effect of PAN-based and pitch-based carbon fibres on microstructure and properties of continuous Cf/ZrB2-SiC UHTCMCs

In this paper the microstructure and mechanical properties of two different Cf/ZrB2-SiC composites reinforced with continuous PyC coated PAN-derived fibres or uncoated pitch-derived fibres were compared. Pitch-derived carbon fibres showed a lower degree of reaction with the matrix phase during sintering compared to PyC/PAN-derived fibres. The reason lies in the different microstructure of the carbon. The presence of a coating for PAN-derived fibres was found to be essential to limit the reaction at the fibre/matrix interface during SPS. However, coated bundles were more difficult to infiltrate, resulting in a less homogeneous microstructure. As far as the mechanical properties are concerned, specimens reinforced with coated PAN-derived fibres provided higher strengths and damage tolerance than uncoated pitch-derived fibres, due to the higher degree of fibre pull-out. On the other hand, the weaker fibre/matrix interface resulted in lower interlaminar shear, off-axis strength and ablation resistance