Accessibility to biologics and its impact on disease activity and quality of life in patients with rheumatoid arthritis in Kuwait

Objective: Biologics are indicated in rheumatoid arthritis (RA) in case of persistent high disease activity despite conventional disease-modifying anti-rheumatic drugs (cDMARDs) or patients with contraindications to cDMARDs or poor prognostic factors. The purpose of this study was to compare the prescription rates of biologics in Kuwaiti and non-Kuwaiti patients and to assess whether this had an impact on disease activity and quality of life in RA patients. Methods: Data were extracted from the Kuwait Registry for Rheumatic Diseases. Adult patients who satisfied the ACR classification criteria for RA from four major hospitals in Kuwait were evaluated from February 2013 through May 2018. The treatment agents, disease activity, and quality of life of Kuwaiti patients were compared with non-Kuwaiti patients. Results: A total of 1651 RA patients were included; 806 (48.8%) were Kuwaiti patients. Among Kuwaiti patients, 62.5% were on biologic drugs in comparison with 14% of non-Kuwaiti patients. In comparison with non-Kuwaiti patients, Kuwaiti patients had significantly lower numbers of swollen joints (p < 0.001) and disease activity score-28 scores (p = 0.02) and less steroid use (p < 0.001) yet a significantly higher health assessment questionnaire-disability index (p < 0.001). Regression analysis showed that DAS-28 scores were significantly associated with the treatment type (p < 0.001) and that nationality was significantly predictive of the treatment type (p < 0.001). Conclusion: In the setting of easy accessibility to treatment for Kuwaiti patients, biologics were prescribed by rheumatologists at a higher rate than for non-Kuwaitis. This may explain the lower disease activity and the lower rate of steroid use in Kuwaiti patients than non-Kuwaitis. Key points: • Significant discrepancies in the rates of prescribing biologic therapies between KP and NKP in Kuwait were observed. • Several treatment outcomes were significantly better in the KP group than in the NKP group even after adjustment of confounding factors. • The poor access to biologic therapies was suggested to limit the effectiveness of RA treatments in the NKP group

Nanoclay compatibilization of phase separated polysulfone/polyimide films for oxygen barrier

Polyimide (PI) and Polysulfone (PSF) films are used in many applications ranging from electronic film capacitors to membranes for gas separation and water purification, yet their phase separation issues limit many potential synergistic blend film applications. To this end, we examine the potential of nanoclays as non-traditional compatibilizers and re-enforcing agents in these technologically important polymer blend films. Herein, we quantify the effect of a nanoclay, Cloisite 30B on the phase separated blend film morphology compatibilization of PSF/PI and associated changes in its mechanical properties and film surface energy. Addition of as little as 1 mass% of organoclay strongly compatibilized the blend phases at all compositions, reducing the scale of blend phase separation by ~ 5 10 times, and interestingly, the net discreet surface phase separated domain area converged to that observed in 50% blend composition for other off-symmetric blend compositions. Clay compatibilization effects also induced a notable reduction of aspect ratio of surface phase separated domains in thin film blends, attributed to a high degree of exfoliation of the nanoclay by the PSF component so that the effective PSF domain interfacial tension with PI is reduced. Surface modification effects on topography leveling and surface energy changes are only qualitatively similar to our previous observations of block copolymer compatibilizer effect on polymer thin film blend phase separation. Thermal decomposition (TGA) measurements of PSF/PI films showed a decrease in thermal stability upon adding C30B due to its surfactant modification, while film mechanical tensile modulus properties improved slightly by adding low concentration of C30B (~ 1 mass%), but higher nanoclay loading decreased tensile strength and elongation at break. Finally we note that in terms of processing, the viscosities of the polymer solutions dramatically changed with addition 1 mass% and 3 mass% of C30B. We anticipate that more generally, nanoclays can act similarly to traditional polymeric compatibilizers in many aspects in suppressing polymer thin film blend phase separation that can have ramifications for many advanced technological applications such as sensors and membranes. To this end, we present preliminary oxygen barrier properties of adding Cloisite 30B on PSF/PI blend films.We would like to acknowledge the American Chemical Society, Petroleum Research Foundation's New Direction (ACS-PRF-ND) program and the W.M. Keck Foundation for support of the research work. The authors also extend their sincere appreciation to the Deanship of Scientific Research at King Saud University for their funding of the Prolific Research Group (PRG-1436-14). We would like to thank Dr. Sergei Nazarenko at the University of Southern Mississippi for the oxygen permeability test. Further acknowledge to Dr. Miko Cakmak at Purdue University for using his real-time tracking-drying instrument of cast polymer films.Scopu

A novel fuzzy trust-based secure routing scheme in flying ad hoc networks

Today, many studies assess vulnerabilities, threats, and attacks in flying ad hoc networks (FANETs) to provide solutions for countermeasures. Protecting FANETs against attackers and coordinating connections are challenging. The purpose of this study is to increase and maintain communication security. In this paper, a fuzzy trust-based secure routing scheme (FTSR) is presented in FANETs. FTSR utilizes two trust assessment mechanisms, namely local trust and path trust. Local trust strategy is a distributed process for finding reliable neighboring nodes and isolating hostile nodes on the network. In this regard, only reliable nodes are allowed to contribute to the path discovery procedure. This lowers the risk of forming fake paths in FANETs. Path trust strategy is responsible for identifying hostile nodes that are not identified in the local trust process. This strategy shows a general view of the trust status of the desired path. To design this mechanism, the source node runs a fuzzy system to select the safest path between source and the destination. Finally, network simulator 2 (NS2) implements FTSR, and the results such as malicious detection rate, packet delivery ratio, packet loss, accuracy, and delay are obtained from the simulation process. These results indicate that FTSR presents better performance compared to TOPCM, MNRiRIP, and MNDA. However, FTSR takes more time to find paths compared to TOPCM

Additional file 1: Table S1. of GNB5 mutation causes a novel neuropsychiatric disorder featuring attention deficit hyperactivity disorder, severely impaired language development and normal cognition

Clinical summary of the study patients. Clinical characteristics of the five patients included in this study with homozygous GNB5 mutation. (DOCX 14 kb