Persistent clinical efficacy and safety of anti-tumour necrosis factor \textgreeka therapy with infliximab in patients with ankylosing spondylitis over 5 years: evidence for different types of response

Background: There is insufficient evidence for the long-term efficacy and safety of anti-tumour necrosis factor therapy in patients with ankylosing spondylitis (AS). This is the first report on the treatment with infliximab over 5 years.Methods: As part of a multicentre randomised trial, 69 patients with active AS at baseline (BL) have been continuously treated with infliximab (5 mg/kg i.v. every 6 weeks)---except for a short discontinuation after 3 years (FU1). The primary outcome of this extension was remission according to the ASsessment in Ankylosing Spondylitis (ASAS) criteria at the end of year 5 of the study (FU2).Results: Of the 43 patients who completed year 3, 42 agreed to continue, 38 of which (90.5%) finished year 5 (55% of 69 initially). Partial clinical remission was achieved in 13 of 38 patients (34.2%) at FU1 and FU2. At FU2, the mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was 2.5±1.9 (BL:6.4, FU1:2.5). BASDAI values <4 were seen in 79% of patients at both, FU1 and FU2. ASAS 20% and 40% responses were seen in 32 (84%) and 24 (63%) patients at FU2, respectively. Most patients classified as non-responders at FU2 were part-time responders, as all but one patient achieved an ASAS 20% response at least once within the last 2 years. Three types of responders were identified. No major side effects occurred during years 4 and 5 of infliximab therapy.Conclusions: Infliximab is safe and efficacious in AS patients over 5 years. The majority of the patients remained on treatment and had rather persistent levels of low disease activity. Different response types could be identified

Towards a methodology for addressing missingness in datasets, with an application to demographic health datasets

Missing data is a common concern in health datasets, and its impact on good decision-making processes is well documented. Our study's contribution is a methodology for tackling missing data problems using a combination of synthetic dataset generation, missing data imputation and deep learning methods to resolve missing data challenges. Specifically, we conducted a series of experiments with these objectives; $a)$ generating a realistic synthetic dataset, $b)$ simulating data missingness, $c)$ recovering the missing data, and $d)$ analyzing imputation performance. Our methodology used a gaussian mixture model whose parameters were learned from a cleaned subset of a real demographic and health dataset to generate the synthetic data. We simulated various missingness degrees ranging from $10 \%$, $20 \%$, $30 \%$, and $40\%$ under the missing completely at random scheme MCAR. We used an integrated performance analysis framework involving clustering, classification and direct imputation analysis. Our results show that models trained on synthetic and imputed datasets could make predictions with an accuracy of $83 \%$ and $80 \%$ on $a)$ an unseen real dataset and $b)$ an unseen reserved synthetic test dataset, respectively. Moreover, the models that used the DAE method for imputed yielded the lowest log loss an indication of good performance, even though the accuracy measures were slightly lower. In conclusion, our work demonstrates that using our methodology, one can reverse engineer a solution to resolve missingness on an unseen dataset with missingness. Moreover, though we used a health dataset, our methodology can be utilized in other contexts.Comment: 16 pages and references, 5 figures and four tables, Paper accepted for presentation at SACAIR 2022 in Stellenbosch, Westen Cape, South Afric

Fatigue analysis of multiple site damage at a row of holes in a wide panel

This paper is concerned with predicting the fatigue life of unstiffened panels which contain multiple site damage (MSD). The initial damage consists of through-the-thickness cracks emanating from a row of holes in the center of a finite width panel. A fracture mechanics analysis has been developed to predict the growth, interaction, and coalescence of the various cracks which propagate in the panel. A strain-life analysis incorporating Neuber's rule for notches, and Miner's rule for cumulative damage, is also employed to predict crack initiation for holes without initial cracking. This analysis is compared with the results of a series of fatigue tests on 2024-T3 aluminum panels, and is shown to do an excellent job of predicting the influence of MSD on the fatigue life of nine inch wide specimens. Having established confidence in the ability to analyze the influence of MSD on fatigue life, a parametric study is conducted to examine the influence of various MSD scenarios in an unstiffened panel. The numerical study considered 135 cases in all, with the parametric variables being the applied cyclic stress level, the lead crack geometry, and the number and location of MSD cracks. The numerical analysis provides details for the manner in which lead cracks and MSD cracks grow and coalesce leading to final failure. The results indicate that MSD located adjacent to lead cracks is the most damaging configuration, while for cases without lead cracks, MSD clusters which are not separated by uncracked holes are most damaging

Clinical characteristics and patient-reported outcomes in patients with inadequately controlled rheumatoid arthritis despite ongoing treatment

Background Despite the wide array of treatments available for rheumatoid arthritis (RA), some patients continue to report unmet clinical needs. We investigated the extent of inadequate disease control in patients with RA. Methods Data were drawn from the Adelphi 2014 RA Disease-Specific Program in France, Germany, Italy, Spain and the UK. Rheumatologists provided patient demographics, comorbidities, satisfaction with RA control and other clinical details. Patients reported their level of satisfaction and completed the EuroQoL 5-Dimensions Health Questionnaire and Work Productivity and Activity Impairment Questionnaire. Patients had been on their current therapy 653 months and had 28-joint disease activity scores (DAS28) reported. Adequately controlled (DAS28 643.2) and inadequately controlled (DAS28 &gt;3.2) patient cohorts were compared using univariate tests. Results Of 1147 patients, 74% were women, the mean age was 52 years and the mean time since RA diagnosis was 7 years. Twenty-seven percent of patients had inadequately controlled RA, whereas 73% had adequately controlled RA. Inadequately controlled patients were more affected clinically versus adequately controlled patients; 69% vs 13% had moderate/severe RA, the current level of pain was 4.6 vs 2.3, and 67% vs 41% experienced flares, respectively (all p&lt;0.0001). Inadequately controlled patients had higher rates of depression (16% vs 5%; p&lt;0.0001), worse health state, greater work and activity impairment, and lower satisfaction rates among the patients and their physicians than the adequately controlled cohort. Conclusion RA was insufficiently controlled in over a quarter of patients despite their current therapy and this had a negative impact on the patients

Vessel labeling in combined confocal scanning laser ophthalmoscopy and optical coherence tomography Images : criteria for blood vessel discrimination

INTRODUCTION: The diagnostic potential of optical coherence tomography (OCT) in neurological diseases is intensively discussed. Besides the sectional view of the retina, modern OCT scanners produce a simultaneous top-view confocal scanning laser ophthalmoscopy (cSLO) image including the option to evaluate retinal vessels. A correct discrimination between arteries and veins (labeling) is vital for detecting vascular differences between healthy subjects and patients. Up to now, criteria for labeling (cSLO) images generated by OCT scanners do not exist. OBJECTIVE: This study reviewed labeling criteria originally developed for color fundus photography (CFP) images. METHODS: The criteria were modified to reflect the cSLO technique, followed by development of a protocol for labeling blood vessels. These criteria were based on main aspects such as central light reflex, brightness, and vessel thickness, as well as on some additional criteria such as vascular crossing patterns and the context of the vessel tree. RESULTS AND CONCLUSION: They demonstrated excellent inter-rater agreement and validity, which seems to indicate that labeling of images might no longer require more than one rater. This algorithm extends the diagnostic possibilities offered by OCT investigations

1950: Abilene Christian College Bible Lectures - Full Text

Introduction We offer with interest and pleasure another volume of a great series of discourses delivered at Abilene Christian College. The following were given in February, 1950. The first of these Lectureships was held in the year 1919, and was published by the Firm Foundation Publishing House in book form. With little exception they have appeared each year since that time. The printing was done by others a few times. Those who are fortunate enough to have a complete set of these fine gospel sermons are possessed of a treasure in religious literature. Only a few of the later years can now be supplied. The rest are numbered among the “rare books” and we frequently have calls for them, but of course cannot supply them. Any reader having a copy for sale is requested to write the office of the Firm Foundation at Austin, Texas. The “Lectureship” of Abilene Christian College has become a great annual affair to the churches of Christ; thousands are in attendance, many of them coming from Canada and other countries besides all over the United States. This annual “mass meeting” must not be understood to be a “Convention” of the churches of Christ. We have no such conventions and do not endorse them. The Lectureship is simply a feature in the work of Abilene Christian College, a series of gospel sermons to which friends and patrons of the school and others are invited. It is our hope that the contents of this book may enrich the life, and strengthen the faith of the reader. G. H. F. SHOWALTER Austin, Texas August 20, 195