Efficacy and safety of rituximab with and without methotrexate in the treatment of rheumatoid arthritis patients: Results from the GISEA register.

Rituximab (RTX) is a monoclonal anti-CD20 antibody approved for the treatment of rheumatoid arthritis (RA) in association with methotrexate (MTX)

Informal payments and intra-household allocation of resources for health care in Albania

<p>Abstract</p> <p>Background</p> <p>Informal payments for health care services can impose financial hardship on households. Many studies have found that the position within the household can influence the decision on how much is spent on each household member. This study analyses the intra-household differences in spending on informal payments for health care services by comparing the resources allocated between household heads, spouses and children.</p> <p>Methods</p> <p>Pooled data from two cross sectional surveys, the Albanian Living Standard Measurement Survey 2002 and 2005, are used to analyse both the probability and the amount paid in inpatient and outpatient health care services. A generalised Hausman specification test is used to compare the coefficients of probit and OLS models for nuclear and extended households.</p> <p>Results</p> <p>We find that due to the widespread informal payments there are no significant differences between households in the incidence of informal payments for households' members, but there are more differences in the amount paid informally. Results suggest that households strategically allocate their resources on health care by favouring individuals with higher earning potential who have invested more in human capital. Extended households pay higher amounts for spouses with higher education compared to nuclear households. On the other hand, nuclear households choose to pay higher amounts for children with a higher level of education compared to extended households.</p> <p>Conclusions</p> <p>The differences between households should be taken into account by public policies which should compensate this by redistribution mechanisms targeting disadvantaged groups. Governments should implement effective measures to deal with informal patient payments.</p> <p><b>JEL Codes: </b>I10, I19, D10</p

Hardware Commissioning of the Refurbished ALPI Linac at INFN-LNL to Serve as SPES Exotic Beam Accelerator

Abstract The ALPI linac at INFN-LNL was substantially refurbished in 2018, especially in view of its use as secondary accelerator for exotic species in the framework of the SPES project. In particular: 10 magnetic triplets were replaced with higher gradient ones; two cryomodules with quarter wave resonator were moved from the PIAVE injector to ALPI, so as to make them available both for exotic and stable beams; the cryogenic plant was renovated; the whole linac, its injector and its beam lines were eventually realigned via LASER tracking (LT). The expected outcome of the refurbishment project is a larger beam transmission (crucial for the efficient transport of the unavoidably low current exotic beams) and improved overall reliability so as to further extend the lifetime of an already 25 years old machine. The hardware commissioning of this new configuration will be reported

Methods of nutrition surveillance in low-income countries

Background In 1974 a joint FAO/UNICEF/WHO Expert Committee met to develop methods for nutrition surveillance. There has been much interest and activity in this topic since then, however there is a lack of guidance for practitioners and confusion exists around the terminology of nutrition surveillance. In this paper we propose a classification of data collection activities, consider the technical issues for each category, and examine the potential applications and challenges related to information and communication technology. Analysis There are three major approaches used to collect primary data for nutrition surveillance: repeated cross-sectional surveys; community-based sentinel monitoring; and the collection of data in schools. There are three major sources of secondary data for surveillance: from feeding centres, health facilities, and community-based data collection, including mass screening for malnutrition in children. Surveillance systems involving repeated surveys are suitable for monitoring and comparing national trends and for planning and policy development. To plan at a local level, surveys at district level or in programme implementation areas are ideal, but given the usually high cost of primary data collection, data obtained from health systems are more appropriate provided they are interpreted with caution and with contextual information. For early warning, data from health systems and sentinel site assessments may be valuable, if consistent in their methods of collection and any systematic bias is deemed to be steady. For evaluation purposes, surveillance systems can only give plausible evidence of whether a programme is effective. However the implementation of programmes can be monitored as long as data are collected on process indicators such as access to, and use of, services. Surveillance systems also have an important role to provide information that can be used for advocacy and for promoting accountability for actions or lack of actions, including service delivery. Conclusion This paper identifies issues that affect the collection of nutrition surveillance data, and proposes definitions of terms to differentiate between diverse sources of data of variable accuracy and validity. Increased interest in nutrition globally has resulted in high level commitments to reduce and prevent undernutrition. This review helps to address the need for accurate and regular data to convert these commitments into practice

Macroevolutionary Patterns in the Aphidini Aphids (Hemiptera: Aphididae): Diversification, Host Association, and Biogeographic Origins

, the most diverse genus in the family. We used a combined dataset of one nuclear and four mitochondrial DNA regions. A molecular dating approach, calibrated with fossil records, was used to estimate divergence times of these taxa.Most generic divergences in Aphidini occurred in the Middle Tertiary, and species-level divergences occurred between the Middle and Late Tertiary. The ancestral state of host use for Aphidini was equivocal with respect to three states: monoecy on trees, heteroecy, and monoecy on grasses. The ancestral state of Rhopalosiphina likely included both heteroecy and monoecy, whereas that of Aphidina was most likely monoecy. The divergence times of aphid lineages at the generic or subgeneric levels are close to those of their primary hosts. The species-level divergences in aphids are consistent with the diversification of the secondary hosts, as a few examples suggest. The biogeographic origin of Aphidini as a whole was equivocal, but the major lineages within Aphidina likely separated into Nearctic, Western Palearctic, and Eastern Palearctic regions.Most generic divergences in Aphidini occurred in the Middle Tertiary when primary hosts, mainly in the Rosaceae, were diverging, whereas species-level divergences were contemporaneous with diversification of the secondary hosts such as Poaceae in the Middle to Late Tertiary. Our results suggest that evolution of host alternation within Aphidini may have occurred during the Middle Tertiary (Oligocene) when the secondary hosts emerged

Hurricane Mitch and the livelihoods of the rural poor in Honduras

This paper assesses the extent to which Hurricane Mitch affected the rural poor in Honduras and whether national and international aid efforts succeeded in providing relief. One of every two surveyed households incurred medical, housing, or other costs due to Mitch. One in three suffered from a loss in crops. One in five lost assets. One in 10 lost wages or business income. Relief was most often provided by churches and nongovernmental organizations. It consisted mainly of food, clothing, and medicine, and it amounted to less than one-tenth of the losses incurred by households. (C) 2001 Elsevier Science Ltd. All rights reserved

Neutrophil arachidonic acid level and adhesive capability are increased in essential hypertension

Background. We recently demonstrated that arachidonic:linoleic acid ratio of erythrocytes of essential hypertension patients is greater than normal. Objective. To investigate fatty acid composition, capability for adhesion to biological substrate and expression of betainf 2 integrins of leucocytes obtained from peripheral blood and skin window exudate of essential hypertension patients. Design. Neutrophil activation state was evaluated by reproducing the various conditions occurring in vivo during the life of the cell (i.e. under the 'resting' condition, such as in peripheral blood, and 'primed' condition, such as after transmigration through the endothelium and after administration of specific chemo-attractants). Because both peripheral blood and skin window leucocytes of the subjects were obtained on the same day, we could be sure that there had been no dietary influences on changes in levels of fatty acid. Thus, the observed changes should reliably reflect the metabolic rate of utilization of fatty acids coupled to the activation and migration of cells. Results. Leucocytes from essential hypertension patients were richer in arachidonic acid than were the corresponding cells from normotensive subjects; this difference was also evident for functionally activated skin window leucocytes, in spite of there having been a greater loss of poly-unsaturated fatty acids and arachidonic acid after migration. Moreover, a greater than normal arachidonic acid:linoleic acid ratio was shown for the first time to apply for leucocytes of essential hypertension patients, so extending our previous findings on the erythrocytes. Leucocytes from essential hypertension patients, collected both from peripheral blood and from skin window exudate, proved far more adhesive than the corresponding cells from age-matched and sex-matched controls, but this was not associated with a quantitative hyperexpression of betainf 2 integrins. Conclusions. The results suggest that an increase in availability of arachidonic acid in leucocytes could be a further expression of the generalized disturbance of fatty acid levels associated with essential hypertension and that a condition of hyperadhesion of neutrophils could occur spontaneously in vivo during the course of hypertension

Clinical associations of anti-CENP-B and anti-Scl70 antibody levels measured by multiplexed fluorescent microsphere immunoassay in systemic sclerosis

The aim of this study was to assess the association between anti-CENP-B and anti-Scl70 antibody levels, measured by multiplexed fluorescent microsphere immunoassay, and the clinical features in patients affected by systemic sclerosis. Clinical evaluation of 80 scleroderma patients was performed in order to evaluate disease activity and organ involvement. Scleroderma-specific autoantibodies were detected using multiplexed fluorescent microsphere immunoassay. Unexpectedly, 11 patients resulted positive for both anti-Scl70 and anti-CENP-B antibodies; six cases showed a weak positivity for one of the two autoantibodies and a stronger positivity for the other one; five cases showed an intense positivity for both autoantibodies. This latter subgroup was excluded from the analysis of the associations between autoantibody levels and the clinical features. In the anti-CENP-B positive patients higher antibody levels were associated with a less extensive skin involvement in comparison with the cases affected by a more extensive skin involvement (521 \ub1 208 vs 395 \ub1 166 U/ml, respectively, P 0.038). In the anti-Scl70 positive patients autoantibody levels were directly correlated with skin involvement (P 0.018), showing higher levels in patients with a more extensive skin involvement in comparison with cases characterized by less extensive skin involvement (734 \ub1 135 vs 490 \ub1 183 U/ml, respectively, P 0.001). The findings of our study supports the association between autoantibody profile and disease severity in systemic sclerosis. In particular high levels of anti-Scl70 antibodies are associated with a worse cutaneous involvement, while high levels of anti-CENP-B antibodies seem to have a protective effect on skin manifestations