Treatment of psoriasis with biologic agents in Malta

Introduction: Biologic therapy has revolutionalised the treatment of moderate to severe psoriasis leading to improved clinical outcomes and quality of life scores. This study aims to determine current biologic use in psoriatic patients at our Dermatology department at Sir Paul Boffa hospital, Malta. Method: All patients who were administered biologic therapy for psoriasis in Malta until the end of 2014 were included. Data included demographic details, disease duration and severity, biologic use and duration, previously attempted treatments, side effects, early and late response to biologic using Psoriasis Area Severity Index (PASI) scores and Dermatology Life Quality index (DLQI) scores. Results: A total of 36 patients were started on a biologic between 2009 and 2014 for psoriasis (M:25, F:11) with a mean age of 46.9 years. These included etanercept (n=22), infliximab (n=8), adalimumab (n=4) and ustekinumab (n=2). Secondary failure was the main reason why biologics were stopped and switched. Most patients had an improvement in their PASI scores after 2 to 4 weeks of starting the biologic and had a PASI 90 score improvement. All patients had more than a 5 point improvement in DLQI score. Discussion: Biologic use in our department is on the increase. Our patients had considerable improvements in their PASI and DLQI scores. Secondary failures have occurred usually after 2 to 4 years and switching has yielded positive results. Biologics are expensive drugs and recently we have switched to cheaper biosimilars. Doctors should be aware of the treatment options available for psoriasis patients, their possible side effects and when to refer to our department. In most cases a satisfactory response can be achieved.peer-reviewe

UAS Literary & Arts Journal

Proof copy provided by Tidal Echoes.Featuring the work of students, faculty, and staff of the University of Alaska Southeast and members of the community.A Note from Emily Wall -- Editor’s Note -- Mask -- Image of Nora, Rendering Seal Oil -- Based of course on hearsay -- Bowl with Spoon -- Gathering Indigo -- Shed -- Decay -- At the Core -- After Summer Time -- Sitka Fishing Boat -- Pericles at the Beach -- Funny Face Fido (detail) -- The Answer Dog -- Direction of the Wind -- Eagle -- An Interview with Nathan Jackson -- Water Becoming Land -- An Interview with John Straley -- Halibut Point View -- Night Monsters -- Sea Lion -- Trophy -- Humpback Flukes -- Homecoming -- Spinning Tires -- Hiking the Salt Chuck Trail -- Sitka Rose -- Columbine -- Chocolate Lily -- Bleeding Hearts -- Salmon Egg Puller—$2.15 an hour -- Granddaughters Dancing -- Sitka Sentinel -- Kootznoowoo -- Ode to Wildlife -- Dinner Party -- Floating Islands (detail) -- To My Departed Kishka -- Wisteria -- Untitled -- Fairweather Laundry -- Struggling with My Language -- “Culture” in the Juneau Museum -- Thane -- Juneau Goldbelt & 9th -- Pink Blue Leaves -- Slow Fall -- Tango -- Pacific Coast Mask with Copper Luster -- Against Confessional -- Sunday Afternoon 3:30 to 3:31 -- Downtown -- Tony, Six Flags Great Adventure, Jackson, New Jersey -- Land and Water Series -- On the Day They Buried Gus Hall -- Solju Sapnu -- Nattie -- The First Half of the Last Century -- A Church Remains -- Mexican Wall -- Eagle Reflections -- The Saving Son -- Axh Leelk’w -- Sinister Place -- Blue Halibuts -- Fishing Again -- The Masai -- Wanting to Know Water -- For Women Like Me -- Mountain Bleu -- Untitled -- Single Word Title -- Charms (detail) -- e.e isn’t Cummings back -- Mocha Gal -- Poppies -- Ideal Woman Blues -- Near the End -- Poet at Work -- Stills -- Serenity -- Lupine Bugs -- Spring Fiddleheads -- What a Piece of Work! -- Biographie

Identification of the severe sepsis patient at triage: a prospective analysis of the Australasian Triage Scale

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/Objective This study aims to investigate the accuracy and validity of the Australasian Triage Scale (ATS) as a tool to identify and manage in a timely manner the deteriorating patient with severe sepsis. Methods This was a prospective observational study conducted in five sites of adult patients. Keywords and physiological vital signs data from triage documentation were analysed for the ‘identified’ status compared with confirmed diagnosis of severe sepsis after admission to the intensive care unit. The primary outcome is the accuracy and validity of the ATS Triage scale categories to identify a prespecified severe sepsis population at triage. Secondary outcome measures included time compliance, antimicrobial administration and mortality prediction. Statistical analysis included parameters of diagnostic performance. Adjusted multivariate logistic regression analysis was applied to mortality prediction. Results Of 1022 patients meeting the criteria for severe sepsis, 995 were triaged through the emergency department, 164 with shock. Only 53% (n=534) were identified at triage. The overall sensitivity of the ATS to identify severe sepsis was 71%. ATS 3 was the most accurate (likelihood ratio positive, 2.45, positive predictive value 0.73) and ATS 2 the most valid (area under the curve 0.567) category. Identified cases were more likely to survive (OR 0.81, 95% CI 0.697 to 0.94, p4 (OR 1.63, 95% CI 1.10 to 2.89, p<0.001) and ATS 1 category (OR 1.55, 95% CI 1.09 to 2.35, p<0.005). Conclusions The ATS and its categories is a sensitive and moderately accurate and valid tool for identifying severe sepsis in a predetermined group, but lacks clinical efficacy and safety without further education or quality improvement strategies targeted to the identification of severe sepsis

The Adipokine C1q Tnf Related Protein 3 (CTRP3) Is Elevated in the Breast Milk of Obese Mothers

Background C1q TNF related protein 3 (CTRP3) is a relatively novel hormonal factor primarily derived from adipose tissue and has anti-diabetic properties. To determine if CTRP3 could play a role in early childhood development, the purpose of this study was to establish the presence of CTRP3 in breast milk (BM) and to determine whether CTRP3 levels were correlated with pregravid obesity status of the mother. Methods Breast milk was collected from breast-feeding mothers who had a pregravid body mass index (BMI) classification of normal weight (BMI 18–25 kg/m2, n = 23) or obese (BMI \u3e 30 kg/m2, n = 14). Immunoprecipitation followed by immunoblot analysis confirmed the presence of CTRP3 in BM. The concentration of CTRP3 in BM samples was determined by ELISA. Additional bioactive components were also measured by commercially available assays: ghrelin, insulin, leptin, adiponectin, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and glucose. Bioactive components in normal weight and obese mothers were compared using unpaired t-test (parametric) and Mann–Whitney U-test (non-parametric), as appropriate. Results The primary findings of this study are that the adipokine CTRP3 is present in BM and CTRP3 levels are increased with pregravid obesity. Additionally, this study independently confirmed previous work that BM from obese mothers has a higher concentration of insulin and leptin. Further, no differences were observed in BM between obese and normal weight mothers in ghrelin, adiponectin, IL-6, TNF-α, or glucose levels. Conclusion This study identified a novel factor in BM, CTRP3, and showed that BM CTRP3 levels higher in obese mothers. Because of the purported insulin sensitizing effect of CTRP3, it is possible that the elevated levels of CTRP3 in the BM of obese mothers may offset negative effects of elevated leptin and insulin levels in the BM of obese mothers. Future studies will need to be conducted to determine the relevance of CTRP3 in BM and to examine the presence of other adipose tissue-derived hormonal factors

Innovating Pedagogy 2017: Exploring new forms of teaching, learning and assessment, to guide educators and policy makers. Open University Innovation Report 6

This series of reports explores new forms of teaching, learning and assessment for an interactive world, to guide teachers and policy makers in productive innovation. This sixth report proposes ten innovations that are already in currency but have not yet had a profound influence on education. To produce it, a group of academics at the Institute of Educational Technology in The Open University collaborated with researchers from the Learning In a NetworKed Society (LINKS) Israeli Center of Research Excellence (I-CORE). Themes: • Big-data inquiry: thinking with data • Learners making science • Navigating post-truth societies • Immersive learning • Learning with internal values • Student-led analytics • Intergroup empathy • Humanistic knowledge-building communities • Open Textbooks • Spaced Learnin

Alumni Journal: : Remembrance -- One Lucky Guy

Alumni new

Better Workers, Better Elections? Electoral Management Body Workforces and Electoral Integrity Worldwide

Building better elections is a central task for the study of democracy and democratisation. Despite this, there have been no cross-national studies on the staff who manage and implement elections: electoral management body (EMB) workforces. This article provides the first macroscopic worldwide picture of workforce characteristics, human resource management practices and employee outcomes, and analyses the effects they have on electoral integrity, based on original international surveys of electoral management bodies (EMBs) (n = 51) and electoral officials (n = 2029). Drawing from the human resource management literature, a framework is developed to explain how these factors might interact with EMB performance. Analysis demonstrates them to be highly related. Adding data on human resource management practices and employee outcomes improves explanatory models designed to predict the performance of EMBs. Chiefly, EMBs that enable greater opportunities for employees to be involved in decision-making processes perform better. Recruitment practices, job satisfaction and levels of stress are also important

RBM5 Is a Male Germ Cell Splicing Factor and Is Required for Spermatid Differentiation and Male Fertility

Alternative splicing of precursor messenger RNA (pre-mRNA) is common in mammalian cells and enables the production of multiple gene products from a single gene, thus increasing transcriptome and proteome diversity. Disturbance of splicing regulation is associated with many human diseases; however, key splicing factors that control tissue-specific alternative splicing remain largely undefined. In an unbiased genetic screen for essential male fertility genes in the mouse, we identified the RNA binding protein RBM5 (RNA binding motif 5) as an essential regulator of haploid male germ cell pre-mRNA splicing and fertility. Mice carrying a missense mutation (R263P) in the second RNA recognition motif (RRM) of RBM5 exhibited spermatid differentiation arrest, germ cell sloughing and apoptosis, which ultimately led to azoospermia (no sperm in the ejaculate) and male sterility. Molecular modelling suggested that the R263P mutation resulted in compromised mRNA binding. Within the adult mouse testis, RBM5 localises to somatic and germ cells including spermatogonia, spermatocytes and round spermatids. Through the use of RNA pull down coupled with microarrays, we identified 11 round spermatid-expressed mRNAs as putative RBM5 targets. Importantly, the R263P mutation affected pre-mRNA splicing and resulted in a shift in the isoform ratios, or the production of novel spliced transcripts, of most targets. Microarray analysis of isolated round spermatids suggests that altered splicing of RBM5 target pre-mRNAs affected expression of genes in several pathways, including those implicated in germ cell adhesion, spermatid head shaping, and acrosome and tail formation. In summary, our findings reveal a critical role for RBM5 as a pre-mRNA splicing regulator in round spermatids and male fertility. Our findings also suggest that the second RRM of RBM5 is pivotal for appropriate pre-mRNA splicing.This work was supported by grants from the National Health and Medical Research Council (NHMRC) to DJ (#606503); the Australian Research Council (ARC) to MKO and CJO; the New South Wales Cancer Council, Cancer Institute New South Wales, Banque Nationale de Paris-Paribas Australia and New Zealand, RT Hall Trust, and the National Breast Cancer Foundation to CJO. DJ was an NHMRC Peter Doherty Postdoctoral Fellow (#384297). MKO and CJO are NHMRC Senior Research Fellows (#545805, #481310). CCG is an NHMRC Australia Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Genesis Mission to Return Solar Wind Samples to Earth

The Genesis spacecraft, launched on 8 August 2001 from Cape Canaveral, Florida, will be the first spacecraft ever to return from interplanetary space. The fifth in NASAs line of low-cost, Discovery-class missions, its goal is to collect samples of solar wind and return them to Earth for detailed isotopic and elemental analysis. The spacecraft is to collect solar wind for over 2 years, while circling the L1 point 1.5 million km Sunward of the Earth, before heading back for a capsule-style re-entry in September 2004. After parachute deployments mid-air helicopter recovery will be used to avoid a hard landing. The mission has been in development over 10 years, and its cost, including development, mission operations, and initial sample analysis, is approximately $209 million

The Iowa Homemaker vol.22, no.2

Keeping Up With Today, Barbara Sgarlata, page 4 Women Score Dating, Julie Wendel, page 5 The Union Feeds the Navy, Betty Ann Iverson, page 6 Glass in Uniform, Dorothy Walker, page 7 Sugar Problem – A Challenge, Anne Koebel, page 8 Enter: Variety in Army Menus, Mary Schmidt, page 10 “Is It All Wool?”, Margaret Anne Clark, page 11 America Conserves Equpment, Bette Simpson, page 12 Morale on a Budget, Pat Hayes, page 14 What’s New in Home Economics, Ruth Vogel, page 16 Bookmarks, Eileen Dudgeon, page 18 Isabelle Bevier - Pioneer, Dorothy Ann Olson, page 20 Alums in the News, Harriet Zook, page 22 Our Part in the War, Virginia Bates, page 23 Iowa Goes “All Out”, Catherine Tidemanson, page 24 Tim Must S-t-r-e-t-c-h, Doris Plagge, page 26 Vanilla Joins Shortage Ranks, Grace Brown, page 28 Her Champion Pie, Pat Galligan, page 29 Across Alumnae Desks, Mary Ellen Sullivan, page 30 Speaking of Veishea, Trymby Calhoun, page 3