Optimising Outcomes for Patients with Early Inflammatory Arthritis

Background: Early and effective treatment of inflammatory arthritis (IA) is essential to preserve patients’ functional ability and prevent joint damage. Recent strategies for optimising care have included implementing treatment to target management and utilising ultrasound to guide treatment decisions. The 2010 ACR/EULAR rheumatoid arthritis (RA) classification criteria were also recently developed with the aim of facilitating the study of early IA. Aims: To determine the phenotype, management and outcomes of patients with early IA, defined using the 2010 RA criteria, in clinical practice. Specific objectives were to risk stratify patients according to future disease severity, determine their response to treatment and assess the potential utility of ultrasound within a treatment to target strategy. Methods: An audit and a prospective longitudinal observational study were conducted in patients attending the Leeds Early Arthritis Clinic. Patients were classified as undifferentiated arthritis (UA) or RA according to the 2010 RA criteria at baseline. Logistic regression methods were used to identify baseline predictors of outcome and treatment response. Results: Ultrasound detectable synovitis at baseline was independently associated with a higher rate of methotrexate use, persistence of IA and development of new ultrasound erosions at one year in patients with UA and RA, as well as progression from UA to RA in the subset of patients with UA at baseline. A lack of concordance was observed between clinical and ultrasound determined remission in RA patients receiving treatment-to-target management. In this sub-group, objective baseline measures of disease were predictive of imaging remission in comparison to the predominantly subjective parameters, which were predictive of clinical remission. Conclusions: This verifies the value of ultrasound as a prognostic tool in the risk stratification of patients with early IA, over and above the clinical application of the 2010 RA criteria and clinical assessments. It supports future research in the use of ultrasound within a treatment to target strategy

Drawing on the Strengths of Community Health Workers to Address Sexually Transmitted Infections: Roles, Medicaid Reimbursement, and Partnerships

Rates of bacterial sexually transmitted infections (STIs) in the United States are high and, largely, still soaring. Though chlamydia cases have decreased slightly since 2017, gonorrhea and syphilis have increased by 25% and 68%, respectively, and congenital syphilis has increased by 184%. Bacterial STI can lead to pain, infertility, and even, in the case of syphilis and congenital syphilis, death. With appropriate detection and treatment, all of these STIs are curable. And yet a range of barriers between communities and the healthcare system perpetuate the STI epidemic. Community health workers (CHWs) could play a key role in helping bridge the gap between the public health and healthcare systems and communities to provide STI education, prevention, detection and treatment services. The Medicaid program, which covers 89 million Americans, is slowly beginning to include CHWs into payment models. However, to date, CHWs’ potential to help address STIs has not been fully explored. This study was undertaken to identify ways that CHWs could be integrated into the STI field with the support of Medicaid coverage and in collaboration with the existing STI workforce

Attitudes toward forensic science: a disconnect between expectations and reality

Following the development of the Attitudes Toward Forensic Science (ATFS) instrument (Horton et al., 2012), students across various tertiary institutions were surveyed to measure their: perception of popular media as a motivator to study forensic science; personal interest in forensic science; perspective of forensic science as a science; and perspective of forensic science as a profession. The focus of the study was changed from a single survey to pre- and post-unit completion testing, in order to compare not only the teaching/learning experience across the institutions, but also the efficiency and effectiveness of each individual unit. However, before pre- and post-unit completion testing could be utilised effectively, the observable differences in a single data collection were ascertained along with the psychometric properties (reliability and validity) of the instrument itself, in order to determine what constructs were truly being measured. The data underwent a preliminary exploratory factor analysis (EFA) to identify the underlying relationship between measured variables to establish a tenable model of the data. After a second round of surveying students, a confirmatory factor analysis (CFA) was undertaken to determine how well the data fit the hypothesised eleven-item, three-factor model. The three factors and the overall scale were examined for evidence of internal consistency using Cronbach’s alpha. The emergent model has provided a better understanding of students’ attitudes toward the discipline of forensic science. The disconnect between our anticipated a priori model and the reality of the respondents’ attitudes illustrates the importance of addressing measurement issues of reliability and validity when exploring contemporary affective concepts. References Horton, R.C., Kelly, T.L., Lenehan, C.E., Lennard, C., Lewis, S.W., Lim, K.F., Roux, C., & Southam, D.C. (2012). Assessing Students’ Attitudes Toward Forensic Science: Collecting an Expert Consensus. Forensic Science Policy & Management: An International Journal, 3(4), 180-188

Molecular identification of adenoviruses associated with respiratory infection in Egypt from 2003 to 2010.

BACKGROUND: Human adenoviruses of species B, C, and E (HAdV-B, -C, -E) are frequent causative agents of acute respiratory infections worldwide. As part of a surveillance program aimed at identifying the etiology of influenza-like illness (ILI) in Egypt, we characterized 105 adenovirus isolates from clinical samples collected between 2003 and 2010. METHODS: Identification of the isolates as HAdV was accomplished by an immunofluorescence assay (IFA) and confirmed by a set of species and type specific polymerase chain reactions (PCR). RESULTS: Of the 105 isolates, 42% were identified as belonging to HAdV-B, 60% as HAdV-C, and 1% as HAdV-E. We identified a total of six co-infections by PCR, of which five were HAdV-B/HAdV-C co-infections, and one was a co-infection of two HAdV-C types: HAdV-5/HAdV-6. Molecular typing by PCR enabled the identification of eight genotypes of human adenoviruses; HAdV-3 (n = 22), HAdV-7 (n = 14), HAdV-11 (n = 8), HAdV-1 (n = 22), HAdV-2 (20), HAdV-5 (n = 15), HAdV-6 (n = 3) and HAdV-4 (n = 1). The most abundant species in the characterized collection of isolates was HAdV-C, which is concordant with existing data for worldwide epidemiology of HAdV respiratory infections. CONCLUSIONS: We identified three species, HAdV-B, -C and -E, among patients with ILI over the course of 7 years in Egypt, with at least eight diverse types circulating

Human intestinal tissue tropism of intimin epsilon O103 Escherichia coli

Human intestinal in vitro organ culture was used to assess the tissue tropism of human isolates of Escherichia coli O103:H2 and O103:H- that express intimin F. Both strains showed tropism for follicle associated epithelium and limited adhesion to other regions of the small and large intestine. This is similar to the tissue tropism shown by intimin gamma enterohaemorrhagic (EHEC) O157:H7, but distinct from that of intimin a enteropathogenic (EPEC) O127:H6. (C) 2002 Federation of European Microbiological Societies. Published by Elsevier Science B.V. All rights reserve

Ribosomal oxygenases are structurally conserved from prokaryotes to humans

2-Oxoglutarate (2OG)-dependent oxygenases have important roles in the regulation of gene expression via demethylation of N-methylated chromatin components1,2 and in the hydroxylation of transcription factors3 and splicing factor proteins4. Recently, 2OG-dependent oxygenases that catalyse hydroxylation of transfer RNA5,6,7 and ribosomal proteins8 have been shown to be important in translation relating to cellular growth, TH17-cell differentiation and translational accuracy9,10,11,12. The finding that ribosomal oxygenases (ROXs) occur in organisms ranging from prokaryotes to humans8 raises questions as to their structural and evolutionary relationships. In Escherichia coli, YcfD catalyses arginine hydroxylation in the ribosomal protein L16; in humans, MYC-induced nuclear antigen (MINA53; also known as MINA) and nucleolar protein 66 (NO66) catalyse histidine hydroxylation in the ribosomal proteins RPL27A and RPL8, respectively. The functional assignments of ROXs open therapeutic possibilities via either ROX inhibition or targeting of differentially modified ribosomes. Despite differences in the residue and protein selectivities of prokaryotic and eukaryotic ROXs, comparison of the crystal structures of E. coli YcfD and Rhodothermus marinus YcfD with those of human MINA53 and NO66 reveals highly conserved folds and novel dimerization modes defining a new structural subfamily of 2OG-dependent oxygenases. ROX structures with and without their substrates support their functional assignments as hydroxylases but not demethylases, and reveal how the subfamily has evolved to catalyse the hydroxylation of different residue side chains of ribosomal proteins. Comparison of ROX crystal structures with those of other JmjC-domain-containing hydroxylases, including the hypoxia-inducible factor asparaginyl hydroxylase FIH and histone Nε-methyl lysine demethylases, identifies branch points in 2OG-dependent oxygenase evolution and distinguishes between JmjC-containing hydroxylases and demethylases catalysing modifications of translational and transcriptional machinery. The structures reveal that new protein hydroxylation activities can evolve by changing the coordination position from which the iron-bound substrate-oxidizing species reacts. This coordination flexibility has probably contributed to the evolution of the wide range of reactions catalysed by oxygenases

Characteristics of outdoor falls among older people: A qualitative study

Background Falls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented. Methods We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses. Results Forty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week. Conclusions This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy