Lifetime self-reported arthritis is associated with elevated levels of mental health burden: A multi-national cross sectional study across 46 low- and middle-income countries

Population-based studies investigating the relationship of arthritis with mental health outcomes are lacking, particularly among low- and middle-income countries (LMICs). We investigated the relationship between arthritis and mental health (depression spectrum, psychosis spectrum, anxiety, sleep disturbances and stress) across community-dwelling adults aged ≥18 years across 46 countries from the World Health Survey. Symptoms of psychosis and depression were established using questions from the Mental Health Composite International Diagnostic Interview. Severity of anxiety, sleep problems, and stress sensitivity over the preceding 30 days were self-reported. Self-report lifetime history of arthritis was collected, including presence or absence of symptoms suggestive of arthritis: pain, stiffness or swelling of joints over the preceding 12-months. Multivariable logistic regression analyses were undertaken. Overall, 245,706 individuals were included. Having arthritis increased the odds of subclinical psychosis (OR = 1.85; 95%CI = 1.72–1.99) and psychosis (OR = 2.48; 95%CI = 2.05–3.01). People with arthritis were at increased odds of subsyndromal depression (OR = 1.92; 95%CI = 1.64–2.26), a brief depressive episode (OR = 2.14; 95%CI = 1.88–2.43) or depressive episode (OR = 2.43; 95%CI = 2.21–2.67). Arthritis was also associated with increased odds for anxiety (OR = 1.75; 95%CI = 1.63–1.88), sleep problems (OR = 2.23; 95%CI = 2.05–2.43) and perceived stress (OR = 1.43; 95%CI = 1.33–1.53). Results were similar for middle-income and low-income countries. Integrated interventions addressing arthritis and mental health comorbidities are warranted to tackle this considerable burden

Down-titration of biologics for the treatment of rheumatoid arthritis: A systematic literature review

Biologic therapies have improved the management of rheumatoid arthritis (RA) and the treat-to-target approach has resulted in many patients achieving remission. In the current treatment landscape, clinicians have begun considering dose reduction/tapering for their patients. Rheumatology guidelines in Asia, Europe, and the United States include down-titration of biologics but admit that the level of evidence is moderate. We conducted a systematic literature review to assess the published studies that evaluate down-titration of biologics in RA. The published literature was searched for studies that down-titrated the following biologics: abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, and tocilizumab. Eligible studies included randomized controlled trials (RCTs), non-RCTs, observational, and pharmacoeconomic studies. The outcomes of interest were (1) efficacy and health-related quality of life, (2) disease flares, and (3) impact on cost. Eleven full-text publications were identified; only three were RCTs. Study results suggest that dosing down may be an option in many patients who have achieved remission or low disease activity. However, some patients are likely to experience a disease flare. Across the studies, the definition of disease flare and the down-titration criteria were inconsistent, making it difficult to conclude which patients may be appropriate and when to attempt down-titration. Studies have evaluated the practice of dosing down biologic therapy in patients with RA; however, a relatively small number of RCTs have been published. Although down-titration may be an option for some patients in LDA or remission, additional RCTs are needed to provide guidance on this practice

Defining optimal soybean seeding rates and associated risk across North America

Soybean [Glycine max (L.) Merr.] seeding rate research across North America is typically conducted in small geo-political regions where environmental effects on the seeding rate × yield relationship are minimized. Data from 211 individual field studies (∼21,000 data points, 2007–2017) were combined from across North America ranging in yield from 1,000– 7,500 kg ha−1. Cluster analysis was used to stratify each individual field study into similar environmental (soil × climate) clusters and into high (HYL), medium (MYL), and low (LYL) yield levels. Agronomically optimal seeding rates (AOSR) were calculated and Monte Carlo risk analysis was implemented. Within the two northern most clusters the AOSR was higher in the LYL followed by the MYL and then HYL. Within the farthest south cluster, a relatively small (±15,000 seeds ha−1) change in seeding rate from the MYL was required to reach the AOSR of the LYL and HYL, respectively. The increase in seeding rate to reach the LYL AOSR was relatively greater (5x) than the decrease to reach the HYL AOSR within the northern most cluster. Regardless, seeding rates below the AOSR presented substantial risk and potential yield loss, while seeding rates above provided slight risk reduction and yield increases. Specific to LYLs and MYLs, establishing and maintaining an adequate plant stand until harvest maximized yield regardless of the seeding rate, while maximizing seed number was important with lower seeding rates. These findings will help growers manage their soybean seed investment by adjusting seeding rates based upon the productivity of the environment.Fil: Gaspar, Adam P.. Dow Agrosciences Argentina Sociedad de Responsabilidad Limitada.; ArgentinaFil: Mourtzinis, Spyridon. University of Wisconsin; Estados UnidosFil: Kyle, Don. Dow Agrosciences Argentina Sociedad de Responsabilidad Limitada.; ArgentinaFil: Galdi, Eric. Dow Agrosciences Argentina Sociedad de Responsabilidad Limitada.; ArgentinaFil: Lindsey, Laura E.. Ohio State University; Estados UnidosFil: Hamman, William P.. Ohio State University; Estados UnidosFil: Matcham, Emma G. University of Wisconsin; Estados UnidosFil: Kandel, Hans J.. North Dakota State University; Estados UnidosFil: Schmitz, Peder. North Dakota State University; Estados UnidosFil: Stanley, Jordan D.. North Dakota State University; Estados UnidosFil: Schmidt, John P.. Dow Agrosciences Argentina Sociedad de Responsabilidad Limitada.; ArgentinaFil: Mueller, Daren S.. University of Iowa; Estados UnidosFil: Nafziger, Emerson D.. University of Illinois; Estados UnidosFil: Ross, Jeremy. University of Arkansas for Medical Sciences; Estados UnidosFil: Carter, Paul R.. Dow Agrosciences Argentina Sociedad de Responsabilidad Limitada.; ArgentinaFil: Varenhorst, Adam J.. University of South Dakota; Estados UnidosFil: Wise, Kiersten A.. University of Kentucky; Estados UnidosFil: Ciampitti, Ignacio Antonio. Kansas State University; Estados UnidosFil: Carciochi, Walter Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata; Argentina. Kansas State University; Estados UnidosFil: Chilvers, Martin I.. Michigan State University; Estados UnidosFil: Hauswedell, Brady. University of South Dakota; Estados UnidosFil: Tenuta, Albert U.. University of Guelph; CanadáFil: Conley, Shawn P.. University of Wisconsin; Estados Unido

Remote assessment of disease and relapse in major depressive disorder (RADAR-MDD): a multi-centre prospective cohort study protocol

BACKGROUND: There is a growing body of literature highlighting the role that wearable and mobile remote measurement technology (RMT) can play in measuring symptoms of major depressive disorder (MDD). Outcomes assessment typically relies on self-report, which can be biased by dysfunctional perceptions and current symptom severity. Predictors of depressive relapse include disrupted sleep, reduced sociability, physical activity, changes in mood, prosody and cognitive function, which are all amenable to measurement via RMT. This study aims to: 1) determine the usability, feasibility and acceptability of RMT; 2) improve and refine clinical outcome measurement using RMT to identify current clinical state; 3) determine whether RMT can provide information predictive of depressive relapse and other critical outcomes. METHODS: RADAR-MDD is a multi-site prospective cohort study, aiming to recruit 600 participants with a history of depressive disorder across three sites: London, Amsterdam and Barcelona. Participants will be asked to wear a wrist-worn activity tracker and download several apps onto their smartphones. These apps will be used to either collect data passively from existing smartphone sensors, or to deliver questionnaires, cognitive tasks, and speech assessments. The wearable device, smartphone sensors and questionnaires will collect data for up to 2-years about participants' sleep, physical activity, stress, mood, sociability, speech patterns, and cognitive function. The primary outcome of interest is MDD relapse, defined via the Inventory of Depressive Symptomatology- Self-Report questionnaire (IDS-SR) and the World Health Organisation's self-reported Composite International Diagnostic Interview (CIDI-SF). DISCUSSION: This study aims to provide insight into the early predictors of major depressive relapse, measured unobtrusively via RMT. If found to be acceptable to patients and other key stakeholders and able to provide clinically useful information predictive of future deterioration, RMT has potential to change the way in which depression and other long-term conditions are measured and managed. KEYWORDS: M-health; Major depressive disorder; Observational cohort; Outcome measurement; Passive sensing; Prospective study; Remote measurement technolog

The Dynamics of Plant Cell-Wall Polysaccharide Decomposition in Leaf-Cutting Ant Fungus Gardens

The degradation of live plant biomass in fungus gardens of leaf-cutting ants is poorly characterised but fundamental for understanding the mutual advantages and efficiency of this obligate nutritional symbiosis. Controversies about the extent to which the garden-symbiont Leucocoprinus gongylophorus degrades cellulose have hampered our understanding of the selection forces that induced large scale herbivory and of the ensuing ecological footprint of these ants. Here we use a recently established technique, based on polysaccharide microarrays probed with antibodies and carbohydrate binding modules, to map the occurrence of cell wall polymers in consecutive sections of the fungus garden of the leaf-cutting ant Acromyrmex echinatior. We show that pectin, xyloglucan and some xylan epitopes are degraded, whereas more highly substituted xylan and cellulose epitopes remain as residuals in the waste material that the ants remove from their fungus garden. These results demonstrate that biomass entering leaf-cutting ant fungus gardens is only partially utilized and explain why disproportionally large amounts of plant material are needed to sustain colony growth. They also explain why substantial communities of microbial and invertebrate symbionts have evolved associations with the dump material from leaf-cutting ant nests, to exploit decomposition niches that the ant garden-fungus does not utilize. Our approach thus provides detailed insight into the nutritional benefits and shortcomings associated with fungus-farming in ants

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

Evaluating the impacts of volcanic eruptions using RiskScape

Abstract RiskScape is a free multi-hazard risk assessment software programme jointly developed by GNS Science and the National Institute of Water and Atmospheric Research (NIWA) in New Zealand. RiskScape has a modular structure, with hazard layers, assets, and loss functions prepared separately. While RiskScape was originally developed for New Zealand, given suitable hazard and exposed asset information, RiskScape can be run anywhere in the world. Volcanic hazards are among the many hazards considered by RiskScape. We first present RiskScape’s framework for all hazards, and then describe in more detail the five volcanic hazards – tephra deposition, pyroclastic density currents, lava flows, lahars, and edifice construction/excavation. We describe how loss functions were selected and developed. We use a scenario example to illustrate not only how RiskScape’s volcanic module works but also how RiskScape can be used to compare across natural hazards