Indications for IVIG in rheumatic diseases

The use of IVIG to treat a wide variety of immune-driven diseases has grown rapidly, although the mechanism of action is not completely understood. Increasing demand for IVIG coupled with concerns regarding potential transmissible agents has led to worldwide supply shortages. National agencies have therefore produced guidelines for its use, with the latest England and Wales guideline being published in 2011. Due to the rarity of the rheumatic diseases, the evidence for IVIG use has been shown to be lacking in some areas and promising in others. Conditions in which IVIG has been shown to have benefit include ITP, Guillain–Barré syndrome and chronic inflammatory demyelinating polyneuropathy occurring in the context of rheumatic disease, as well as in SLE, idiopathic inflammatory myopathies and ANCA-associated vasculitides. This review looks at current IVIG use and is designed to be an aid for rheumatologists when considering the use of IVIG in clinical practice

Correction of Measurement Error in Monthly USDA Pig Crop: Generating Alternative Data Series

The imputed pig death loss contained in the reported monthly U.S. Department of Agriculture (USDA) pig crop data over the December 1995–June 2006 period ranged from 24.93% to 12.75%. Clearly, there are substantial measurement errors in the USDA monthly pig crop data. In this paper, we present alternative monthly U.S. pig crop data using the biological production process, which is compatible with prior knowledge of the U.S. hog industry. Alternative pig crop data are applied to a slaughter hog model and tested comparatively to USDA pig crop. Test results reject the validity of USDA pig crop data in favor of the alternative data.biological production process, measurement error, monthly USDA pig crop data, pig death loss, Agribusiness, Farm Management, Livestock Production/Industries, Q11, Q13, C12,

The Vulnerability of Distance Learning Initial Teacher Education (DLITE)

Peer reviewedPublisher PD

Individuals living with lupus: findings from the LUPUS UK Members Survey 2014

Systemic lupus erythematosus (SLE) is a complex and unpredictable disease which varies greatly among patients and has a significant impact on an individual’s daily living and quality of life. A better understanding of the patients’ experiences with the disease is vital to the effective management of the disease. LUPUS UK, a national UK-registered charity supporting people with systemic and discoid lupus, conducted a UK-wide survey of individuals living with lupus in order to provide foundation information to support and identify gaps needing further research. An anonymous survey was sent to 5660 LUPUS UK members in order to obtain demographic, diagnosis, symptom and treatment information. A total of 2527 surveys were returned by 2371 females (mean age 56.9 years, SD 13.6) and 156 males, (mean age 60.9 years, SD 15.7). Individuals reported a mean (SD) time to diagnosis from the first symptom of 6.4 (9.5) years, with 47% (n ¼ 1186) initially being given a different diagnosis prior to lupus. Fatigue/weakness (91%, n ¼ 2299) and joint pain/swelling (77.4%, n ¼ 1957) were the most common symptoms that interfere with daily activities, while 73% (n ¼ 1836) noted having some problems that make them unable to carry out their usual daily activities. Thirty-two per cent (n ¼ 806) were also seeking support beyond traditional pharmacological treatments, such as acupuncture and massage. This study highlights the range and frequency of symptoms difficult to live with on a daily basis and support areas needing further research to improve patients’ well-being

Burden of diabetes and hyperglycaemia in adults in the Americas, 1990–2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background High prevalence of diabetes has been reported in the Americas, but no comprehensive analysis of diabetes burden and related factors for the region is available. We aimed to describe the burden of type 1 and type 2 diabetes and that of hyperglycaemia in the Americas from 1990 to 2019. Methods We used estimates from GBD 2019 to evaluate the burden of diabetes in adults aged 20 years or older and high fasting plasma glucose in adults aged 25 years or older in the 39 countries and territories of the six regions in the Americas from 1990 to 2019. The main source to estimate the mortality attributable to diabetes and to chronic kidney disease due to diabetes was vital registration. Mortality due to overall diabetes (ie, diabetes and diabetes due to chronic kidney disease) was estimated using the Cause of Death Ensemble model. Years of life lost (YLLs) were calculated as the number of deaths multiplied by standard life expectancy at the age that the death occurred, years lived with disability (YLDs) were estimated based on the prevalence and severity of complications of diabetes. Disability-adjusted life-years (DALYs) were estimated as a sum of YLDs and YLLs. We assessed the association of diabetes burden with the level of development of a country (according to the Socio-demographic Index), health-care access and quality (estimated with the Healthcare Access and Quality Index), and diabetes prevalence. We also calculated the population attributable fraction (PAF) of diabetes burden due to each of its risk factors. We report the 95% uncertainty intervals for all estimates. Findings In 2019, an estimated total of 409 000 (95% uncertainty interval 373 000–443 000) adults aged 20 years or older in the Americas died from diabetes, which represented 5 ·9% of all deaths. Diabetes was responsible for 2266 (1930–2649) crude DALYs per 100 000 adults in the Americas, and high fasting plasma glucose for 4401 DALYs (3685–5265) per 100 000 adults, with large variation across regions. DALYs were mostly due to type 2 diabetes and distribution was heterogeneous, being highest in central Latin America and the Caribbean and lowest in high-income North America and southern Latin America. Between 1990 and 2019, age-standardised DALYs due to type 2 diabetes increased 27 ·4% (22·0–32·5). This increase was particularly high in Andean Latin America and high-income North America. Burden for both type 1 and type 2 diabetes across countries increased with higher diabetes prevalence and decreased with greater Socio-demographic and Healthcare Access and Quality Indices. Main risk factors for the burden were high BMI, with a PAF of 63·2% and dietary risks, with a PAF of 27·5%. The fraction of burden due to disability has increased since 1990 and now represents nearly half of the overall burden in 2019. Interpretation The burden of diabetes in the Americas is large, increasing, heterogeneous, and expanding. To confront the rising burden, population-based interventions aimed to reduce type 2 diabetes risk and strengthening health systems to provide effective and cost-efficient care for those affected are mandatory

What Does it Mean to be a British Isles Lupus Assessment Group-Based Composite Lupus Assessment Responder? Post Hoc Analysis of 2 Phase 3 Trials

OBJECTIVE: The British Isles Lupus Assessment Group–based Composite Lupus Assessment (BICLA) is a validated global measure of treatment response in systemic lupus erythematosus (SLE) clinical trials. To understand the relevance of BICLA in clinical practice, we investigated relationships between BICLA response and routine SLE assessments, patient-reported outcomes (PROs), and medical resource utilization. METHODS: This was a post hoc analysis of pooled data from the phase III, randomized, placebo-controlled, 52-week TULIP-1 (ClinicalTrials.gov identifier: NCT02446912; n = 457) and TULIP-2 (ClinicalTrials.gov identifier: NCT02446899; n = 362) trials of intravenous anifrolumab (150/300 mg once every 4 weeks) in patients with moderate-to-severe SLE. Changes from baseline to week 52 in clinical assessments, PROs, and medical resource use were compared in BICLA responders versus nonresponders, regardless of treatment assignment. RESULTS: BICLA responders (n = 318) achieved significantly improved outcomes compared with nonresponders (n = 501), including lower flare rates, higher rates of attainment of sustained oral glucocorticoid taper to ≤7.5 mg/day, greater improvements in PROs (Functional Assessment of Chronic Illness Therapy–Fatigue, Short Form 36 Health Survey), and fewer SLE-related hospitalizations/emergency department visits (all nominal P < 0.001). Compared with nonresponders, BICLA responders had greater improvements in global and organ-specific disease activity (Physician’s Global Assessment, SLE Disease Activity Index 2000, Cutaneous Lupus Erythematosus Disease Area and Severity Index Activity, and joint counts; all nominal P < 0.001). BICLA responders had fewer lupus-related serious adverse events than nonresponders. CONCLUSION: BICLA response is associated with clinical benefit in SLE assessments, PROs, and medical resource utilization, confirming its value as a clinical trial end point that is associated with measures important to patient care

Eight Year Climatologies from Observational (AIRS) and Model (MERRA) Data

We examine climatologies derived from eight years of temperature, water vapor, cloud, and trace gas observations made by the Atmospheric Infrared Sounder (AIRS) instrument flying on the Aqua satellite and compare them to similar climatologies constructed with data from a global assimilation model, the Modern Era Retrospective-Analysis for Research and Applications (MERRA). We use the AIRS climatologies to examine anomalies and trends in the AIRS data record. Since sampling can be an issue for infrared satellites in low earth orbit, we also use the MERRA data to examine the AIRS sampling biases. By sampling the MERRA data at the AIRS space-time locations both with and without the AIRS quality control we estimate the sampling bias of the AIRS climatology and the atmospheric conditions where AIRS has a lower sampling rate. While the AIRS temperature and water vapor sampling biases are small at low latitudes, they can be more than a few degrees in temperature or 10 percent in water vapor at higher latitudes. The largest sampling biases are over desert. The AIRS and MERRA data are available from the Goddard Earth Sciences Data and Information Services Center (GES DISC). The AIRS climatologies we used are available for analysis with the GIOVANNI data exploration tool. (see, http://disc.gsfc.nasa.gov)

Inhomogeneous ground state and the coexistence of two length scales near phase transitions in real solids

Real crystals almost unavoidably contain a finite density of dislocations. We show that this generic type of long--range correlated disorder leads to a breakdown of the conventional scenario of critical behavior and standard renormalization group techniques based on the existence of a simple, homogeneous ground state. This breakdown is due to the appearance of an inhomogeneous ground state that changes the character of the phase transition to that of a percolative phenomenon. This scenario leads to a natural explanation for the appearance of two length scales in recent high resolution small-angle scattering experiments near magnetic and structural phase transitions.Comment: 4 pages, RevTex, no figures; also available from http://www.tp3.ruhr-uni-bochum.de/archive/tpiii_archive.htm

Estimating sampling biases and measurement uncertainties of AIRS/AMSU-A temperature and water vapor observations using MERRA reanalysis

We use MERRA (Modern Era Retrospective-Analysis for Research Applications) temperature and water vapor data to estimate the sampling biases of climatologies derived from the AIRS/AMSU-A (Atmospheric Infrared Sounder/Advanced Microwave Sounding Unit-A) suite of instruments. We separate the total sampling bias into temporal and instrumental components. The temporal component is caused by the AIRS/AMSU-A orbit and swath that are not able to sample all of time and space. The instrumental component is caused by scenes that prevent successful retrievals. The temporal sampling biases are generally smaller than the instrumental sampling biases except in regions with large diurnal variations, such as the boundary layer, where the temporal sampling biases of temperature can be ± 2 K and water vapor can be 10% wet. The instrumental sampling biases are the main contributor to the total sampling biases and are mainly caused by clouds. They are up to 2 K cold and > 30% dry over midlatitude storm tracks and tropical deep convective cloudy regions and up to 20% wet over stratus regions. However, other factors such as surface emissivity and temperature can also influence the instrumental sampling bias over deserts where the biases can be up to 1 K cold and 10% wet. Some instrumental sampling biases can vary seasonally and/or diurnally. We also estimate the combined measurement uncertainties of temperature and water vapor from AIRS/AMSU-A and MERRA by comparing similarly sampled climatologies from both data sets. The measurement differences are often larger than the sampling biases and have longitudinal variations

AIRS Data Service at NASA Goddard Earth Sciences Data and Information Services (GES DISC) and Its Application to Climate Change Study

The Atmospheric Infrared Sounder (AIRS) instrument suite is designed to observe and characterize the entire atmospheric column from the surface to the top of the atmosphere in terms of surface emissivity and temperature, atmospheric temperature and humidity profiles, cloud amount and height, and the spectral outgoing infrared radiation on a global scale. The AIRS Data Support Team at the GES DISC provides data support to assist others in understanding, retrieving and extracting information from the AIRS/AMSU/HSB data products. Because a number of years has passed since its operation started, the amount of data has reached a certain level of maturity where we can address the climate change study utilizing AIRS data, In this presentation we will list various service we provide and to demonstrate how to utilize/apply the existing service to long-term and short-term variability study