Screening, diagnosis, and monitoring of interstitial lung disease in autoimmune rheumatic diseases: A narrative review.

Interstitial lung disease (ILD) is a common and serious manifestation of autoimmune rheumatic diseases. While the prevalence of ILD differs among the individual autoimmune rheumatic diseases, ILD remains an important cause of morbidity and mortality in systemic sclerosis, systemic lupus erythematosus, mixed connective tissue disease, primary Sjögrens disease, rheumatoid arthritis, and idiopathic inflammatory myositis. The present review summarizes recent literature on autoimmune-associated ILD with a focus on screening and monitoring for ILD progression. Reflecting on the currently available evidence, the authors propose a guideline for monitoring for progression in patients with newly diagnosed autoimmune-associated ILD. This review also highlights clinical and biological predictors of progressive pulmonary fibrosis and describes opportunity for further study in the rapidly evolving area of rheumatology and pulmonology

Finite element model of SCOLE laboratory configuration

The Spacecraft Control Laboratory Experiment (SCOLE) is defined by element properties: material constants; mast, reflector, rigid links as beam elements; cable as bar element; and space shuttle as very stiff beam. Two boundary conditions are modeled: suspended (6 degrees of freedom for all joints except the top of the cable) and cantilevered cables (shuttle platform fixed in all degrees of freedon). Calculations include stiffness and mass matrices, initial stresses, static displacements and reactions, and eigensolutions

Preclinical/subclinical rheumatoid arthritis-associated interstitial lung disease: misleading terms with potentially deleterious consequences

Interstitial lung disease (ILD) is a leading cause of mortality in patients with rheumatic diseases, including rheumatoid arthritis. The 5-year mortality rate is twice as high in patients with rheumatoid arthritis-associated ILD than in patients with rheumatoid arthritis without ILD. Moreover, a report showed that mortality rates in patients with disease codes for rheumatoid arthritis-associated ILD remained unchanged from 2005–18, even though the overall rheumatoid arthritis mortality rate declined during this time period. Despite the evidence that ILD contributes to premature death in rheumatoid arthritis, screening for ILD in patients with rheumatoid arthritis is not routinely performed in clinical practice and numerous questions remain regarding the management of rheumatoid arthritis-associated ILD

Predicting Driver Safety in Parkinson’s Disease: An Interim Report of an Ongoing Longitudinal Study

This article summarizes the baseline results of an ongoing longitudinal, NIH-funded study on prediction of driver safety in patients with Parkinson’s disease (PD). Patients with even mild to moderate PD who drive and live independently suffer from visual and cognitive dysfunction, which appear to be the main contributors to decreased driving performance and safety, rather than the motor dysfunction for which PD is known

A Spectacular Hα\alpha Complex in Virgo: Evidence for a Collision Between M86 and NGC 4438 and Implications for Collisional ISM Heating of Ellipticals

Deep wide-field H$\alpha$+[NII] imaging around the Virgo cluster giant elliptical galaxy M86 reveals a highly complex and disturbed ISM/ICM. The most striking feature is a set of H$\alpha$ filaments which clearly connect M86 with the nearby disturbed spiral NGC 4438 (23$'$=120 kpc projected away), providing strong evidence for a previously unrecognized collision between them. Spectroscopy of selected regions show a fairly smooth velocity gradient between M86 and NGC 4438, consistent with the collision scenario. Such a collision would impart significant energy into the ISM of M86, probably heating the gas and acting to prevent the gas from cooling to form stars. We propose that cool gas stripped from NGC 4438 during the collision and deposited in its wake is heated by shocks, ram pressure drag, or thermal conduction, producing most of the H$\alpha$ filaments. Some H$\alpha$ filaments are associated with the well-known ridge of bright X-ray emission to the NW of the nucleus, suggesting that the collision is responsible for peculiarities of M86 previously ascribed to other effects. M86 is radio-quiet, thus AGN heating is unlikely to play a significant role. The M86 system has implications for understanding the role of gravitational interactions in the heating of the ISM in ellipticals, and how collisions in clusters transform galaxies.Comment: 6 pages, 2 figures. For high-resolution images, see http://www.astro.yale.edu/tal/research/index.htm

The Relationship Between Driving Behavior and Entropy

OBJECTIVES High variability in the lateral control of a vehicle may result in an increased likelihood of accidents. Boer (2000) proposed a method of quantifying variability in steering wheel position, termed “entropy” (scaled between 0 and 1). In this approach, the steering wheel position at each time point is predicted based on the position at the three preceding time points, and the discrepancies between the predicted and observed values are utilized to define a baseline distribution of prediction errors within a subject. This distribution is then used as a reference for calculating a summary “entropy” metric in follow-up segments of driving, such as when a driver may be distracted when using a cell phone. This same concept has also been applied to the lateral position of a vehicle (Dawson et al., 2006). The objective of this study was to ascertain whether entropy was affected by behavioral factors such as steering techniques and speed. We hoped to gain insight regarding the usefulness of entropy measures, and the appropriate interpretation of statistical tests based on entropy. METHODS We designed a simple driving route in a simulator known as SIREN (Rizzo, 2004), with a straight road segment of 3.7 km, followed by an S-curved road segment of 3.8 km. Using an expert driver familiar with the simulator, we performed a factorial experiment with different steering techniques (normal driving, swerving, and steering using a rigid grip and sudden “jerks”) and driving speeds (35 mph, 55 mph, and 75 mph). Data on steering wheel position and lane position were collected at 30 frames per second, and then reduced to 5-frame blocks of 167 msec each. Based on these blocks, we estimated the baseline parameter to characterize the prediction errors for each drive during the straight road section, and then applied this parameter to the straight and curved road sections in order to calculate entropy. This approach was used for both steering and lane position entropy. The data were analyzed using multiple linear regresssion to assess the affects of steering technique and speed, adjusting for road curvature. We also calculated Pearson correlation coefficients to measure the association between steering and lane position entropy. RESULTS Data were obtained on a total of 40 drive segments. Steering entropy ranged from 0.34 to 0.90, with a mean (SD) of 0.56 (0.16). Lane position entropy ranged from 0.34 to 0.93, with a mean (SD) of 0.61 (0.15). Compared to normal driving, steering behavior involving jerking motions tended to lower the steering entropy by 0.14 (p=0.012), and tended to lower the lane position entropy by 0.25 (p<0.001). Swerving in wide lateral motions had no effect on steering entropy, and only a minor effect on lane position entropy, decreasing it by 0.07. Compared to driving at 35 mph, driving at either 55 mph or 75 mph increased the steering entropy by an average of 0.08, but had no effect on lane position entropy. Although not our primary focus, we found that driving in curved sections tended to have higher entropy measures (increase of 0.21 for steering and 0.20 for lane position; p<0.001 in both cases). Despite a few outliers, the correlation between steering and lane position entropy was found to be high (r=0.84; see Figure 1). CONCLUSIONS Although entropy is often considered as an increasing function of workload, and would presumably increase in non-optimal conditions, some unsafe driving behaviors are actually negatively associated with entropy. Safe driving often involves making frequent minor steering adjustments, especially in curved sections of the road, which might lead to an increase in the entropy measure. If a driver rigidly holds onto the steering wheel and then makes large corrections when approaching or crossing a lane boundary, the fixed steering wheel position over several seconds may actually cause an apparent decrease in entropy. In summary, entropy may be a useful tool in quantifying vehicular control, but caution should be exercised when interpreting the results, as the associations involving entropy are not always in the anticipated direction

Social media for research discourse, dissemination, and collaboration in rheumatology

Social media has become an important venue for rheumatologists, patients, organizations, and other stakeholders to discuss recent research advances in diagnosis and management of rheumatic disorders. In this article, we describe the current state of how social media may enhance dissemination, discourse, and collaboration in rheumatology research. Social media may refer to social platforms like Twitter and Instagram or digital media like podcasts and other websites that are operated for providing as free, open-access medical education (FOAM). Twitter has been one of the most active social media venues and continues to host a vibrant rheumatology community. Examples of research discussions on Twitter include organic user tweets, educational threads ( tweetorials ), live-tweeting academic conferences, and journals posting recently-accepted articles. Some research collaborations have been initiated through social media interactions. Social media may also directly contribute to research by facilitating the recruitment of study participants and the collection of survey-based data. Thus, social media is an evolving and important tool to enhance research discourse, dissemination, and collaboration in rheumatology

A rush to judgment? Rapid reporting and dissemination of results and its consequences regarding the use of hydroxychloroquine for COVID-19

Funding Information: Disclosures: Dr. Kim reports personal fees from Exagen Diagnostics and GlaxoSmithKline and grants from the National Institutes of Health and the Rheumatology Research Foundation outside the submitted work. Dr. Sparks reports grants from the National Institute of Allergy and Infectious Diseases Autoimmune Centers of Excellence, National Institutes of Health, during the conduct of the study and personal fees from Bristol-Myers Squibb, Gilead, Inova, Janssen, and Optum outside the submitted work. Dr. Berenbaum reports personal fees from Boehringer, Bone Therapeutics, Expanscience, Galapagos, Gilead, GSK, Merck Sereno, MSD, Nordic, No-vartis, Pfizer, Regulaxis, Roche, Sandoz, Sanofi, Servier, UCB, Peptinov, TRB Chemedica, and 4P Pharma outside the submitted work. Dr. Korsten reports personal fees from GlaxoSmith-Kline, Sanofi-Aventis, Pfizer, AbbVie, Novartis Pharma, Lilly, and Bristol-Myers Squibb outside the submitted work. Dr. Sat-tui reports funding from a Vasculitis Clinical Research Consortium (VCRC)/Vasculitis Foundation Fellowship. The VCRC is part of the Rare Diseases Clinical Research Network, an initiative of the Office of Rare Diseases Research, National Center for Advancing Translational Science (NCATS). The VCRC is funded through collaboration between NCATS and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (U54 AR057319). Dr. Ugarte-Gil reports grants from Pfizer and Janssen outside the submitted work. Dr. Grainger reports nonfinancial support from Pfizer Australia and Janssen Australia and personal fees from Pfizer Australia, Cornerstones, Janssen New Zealand, and Novartis outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www .acponline.org/authors/icmje/ConflictOfInterestForms.do?ms Num=M20-1223.publishersversio

Therapeutic interception in individuals at risk of rheumatoid arthritis to prevent clinically impactful disease

Multiple clinical trials for rheumatoid arthritis (RA) prevention have been completed. Here, we set out to report on the lessons learnt from these studies. Researchers who conducted RA prevention trials shared the background, rationale, approach and outcomes and evaluated the lessons learnt to inform the next generation of RA prevention trials. Individuals at risk of RA can be identified through population screening, referrals to musculoskeletal programmes and by recognition of arthralgia suspicious for RA. Clinical trials in individuals at risk for future clinical RA have demonstrated that limited courses of corticosteroids, atorvastatin and hydroxychloroquine do not alter incidence rates of clinical RA; however, rituximab delays clinical RA onset, and methotrexate has transient effects in individuals who are anticitrullinated protein antibody-positive with subclinical joint inflammation identified by imaging. Abatacept delays clinical RA onset but does not fully prevent onset of RA after treatment cessation. Additionally, subclinical joint inflammation and symptoms appear responsive to interventions such as methotrexate and abatacept. To advance prevention, next steps include building networks of individuals at risk for RA, to improve risk stratification for future RA and to understand the biological mechanisms of RA development, including potential endotypes of disease, which can be targeted for prevention, thus adopting a more precision-based approach. Future trials should focus on interceptions aimed at preventing clinical RA onset and which treat existing symptoms and imaging-defined subclinical inflammation. These trials may include advanced designs (eg, adaptive) and should be combined with mechanistic studies to further define pathophysiological drivers of disease development