Phenotypic heterogeneity in Hidradenitis Suppurativa (Acne Inversa): classification is an essential step toward personalized therapy

Awareness is increasing that there is phenotypic heterogeneity within the hidradenitis suppurativa (HS) disease spectrum. However, the few randomized HS trials that are available have not distinguished between the subtypes of the disease. In this issue, Canoui-Poitrine et al. used latent class (LC) analysis of the largest HS cohort described to date to generate three phenotypic subtypes. LC 1 correlates with "typical" European HS, mainly involving the axilla, groin, and, in women, the inframammary region. "Atypical" HS, which may be linked to γ-secretase gene mutations, was subdivided further into LC2 and LC3 subtypes

CRITICAL ECONOMIC FACTORS FOR SUCCESS OF A BIOMASS CONVERSION PLANT FOR AGRICULTURAL RESIDUE, YARD RESIDUE AND WOOD WASTE IN FLORIDA

This model evaluates the potential success of a cellulosic ethanol plant in Florida. Critical Economic factors of the plant were simulated to assess the ability of this project. These critical factors include the feedstock to be used, the cost of the facility, transportation costs and the discount rate for the net present value (NPV). Results and observations are presented in this paper.Biofuels, renewable energy, cellulosic ethanol, biomass, Agribusiness, Community/Rural/Urban Development, Crop Production/Industries, Financial Economics, Production Economics, Productivity Analysis, Resource /Energy Economics and Policy, Risk and Uncertainty,

Development of core outcome sets in hidradenitis suppurativa:a systematic review of outcome measure instruments to inform the process

Background The recent hidradenitis suppurativa (HS) Cochrane review identified outcome measure heterogeneity as an important issue to address when designing future HS trials. Objectives To follow the Harmonising Outcome Measures for Eczema (HOME) roadmap, by performing a systematic review of HS outcome measure instruments to inform the development of a HS core outcome set. Methods We performed a systematic review to identify validation evidence for outcome measure instruments used in HS randomised controlled trials (RCTs), and assessed the methodological quality of all HS outcome measure validity studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Results The 12 RCTs included in the HS Cochrane review utilised a total of 30 outcome measure instruments, including 16 physician reported instruments, 11 patient reported instruments and three composite measures containing elements of both. Twenty-seven (90%) of the instruments lacked any validation data. Two further instruments have been developed and partially validated recently. Of the seven studies meeting our systematic review inclusion criteria, six were of ‘fair’ or ‘poor’ methodological quality, in part because most of the studies were not primarily designed for instrument validation. The HiSCR instrument is supported by good quality validation data but there are gaps including assessment of internal consistency, inter-rater reliability and minimal clinically important difference, and convergent validity fell below the acceptable range for some comparisons. Conclusions Multiple, usually unvalidated outcome measure instruments have been used in HS RCTs. Where validation evidence is available there are issues of low methodological quality or incomplete validity assessment and so no instruments can be fully recommended currently

Problems in the reporting of acne clinical trials: a spot check from the 2009 Annual Evidence Update on Acne Vulgaris

In the course of producing the 2009 NHS Evidence - skin disorders Annual Evidence Update on Acne Vulgaris, 25 randomised controlled trials were examined. From these, at least 12 potentially serious problems of trial reporting were identified. Several trials concluded no effect of a treatment yet they were insufficiently powered to exclude potentially useful benefits. There were examples of duplicate publication and "salami publication", as well as two trials being combined and reported as one. In some cases, an incorrect "within-groups" statistical comparison was made and one trial report omitted original efficacy data and included only P values. Both of the non-inferiority studies examined failed to pre-specify a non-inferiority margin. Trials reported as "double-blind" compared treatments that were dissimilar in appearance or had differing adverse effect profiles. In one case an intention-to-treat analysis was not performed and there was a failure to account for all of the randomized participants. Trial results were made to sound more impressive by selective outcome reporting, emphasizing the statistical significance of treatment effects that were clinically insignificant, and by the use of larger-sounding odds ratios rather than rate ratios for common events. Most of the reporting problems could have been avoided by use of the CONSORT guidelines and prospective trial registration on a public clinical trials database

Tracking Cyber Adversaries with Adaptive Indicators of Compromise

A forensics investigation after a breach often uncovers network and host indicators of compromise (IOCs) that can be deployed to sensors to allow early detection of the adversary in the future. Over time, the adversary will change tactics, techniques, and procedures (TTPs), which will also change the data generated. If the IOCs are not kept up-to-date with the adversary's new TTPs, the adversary will no longer be detected once all of the IOCs become invalid. Tracking the Known (TTK) is the problem of keeping IOCs, in this case regular expressions (regexes), up-to-date with a dynamic adversary. Our framework solves the TTK problem in an automated, cyclic fashion to bracket a previously discovered adversary. This tracking is accomplished through a data-driven approach of self-adapting a given model based on its own detection capabilities. In our initial experiments, we found that the true positive rate (TPR) of the adaptive solution degrades much less significantly over time than the naive solution, suggesting that self-updating the model allows the continued detection of positives (i.e., adversaries). The cost for this performance is in the false positive rate (FPR), which increases over time for the adaptive solution, but remains constant for the naive solution. However, the difference in overall detection performance, as measured by the area under the curve (AUC), between the two methods is negligible. This result suggests that self-updating the model over time should be done in practice to continue to detect known, evolving adversaries.Comment: This was presented at the 4th Annual Conf. on Computational Science & Computational Intelligence (CSCI'17) held Dec 14-16, 2017 in Las Vegas, Nevada, US

Graduation Rate Differences by Ethnicity/Race at Texas Community Colleges: A Statewide, Multiyear Examination

In this multiyear, statewide investigation, the degree to which differences were present in graduation rates between Black and White, Black and Hispanic, and Black and Asian students was addressed for the 2007-2008 academic year to the 2015-2016 academic years. Inferential statistical procedures revealed the presence of statistically significant differences for all 9 academic years. In all 9 years, Black students had statistically significantly lower graduation rates than White, Hispanic, and Asian students. Also identified were the Texas community colleges that had the highest and that had the lowest graduation rates of their Black students in the last two academic years. Implications of these findings and recommendations for future research were discussed

Dermatology life quality index (DLQI) as a psoriasis referral triage tool

Most primary care psoriasis referrals in the UK are triaged as ‘routine’, in part because of the prioritisation of skin cancer. As a result, patients with severe psoriasis may wait several months to be seen, enduring quality of life (QoL) impairment that could have been reduced. Furthermore some patients may spontaneously improve by the time they are seen by a specialist, making the appointment unnecessary at that time. Therefore, following approval from the local ethics committee, we conducted a prospective study to evaluate the usefulness of Dermatology Life Quality Index (DLQI) scores in triaging patients with psoriasis referred to our dermatology secondary health care services