Intensification of tilted atmospheric vortices by asymmetric diabatic heating

P\"aschke et al. (JFM, 701, 137--170 (2012)) studied the nonlinear dynamics of strongly tilted vortices subject to asymmetric diabatic heating by asymptotic methods. They found, i.a., that an azimuthal Fourier mode 1 heating pattern can intensify or attenuate such a vortex depending on the relative orientation of tilt and heating asymmetries. The theory originally addressed the gradient wind regime which, asymptotically speaking, corresponds to vortex Rossby numbers of order O(1) in the limit. Formally, this restricts the appicability of the theory to rather weak vortices in the near equatorial region. It is shown below that said theory is, in contrast, uniformly valid for vanishing Coriolis parameter and thus applicable to vortices up to hurricane strength. The paper's main contribution is a series of three-dimensional numerical simulations which fully support the analytical predictions.Comment: 22 pages, 11 figure

Comparison of treatment response, remission rate and drug adherence in polyarticular juvenile idiopathic arthritis patients treated with etanercept, adalimumab or tocilizumab

Background Treatment response, remission rates and compliance in patients with polyarticular juvenile idiopathic arthritis (polyJIA) treated with adalimumab, etanercept, or tocilizumab were analyzed in clinical practice. Methods Data collected in the German BIKER registry were analyzed in patients with polyJIA who started treatment with approved biologics, adalimumab, etanercept or tocilizumab, from 2011 to 2015. Baseline patient characteristics, treatment response, safety and drug survival were compared. Results Two hundred thirty- six patient started adalimumab, 419 etanercept and 74 tocilizumab, with differences in baseline patient characteristics. Baseline Juvenile Disease Activity Score (JADAS)10 (mean ± SD) in the adalimumab/etanercept/tocilizumab cohorts was 12.1+/−7.6, 13.8 ± 7.1 and 15.1 ± 7.4, respectively (adalimumab vs etanercept, p = 0.01), and Childhood Health Assessment Questionnaire (CHAQ)-disability index scores was 0.43 ± 0.58, 0.59 ± 0.6 and 0.63 ± 0.55, respectively (adalimumab vs etanercept, p < 0.001). Uveitis history was more frequent in the adalimumab cohort (OR 5.73; p < 0.001). Balanced patients’ samples were obtained by a generalized propensity score to adjust for baseline differences. Pediatric ACR30/50/70/90 criterion improvement after 3 months treatment was achieved by 68%/60%/42%/24% in the etanercept cohort, 67%/59%/43%/27% in the adalimumab cohort and 61%/52%/35%/26% in the tocilizumab cohort. At 24 months, JADAS minimal disease activity was achieved in 52.4%/61.3%/52.4% and JADAS remission in 27.9%/34.8%/27.9% patients in the adalimumab/etanercept/tocilizumab cohorts, respectively. Etanercept was used in 95.5% of patients as a first biologic, adalimumab in 50.8% and tocilizumab in 20.2%. There were no important differences in efficacy between first-line and second-line use of biologics. In total 60.4%/49.4%/31.1% patients discontinued adalimumab/etanercept/tocilizumab, respectively (HR for adalimumab 1.67; p < 0.001; HR for tocilizumab 0.35; p = 0.001). Drug survival rates did not differ significantly in patients on biologic monotherapy compared with combination therapy with methotrexate. Over 4 years observation under etanercept/adalimumab/tocilizumab, 996/386/103 adverse events, and 148/119/26 serious adverse events, respectively, were reported. Conclusions In clinical practice, etanercept is most frequently used as first-line biologic. Adalimumab/etanercept/tocilizumab showed comparable efficacy toward polyJIA. Overall, tolerance was acceptable. Interestingly, compliance was highest with tocilizumab and lowest with adalimumab. This study provides the first indication for the comparison of different biologic agents in polyarticular JIA based on observational study data with all their weaknesses and demonstrates the need for well-controlled head-to-head studies for confirmation

General Protein Diffusion Barriers Create Compartments within Bacterial Cells

In eukaryotes, the differentiation of cellular extensions such as cilia or neuronal axons depends on the partitioning of proteins to distinct plasma membrane domains by specialized diffusion barriers. However, examples of this compartmentalization strategy are still missing for prokaryotes, although complex cellular architectures are also widespread among this group of organisms. This study reveals the existence of a protein-mediated membrane diffusion barrier in the stalked bacterium Caulobacter crescentus. We show that the Caulobacter cell envelope is compartmentalized by macromolecular complexes that prevent the exchange of both membrane and soluble proteins between the polar stalk extension and the cell body. The barrier structures span the cross-sectional area of the stalk and comprise at least four proteins that assemble in a cell-cycle-dependent manner. Their presence is critical for cellular fitness because they minimize the effective cell volume, allowing faster adaptation to environmental changes that require de novo synthesis of envelope proteins

Laços com a loucura: a cidade como espaço de promoção de saúde mental

Este ensaio aborda a relação da cidade com a loucura. Busca analisar o espaço público com suas normas e desvios e refletir sobre o cuidado em saúde mental. Aborda o dispositivo do Acompanhamento Terapêutico em sua perspectiva antimanicomial e de fortalecimento do cuidado em liberdade. Dialoga com a perspectiva da psicologia ambiental e da psicanálise para refletir sobre essa complexa trama entre loucura, cidade, laço social e saúde mental

Prevention of disease flares by risk-adapted stratification of therapy withdrawal in juvenile idiopathic arthritis : results from the PREVENT-JIA trial

Publisher Copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVES: To investigate the ability of high-sensitivity C-reactive protein (hsCRP) and S100A12 to serve as predictive biomarkers of successful drug withdrawal in children with clinical remission of juvenile idiopathic arthritis (JIA). METHODS: This multicentre trial (PREVENT-JIA) enrolled 119 patients with JIA in clinical remission, and 100 patients reached the intervention phase in which the decision whether to continue or stop treatment was based on S100A12 and hsCRP levels. Patients were monitored for 12 months after stopping medication for flares of disease. Results were compared with withdrawal of therapy without biomarker-based stratification in patients from the German Biologika in der Kinderrheumatologie (BiKeR) pharmacovigilance registry. RESULTS: In the PREVENT-JIA group, 49 patients had a flare, and 45% of patients stopping medication showed flares within the following 12 months. All patients (n=8) continuing therapy due to permanently elevated S100A12/hsCRP at more than one visit flared during the observation phase. In the BiKeR control group, the total flare rate was 62%, with 60% flaring after stopping medication. The primary outcome, time from therapy withdrawal to first flare (cumulative flare rate after therapy withdrawal), showed a significant difference in favour of the PREVENT-JIA group (p=0.046; HR 0.62, 95% CI 0.38 to 0.99). As additional finding, patients in the PREVENT-JIA trial stopped therapy significantly earlier. CONCLUSION: Biomarker-guided strategies of therapy withdrawal are feasible in clinical practice. This study demonstrates that using predictive markers of subclinical inflammation is a promising tool in the decision-making process of therapy withdrawal, which translates into direct benefit for patients. TRIAL REGISTRATION NUMBER: ISRCTN69963079.publishersversionPeer reviewe

User-centered design of the C3-cloud platform for elderly with multiple diseases - functional requirements and application testing

The number of patients with multimorbidity has been steadily increasing in the modern aging societies. The European C3-Cloud project provides a multidisciplinary and patient-centered “Collaborative Care and Cure-system” for the management of elderly with multimorbidity, enabling continuous coordination of care activities between multidisciplinary care teams (MDTs), patients and informal caregivers (ICG). In this study various components of the infrastructure were tested to fulfill the functional requirements and the entire system was subjected to an early application testing involving different groups of end-users. MDTs from participating European regions were involved in requirement elicitation and test formulation, resulting in 57 questions, distributed via an internet platform to 48 test participants (22 MDTs, 26 patients) from three pilot sites. The results indicate a high level of satisfaction with all components. Early testing also provided feedback for technical improvement of the entire system, and the paper points out useful evaluation methods

Publikumsinklusion beim "Freitag": Fallstudienbericht aus dem DFG-Projekt "Die (Wieder-)Entdeckung des Publikums"

Der Bericht stellt Ergebnisse einer Fallstudie beim Freitag und bei freitag.de vor, die im Rahmen eines Forschungsprojekts zur Rolle von Publikumsbeteiligung im professionellen, redaktionell organisierten Journalismus in Deutschland durchgeführt wurde. Auf Grundlage eines theoretisch-analytischen Modells, das Partizipation als Zusammenspiel von Inklusionsleistungen und Inklusionserwartungen auf Seiten des Journalismus und des Publikums versteht, werden Befunde aus qualitativen Interviews mit Redaktionsmitgliedern (n = 6) und Lesern bzw. Nutzern unterschiedlichen Aktivitätsgrads (n = 6) sowie aus standardisierten Befragungen von Redaktionsmitgliedern (n = 10) sowie von Nutzern von freitag.de (n = 344) vorgestellt. Auf journalistischer Seite kann so nachgezeichnet werden, dass für die vergleichsweise kleine Redaktion des Freitag Formen der Publikumsbeteiligung eine wichtige Rolle für das redaktionelle Selbstverständnis als "Debattenmedium" spielen und als Teil des "Markenkerns" betrachtet werden. Das Publikum wird vor allem als "Community" adressiert, die auf freitag.de eigene Nutzer-Blogs betreiben kann. Diese dienen regelmäßig als Ressource, aus der Beiträge zur Publikation auf der Website und z. T. auch in der Printausgabe ausgewählt werden. Deutlich wird, dass diese weitreichende Form der Publikumsbeteiligung auch auf gewisse publizistisch-ökonomische Zwänge zurückgeht: Die Beiträge aus dem Publikum werden gebraucht, allein um einen gewissen Angebotsumfang zu garantieren. Auf Publikumsseite lässt sich außerdem zeigen, dass der Freitag ein vergleichsweise aktives, durchaus auch kommentierfreudiges Publikum hat, das besonderen Wert auf Quellentransparenz und Möglichkeiten der Anschlusskommunikation (auch untereinander) legt und vom Freitag vor allem auch eine kritische und meinungsbetonte Haltung erwartet. Der Abgleich beider Seiten erlaubt es zudem, Aussagen über das Inklusionslevel und die Inklusionsdistanz zu treffen: Das Inklusionslevel ist insgesamt als hoch zu bezeichnen, da der Freitag neben den Standardelementen der Publikumsbeteiligung (wie Kommentarbereiche unter Online-Artikeln) mit einigem redaktionellen Aufwand eine Community pflegt. In diese bringt sich zwar nur eine Minderheit des Publikums aktiv und auch nur ein "harter Kern" regelmäßig in Form von selbstverfassten Beiträgen ein. Allerdings trägt zu einem ausgeglichenen Inklusionslevel bei, dass der hohe redaktionsseitige Aufwand (z. T.) dadurch aufgewogen erscheint, dass diese Inhalte regelmäßig und substanziell für die Erweiterung der Inhalte der Website gebraucht und ggf. auch im Printprodukt publiziert werden. Die Inklusionsdistanz fällt im Hinblick auf die unter diesem Konzept subsumierten Dimensionen uneinheitlich aus: Es liegt weitgehende Übereinstimmung zwischen der vom Publikum erwarteten und der redaktionsseitig angestrebten journalistischen Rolle vor: Zu den beidseitig als am wichtigsten eingeschätzten Aufgaben gehören diejenigen, welche einen kritisch-kontrollierenden (und politisch links stehenden) Journalismus charakterisieren. Allerdings wird Publikumsbeteiligung in ihrer Wichtigkeit für das Publikum von den befragten Redaktionsmitgliedern z. T. sehr deutlich überschätzt; demgegenüber unterschätzen sie stark die Bedeutung, die Quellentransparenz für ihr Publikum hat. Als deutlich wichtiger als die befragten Publikumsmitglieder schätzen sie auch Beteiligungsmotive von aktiven Nutzerinnen und Nutzern ein, die in Richtung "Austausch und Vernetzung innerhalb der Community" gehen. Diese scheinen jedoch vor allem für die besonders aktiven Nutzer relevant. Insgesamt wird deutlich: Das redaktionsseitig erklärte strategische Ziel "die Grenzen zwischen Redaktion und Community so weit wie möglich abzusenken" (DF_Leit §18) erscheint durch die weitreichenden Beteiligungsmöglichkeiten zwar prinzipiell erreicht, allerdings möchte nur ein (geringer) Teil der Nutzer diese Grenze auch überschreiten bzw. aufgehoben wissen

Our nature project: an experience report

This extension activity aimed to encourage the use of green leisure spaces by parents and children as a strategy for the promotion of health and well-being. From this purpose, the project worked in two fronts: realization of workshops in the Ecological Municipal Park Professor David Ferreira Lima (Florianópolis) and diffusion of information through Internet channels. The activities were carried out between April 2016 and March 2017 and involved 80 participants — including 41 children — in practical activities. The project also reached 5.648 people through the contents published in a social network and in the page of the Environmental Psychology Laboratory at UFSC. It is considered the project has achieved the objectives of awareness and dissemination of the theme about the benefits of natural environments for human development, interaction between people and connection with nature

ESVM guidelines:the diagnosis and management of Raynaud's phenomenon

Regarding the clinical diagnosis of Raynaud's phenomenon and its associated conditions, investigations and treatment are substantial, and yet no international consensus has been published regarding the medical management of patients presenting with this condition. Most knowledge on this topic derives from epidemiological surveys and observational studies; few randomized studies are available, almost all relating to drug treatment, and thus these guidelines were developed as an expert consensus document to aid in the diagnosis and management of Raynaud's phenomenon. This consensus document starts with a clarification about the definition and terminology of Raynaud's phenomenon and covers the differential and aetiological diagnoses as well as the symptomatic treatment