DAS28: a useful instrument to monitor infliximab treatment in patients with rheumatoid arthritis

The Disease Activity Score using 28 joint counts (DAS28) has been developed in a cohort of patients with rheumatoid arthritis in which only conventional anti-rheumatic treatments were used. It has extensively been validated to monitor disease activity in daily clinical practice as well as in clinical trials. The study of Vander Cruyssen and colleagues showed that the DAS28 correlated best with the decisions of rheumatologists to increase the infliximab dose because of insufficient response. This result once more confirms the validity of the DAS28 to monitor disease activity in patients with rheumatoid arthritis and to titrate treatment with biologicals

Growth rates of adult sea turtles

This is the final version of the article. Available from Inter Research via the DOI in this record.Indeterminate growth, i.e. growth that persists throughout life, is common in longlived reptiles. Because fecundity and body size tend to be correlated in such species, individuals face a life-history trade-off at sexual maturity. Saturation tagging and intensive monitoring at nesting grounds can potentially provide opportunities to accumulate data on individual measurements and reproductive output. Until recently, however, shortcomings from these methods have prevented the testing of theories on resource allocation between growth and reproduction at sexual maturity in wild populations of sea turtles. Here, we review the state of knowledge of growth rates in adult sea turtles and potential life-history trade-offs. We found that post-maturity growth rates varied among ocean basins. They appeared highest in the Atlantic Ocean for both green turtles Chelonia mydas and hawksbill turtles Eretmochelys imbricata, and highest in the Mediterranean Sea for loggerhead turtles Caretta caretta. For other species, there are too few studies at present to allow for intraspecific comparison. Additionally, we found no significant difference in mean female compound annual growth rates among species and ocean basins. Although captive studies have provided great insight into changes in energy allocation at sexual maturity and life-history trade-offs, this review highlights the lack of data on wild animals regarding changes in post-maturity growth rates and reproductive output over time. Such data are desirable to further our understanding of energy allocation, growth and ageing in wild sea turtles. They are further required to assess the status of species and to understand population dynamics for both conservation and management

Outcome measures in inflammatory rheumatic diseases

Inflammatory rheumatic diseases are generally multifaceted disorders and, therefore, measurement of multiple outcomes is relevant to most of these diseases. Developments in outcome measures in the rheumatic diseases are promoted by the development of successful treatments. Outcome measurement will increasingly deal with measurement of low levels of disease activity and avoidance of disease consequences. It is an advantage for patient management and knowledge transfer if the same outcomes are used in practice and in trials. Continuous measures of change are generally the most powerful and, therefore, are preferred as primary outcomes in trials. For daily clinical practice, outcome measures should reflect the patients' state and have to be easily derivable. The objective of this review is to describe recent developments in outcome measures for inflammatory rheumatic diseases for trials and clinical practice, with an emphasis on rheumatoid arthritis

Determinate or indeterminate growth? Revisiting the growth strategy of sea turtles

This is the author's accepted manuscript.The final version is available from Inter Research via the DOI in this record.Traditionally, growth can be either determinate, ceasing during the natural lifespan of individuals, or indeterminate, persisting throughout life. Although indeterminate growth is a widely accepted strategy and believed to be ubiquitous among long-lived species, it may not be as common as previously thought. Sea turtles are believed to be indeterminate growers despite the paucity of long-term studies into post-maturity growth. In this study, we provide the first temporal analysis of post-maturity growth rates in wild living sea turtles, using 26 yr of data on individual measurements of females nesting in Cyprus. We used generalised additive/linear mixed models to incorporate multiple growth measurements for each female and model post-maturity growth over time. We found post-maturity growth to persist in green Chelonia mydas and loggerhead Caretta caretta turtles, with growth decreasing for approximately 14 yr before plateauing around zero for a further decade solely in green turtles. We also found growth to be independent of size at sexual maturity in both species. Additionally, although annual growth and compound annual growth rates were higher in green turtles than in loggerhead turtles, this difference was not statistically significant. While indeterminate growth is believed to be a key life-history trait of ectothermic vertebrates, here, we provide evidence of determinate growth in green and loggerhead turtles and suggest that determinate growth is a life-history trait shared by cheloniid species. Our results highlight the need for long-term studies to refine life-history models and further our understanding of ageing and longevity of wild sea turtles for conservation and management.Fieldwork was supported by the British Associate of Tortoise Keepers, British Chelonia Group, British High Commission in Cyprus, British Residents Society, Carnegie Trust for the Universities of Scotland, Darwin Initiative, Erwin Warth Foundation, Friends of SPOT, Glasgow Uni versity Court, Kuzey Kıbrıs Turkcell, MEDASSET UK, and Natural Environment Research Council

Are patients' judgments of health status really different from the general population?

Background: Many studies have found discrepancies in valuations for health states between the general population (healthy people) and people who actually experience illness (patients). Such differences may be explained by referring to various cognitive mechanisms. However, more likely most of these observed differences may be attributable to the methods used to measure these health states. We explored in an experimental setting whether such discrepancies in values for health states exist. It was hypothesized that the more the measurement strategy was incorporated in measurement theory, the more similar the responses of patients and healthy people would be. Methods: A sample of the general population and two patient groups (cancer, rheumatoid arthritis) were included. All three study groups judged the same 17 hypothetical EQ-5D health states, each state comprising the same five health domains. The patients did not know that apart from these 17 states their own health status was also included in the set of states they were assessing. Three different measurement strategies were applied: 1) ranking of the health states; 2) placing all the health states simultaneously on a visual analogue scale (VAS); 3) separately assessing the health states with the time trade-off (TTO) technique. Regression analyses were performed to determine whether differences in the VAS and TTO can be ascribed to specific health domains. In addition, effect of being member of one of the two patient groups and the effect of the assessment of the patients' own health status was analyzed. Results: Except for some moderate divergence, no differences were found between patients and healthy people for the ranking task or for the VAS. For the time trade-off technique, however, large differences were observed between patients and healthy people. The regression analyses for the effect of belonging to one of the patient groups and the effect of the value assigned to the patients' own health state showed that only for the TTO these patient-specific parameters did offer some additional information in explaining the 17 hypothetical EQ-5D states. Conclusions: Patients' assessment of health states is similar to that of the general population when the judgments are made under conditions that are defended by modern measurement theory

Time to achieve remission determines time to be in remission

Contains fulltext : 87665.pdf (publisher's version ) (Open Access)INTRODUCTION: Though remission is currently a treatment goal in patients with rheumatoid arthritis (RA), the number of patients who achieve and sustain remission in daily practice is still small. It is suggested that early remission will be associated with sustainability of remission. The aim was to study the association between time-to-remission and sustainability of remission in a cohort of early RA patients treated according to daily practice. METHODS: For this study, three-year follow-up data were used from the Nijmegen RA Inception Cohort of patients included between 1985 and 2005 (N=753). Patients were included upon diagnosis (ACR criteria), were systematically evaluated at three-monthly visits and treated according to daily practice. Remission was defined according to the Disease Activity Score (DAS)<1.6 and the ACR remission criteria. Remission of at least 6 months duration was regarded as sustained remission. Predictors for time-to-remission were identified by Cox-regression analyses. The relation between time-to-remission and sustained remission was analyzed using longitudinal binary regression. RESULTS: N=398 (52%) patients achieved remission with a median time-to-remission of 12 months. Male gender, younger age and low DAS at baseline were predictive to reach remission rapidly. There were n=142 (36%) patients experiencing sustained remission, which was determined by a shorter time-to-remission only. The relationship between time-to-remission and sustained remission was described by a significant odds ratio (1.11) (1.10 to 1.12-95% CI) that was constant over the whole period 1985 to 2005. Results obtained with the ACR remission criteria were similar. CONCLUSIONS: A shorter time-to-remission is related to sustainability of remission, supporting striving for early remission in patients with RA

The importance of passive integrated transponder (PIT) tags for measuring life-history traits of sea turtles

This is the final version. Available from the publisher via the DOI in this record.Capture-mark-recapture studies rely on the identification of individuals through time, using markers or tags, which are assumed to be retained. This assumption, however, may be violated, having implications for population models. In sea turtles, individual identification is typically based on external flipper tags, which can be combined with internal passive integrated transponder (PIT) tags. Despite the extensive use of flipper tags, few studies have modelled tag loss using continuous functions. Using a 26-year dataset for sympatrically nesting green (Chelonia mydas) and loggerhead (Caretta caretta) turtles, this study aims to assess how PIT tag use increases the accuracy of estimates of life-history traits. The addition of PIT tags improved female identification: between 2000 and 2017, 53% of green turtles and 29% of loggerhead turtles were identified from PIT tags alone. We found flipper and PIT tag losses were best described by decreasing logistic curves with lower asymptotes. Excluding PIT tags from our dataset led to underestimation of flipper tag loss, reproductive periodicity, reproductive longevity and annual survival, and overestimation of female abundance and recruitment for both species. This shows the importance of PIT tags in improving the accuracy of estimates of life-history traits. Thus, estimates where tag loss has not been corrected for should be interpreted with caution and could bias IUCN Red List assessments. As such, long-term population monitoring programmes should aim to estimate tag loss and assess the impact of loss on life-history estimates, to provide robust estimates without which population models and stock assessments cannot be derived accuratel

The evolution of civil war severity, 1816-2005

© 2016 Walter de Gruyter GmbH, Berlin/Boston. Previous analyses of civil war trends tend to be informal and consider only post 1945 data. We examine data on civil wars over the period 1816-2005, using new methods for evolutionary growth processes. We find a number of new patterns and trends in civil war that have received little attention in previous research, including a structural break in frequency of conflict with decolonialization, as well as evidence of periodicity in civil conflict. We develop new measures of civil war intensity and impact, and find that conflicts have been generally more severe in the 20th than in the 19th century. We also find that the frequency-severity distribution of civil war does not appear to follow a power-law distribution, unlike data on many other types of conflict. Although structural trends suggest an increase in future civil wars, we discuss possible limiting factors that might prevent this in light of the recent observed decline in civil wars after the Cold War

Assessing the Effects of Banana Pingers as a Bycatch Mitigation Device for Harbour Porpoises (Phocoena phocoena)

This is the final version. Available on open access from Frontiers Media via the DOI in this recordData Availability Statement: The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation, to any qualified researcher.Bycatch is a significant cause of population declines of marine megafauna globally. While numerous bycatch mitigation strategies exist, acoustic alarms, or pingers, are the most widely adopted strategy for small cetaceans. Although pingers have been shown to be an effective measure for numerous species, there are some concerns about their long-term use. Bycatch is recognized as a persistent problem in waters around Cornwall, United Kingdom, where several cetacean species are resident, with harbour porpoises (Phocoena phocoena) being the most-commonly sighted. In this study, we assessed the effects of a Banana Pinger (Fishtek Marine Limited) on harbour porpoises in Cornwall between August 2012 and March 2013. Two passive acoustic loggers (C-PODs; Chelonia Limited) were deployed 100 m apart to record cetacean activity during cycles of active and inactive pinger periods. Harbour porpoises were 37% less likely to be detected at the C-POD near the pinger when the pinger was active, while they were only 9% less likely to be detected 100 m further away. The effect of the pinger was constant over the study period at both C-PODs despite the temporal variation in harbour porpoise detections. In addition, we found no evidence of reduced pinger effect with changing environmental conditions. Furthermore, harbour porpoise detections at the C-POD near the pinger did not depend on the time elapsed since the pinger turned off, with harbour porpoises returning to the ensonified area with no delay. Together these results suggest that (1) harbour porpoises did not habituate to the pinger over an 8-month period, (2) the pinger effect is very localized, and (3) pinger use did not lead to harbour porpoise displacement over the study period, suggesting an absence of long-term behavioral effects. We suggest that the deployment of pingers on fishing nets would likely reduce net-porpoise interactions, thereby mitigating bycatch of harbour porpoises and potentially other cetacean species. As the small-scale fishery dominates in United Kingdom waters, there is an acute need for cost-effective mitigation strategies with concurrent monitoring to be implemented rapidly in order to address the problem of harbour porpoise, and more generally, cetacean bycatch.Whale and Dolphin ConservationFishtek Marine Limite

HRV analysis: Unpredictability of approximate entropy in chronic obstructive pulmonary disease

Introduction: Approximate entropy (ApEn) is a widely imposed metric to evaluate a chaotic response and irregularities of RR-intervals from an electrocardiogram. Yet, the technique is problematic due to the accurate choice of the tolerance (r) and embedding dimension (M). We prescribed the metric to evaluate these responses in subjects exhibiting symptoms of chronic obstructive pulmonary disease (COPD) and we strived to overcome this disadvantage by applying different groupings to detect the optimal. Methods: We examined 38 subjects split equally: COPD and control. To evaluate autonomic modulation the heart rate was measured beat-by-beat for 30 min in a supine position without any physical, sensory, or pharmacological stimuli. In the time-series obtained the ApEn was then applied with set values for tolerance, r and embedding dimension, M. Then, the differences between the two groups and their effect size by two measures (Cohen’s ds and Hedges’s gs) were computed. Results: The highest value of statistical significance accomplished for any effect size statistical combinations undertaken was -1.13 for Cohen’s ds, and -1.10 for Hedges’s gs with embedding dimension, M = 2 and tolerance, r = 0.1. Conclusion: ApEn was capable of optimally identifying the decrease in chaotic response in COPD. The optimal combination of r and M for this were 0.1 and 2, respectively. Despite this, ApEn is a relatively unpredictable mathematical marker and the use of other techniques to evaluate a healthy or pathological condition is encouraged