Social Competence as a Mediating Factor in Reduction of Behavioral Problems

The main purpose of the present study was to explore how social competence reduces behavioral problems. Based on previous findings, we assume that increased social competence can be regarded as a mediating factor in reducing behavior problems. All participants (children and adolescents, n ¼ 112) received an intervention intended to increase social competence: Aggresion Replacement Training (ART). Social competence and problem behavior were assessed twice before the ART intervention and then twice afterwards. Both measures improved following the training period, but no changes occurred during the pre-training period. Further, behavioral problems continued to reduce notably in follow-up probes after the training period. More detailed analyses indicate that in youngsters, increased social competence (e.g., improved self-control and cooperation) mediates the effect of ART on behavioral problems, but important moderating factors (e.g., age, individual levels of social competence, and problem behavior) need to be taken into consideration

Long-Term Weight Changes After Starting Anti-IL-5/5Ra Biologics in Severe Asthma: The Role of Oral Corticosteroids

BACKGROUND Many patients with severe asthma are overweight or obese, often attributed to unintentional weight gain as a side effect of oral corticosteroids (OCSs). Anti-IL-5/5Ra biologics significantly reduce OCS use, but their long-term effects on weight are unknown. OBJECTIVES To examine (1) weight change up to 2 years after anti-IL-5/5Ra initiation in subgroups on the basis of maintenance OCS use at start of treatment and (2) whether cumulative OCS exposure before or changes in OCS exposure during treatment are related to weight change. METHODS Real-world data on weight and cumulative OCS dose from adults included in the Dutch Registry of Adult Patients with Severe asthma for Optimal DIsease management before and at least 2 years after starting anti-IL-5/5Ra were analyzed using linear mixed models and linear regression analyses. RESULTS For the included 389 patients (55% female; mean body mass index, 28 ± 5 kg/m$^{2}$; 58% maintenance OCS), mean weight decreased -0.27 kg/y (95% CI, -0.51 to -0.03; P = .03), with more weight loss in patients with maintenance OCS use than in those without maintenance OCS use (-0.87 kg/y [95% CI, -1.21 to -0.52; P < .001] vs +0.54 kg/y [0.26 to 0.82; P < .001]). Greater weight loss at 2 years was associated with higher cumulative OCS dose in the 2 years before anti-IL-5/5Ra initiation (β = -0.24 kg/g; 95% CI, -0.38 to -0.10; P < .001) and, independently, greater reduction in cumulative OCS dose during follow-up (β = 0.27 kg/g; 95% CI, 0.11 to 0.43; P < .001). CONCLUSIONS Anti-IL-5/5Ra therapy is associated with long-term weight reduction, especially in patients with higher OCS exposure before treatment and those able to reduce OCS use during treatment. However, the effect is small and does not apply to all patients, and so additional interventions seem necessary if weight change is desired

Position statement on the role of healthcare professionals, patient organizations and industry in European Reference Networks

A call from the EU for the set-up of European Reference Networks (ERNs) is expected to be launched in the first quarter of 2016. ERNs are intended to improve the care for patients with low prevalent or rare diseases throughout the EU by, among other things, facilitating the pooling and exchange of experience and knowledge and the development of protocols and guidelines. In the past, for example where costly orphan drugs have been concerned, industry has played an important role in facilitating consensus meetings and publication of guidelines. The ERNs should provide a unique opportunity for healthcare professionals and patients to lead these activities in an independent way. However, currently costs for networking activities are not to be covered by EU funds and alternative sources of funding are being explored. There is growing concern that any involvement of the industry in the funding of ERNs and their core activities may create a risk of undue influence. To date, the European Commission has not been explicit in how industry will be engaged in ERNs. We believe that public funding and a conflict of interest policy are needed at the level of the ERNs, Centers of Expertise (CEs), healthcare professionals and patient organizations with the aim of maintaining scientific integrity and independence. Specific attention is needed where it concerns the development of clinical practice guidelines. A proposal for a conflict of interest policy is presented, which may support the development of a framework to facilitate collaboration, safeguard professional integrity and to establish and maintain public acceptability and trust among patients, their organizations and the general public

Social Competence as a Mediating Factor in Reduction of Behavioral Problems

The main purpose of the present study was to explore how social competence reduces behavioral problems. Based on previous findings, we assume that increased social competence can be regarded as a mediating factor in reducing behavior problems. All participants (children and adolescents, n ¼ 112) received an intervention intended to increase social competence: Aggresion Replacement Training (ART). Social competence and problem behavior were assessed twice before the ART intervention and then twice afterwards. Both measures improved following the training period, but no changes occurred during the pre-training period. Further, behavioral problems continued to reduce notably in follow-up probes after the training period. More detailed analyses indicate that in youngsters, increased social competence (e.g., improved self-control and cooperation) mediates the effect of ART on behavioral problems, but important moderating factors (e.g., age, individual levels of social competence, and problem behavior) need to be taken into consideration

A causal analysis framework for land-use change and the potential role of bioenergy policy

We propose a causal analysis framework to increase understanding of land-use change (LUC) and the reliability of LUC models. This health-sciences-inspired framework can be applied to determine probable causes of LUC in the context of bioenergy. Calculations of net greenhouse gas (GHG) emissions for LUC associated with biofuel production are critical in determining whether a fuel qualifies as a biofuel or advanced biofuel category under regional (EU), national (US, UK), and state (California) regulations. Biofuel policymakers and scientists continue to discuss to what extent presumed indirect land-use change (ILUC) estimates should be included in GHG accounting for biofuel pathways. Current estimates of ILUC for bioenergy rely largely on economic simulation models that focus on causal pathways involving global commodity trade and use coarse land-cover data with simple land classification systems. This paper challenges the application of such models to estimate global areas of LUC in the absence of causal analysis. The proposed causal analysis framework begins with a definition of the change that has occurred and proceeds to a strength-of-evidence approach that includes plausibility of relationship, completeness of causal pathway, spatial co-occurrence, time order, analogous agents, simulation model results, and quantitative agent–response relationships. We discuss how LUC may be allocated among probable causes for policy purposes and how the application of the framework has the potential to increase the validity of LUC models and resolve controversies about ILUC, such as deforestation, and biofuels

Isolation of sequences from a random-sequence expression library that mimic viral epitopes

We describe the use of random peptide sequences for the mapping of antigenic determinants. An oligonucleotide with a completely degenerate sequence of 17 or 23 nucleotides was inserted into a bacterial expression vector. This resulted in an expression library producing random hexa- or octapeptides attached to a β-galactosidase hybrid protein. Mimotopes, or antigenic sequences that mimic an epitope, were selected by immunoscreening of colonies with monoclonal antibodies, which were specific for antigenic sites on the spike protein of the coronavirus transmissible gastroenteritis virus. We report one mimotope for antigenic site II, eight for site III and one for site IV. The site III and site IV mimotopes were closely similar to the corresponding linear epitopes, localized previously in the amino acid sequence of the S protein. An alignment of the site II mimotope and the sequence of the S protein around Trp97, which is substituted in escape mutants, suggests that this mimotope mimics a conformational epitope located around residues 97-103. Applications of mimotopes to epitope mapping, serodiagnosis and vaccine development are discussed

Isolation of sequences from a random-sequence expression library that mimic viral epitopes

We describe the use of random peptide sequences for the mapping of antigenic determinants. An oligonucleotide with a completely degenerate sequence of 17 or 23 nucleotides was inserted into a bacterial expression vector. This resulted in an expression library producing random hexa- or octapeptides attached to a β-galactosidase hybrid protein. Mimotopes, or antigenic sequences that mimic an epitope, were selected by immunoscreening of colonies with monoclonal antibodies, which were specific for antigenic sites on the spike protein of the coronavirus transmissible gastroenteritis virus. We report one mimotope for antigenic site II, eight for site III and one for site IV. The site III and site IV mimotopes were closely similar to the corresponding linear epitopes, localized previously in the amino acid sequence of the S protein. An alignment of the site II mimotope and the sequence of the S protein around Trp97, which is substituted in escape mutants, suggests that this mimotope mimics a conformational epitope located around residues 97-103. Applications of mimotopes to epitope mapping, serodiagnosis and vaccine development are discussed

A long term follow-up study of the development of hip disease in Mucopolysaccharidosis type VI

Hip problems in Mucopolysaccharidosis type VI (MPS VI) lead to severe disability. Lacic of data on the course of hip disease in MPS VI make decisions regarding necessity, timing and type of surgical intervention difficult. We therefore studied the development of hip pathology in MPS VI patients over time. Data were collected as part of a prospective follow-up study. Standardized supine AP pelvis and frog leg lateral radiographs of both hips were performed yearly or every 2 years. Image assessment was performed quantitatively (angle measurements) and qualitatively (hip morphology). Clinical burden of hip disease was evaluated by physical examination, six minute walking test (6MWT) and a questionnaire assessing pain, wheelchair-dependency and walking distance. A total of 157 pelvic radiographs of 14 ERT treated MPS VI patients were evaluated. Age at first image ranged from 2.0 to 21.1 years. Median follow up duration was 6.8 years. In all patients, even in the youngest, the acetabulum and os ilium were dysplastic. Coverage of the femoral head by the acetabulum improved over time, but remained insufficient. While the femoral head appeared normal in the radiographs at young age, the ossification pattern became abnormal in all patients over time. In all patients the distance covered in the 6MWT was reduced (median Z scores -3.3). Twelve patients had a waddling gait. Four patients were partially wheelchair-dependent and ten patients had limitations in their maximum walking distance. In conclusion, clinically significant hip abnormalities develop in all MPS VI patients from very early in life, starting with deformities of the os ilium and acetabulum. Femoral head abnormalities occur later, most likely due to altered mechanical forces in combination with epiphyseal abnormalities due to glycosaminoglycan storage. The final shape and angle of the femoral head differs significantly between individual MPS VI patients and is difficult to predict. (C) 2017 Elsevier Inc. All rights reserve