Increased radiographic progression of distal hand osteoarthritis occurring during biologic DMARD monotherapy for concomitant rheumatoid arthritis.

OBJECTIVES A considerable proportion of patients with rheumatoid arthritis (RA) also suffer from hand osteoarthritis (OA). We here assess the association between conventional synthetic (cs) and biological (b) disease-modifying antirheumatic drugs (DMARDs) and radiographic distal interphalangeal-(DIP) OA in patients with RA. METHODS Adult RA patients from a longitudinal Swiss registry of rheumatic diseases who had ≥ 2 hand radiographs were included at the first radiograph and followed until the outcome or the last radiograph. Patients were grouped into two cohorts based on whether DIP OA was present or absent at cohort entry (cohorts 1 and 2, respectively). Modified Kellgren-Lawrence scores (KLS) were obtained by evaluating DIP joints for the severity of osteophytes, joint space narrowing, subchondral sclerosis, and erosions. KLS ≥ 2 in ≥ 1 DIP joint indicated incident or existing OA, and increase of ≥ 1 in KLS in ≥ 1 DIP joint indicated progression in existing DIP OA. Time-varying Cox regression and generalized estimating equation (GEE) analyses were performed. We estimated hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CI) of DIP OA incidence (cohort 2), or progression (cohort 1), in bDMARD monotherapy, bDMARD/csDMARD combination therapy, and past or never DMARD use, when compared to csDMARD use. In post hoc analyses, we descriptively and analytically assessed the individual KLS features in cohort 1. RESULTS Among 2234 RA patients with 5928 radiographs, 1340 patients had DIP OA at baseline (cohort 1). Radiographic progression of DIP OA was characterized by new or progressive osteophyte formation (666, 52.4%), joint space narrowing (379, 27.5%), subchondral sclerosis (238, 17.8%), or erosions (62, 4.3%). bDMARD monotherapy had an increased risk of radiographic DIP OA progression compared to csDMARD monotherapy (adjusted HR 1.34 [95% CI 1.07-1.69]). The risk was not significant in csDMARD/bDMARD combination users (HR 1.12 [95% CI 0.96-1.31]), absent in past DMARD users (HR 0.96 [95% CI 0.66-1.41]), and significantly lower among never DMARD users (HR 0.54 [95% CI 0.33-0.90]). Osteophyte progression (HR 1.74 [95% CI 1.11-2.74]) was the most significantly increased OA feature with bDMARD use compared to csDMARD use. In 894 patients without initial DIP OA (cohort 2), the risk of incident OA did not differ between the treatment groups. The results from GEE analyses corroborated all findings. CONCLUSIONS These real-world RA cohort data indicate that monotherapy with bDMARDs is associated with increased radiographic progression of existing DIP OA, but not with incident DIP OA

Detection and Grading of Radiographic Hand Osteoarthritis Using an Automated Machine Learning Platform.

Automated machine learning (autoML) platforms allow health care professionals to play an active role in the development of machine learning (ML) algorithms according to scientific or clinical needs. The aim of this study was to develop and evaluate such a model for automated detection and grading of distal hand osteoarthritis (OA). A total of 13,690 hand radiographs from 2,863 patients within the Swiss Cohort of Quality Management (SCQM) and an external control data set of 346 non-SCQM patients were collected and scored for distal interphalangeal OA (DIP-OA) using the modified Kellgren/Lawrence (K/L) score. Giotto (Learn to Forecast [L2F]) was used as an autoML platform for training two convolutional neural networks for DIP joint extraction and subsequent classification according to the K/L scores. A total of 48,892 DIP joints were extracted and then used to train the classification model. Heatmaps were generated independently of the platform. User experience of a web application as a provisional user interface was investigated by rheumatologists and radiologists. The sensitivity and specificity of this model for detecting DIP-OA were 79% and 86%, respectively. The accuracy for grading the correct K/L score was 75%, with a κ score of 0.76. The accuracy per DIP-OA class differed, with 86% for no OA (defined as K/L scores 0 and 1), 71% for a K/L score of 2, 46% for a K/L score of 3, and 67% for a K/L score of 4. Similar values were obtained in an independent external test set. Qualitative and quantitative user experience testing of the web application revealed a moderate to high demand for automated DIP-OA scoring among rheumatologists. Conversely, radiologists expressed a low demand, except for the use of heatmaps. AutoML platforms are an opportunity to develop clinical end-to-end ML algorithms. Here, automated radiographic DIP-OA detection is both feasible and usable, whereas grading among individual K/L scores (eg, for clinical trials) remains challenging

Association of nutritional risk and adverse medical outcomes across different medical inpatient populations

OBJECTIVE: The aim of this study was to examine the prevalence of nutritional risk and its association with multiple adverse clinical outcomes in a large cohort of acutely ill medical inpatients from a Swiss tertiary care hospital. METHODS: We prospectively followed consecutive adult medical inpatients for 30 d. Multivariate regression models were used to investigate the association of the initial Nutritional Risk Score (NRS 2002) with mortality, impairment in activities of daily living (Barthel Index /=3 points. We found strong associations (odds ratio/hazard ratio [OR/HR], 95% confidence interval [CI]) between nutritional risk and mortality (OR/HR, 7.82; 95% CI, 6.04-10.12), impaired Barthel Index (OR/HR, 2.56; 95% CI, 2.12-3.09), time to hospital discharge (OR/HR, 0.48; 95% CI, 0.43-0.52), hospital readmission (OR/HR, 1.46; 95% CI, 1.08-1.97), and all five dimensions of QoL measures. Associations remained significant after adjustment for sociodemographic characteristics, comorbidities, and medical diagnoses. Results were robust in subgroup analysis with evidence of effect modification (P for interaction > 0.05) based on age and main diagnosis groups. CONCLUSION: Nutritional risk is significant in acutely ill medical inpatients and is associated with increased medical resource use, adverse clinical outcomes, and impairments in functional ability and QoL. Randomized trials are needed to evaluate evidence-based preventive and treatment strategies focusing on nutritional factors to improve outcomes in these high-risk patients

Entwicklung eines integrierten Energiekonzepts: Erfassung des Emissions-Reduktions-Potentials klimawirksamer Spurengase im Bereich rationeller Energienutzung fuer die alten Bundeslaender. Hauptband

The task of the research project was to develop an integrated energy concept for the Federal Republic of Germany (old Laender), that can be applied to quantify and depict the present energy use and the future potentials for the reduction of energy and emissions. As a basis for the energy concept an energy model had to be developed, that images the flow of energy demand from the energy service to the use of primary energy. Thus te energy model PROGRES (programme for the development of energy scenarios) that was developed by the researchers for this purpose, had to meet the requirement to model also thhe first step of the flow of energy demand, which as not been included in the models so far. This step lies between the energy service and the use of collectible energy necessary for the provision of this service. The energy model should image all sectors relevant to energy, i.e. the sectors households, small consumers, industry and traffic as well as the conversion sector. Apart from the elaboration of an energy model the central task of the research project was to find potentials for the energy conservation and reduction of emissions (CO_2) and describe solutions for teir realisation by means of scenarios. Three scenarios were set up for this task: ''Business as usual'', ''efficiency'' and ''ecological structure policy''. The period of the scenarios for the calculations in the frame of the research project should terminate in 2020. Since the project was approved before the reunification of Germany, all calculations only refer to the territory of the old Laender. (orig./UA)Aufgabe des Forschungsprojekts war es, ein integriertes Energiekonzept fuer die Bundesrepublik Deutschland (alte Bundeslaender) zu entwickeln, mit dessen Hilfe es moeglich ist, den heutigen Energieeinsatz und die zukuenftigen Energie-und Emissionsreduktionspotentiale quantifizieren und beschreiben zu koennen. Als Grundlage des Energiekonzepts war ein Energiemodell zu entwickeln, das den Energienachfragefluss von der Energiedienstleistung bis zum Primaerenergieeinsatz abbildet. Das von den Mitarbeitern des Forschungsprojekts fuer diesen Zweck erarbeitete Energiemodell PROGRES (Programm zur Entwicklung von Energie-Szenarien) hatte somit die Bedingung zu erfuellen, auch den in den Modellen bisher nicht erfassten ersten Schritt des Energienachfrageflusses zu modellieren - den zwischen der Energiedienstleistung und dem fuer ihre Bereitstellung notwendigen Nutzenergieeinsatz. Das Energiemodell sollte dabei alle energierelevanten Sektoren abbilden, d.h. die Sektoren Haushalte, Kleinverbraucher, Industrie und Verkehr sowie den Umwandlungsbereich. Neben der Erstellung eines Energiemodells war die zentrale Aufgabe des Forschungsprojekts, mittels Szenarien die zukuenftigen Energieeinspar- und Emissionsreduktionspotentiale (CO_2) zu ermitteln und Wege fuer ihre Realisierung zu beschreiben. Das Projekt ist diesem Auftrag mit den drei Szenarien ''Business as Usual'', ''Effizienz'' und ''Oekologische Strukturpolitik'' nachgekommen. Der Szenarienzeitraum der Berechnungen des Forschungsprojekts sollte sich bis zum Jahre 2020 erstrecken. Da das Projekt vor der Vereinigung Deutschlands genehmigt wurde, beziehen sich die Berechnungen nur auf das Gebiet der alten Bundeslaender. (orig./UA)Available from TIB Hannover: F95B293+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Forschung und Technologie (BMFT), Bonn (Germany); Ministerium fuer Wirtschaft, Mittelstand und Technologie des Landes Nordrhein-Westfalen, Duesseldorf (Germany)DEGerman

Klimaschutz durch Effizienzsteigerung von Geraeten und Anlagen im Bereich Haushalte und Kleinverbrauch - Sachstand/Projektionen/CO_2-Minderungspotentiale

The report gives an overview of the present and future electricity consumption of electric appliances and equipment in the domestic and the commercial/institutional sector, which account for approx. 183 TWh/a - more than one third of the total annual electricity consumption in Germany. Furthermore, the report includes a differentiated analysis of the specific saving potentials of the various technical applications. A comparison between a 'business as usual' and an 'efficiency' scenario reveals significant contributions to electricity saving and emission cutting by exhausting the existing efficiency potentials. As a whole, 13 mio. tons of CO_2 equivalents in 2005 (a constant CO_2 emission factor in the electricity production provided) might be saved compared to the expected trend development. The contribution of this sector rises to 21 mio. tons of CO_2 equivalents until 2010. (orig.)Available from TIB Hannover: RN 8908(2000,463) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Umwelt, Naturschutz und Reaktorsicherheit, Bonn (Germany)DEGerman

Association of nutritional risk and adverse medical outcomes across different medical inpatient populations

OBJECTIVE The aim of this study was to examine the prevalence of nutritional risk and its association with multiple adverse clinical outcomes in a large cohort of acutely ill medical inpatients from a Swiss tertiary care hospital. METHODS We prospectively followed consecutive adult medical inpatients for 30 d. Multivariate regression models were used to investigate the association of the initial Nutritional Risk Score (NRS 2002) with mortality, impairment in activities of daily living (Barthel Index <95 points), hospital length of stay, hospital readmission rates, and quality of life (QoL; adapted from EQ5 D); all parameters were measured at 30 d. RESULTS Of 3186 patients (mean age 71 y, 44.7% women), 887 (27.8%) were at risk for malnutrition with an NRS ≥3 points. We found strong associations (odds ratio/hazard ratio [OR/HR], 95% confidence interval [CI]) between nutritional risk and mortality (OR/HR, 7.82; 95% CI, 6.04-10.12), impaired Barthel Index (OR/HR, 2.56; 95% CI, 2.12-3.09), time to hospital discharge (OR/HR, 0.48; 95% CI, 0.43-0.52), hospital readmission (OR/HR, 1.46; 95% CI, 1.08-1.97), and all five dimensions of QoL measures. Associations remained significant after adjustment for sociodemographic characteristics, comorbidities, and medical diagnoses. Results were robust in subgroup analysis with evidence of effect modification (P for interaction < 0.05) based on age and main diagnosis groups. CONCLUSION Nutritional risk is significant in acutely ill medical inpatients and is associated with increased medical resource use, adverse clinical outcomes, and impairments in functional ability and QoL. Randomized trials are needed to evaluate evidence-based preventive and treatment strategies focusing on nutritional factors to improve outcomes in these high-risk patients

Langfristszenarien fuer eine nachhaltige Energienutzung in Deutschland

The study was able to show, and explain vividly through scenarios describing change processes, that a sustainable use of energy (aimed, among other things, at reducing CO_2 emissions by 80% by 2050 compared with 1990 levels) is technically feasible, economically viable, compatible with farther-reaching objectives of energy policy (e.g. supply security), and does not, in spite of the substantial need for change, present the players involved with any insurmountable problems but, rather, constitutes both a challenge and an opportunity. Such a development is possible only if the efforts launched to give momentum to the increased use of renewable energy sources are continued consistently, the impending need for replacement and renewal within the generation system is consistently utilised for increasing efficiency and a reorientation mainly towards combined heat and power production, and energy saving is made a new focal point of energy policy. Furthermore, with regard to long-term infrastructure requirements (decentralisation, new fuels), the necessary decisions must be prepared at an early stage and sufficiently robust lines of development must be identified and followed. (orig.)Im Rahmen der Untersuchung konnte aufgezeigt und an, Veraenderungsprozesse beschreibenden, Wendeszenen plastisch erlaeutert werden, dass eine nachhaltige Energieversorgung (die u.a. eine Minderung der CO_2-Emissionen von 80% bis zum Jahr 2050 gegenueber 1990 zum Ziel hat) technisch moeglich, oekonomisch tragfaehig, mit weitergehenden Zielen der Energiepolitik (z.B. Versorgungssicherheit) kompatibel ist und die Akteure trotz des zum Teil hohen Veraenderungsbedarfs vor keine unloesbaren Probleme stellt, sondern Herausforderung und Chance zugleich darstellt. Eine derartige Entwicklung ist nur dann moeglich, wenn die begonnene Dynamik der verstaerkten Nutzung erneuerbarer Energie konsequent fortgesetzt wird, der anstehende Ersatz- und Erneuerungsbedarf im Kraftwerkspark konsequent zu einer Effizienzsteigerung und Umorientierung auf eine im Wesentlichen gekoppelte Strom- und Waermeerzeugung genutzt wird und mit der Energieeinsparung ein neuer Schwerpunkt der Energiepoltik etabliert wird. Darueber hinaus muessen fuer die langfristig anstehenden Infrastrukturanforderungen (Dezentralisierung, neue Treibstoffe) die notwendigen Entscheidungen fruehzeitig vorbereitet und hinreichend robuste Entwicklungslinien identifiziert und aufgegriffen werden. (orig.)Available from TIB Hannover: RN 8908(2000,314) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Umwelt, Naturschutz und Reaktorsicherheit, Bonn (Germany)DEGerman