Tofacitinib in the management of active psoriatic arthritis: patient selection and perspectives.

Tofacitinib is an oral Janus kinase inhibitor approved for the treatment of psoriatic arthritis (PsA). It provides an alternative option for patients who have had an inadequate response and tolerance to other disease modifying antirheumatic drugs (DMARDs). It has demonstrated comparable efficacy to biologics, is effective in the management of treatment resistant disease, and is reported to improve enthesitis, dactylitis, and radiographic progression. Tofacitinib is also associated with an increased risk of serious infections, malignancy, and laboratory abnormalities. There is currently a large armamentarium of therapies for psoriatic arthritis, and choosing among treatments can be challenging. Due to this wide selection, a thorough assessment of psoriatic disease phenotype, patient preference, disease presentation, and comorbidities is critical. This review addresses key considerations in patient selection for the treatment of PsA with tofacitinib

BRAIN AGE AS A MEASURE OF BRAIN RESERVE IN NEUROPSYCHIATRIC DISORDERS

Aging represents a highly heterogeneous process with highly variable clinical outcomes. Differential expression of risk and resilience factors may provide explanations for this variability. Gaining a better understanding of resilience in aging is critical as it will allow for improved individualized outcome prediction, as well as providing insight for targeted interventions that may improve the process of aging. Currently, the prevailing models of neurocognitive resilience are cognitive reserve and brain reserve. The theory of cognitive reserve suggests that those with greater cognitive reserve may better cope with loss of brain integrity through presence of more adaptable and efficient neural systems. Most studies utilize education level to assess cognitive reserve; however, many proxy measures are subjective and susceptible to hindsight bias. The concept of brain reserve overlaps with that of cognitive reserve but focuses instead on the biological characteristics that allow the brain to be resilient to the effects of aging and pathological insults. It is generally thought that with sufficient brain substrate (e.g., larger grey matter volumes, greater synaptic density, more elaborate network complexity), the brain is more capable of preserving normal functioning and maintaining homeostasis despite the presence of factors of neurodegeneration or trauma. Overall, the main goals of this dissertation are to demonstrate the impact of cognitive and brain reserve on neuropsychological outcomes and brain activation patterns (Aim 1, Chapters 2 and 3), to utilize machine learning brain age prediction as a novel proxy of brain reserve (Aim 2, Chapter 4), and to utilize brain age prediction in several iv neuropsychiatric disorders to predict outcome or gain a better understanding on the disease process (Aim 3, Chapters 5, 6, 7)

Revisión crítica: evidencias de rasurado del cabello en pacientes programados a cirugía intracraneal en relación a infección postoperatoria

La presente investigación secundaria examina el efecto de remover el cabello como preparación preoperatoria de una cirugía intracraneal en los pacientes programados. La investigación se realizó en base a la metodología de estudio de caso, obteniendo información de diversas fuentes, como estudio de casos, ensayos, revisión de literatura. En el primer capítulo se detalla el marco metodológico que desarrolla los puntos tales como: tipo de investigación, metodología EBE, formulación de pregunta según esquema de Picot, viabilidad y pertinencia de la pregunta clínica, metodología de búsqueda de información, síntesis de evidencia encontrada a través de la Guía de Validez y utilidad aparentes de Gálvez y Toro y las listas de chequeo especificas a emplear en los trabajos seleccionados. Cada una de estas temáticas permitió el proceso de investigación en la revisión crítica seleccionada, realizando un conjunto de procesos consecutivos y ordenados. En el segundo capítulo se desarrolla el comentario crítico, consta de las siguientes partes: artículo científico seleccionado, comentario crítico, respuesta a la pregunta clínica y las recomendaciones. En este capítulo se desarrolla la opinión de la investigadora en busca de argumentos o evidencias que respalden su acotación sobre el tema a desarrollar, validando la información con las evidencias encontradas en las investigaciones desarrolladas

A Homeostatic Model of Subjective Cognitive Decline

Subjective Cognitive Decline (SCD) is possibly one of the earliest detectable signs of dementia, but we do not know which mental processes lead to elevated concern. In this narrative review, we will summarize the previous literature on the biomarkers and functional neuroanatomy of SCD. In order to extend upon the prevailing theory of SCD, compensatory hyperactivation, we will introduce a new model: the breakdown of homeostasis in the prediction error minimization system. A cognitive prediction error is a discrepancy between an implicit cognitive prediction and the corresponding outcome. Experiencing frequent prediction errors may be a primary source of elevated subjective concern. Our homeostasis breakdown model provides an explanation for the progression from both normal cognition to SCD and from SCD to advanced dementia stages

La voix humaine Cocteau/Poulenc : a intérprete e a expressão de emoções

Doutoramento em MúsicaEste trabalho pretende ser uma reflexão acerca dos sentidos que se escondem para além do texto e da notação musical, na obra La Voix Humaine de Poulenc/Cocteau e suas implicações e contribuições para a interpretação musical. Partindo de uma contextualização histórica, passando pela estrutura textual e musical, sem esquecer o precioso testemunho das entrevistas realizadas a onze cantoras portuguesas, pretende-se, evidenciar os afectos sugeridos pelo compositor e transmiti-los através da interpretação reforçando assim o lugar da intérprete numa cadeia de expressão de emoções.This work aims to be a reflection of the meanings hidden beyond the text and musical notation on La Voix Humaine by Poulenc/Cocteau and its implications and contributions to a performance. From a historical perspective, passing through an analysis of the text and music, not forgetting the valuable interviews with eleven Portuguese singers, this work aims to highlight the emotions suggested by the composer and communicate them through a performance emphasizing the role of the singer on a chaine of expressing emotions

A estética expressionista na obra Pierrot Lunaire de Arnold Schoenberg: contributos para uma interpretação

Mestrado em MúsicaO trabalho aqui exposto, a partir de uma reflexão sobre as linhas gerais do expressionismo alemão nos seus vários domínios, procura indagar acerca das influências expressionistas na obra Pierrot Lunaire de Arnold Schoenberg, com vista a uma melhor compreensão da obra em questão e visando uma interpretação da obra que as referencie. A estrutura do texto apresenta-se em duas partes, sendo a primeira uma exposição do movimento expressionista nos vários domínios artísticos, desde a sua génese até ao seu declínio. A segunda incide fundamentalmente na obra Pierrot Lunaire, nos vários elementos que lhe são subjacentes e relevantes para a interpretação apresentada (gravação em DVD – Anexo I). Conhecer o compositor e a obra Pierrot Lunaire numa perspectiva interpretativa, foi o propósito desta investigação que poderá ser uma plataforma para outras discussões ou outros estudos mais aprofundados.This work is a reflection upon German Expressionism in general and in specific, and its influence upon the work Pierrot Lunaire of Arnold Schoenberg. The text is organised in two parts. The first is an introduction to the Expressionistic Movement across a number of artistic domains from its earliest days to its decline. The second part focuses upon the work Pierrot Lunaire and all the underlying elements relevant to the presented performance (recorded on DVD and available as Annex I). To know better the composer and the work Pierrot Lunaire in a performance perspective was the purpose of this study, so it may be a basis to other discussions or deeper studies

ANALISIS EKONOMI PENGGUNAAN TEPUNG KULIT PISANG KEPOK TERFERMENTASI DALAM RANSUM BABI PERANAKAN LANDRACE

The study was carried out in the starter pens of Mad Susur pig farm in jln. Safne’o, Dusun Neketuka, Desa Baumata Timur, Kecamatan Taebenu, Kabupaten Kupang. The varibles studied in the study were: farm codition and farmer profile, income over feed cost (IOFC), production cost (variable and fixed cost), income and break even point (BEP: production and price BEP), and Net income of the pig farmer by using certain level of fermented banana skin (FBS) in the feed. There were 12 landrace crossbred pigs used in the study. Block design 4 treatments with 3 block was applied. The 4 treatments feed offered were formulated as: R0 (feed without FBS); R1 (feed with 2% FBS); R2 (feed with 4% FBS); and R3 (feed with 6% FBS). Varible studied in the study consisted of: IOFC, production cost (variable and fixed cost), income, benefit and BEP (production and price BEP). Economic analysis shows that including FBS in the feed up to the level 6% reduced IOFC to 517.087 IDR; production cost to 1.683.287 IDR; income to 918.333 IDR; increased net income up to 216.713 IDR; productin BEP at 0,84 (±1) pigs and Price BEP of 1.683.287 IDR per pig. The conclusion is that FBS can be included up to 6% in the landrace crossbred pig feed. ABSTRAK Penelitian ini dilaksanakan di kandang peternakan babi Mad Susur yang terletak di Jln. Safne’o, Dusun Neketuka, Desa Baumata Timur, Kecamatan Taebenu, Kabupaten Kupang. Permaslahan dalam penelititan ini adalah bagaimanakah keadaan usaha ternak dan karakteristik peternak serta berapa besar income over feed cost (IOFC), biaya produksi (biaya variabel dan biaya tetap), penerimaan dan break even point (BEP), yakni BEP harga dan BEP produksi dan pendapatan bersih yang diperoleh peternak dengan menggunakan tepung kulit pisang terfermentasi dalam ransum babi peranakan Landrace pada level tertentu. Penelitian ini bertujuan untuk mengevaluasi IOFC, biaya produksi, penerimaan dan BEP serta pendapatan bersih yang diperoleh peternak. Materi yang digunakan dalam penelitian ini adalah 12 ekor ternak babi Landrace. Penelitian ini menggunakan metode rancangan acak kelompok (RAK) dengan 4 perlakuan dan 3 ulangan. Perlakuan yang dicobakan adalah R0: Ransum tanpa penggunaan tepung kulit pisang terfermentasi (TKPF); R1: Ransum menggunakan 2% TKPF; R2: ransum menggunakan 4% TKPF; dan R3: ransum menggunakan 6% TKPF. Varibael dalam penelitian ini adalah IOFC, biaya produksi (biaya variabel dan biaya tetap), penerimaan, keuntungan dan BEP (produksi dan harga). Hasil analisis ekonomi menunjukkan bahwa penggunaan TKPF dalam ransum hingga level 6%: IOFC yang diperoleh hingga Rp.517.087; mampu menekan biaya produksi hingga Rp.1.683.287; penerimaan yang diperoleh hingga Rp.918.333; keuntungan bersih yang didapat semakin meningkat hingga Rp.216.713; serta mampu memberikan break even point (BEP) produksi pada 0,84 ekor dan harga sebanyak Rp. 1.683.287 per ekor ternak. Berdasarkan hal tersebut disimpulkan bahwa TKPF dapat digunakan dalam ransum babi peranakan landrace hingga level 6%

Changes in Poultry Handling Behavior and Poultry Mortality Reporting among Rural Cambodians in Areas Affected by HPAI/H5N1

BACKGROUND: Since 2004, 21 highly pathogenic avian influenza H5N1 outbreaks in domestic poultry and eight human cases have been confirmed in Cambodia. As a result, a large number of avian influenza education campaigns have been ongoing in provinces in which H5N1outbreaks have occurred in humans and/or domestic poultry. METHODOLOGY/PRINCIPAL FINDINGS: Data were collected from 1,252 adults >15 years old living in two southern provinces in Cambodia where H5N1 has been confirmed in domestic poultry and human populations using two cross-sectional surveys conducted in January 2006 and in November/December 2007. Poultry handling behaviors, poultry mortality occurrence and self-reported notification of suspect H5N1 poultry cases to animal health officials in these two surveys were evaluated. Our results demonstrate that although some at risk practices have declined since the first study, risky contact with poultry is still frequent. Improved rates of reporting poultry mortality were observed overall, but reporting to trained village animal health workers decreased by approximately 50%. CONCLUSIONS/SIGNIFICANCE: Although some improvements in human behavior have occurred, there are still areas--particularly with respect to the handling of poultry among children and the proper treatment of poultry and the surrounding household environment--that need to be addressed in public health campaigns. Though there were some differences in the sampling methods of the 2006 and 2007 surveys, our results illustrate the potential to induce considerable, potentially very relevant, behavioral changes over a short period of time

Factors Influencing Sleep Difficulty and Sleep Quantity in the Citizen Pscientist Psoriatic Cohort.

IntroductionSleep is essential for overall health and well-being, yet more than one-third of adults report inadequate sleep. The prevalence is higher among people with psoriasis, with up to 85.4% of the psoriatic population reporting sleep disruption. Poor sleep among psoriasis patients is particularly concerning because psoriasis is independently associated with many of the same comorbidities as sleep dysfunction, including cardiovascular disease, obesity, and depression. Given the high prevalence and serious consequences of disordered sleep in psoriasis, it is vital to understand the nature of sleep disturbance in this population. This study was designed to help meet this need by using survey data from Citizen Pscientist, an online patient portal developed by the National Psoriasis Foundation.MethodsOur analysis included 3118 participants who identified as having a diagnosis by a physician of psoriasis alone or psoriasis with psoriatic arthritis. Demographic information, psoriasis severity and duration, sleep apnea status, smoking and alcohol consumption, itch timing, and sleep characteristics were included. Two separate multivariate logistic regression models in STATA were used to determine whether the presence of psoriatic arthritis, age, gender, body mass index, comorbid sleep apnea, psoriasis severity, timing of worst itch, smoking status, or high-risk alcohol consumption were associated with sleep difficulty or low sleep quantity, defined by the American Academy of Sleep Medicine as less than 7 h of sleep per night on average.ResultsResults from the multivariate logistic regressions found that sleep difficulty was associated with psoriatic arthritis (OR 2.15, 95% CI [1.79-2.58]), female gender (2.03 [1.67-2.46]), obese body mass index (BMI ≥ 30) (1.25 [1.00-1.56]), sleep apnea (1.41 [1.07-1.86]), psoriasis severity of moderate (1.59 [1.30-1.94]) or severe (2.40 [1.87-3.08]), and smoking (1.60 [1.26-2.02]). Low sleep quantity was associated with obese BMI (1.62 [1.29-2.03]), sleep apnea (1.30 [1.01-1.68]), psoriasis severity of moderate (1.41 [1.16-1.72]) or severe (1.40 [1.11-1.76]), and smoking (1.62 [1.31-2.00]). Sleep difficulty and low sleep quantity were not associated with age, alcohol consumption, or timing of worst itch.ConclusionThese results are potentially meaningful in several aspects. We identify an important distinction between sleep difficulty and sleep quantity in psoriatic disease, whereby having psoriatic arthritis and being female are each associated with sleep difficulty despite no association with low sleep quantity. Furthermore, there is conflicting evidence from prior studies as to whether psoriasis severity is associated with sleep difficulty, but this well-powered, large study revealed a strong, graded relationship between psoriasis severity and both sleep difficulty and low sleep quantity. Overall, our results show that both sleep difficulty and low sleep quantity were associated with multiple factors in this analysis of a large psoriatic cohort. These findings suggest that dermatologists may gather clinically useful information by screening psoriatic patients for trouble sleeping and low sleep quantity to identify potential comorbidities and to more effectively guide disease management

Process of adaptation, development and assessment of acceptability of a health educational intervention to improve referral uptake by people with diabetes in Sri Lanka.

BACKGROUND: One major barrier to uptake of diabetic retinopathy (DR) services is lack of knowledge and awareness of DR among the people with diabetes (PwDM). Targeted health education (HE) can be a key element in improving the uptake of eye care services. Such interventions are lacking in Sri Lanka. METHODS: A local context specific HE intervention (HEI) was developed by adopting available resources and incorporating views from PwDM and key stakeholders. Four sessions of participatory workshops with PwDM (20 Sinhala and 13 Tamil speaking) and two stage 12 stakeholder interviews were conducted to both develop and pre-test the material. The products were a video and a leaflet, delivered at a medical clinic to a sample of 45 PwDM identified as having DR. Semi-structured interviews were conducted after 4 weeks, to evaluate the acceptability and comprehension of the HEI. Additionally, nine interviews were conducted with clinical providers to explore process issues related to delivery of the HEI. Data analysis was conducted using thematic analysis. RESULTS: The lack of knowledge and awareness on DR, and of the importance of regular DR screening and follow up, combined with poor information on referral pathways were key elements identified from the workshops with PwDM. The stakeholders prioritised the importance of using simple language, and the need for emphasis on improving understanding about the asymptomatic phase of DR. The overall acceptability of the HEI material was satisfactory, although there was some difficulty with interpretation of medical images. Overall, although PwDM liked the ideas of the video, the leaflet was seen as a more practical option, given the busy clinic environment. The key issue was both formats required interaction with the provider, in order to support understanding of the messages. CONCLUSIONS: The process of adapting HE material is not simply translation into the appropriate language. Instead, a tailored approach in a country, context and particular health services setting is needed. This study illustrates the value of using a participatory approach and involving PwDM and stakeholders in the adaptation and pilot testing of a HEI to improve uptake of screening for DR in the context of Sri Lanka