3.4 Physical activity in adolescents with juvenile idiopathic arthritis

OBJECTIVE: To explore physical activity (PA) in adolescents with juvenile idiopathic arthritis (JIA) compared with a healthy population and to examine associations between PA and disease-related factors. METHODS: Total energy expenditure (TEE), activity-related energy expenditure (AEE), PA level, and PA pattern were assessed with a 3-day activity diary. Aerobic capacity was assessed using a Symptom Limited Bicycle Ergometry test. Functional ability was assessed with the Childhood Health Assessment Questionnaire. Disease activity was assessed using Paediatric Rheumatology International Trials Organisation core set criteria. Overall well-being was measured using a visual analog scale, and time since diagnosis was assessed by retrospective study from patients' charts. We used a cross-sectional study design. Reference data were collected from healthy Dutch secondary school children. RESULTS: Thirty patients and 106 controls were included (mean +/- SD age 17.0 +/- 0.6 and 16.7 +/- 0.9 years, respectively). TEE, AEE, and PA level were significantly lower in the JIA group. The JIA group spent more time in bed and less time on moderate to vigorous PA. Only 23% of the JIA patients met public health recommendations to perform >/=1 hour daily moderate to vigorous PA compared with 66% in the reference group. Higher PA was associated with higher levels of well-being and maximal oxygen consumption. CONCLUSION: Adolescents with JIA have low PA levels and are at risk of losing the benefits of PA. Low PA is not related to disease activity, and control over the disease does not restore previous PA levels. Interventions by pediatric rheumatologists are needed to increase PA levels in patients with JIA

Classical orbital paramagnetism in non-equilibrium steady state

We report the results of our numerical simulation of classical-dissipative dynamics of a charged particle subjected to a non-markovian stochastic forcing. We find that the system develops a steady-state orbital magnetic moment in the presence of a static magnetic field. Very significantly, the sign of the orbital magnetic moment turns out to be {\it paramagnetic} for our choice of parameters, varied over a wide range. This is shown specifically for the case of classical dynamics driven by a Kubo-Anderson type non-markovian noise. Natural spatial boundary condition was imposed through (1) a soft (harmonic) confining potential, and (2) a hard potential, approximating a reflecting wall. There was no noticeable qualitative difference. What appears to be crucial to the orbital magnetic effect noticed here is the non-markovian property of the driving noise chosen. Experimental realization of this effect on the laboratory scale, and its possible implications are briefly discussed. We would like to emphasize that the above steady-state classical orbital paramagnetic moment complements, rather than contradicts the Bohr-van Leeuwen (BvL) theorem on the absence of classical orbital diamagnetism in thermodynamic equilibrium.Comment: 6 pages, 4 figures, Has appeared in Journal of Astrophysics and Astronomy special issue on 'Physics of Neutron Stars and Related Objects', celebrating the 75th birth-year of G. Srinivasa

Corticosteroid transdermal delivery significantly improves arthritis pain and functional disability

Arthritis is characterized by pain and functional limitation affecting the patients’ quality of life. We performed a clinical study to investigate the efficacy of a betamethasone valerate medicated plaster (Betesil) in improving pain and functional disability in patients with arthritis and osteoarthritis. We enrolled 104 patients affected by osteoarthritis (n = 40) or arthritis (n = 64) in different joints. Patients received diclofenac sodium cream (2 g, four times a day) or a 2.25-mg dose of Betesil applied to the painful joint every night before bedtime for 10 days. Pain and functional disability were assessed, by the Visual Analogue Scale (VAS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) scores. Redness was assessed by clinical inspection, and edema by the Bfovea sign^ method. C-reactive protein (CRP) was also measured; CRP can be used to cost-effectively monitor the pharmacological treatment efficacy and is increased during the acute-phase response, returning to physiological values after tissue recovery and functional restoration. All measurements were at baseline and at 10-day follow-up. At 10-day follow-up, a greater improvement in VAS and WOMAC pain and WOMAC stiffness and functional limitation scores from baseline was observed in patients treated with Betesil compared with diclofenac (all p < 0.01). At 10-day follow-up, improvement in redness, edema, and CRP levels from baseline was also greater in patients treated with Betesil compared with diclofenac (all p < 0.01). This study demonstrates the safety and efficacy of transdermal delivery of betamethasone valerate in patients affected by arthritis and osteoarthritis

Incidence and management of Osgood-Schlatter disease in general practice:retrospective cohort study

BACKGROUND: Osgood–Schlatter disease (OSD) is a non-traumatic knee problem that is primarily observed in sports-active children and adolescents aged 8–15 years. AIM: To determine the incidence of OSD and to gain an insight into the management of children and adolescents with OSD in general practice. DESIGN AND SETTING: A retrospective cohort study was conducted using a healthcare database containing full electronic health records of over 200 000 patients in general practice in and around the Dutch city of Rotterdam. METHOD: Patients with a new diagnosis of OSD from 1 January 2012 to 31 December 2017 were extracted using a search algorithm based on International Classification of Primary Health Care coding and search terms in free text. Data on the management of OSD were manually interpreted. RESULTS: The mean incidence over the study period was 3.8 (95% confidence interval [CI] = 3.5 to 4.2) per 1000 person–years in those aged 8–18 years. Boys had a higher incidence rate of 4.9 (95% CI = 4.3 to 5.5) compared with girls (2.7, 95% CI = 2.3 to 3.2). Peak incidence was at 12 years of age for boys and 11 years for girls. Advice was the most commonly applied strategy (55.1%), followed by rest (21.0%), referral for imaging (19.5%), and physiotherapy (13.4%). CONCLUSION: To the authors’ knowledge, for the first time the incidence of OSD has been calculated using GP electronic medical files. There is a discrepancy, especially for imaging and referral to a medical specialist, between the current Dutch general practice guidelines and how GPs actually manage the condition in clinical practice

Flexible constrained sampling with guarantees for pattern mining

Pattern sampling has been proposed as a potential solution to the infamous pattern explosion. Instead of enumerating all patterns that satisfy the constraints, individual patterns are sampled proportional to a given quality measure. Several sampling algorithms have been proposed, but each of them has its limitations when it comes to 1) flexibility in terms of quality measures and constraints that can be used, and/or 2) guarantees with respect to sampling accuracy. We therefore present Flexics, the first flexible pattern sampler that supports a broad class of quality measures and constraints, while providing strong guarantees regarding sampling accuracy. To achieve this, we leverage the perspective on pattern mining as a constraint satisfaction problem and build upon the latest advances in sampling solutions in SAT as well as existing pattern mining algorithms. Furthermore, the proposed algorithm is applicable to a variety of pattern languages, which allows us to introduce and tackle the novel task of sampling sets of patterns. We introduce and empirically evaluate two variants of Flexics: 1) a generic variant that addresses the well-known itemset sampling task and the novel pattern set sampling task as well as a wide range of expressive constraints within these tasks, and 2) a specialized variant that exploits existing frequent itemset techniques to achieve substantial speed-ups. Experiments show that Flexics is both accurate and efficient, making it a useful tool for pattern-based data exploration.Comment: Accepted for publication in Data Mining & Knowledge Discovery journal (ECML/PKDD 2017 journal track

Contrasting Worldviews in Revival: Ferryden, Scotland, in 1859

Objective-To investigate mortality, functional capacity; and prognostic factors for mortality in an inception cohort of patients with recently diagnosed RA followed up for up to 10 years. Methods-The observed mortality of this inception cohort with recently diagnosed RA, was analysed in relation to the expected mortality, calculated with the aid of life tables of the general population of the Netherlands (matched for age and sex). Functional capacity was measured by the Health Assessment Questionnaire. Prognostic factors for mortality were analysed multivariately by the Cox proportional hazards model. Results-Between January 1985 and April 1997, 622 patients entered the study, and were included in the analysis of mortality. The death rate in the first 10 years of the disease was not significantly different from that of the general population. Fifty five patients from the study group died (16% up to 10 years of follow up). The most commonly reported causes of death were of cardiovascular and respiratory origin. The other causes of death could be classified into cancer, sepsis, amyloidosis, leukaemia, renal insufficiency of unknown cause, perforation of the oesophagus, probably related to the treatment with non-steroidal anti-inflammatory drugs, and pancytopenia during aurothioglucose treatment. Functional capacity improved significantly during the first six years compared with the value at start. Statistically significant predictors for death were age at the start and male sex. Conclusions-In contrast with earlier studies performed, no excess mortality in the first 10 years of an inception cohort of patients with RA was seen. In addition, the functional capacity was relatively constant during the first six years after an initial improvement from baseline. Age at start and male sex were the only statistically significant predictors for death

Assessing the grapevine crop water stress indicator over the flowering-veraison phase and the potential yield lose rate in important European wine regions

In Europe, most of vineyards are managed under rainfed conditions, where water deficit has become increasingly an issue. The flowering-veraison phenophase represents an important period for vine response to water stress, which is known to depend on variety characteristics, soil and climate conditions. In this paper, we have carried out a retrospective analysis for important European wine regions over 1986-2015, with objectives to assess the mean Crop Water Stress Indicator (CWSI) during flowering-veraison phase, and potential Yield Lose Rate (YLR) due to seasonal cumulative water stress. Moreover, we also investigate if advanced flowering-veraison phase can lead to alleviated CWSI under recent-past conditions, thus contributing to reduced YLR. A process-based grapevine model is employed, which has been extensively calibrated for simulating both flowering and veraison stages using location-specific observations representing 10 different varieties. Subsequently, grid-based modelling is implemented with gridded climate and soil datasets and calibrated phenology parameters. The findings suggest wine regions with higher mean CWSI of flowering-veraison phase tend to have higher potential YLR. However, contrasting patterns are found between wine regions in France-Germany-Luxembourg and Italy Portugal-Spain. The former tends to have slight-to-moderate drought conditions (CWSI0.5) and substantial YLR (>40%). Wine regions prone to a high drought risk (CWSI>0.75) are also identified, which are concentrated in southern Mediterranean Europe. Advanced flowering-veraison phase over 1986-2015, could have benefited from more spring precipitation and cooler temperatures for wine regions of Italy-Portugal-Spain, leading to reduced mean CWSI and YLR. For those of France-Germany-Luxembourg, this can have reduced flowering-veraison precipitation, but prevalent reductions of YLR are also found, possibly due to shifted phase towards a cooler growing-season with reduced evaporative demands. Our study demonstrates flowering-verasion water deficit is critical for potential yield, which can have different impacts between Central and Southern European wine regions. This phase can be advanced under a warmer climate, thus having important implications for European rainfed vineyards. The overall outcome may provide new insights for appropriate viticultural management of seasonal water deficits under climate change.This study was funded by Clim4Vitis project-"Climate change impact mitigation for European viticulture: knowledge transfer for an integrated approach", funded by the European Union's Horizon 2020 Research and Innovation Programme, under grant agreement no. 810176; it was also supported by FCT-Portuguese Foundation for Science and Technology, under the project UIDB/04033/2020. We acknowledge the data provisions from members of the PEP725 project, from IPHEN project and from the Consejo Regulador of Ribera de Duero and Rioja DOCa