An educational leaflet improves response to invitation for screening for arthritis in patients with psoriasis in primary care, but only in practices in the most deprived areas

This study hypothesises that an educational leaflet about psoriatic arthritis (PsA) will improve psoriasis patients’ attendance for screening for PsA. A random sample of patients ≥18 years old with a coded diagnosis of psoriasis and no diagnosis of PsA, rheumatoid arthritis or ankylosing spondylitis were identified from five GP surgeries in Yorkshire, UK. Patients were randomised 1:1 to receive study information alone or with the educational leaflet, with an invitation to attend for a screening examination by a dermatologist and rheumatologist. Nine hundred thirty-two invitation packs were sent to recruit 191 (20.5%) participants. One hundred sixty-nine (88.5%) had current or previous psoriasis and 17 (10.1%) had previously undiagnosed PsA. The estimated prevalence of PsA was 18.1% (95% CI: 16.2, 20.1%). The response rate was lower than expected and was not significantly higher when patients received the educational leaflet (22.8 vs 18.3%, p = 0.08). Response rates varied by practice (14.7 to 30.6%). However, deprivation scores for each practice revealed a significant increase in response with the leaflet for deprivation decile of 3 (p < 0.001) but no significant differences in the other practices. An educational leaflet about PsA improves attendance for screening in primary care, but only in those practices with higher levels of socioeconomic deprivation

Intermixing at the heterointerface between ZnS Zn S,O bilayer buffer and CuInS2 thin film solar cell absorber

The application of Zn compounds as buffer layers was recently extended to wide gap CuInS2 CIS based thin film solar cells. Using a new chemical deposition route for the buffer preparation aiming at the deposition of a single layer, nominal ZnS buffer without the need for any toxic reactants such as, e.g. hydrazine has helped to achieve a similar efficiency as respective CdS buffered reference devices. After identifying the deposited Zn compound, as ZnS Zn S,O bi layer buffer in former investigations [M. Bär, A. Ennaoui, J. Klaer, T. Kropp, R. S ez Araoz, N. Allsop, I. Lauermann, H. W. Schock, and M.C. Lux Steiner, Formation of a ZnS Zn S,O bilayer buffer on CuInS2 thin film solar cell absorbers by chemical bath deposition , J. Appl. Phys., accepted.], this time the focus lies on potential diffusion intermixing processes at the buffer absorber interface possibly, clarifying the effect of the heat treatment, which drastically enhances the device performance of respective final solar cells. The interface formation was investigated by x ray photoelectron and x ray excited Auger electron spectroscopy. In addition, photoelectron spectroscopy PES measurements were also conducted using tuneable monochromatized synchrotron radiation in order to gain depth resolved information. The buffer side of the buffer absorber heterointerface were investigated by means of the characterization of Zn S,O ZnS CIS structures where the ZnS Zn S,O bi layer buffer was deposited successively by different deposition times. In order to make the in terms of PES information depth deeply buried absorber side of the buffer absorber heterointerface accessible for characterization, in these cases the buffer layer was etched away by dilute HClaq. We found that while out leached Cu from the absorber layer forms together with the educts in the chemical bath a Zn 1 Z ,Cu2Z S like interlayer between buffer and absorber, Zn is incorporated in the uppermost region of the absorber. Both effects are strongly enhanced by postannealing the Zn S,O ZnS CIS samples. However, it was determined that the major fraction of the Cu and Zn can be found quite close to the heterointerface in the buffer and absorber layer, respectively. Due to this limited in the range of one monolayer spatial extent, these diffusion mechanisms were rather interpreted as a CBD induced and heat treatment promoted Cu Zn ion exchange at the buffer absorber interface. Possible impacts of this intermixing on the performance of the final solar cell devices will also be discusse

Prostate involvement during sexually transmitted infections as measured by prostate-specific antigen concentration

Background:We investigated prostate involvement during sexually transmitted infections by measuring serum prostate-specific antigen (PSA) as a marker of prostate infection, inflammation, and/or cell damage in young, male US military members.Methods:We measured PSA before and during infection for 299 chlamydia, 112 gonorrhoea, and 59 non-chlamydial, non-gonococcal urethritis (NCNGU) cases, and 256 controls.Results:Chlamydia and gonorrhoea, but not NCNGU, cases were more likely to have a large rise (⩾40%) in PSA than controls (33.6%, 19.1%, and 8.2% vs 8.8%, P<0.0001, 0.021, and 0.92, respectively).Conclusion:Chlamydia and gonorrhoea may infect the prostate of some infected men

Achieving minimal disease activity in psoriatic arthritis predicts meaningful improvements in patients’ health-related quality of life and productivity

Background Although psoriatic arthritis is complex and involves multiple domains, recent advances in treatments have made remission or near-remission of most symptoms a potentially achievable goal for many patients. We sought to evaluate whether achieving minimal disease activity (MDA) criteria represented meaningful improvement from the patient perspective. Methods Data were combined from two randomized, multinational, 24 week clinical studies of ixekizumab, a high-affinity monoclonal antibody selectively targeting interleukin-17A, in biological drug-naïve or experienced adults. MDA required 5 of 7 of: tender joint count ≤1; swollen joint count ≤1; Psoriasis Area and Severity Index total score ≤ 1 or body surface area ≤ 3%; patient’s assessment of pain visual analogue scale (VAS) ≤15; patient’s global assessment of disease activity VAS ≤20; Health Assessment Questionnaire Disability Index ≤0.5; and tender entheseal points ≤ 1. MDA responders and non-responders were compared for mean change from baseline on the 36-Item Short Form Health Survey (SF-36), European Quality of Life 5 Dimension 5 Level Health Questionnaire (EQ-5D-5 L); EQ-5D-5 L VAS; and Work Productivity and Activity Impairment–Specific Health Problem (WPAI-SHP) questionnaire. Results MDA responders had significantly greater improvements versus non-responders in each SF-36 domain and in the SF-36 physical summary score; improvements were also greater in the EQ-5D-5 L and EQ-5D-5 L VAS, and in 3 of the 4 WPAI-SHP domains. MDA responders were more likely to achieve minimal clinically important differences than non-responders. Conclusion These findings support MDA response as being strongly associated with achieving improved disease status based on measures of patient reported health-related quality of life and productivity. Trial registration SPIRIT-P1, NCT01695239, First Posted: September 27, 2012; and SPIRIT-P2, NCT02349295, First Posted: January 28, 2015

Access to the next wave of biologic therapies (Abatacept and Tocilizumab) for the treatment of rheumatoid arthritis in England and Wales: Addressing treatment outside the current NICE guidance

Patients in England and Wales with rheumatoid arthritis (RA) receive treatment from the National Health Service (NHS) with therapies approved by the European Medicines Agency (EMA), under guidance from the National Institute for Health and Clinical Excellence (NICE). This document overviews the current NICE guidelines for the treatment of RA and identifies scenarios when such guidance may not represent the optimum management strategy for individual patients. Specifically, we consider the use of tocilizumab or abatacept as the most appropriate treatments for some patients. In such scenarios, it may be possible for the clinician to secure access to the required therapy through an application procedure known as an ‘individual funding request’, the process of which is described in detail here. At present, it is unclear the extent to which the proposed reform of the NHS will affect the role of NICE in providing guidance and setting standards of care. Until the full impact of the proposed changes are realized, individual funding requests will remain a valuable way of securing the optimal treatment for all patients suffering from RA

A case-study in the clinical epidemiology of psoriatic arthritis: multistate models and causal arguments.

In psoriatic arthritis, permanent joint damage characterizes disease progression and represents a major debilitating aspect of the disease. Understanding the process of joint damage will assist in the treatment and disease management of patients. Multistate models provide a means to examine patterns of disease, such as symmetric joint damage. Additionally, the link between damage and the dynamic course of disease activity (represented by joint swelling and stress pain) at both the individual joint level and otherwise can be represented within a correlated multistate model framework. Correlation is reflected through the use of random effects for progressive models and robust variance estimation for non-progressive models. Such analyses, undertaken with data from a large psoriatic arthritis cohort, are discussed and the extent to which they permit causal reasoning is considered. For this, emphasis is given to the use of the Bradford Hill criteria for causation in observational studies and the concept of local (in)dependence to capture the dynamic nature of the relationships