Clinical and Genetic Risk Factors Associated with Psoriatic Arthritis among Patients with Psoriasis.

IntroductionPsoriatic arthritis (PsA) is a chronic, inflammatory arthritis that affects an estimated 30% of patients with psoriasis. PsA is underdiagnosed in primary care and dermatology clinics due to a variety of reasons, including failure of healthcare providers to ask about symptoms, overlap of symptoms and signs with other rheumatologic conditions, and lack of a specific diagnostic test. A delay in PsA diagnosis and treatment, even as short as 6 months, can lead to decreased quality of life, increased joint damage, and worse long-term physical function. In this study, we sought to identify the clinical and genetic factors that help discriminate patients with PsA from those with cutaneous psoriasis only.MethodsWe analyzed a cohort of 974 psoriasis patients at an academic medical center, of whom 175 had confirmed PsA, and performed univariate, multivariate, and predictive modeling to determine factors associated with PsA.ResultsThe univariate analysis revealed significant positive associations of PsA with age, nail involvement, scalp involvement, skin fold involvement, elbow/knee involvement, psoriasis severity, plaque subtype, erythrodermic subtype, hypertension, type 2 diabetes, and coronary artery disease, and a significant negative association of PsA with the human leukocyte antigen (HLA)-C*06:02 allele. In the multivariate analysis, nail involvement, type 2 diabetes, and pustular psoriasis remained significantly associated with PsA, while HLA-C*06:02 positivity remained protective. There was a trend towards an association of PsA with older age, younger age of psoriasis onset, and skin fold involvement, while there was protective trend for smoking. A predictive model including both clinical and genetic factors showed reasonable discriminative ability between psoriasis and PsA, with an area under the curve of 0.87 for a receiver operating characteristic curve.ConclusionThis study identified a number of clinical and genetic features that could help stratify patients who are at higher risk for having PsA and for whom rheumatology referral may be beneficial

Relationships between Risk Factors, Perceptions of School Membership and Academic and Behavioral Engagement of Students Who Attend an Alternative School for Behavioral and Emotional Challenges

The purpose of this study was to investigate the relationships between the perceptions of school membership, risk factors, and behavioral and academic engagement among a sample of alternative school students. The study subjects were 48 7th-9th graders who were at high risk for school failure because of their serious and chronic behavioral and academic problems. All subjects had an Individualized Education Plan (IEP). A 25 item school membership questionnaire adapted from existing school membership surveys was used to assess students’ perceived school membership. The study participants reported a moderately positive school membership score. The findings indicated that commonly known risk factors, such as being a male, minority, low SES, no participation in extracurricular activities, and a history of involvement with the juvenile justice system did not negatively affect study participants’ perceptions of school membership. The relationships between students’ school outcomes and the risk variables were also analyzed. The findings indicated that the above mentioned risk variables did not result in significantly negative effects on school outcomes (GPA, number of missed school days, hours spent for in-school suspension, and days spent for out-of school suspension). Instead, academic and behavioral school outcome variables were found to be closely related with each other, and also with some demographic factors, including race/ethnicity and grade levels. Implications for planning academic and behavioral interventions for students with emotional and behavioral challenges are discussed

Temperature-dependent errors in nuclear lattice simulations

We study the temperature dependence of discretization errors in nuclear lattice simulations. We find that for systems with strong attractive interactions the predominant error arises from the breaking of Galilean invariance. We propose a local "well-tempered" lattice action which eliminates much of this error. The well-tempered action can be readily implemented in lattice simulations for nuclear systems as well as cold atomic Fermi systems.Comment: 33 pages, 17 figure

Settleability assessment protocol for anaerobic granular sludge and its application

A simple method for settleability assessment of anaerobic granular sludge was proposed and its applicability as an opera parameter was evaluated in a lab-scale UASB reactor treating brewery wastewater. Based on the settleability protocol, the O was increased up to 28 kg COD.m-3.d-1 (67 kg COD.m-3 of granular bed volume.d-1) which corresponds to an HRT of 1 h. The re revealed that the protocol was sufficiently sensitive to define the settleability of the sludge samples and to accurately determ their allowable upflow velocities, resultant organic loading rates, and recycling ratios according to the settleability of the gran bed. Also, a series of graphical procedures with settling tests which are very easy to apply for settleability monitoring improvised, capable of direct use as an operational and monitoring parameter of the granular bed with laboratory and full-scale reactors, without need for additional sludge bed control such as dosing of chemicals. In addition, this method was also found to be applicable to improve and monitor system performance according to high or low-strength wastewater characteristics. Image analysis of the granular biomass supported the suitability of this graphical method. WaterSA Vol.29(4) 2003: 419-42

Ganglioside-liposome immunoassay for the detection of botulinum toxin

A rapid and highly sensitive receptor immunoassay for botulinum toxin (BT) has been developed using ganglioside-incorporated liposomes. Botulism outbreaks are relatively rare, but their results can be very severe, usually leading to death from respiratory failure. To exert their toxicity, the biological toxins must first bind to receptors on the cell surface, and the trisialoganglioside GT1b has been identified as the cell receptor for BT. Therefore, in this study, GT1b was used to prepare the ganglioside-liposomes by spontaneous insertion into the phospholipid bilayer. In a sandwich-based, hybrid receptor immunoassay, BT is detected as a colored band on a nitrocellulose membrane strip, where BT bound to the GT1b-liposomes are captured by anti-BT antibodies immobilized in a band across the strip. The intensity of the colored band can be visually estimated, or measured by densitometry using computer software. The limit of detection (LOD) for BT in the lateral-flow assay system was 15pgmL−1, which is comparable to the limits of detection achieved with the most sensitive assays previously reported. However, this rapid assay can be completed in less than 20min. These results demonstrate that the sandwich assay using GT1b-liposomes for detection of BT is rapid and very sensitive, suggesting the possibility for detecting BT in field screening, simply and reliably, without the need for complex instrumentatio

Policy Networks and Institutional Collective Action: A Research Agenda

Policy fragmentation in the American federalist system leads to inefficiencies as decisions by one authority impose positive and negative externalities on other authorities and their constituencies. We focus on the role of policy networks in shaping coordinated decisions that enhance the joint outcomes among governmental authorities. We advance two competing perspectives relating networks to collective action, one emphasizing the role of tightly-clustered strong-tie relationships capable of enhancing the credibility of commitments among network members, and the other emphasizing the role of extensive, weak-tie relationships linking diverse stakeholders in enhancing the shared information required to coordinate collective decisions. Our previous projects established the importance of local policy networks in enhancing compliance with federal regulations and developing coordinated policy agreements in local watersheds. The research provides initial evidence that extensive weak-tie networks play the most critical role in establishing joint projects, at least among specialized authorities managing an estuary\u27s natural resources. Our research agenda focuses on two critical settings, one emphasizing horizontal fragmentation (the joint provision of local services by municipalities), and the other emphasizing vertical fragmentation (the development of joint projects among federal, state, and local resource management agencies). In each setting, we will develop relevant formal models about the capabilities of different network structures and test them using an array of archival and survey data

Transcriptional landscape of epithelial and immune cell populations revealed through FACS-seq of healthy human skin.

Human skin consists of multiple cell types, including epithelial, immune, and stromal cells. Transcriptomic analyses have previously been performed from bulk skin samples or from epithelial and immune cells expanded in cell culture. However, transcriptomic analysis of bulk skin tends to drown out expression signals from relatively rare cells while cell culture methods may significantly alter cellular phenotypes and gene expression profiles. To identify distinct transcriptomic profiles of multiple cell populations without substantially altering cell phenotypes, we employed a fluorescence activated cell sorting method to isolate keratinocytes, dendritic cells, CD4+ T effector cells, and CD8+ T effector cells from healthy skin samples, followed by RNA-seq of each cell population. Principal components analysis revealed distinct clustering of cell types across samples, while differential expression and coexpression network analyses revealed transcriptional profiles of individual cell populations distinct from bulk skin, most strikingly in the least abundant CD8+ T effector population. Our work provides a high resolution view of cutaneous cellular gene expression and suggests that transcriptomic profiling of bulk skin may inadequately capture the contribution of less abundant cell types