Use and cost of disease-modifying therapies by Sonya Slifka Study participants: has anything really changed since 2000 and 2009?

Background:Disease-modifying therapies benefit individuals with relapsing forms of multiple sclerosis, but their utility remains unclear for those without relapses. Objective:To determine disease-modifying therapy use and costs in 2009, compare use in 2009 and 2000, and examine compliance with evidence-based guidelines. Methods:We determined the extent and characteristics of disease-modifying therapy use by participants in the Sonya Slifka Longitudinal Multiple Sclerosis Study (Slifka) in 2000 (n=2156) and 2009 (n=2361) and estimated out-of-pocket and total (payer) costs for 2009. Two multivariable logistic regressions predicted disease-modifying therapy use. Results:Disease-modifying therapy use increased from 55.3% in 2000 to 61.5% in 2009. In 2009, disease-modifying therapy use was reported by 76.5% of participants with relapsing-remitting multiple sclerosis, 73.2% with progressive-relapsing multiple sclerosis, 62.5% with secondary progressive multiple sclerosis, and 41.8% with primary progressive multiple sclerosis. Use was significantly associated with relapsing-remitting multiple sclerosis, shorter duration of illness, one to two relapses per year, non-ambulatory symptoms, using a cane, younger age, higher family income, and having health insurance. Average annual costs in 2009 were US$939-3101 for patients and US$16,302-18,928 for payers. Conclusion:Use rates were highest for individuals with relapsing-remitting multiple sclerosis, but substantial for those with progressive courses although clinical trials have not demonstrated significant benefits for them

Information extraction and transmission techniques for spaceborne synthetic aperture radar images

Information extraction and transmission techniques for synthetic aperture radar (SAR) imagery were investigated. Four interrelated problems were addressed. An optimal tonal SAR image classification algorithm was developed and evaluated. A data compression technique was developed for SAR imagery which is simple and provides a 5:1 compression with acceptable image quality. An optimal textural edge detector was developed. Several SAR image enhancement algorithms have been proposed. The effectiveness of each algorithm was compared quantitatively

A Phase 1 study of intravenous infusions of tigecycline in patients with acute myeloid leukemia.

Acute myeloid leukemia (AML) cells meet the higher energy, metabolic, and signaling demands of the cell by increasing mitochondrial biogenesis and mitochondrial protein translation. Blocking mitochondrial protein synthesis through genetic and chemical approaches kills human AML cells at all stages of development in vitro and in vivo. Tigecycline is an antimicrobial that we found inhibits mitochondrial protein synthesis in AML cells. Therefore, we conducted a phase 1 dose-escalation study of tigecycline administered intravenously daily 5 of 7 days for 2 weeks to patients with AML. A total of 27 adult patients with relapsed and refractory AML were enrolled in this study with 42 cycles being administered over seven dose levels (50-350 mg/day). Two patients experienced DLTs related to tigecycline at the 350 mg/day level resulting in a maximal tolerated dose of tigecycline of 300 mg as a once daily infusion. Pharmacokinetic experiments showed that tigecycline had a markedly shorter half-life in these patients than reported for noncancer patients. No significant pharmacodynamic changes or clinical responses were observed. Thus, we have defined the safety of once daily tigecycline in patients with refractory AML. Future studies should focus on schedules of the drug that permit more sustained target inhibition

GPU implementation of Krylov solvers for block-tridiagonal eigenvalue problems

The final publication is available at Springer via http://dx.doi.org/10.1007/978-3-319-32149-3_18In an eigenvalue problem defined by one or two matrices with block-tridiagonal structure, if only a few eigenpairs are required it is interesting to consider iterative methods based on Krylov subspaces, even if matrix blocks are dense. In this context, using the GPU for the associated dense linear algebra may provide high performance. We analyze this in an implementation done in the context of SLEPc, the Scalable Library for Eigenvalue Problem Computations. In the case of a generalized eigenproblem or when interior eigenvalues are computed with shift-and-invert, the main computational kernel is the solution of linear systems with a block-tridiagonal matrix. We explore possible implementations of this operation on the GPU, including a block cyclic reduction algorithm.This work was partially supported by the Spanish Ministry of Economy and Competitiveness under grant TIN2013-41049-P. Alejandro Lamas was supported by the Spanish Ministry of Education, Culture and Sport through grant FPU13-06655.Lamas Daviña, A.; Román Moltó, JE. (2016). GPU implementation of Krylov solvers for block-tridiagonal eigenvalue problems. En Parallel Processing and Applied Mathematics. Springer. 182-191. https://doi.org/10.1007%2F978-3-319-32149-3_18S182191Baghapour, B., Esfahanian, V., Torabzadeh, M., Darian, H.M.: A discontinuous Galerkin method with block cyclic reduction solver for simulating compressible flows on GPUs. Int. J. Comput. Math. 92(1), 110–131 (2014)Bientinesi, P., Igual, F.D., Kressner, D., Petschow, M., Quintana-Ortí, E.S.: Condensed forms for the symmetric eigenvalue problem on multi-threaded architectures. Concur. Comput. Pract. Exp. 23, 694–707 (2011)Haidar, A., Ltaief, H., Dongarra, J.: Toward a high performance tile divide and conquer algorithm for the dense symmetric eigenvalue problem. SIAM J. Sci. Comput. 34(6), C249–C274 (2012)Heller, D.: Some aspects of the cyclic reduction algorithm for block tridiagonal linear systems. SIAM J. Numer. Anal. 13(4), 484–496 (1976)Hernandez, V., Roman, J.E., Vidal, V.: SLEPc: a scalable and flexible toolkit for the solution of eigenvalue problems. ACM Trans. Math. Softw. 31(3), 351–362 (2005)Hirshman, S.P., Perumalla, K.S., Lynch, V.E., Sanchez, R.: BCYCLIC: a parallel block tridiagonal matrix cyclic solver. J. Comput. Phys. 229(18), 6392–6404 (2010)Minden, V., Smith, B., Knepley, M.G.: Preliminary implementation of PETSc using GPUs. In: Yuen, D.A., Wang, L., Chi, X., Johnsson, L., Ge, W., Shi, Y. (eds.) GPU Solutions to Multi-scale Problems in Science and Engineering. Lecture Notes in Earth System Sciences, pp. 131–140. Springer, Heidelberg (2013)NVIDIA: CUBLAS Library V7.0. Technical report, DU-06702-001 $$\_$$ v7.0, NVIDIA Corporation (2015)Park, A.J., Perumalla, K.S.: Efficient heterogeneous execution on large multicore and accelerator platforms: case study using a block tridiagonal solver. J. Parallel and Distrib. Comput. 73(12), 1578–1591 (2013)Reguly, I., Giles, M.: Efficient sparse matrix-vector multiplication on cache-based GPUs. In: Innovative Parallel Computing (InPar), pp. 1–12 (2012)Roman, J.E., Vasconcelos, P.B.: Harnessing GPU power from high-level libraries: eigenvalues of integral operators with SLEPc. In: International Conference on Computational Science. Procedia Computer Science, vol. 18, pp. 2591–2594. Elsevier (2013)Seal, S.K., Perumalla, K.S., Hirshman, S.P.: Revisiting parallel cyclic reduction and parallel prefix-based algorithms for block tridiagonal systems of equations. J. Parallel Distrib. Comput. 73(2), 273–280 (2013)Stewart, G.W.: A Krylov-Schur algorithm for large eigenproblems. SIAM J. Matrix Anal. Appl. 23(3), 601–614 (2001)Tomov, S., Nath, R., Dongarra, J.: Accelerating the reduction to upper Hessenberg, tridiagonal, and bidiagonal forms through hybrid GPU-based computing. Parallel Comput. 36(12), 645–654 (2010)Vomel, C., Tomov, S., Dongarra, J.: Divide and conquer on hybrid GPU-accelerated multicore systems. SIAM J. Sci. Comput. 34(2), C70–C82 (2012)Zhang, Y., Cohen, J., Owens, J.D.: Fast tridiagonal solvers on the GPU. In: Proceedings of the 15th ACM SIGPLAN Symposium on Principles and Practice of Parallel Programming. PPopp 2010, pp. 127–136 (2010

Blockade of T-cell activation by dithiocarbamates involves novel mechanisms of inhibition of nuclear factor of activated T cells.

Dithiocarbamates (DTCs) have recently been reported as powerful inhibitors of NF-kappaB activation in a number of cell types. Given the role of this transcription factor in the regulation of gene expression in the inflammatory response, NF-kappaB inhibitors have been suggested as potential therapeutic drugs for inflammatory diseases. We show here that DTCs inhibited both interleukin 2 (IL-2) synthesis and membrane expression of antigens which are induced during T-cell activation. This inhibition, which occurred with a parallel activation of c-Jun transactivating functions and expression, was reflected by transfection experiments at the IL-2 promoter level, and involved not only the inhibition of NF-kappaB-driven reporter activation but also that of nuclear factor of activated T cells (NFAT). Accordingly, electrophoretic mobility shift assays (EMSAs) indicated that pyrrolidine DTC (PDTC) prevented NF-kappaB, and NFAT DNA-binding activity in T cells stimulated with either phorbol myristate acetate plus ionophore or antibodies against the CD3-T-cell receptor complex and simultaneously activated the binding of AP-1. Furthermore, PDTC differentially targeted both NFATp and NFATc family members, inhibiting the transactivation functions of NFATp and mRNA induction of NFATc. Strikingly, Western blotting and immunocytochemical experiments indicated that PDTC promoted a transient and rapid shuttling of NFATp and NFATc, leading to their accelerated export from the nucleus of activated T cells. We propose that the activation of an NFAT kinase by PDTC could be responsible for the rapid shuttling of the NFAT, therefore transiently converting the sustained transactivation of this transcription factor that occurs during lymphocyte activation, and show that c-Jun NH2-terminal kinase (JNK) can act by directly phosphorylating NFATp. In addition, the combined inhibitory effects on NFAT and NF-KB support a potential use of DTCs as immunosuppressants

Policy challenges for the pediatric rheumatology workforce: Part I. Education and economics

For children with rheumatic conditions, the available pediatric rheumatology workforce mitigates their access to care. While the subspecialty experiences steady growth, a critical workforce shortage constrains access. This three-part review proposes both national and international interim policy solutions for the multiple causes of the existing unacceptable shortfall. Part I explores the impact of current educational deficits and economic obstacles which constrain appropriate access to care. Proposed policy solutions follow each identified barrier

Burden of childhood-onset arthritis

Juvenile arthritis comprises a variety of chronic inflammatory diseases causing erosive arthritis in children, often progressing to disability. These children experience functional impairment due to joint and back pain, heel pain, swelling of joints and morning stiffness, contractures, pain, and anterior uveitis leading to blindness. As children who have juvenile arthritis reach adulthood, they face possible continuing disease activity, medication-associated morbidity, and life-long disability and risk for emotional and social dysfunction. In this article we will review the burden of juvenile arthritis for the patient and society and focus on the following areas: patient disability; visual outcome; other medical complications; physical activity; impact on HRQOL; emotional impact; pain and coping; ambulatory visits, hospitalizations and mortality; economic impact; burden on caregivers; transition issues; educational occupational outcomes, and sexuality