Comparative effectiveness of abatacept versus tocilizumab in rheumatoid arthritis patients with prior TNFi exposure in the US Corrona registry

BACKGROUND: We compared the effectiveness of abatacept (ABA) vs tocilizumab (TCA) in tumor necrosis factor inhibitor (TNFi) experienced patients. METHODS: We identified rheumatoid arthritis (RA) patients from a large observational US cohort (1 January 2010-31 May 2014) who had discontinued at least one TNFi and initiated ABA or TCZ in moderate or high disease activity based on the Clinical Disease Activity Index (CDAI) and had no prior exposure to the comparator drug. Using propensity score matching (1:1) stratified by prior TNF use (1 TNFi vs ≥2 TNFis), effectiveness at 6 months after initiation was evaluated. Mean change in CDAI over 6 months following initiation was the primary outcome, with secondary outcomes of achievement of low disease activity/remission (CDAI ≤ 10) and mean change in modified Health Assessment Questionnaire (mHAQ) score. RESULTS: The 264 pairs of propensity score-matched ABA and TCZ initiators were well matched with no substantial differences in the baseline characteristics, defined as standardized differences \u3e0.1 in the stratification. Both treatment groups had similar mean change in CDAI at 6 months (-11.3 in ABA vs -9.9 in TCZ; mean difference -1.27, 95% CI -3.65, 1.11). Similar proportions of both treatment groups achieved low disease activity/remission (adjusted odds ratio for ABA vs TCZ 0.99, 95% CI 0.69, 1.43). Mean change in mHAQ was -0.12 in ABA initiators vs -0.11 in TCZ initiations (mean difference -0.01, 95% CI -0.09, 0.06). CONCLUSIONS: Patients receiving either ABA or TCZ had substantial improvement in clinical disease activity. In this propensity score-matched sample, similar outcomes were observed for both treatment cohorts

The comparative effectiveness of abatacept versus anti-tumour necrosis factor switching for rheumatoid arthritis patients previously treated with an anti-tumour necrosis factor

OBJECTIVE: We compared the effectiveness of abatacept (ABA) versus a subsequent anti-tumour necrosis factor inhibitor (anti-TNF) in rheumatoid arthritis (RA) patients with prior anti-TNF use. METHODS: We identified RA patients from a large observational US cohort (2/1/2000-8/7/2011) who had discontinued at least one anti-TNF and initiated either ABA or a subsequent anti-TNF. Using propensity score (PS) matching (n:1 match), effectiveness was measured at 6 and 12 months after initiation based on mean change in Clinical Disease Activity Index (CDAI), modified American College of Rheumatology (mACR) 20, 50 and 70 responses, modified Health Assessment Questionnaire (mHAQ) and CDAI remission in adjusted regression models. RESULTS: The PS-matched groups included 431 ABA and 746 anti-TNF users at 6 months and 311 ABA and 493 anti-TNF users at 12 months. In adjusted analyses comparing response following treatment with ABA and anti-TNF, the difference in weighted mean change in CDAI (range 6-8) at 6 months (0.46, 95% CI -0.82 to 1.73) and 12 months was similar (-1.64, 95% CI -3.47 to 0.19). The mACR20 responses were similar at 6 (28-32%, p=0.73) and 12 months (35-37%, p=0.48) as were the mACR50 and mACR70 (12 months: 20-22%, p=0.25 and 10-12%, p=0.49, respectively). Meaningful change in mHAQ was similar at 6 and 12 months (30-33%, p=0.41 and 29-30%, p=0.39, respectively) as was CDAI remission rates (9-10%, p=0.42 and 12-13%, p=0.91, respectively). CONCLUSIONS: RA patients with prior anti-TNF exposures had similar outcomes if they switched to a new anti-TNF as compared with initiation of ABA

PREDICTING THE IMPACT OF JOB SATISFACTION LEVEL IN BOLSTERING TURNOVER INTENTIONS OF FRONTLINE HEALTH WORKERS: EVIDENCE FROM SOUTHERN NIGERIA

Improvement in health care delivery requires a deliberate focus on quality of health services. Nigeria is among the 57 countries worldwide considered by The World Health Organization (WHO) to experience a critical shortage of health workers. While it is evident that there is high turnover among frontline health workers (i.e. frontline health workers, midwives, nurse/midwives, community health officers and community health extension workers), the magnitude of or reasons for turnover is complex, challenging and unknown. Their intention to leave their jobs in the next 5 years has not also been investigated. Hence, this study assessed the key enablers and drivers of turnover intention of frontline health workers in Nigeria. The study used a quantitative approach to address the research questions. This research is directed at managing job satisfaction levels of frontline health workers in Nigeria. Four hospitals were purposively selected and adjudged to be among the best private hospitals in Nigeria based on their standard and popularity, length of existence, standard medical equipment and high customer patronage. Data were collected from 782 frontline health workers and analyzed with descriptive statistics, Structural and Measurement models. The findings indicated that 56% of frontline health workers planned to leave the hospital next year, and 66% said they would look for another work if the situation at the hospital become progressively unsatisfactory. Salary satisfaction, promotion satisfaction, and job satisfaction all influence turnover intentions. The majority of nurses want to move, thus hospital management should re-evaluate the wage and incentive scheme. Promotions must be offered honestly and equitably, and training and education programs must be established to help frontline health workers advance in their careers. Implementation of friendly healthcare strategies that reflect the needs of frontline health workers is imperative to reduce turnover intention and improve health service outcome

Gas Chromatography Mass Spectrometry Identification of Antiangiogenic Phytochemicals in Aframomum danielli K. Schum: An In silico Study

Aframomum danielli is one of the African spices used in folklore medicine for the management of several diseases. This study identified the phytochemical components present in the n-hexane seed extract of the A. danielli by gas chromatography-mass spectrometry (GC-MS) analysis and also evaluated the antiangiogenic potential of the identified phytochemicals by performing molecular docking against human Vascular Endothelial Growth Factor (VEGF) and matrix metalloproteinases (MMP) using Molegro Virtual Docker. The GC-MS analysis identified the presence of phytochemical components β-Caryophyllene (RT: 18.479), α-Caryophyllene (RT: 19.189), (4-Hydroxy-3-methoxyphenyl)ethyl methyl ketone (RT: 22.976), N-Acetyl-m-aminobenzoic acid (RT: 31.651) and 3-Pyridineacetic acid (RT: 32.446). (4-Hydroxy- 3-methoxyphenyl)ethyl methyl ketone were the strongest binding ligand (-65.744 kcal/mol for VEGF) and (- 99.7836kcal/mol for MMP) while β-Caryophyllene was the weakest binding ligand. These compounds showed relative strong docking to VEGF with docking energies comparable to an anticancer drug, bevacizumab (-77.883kcal/mol for VEGF) and (-109.021kcal/mol for MMP). This in silico molecular docking study has shown that these phytochemical components could be responsible for antiangiogenic properties of A. danielli

Ultrafast Laser Ablation, Intrinsic Threshold, and Nanopatterning of Monolayer Molybdenum Disulfide

Laser direct writing is an attractive method for patterning 2D materials without contamination. Literature shows that the femtosecond ablation threshold of graphene across substrates varies by an order of magnitude. Some attribute it to the thermal coupling to the substrates, but it remains by and large an open question. For the first time the effect of substrates on femtosecond ablation of 2D materials is studied using MoS$_{2}$ as an example. We show unambiguously that femtosecond ablation of MoS$_{2}$ is an adiabatic process with negligible heat transfer to the substrates. The observed threshold variation is due to the etalon effect which was not identified before for the laser ablation of 2D materials. Subsequently, an intrinsic ablation threshold is proposed as a true threshold parameter for 2D materials. Additionally, we demonstrate for the first time femtosecond laser patterning of monolayer MoS$_{2}$ with sub-micron resolution and mm/s speed. Moreover, engineered substrates are shown to enhance the ablation efficiency, enabling patterning with low-power femtosecond oscillators. Finally, a zero-thickness approximation is introduced to predict the field enhancement with simple analytical expressions. Our work clarifies the role of substrates on ablation and firmly establishes femtosecond laser ablation as a viable route to pattern 2D materials

Immunosuppressive treatment and the risk of diabetes in rheumatoid arthritis

OBJECTIVE: Inflammation and anti-inflammatory treatments might influence the risk of diabetes. The objective of this study was to assess factors associated with incident diabetes in rheumatoid arthritis (RA). METHODS: The study population consisted of RA patients from a multi-center cohort study, Corrona. To assess risk associated with disease modifying antirheumatic drug (DMARD) exposure, we assessed five mutually exclusive DMARD groups. Additionally, we assessed the risk associated with body mass index (BMI, \u3c 25, 25-30, \u3e 30 kg/m2) and glucocorticoid usage. Incident cases of diabetes were confirmed through adjudication, and Cox regression models were fit to estimate the risk of incident diabetes. RESULTS: We identified 21,775 DMARD treatment regimens, the mean (SD) age at the index visit was 58 (13) years, disease duration 10 (10) years, and 30% used oral glucocorticoids at the time. Eighty-four incident cases of diabetes were confirmed within the treatment exposure periods. The hazard ratio (HR, 95% confidence interval) for diabetes was significantly reduced in patients receiving TNF inhibitors, HR 0.35 (0.13, 0.91), compared to patients treated with non-biologic DMARDs other than hydroxychloroquine and methotrexate. Hydroxychloroquine, methotrexate and use of other biologic DMARDs had a numerically reduced risk compared to the same group. Patients prescribed \u3e /=7.5 mg of glucocorticoids had a HR of 2.33 (1.68, 3.22) of incident diabetes compared with patients not prescribed oral glucocorticoids. RA patients with a BMI \u3e 30 had a HR of 6.27 (2.97, 13.25) compared to patients with BMI \u3c /=25. CONCLUSION: DMARDs, glucocorticoids and obesity influenced the risk of incident diabetes in a large cohort of RA patients. Monitoring for the occurrence of diabetes should be part of routine RA management with a focus on specific subgroups

Identifying factors associated with concordance with the American College of Rheumatology rheumatoid arthritis treatment recommendations

BACKGROUND: Factors associated with care concordant with the American College of Rheumatology (ACR) recommendations for the use of disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) are unknown. METHODS: We identified a national cohort of biologic-naive patients with RA with visits between December 2008 and February 2013. Treatment acceleration (initiation or dose escalation of biologic and nonbiologic DMARDs) in response to moderate to high disease activity (using the Clinical Disease Activity Index) was assessed. The population was divided into two subcohorts: (1) methotrexate (MTX)-only users and (2) multiple nonbiologic DMARD users. In both subcohorts, we compared the characteristics of patients who received care consistent with the ACR recommendations (e.g., prescriptions for treatment acceleration) and their providers with the characteristics of those who did not at the conclusion of one visit and over two visits, using logistic regression and adjusting for clustering of patients by rheumatologist. RESULTS: Our study included 741 MTX monotherapy and 995 multiple nonbiologic DMARD users cared for by 139 providers. Only 36.2 % of MTX monotherapy users and 39.6 % of multiple nonbiologic DMARD users received care consistent with the recommendations after one visit, which increased over two visits to 78.3 % and 76.2 %, respectively (25-30 % achieved low disease activity by the second visit without DMARD acceleration). Increasing time since the ACR publication on RA treatment recommendations was not associated with improved adherence. CONCLUSIONS: Allowing two encounters for treatment acceleration was associated with an increase in care concordant with the recommendations; however, time since publication was not

L-Edge Spectroscopy of Dilute, Radiation-Sensitive Systems Using a Transition-Edge-Sensor Array

We present X-ray absorption spectroscopy and resonant inelastic X-ray scattering (RIXS) measurements on the iron L-edge of 0.5 mM aqueous ferricyanide. These measurements demonstrate the ability of high-throughput transition-edge-sensor (TES) spectrometers to access the rich soft X-ray (100-2000eV) spectroscopy regime for dilute and radiation-sensitive samples. Our low-concentration data are in agreement with high-concentration measurements recorded by conventional grating-based spectrometers. These results show that soft X-ray RIXS spectroscopy acquired by high-throughput TES spectrometers can be used to study the local electronic structure of dilute metal-centered complexes relevant to biology, chemistry and catalysis. In particular, TES spectrometers have a unique ability to characterize frozen solutions of radiation- and temperature-sensitive samples.Comment: 19 pages, 4 figure