Biological therapies for the treatment of juvenile idiopathic arthritis: Lessons from the adult and pediatric experiences

Biologics have advanced the therapy of adult and pediatric arthritis. They have been linked to rare serious adverse outcomes, but the actual risk of these events is controversial in adults, and largely unknown in pediatrics. Because of the paucity of safety and efficacy data in children, pediatric rheumatologists often rely on the adult literature. Herein, we reviewed the adult and pediatric literature on five classes of medicines: Tumor necrosis factor (TNF) inhibitors, anakinra, rituximab, abatacept, and tocilizumab. For efficacy, we reviewed randomized controlled studies in adults, but did include lesser qualities of evidence for pediatrics. For safety, we utilized prospective and retrospective studies, rarely including reports from other inflammatory conditions. The review included studies on rheumatoid arthritis and spondyloarthritis, as well as juvenile idiopathic arthritis. Overall, we found that the TNF inhibitors have generally been found safe and effective in adult and pediatric use, although risks of infections and other adverse events are discussed. Anakinra, rituximab, abatacept, and tocilizumab have also shown positive results in adult trials, but there is minimal pediatric data published with the exception of small studies involving the subgroup of children with systemic onset juvenile idiopathic arthritis, in whom anakinra and tocilizumab may be effective therapies

Computational tools for the simulation and analysis of spin-polarized EPR spectra

The EPR spectra of paramagnetic species induced by photoexcitation typically exhibit enhanced absorptive and emissive features resulting from sublevel populations that differ from thermal equilibrium. The populations and the resulting spin polarization of the spectra are dictated by the selectivity of the photophysical process generating the observed state. Simulation of the spin-polarized EPR spectra is crucial in the characterization of both the dynamics of formation of the photoexcited state as well as its electronic and structural properties. EasySpin, the simulation toolbox for EPR spectroscopy, now includes extended support for the simulation of the EPR spectra of spin-polarized states of arbitrary spin multiplicity and formed by a variety of different mechanisms, including photoexcited triplet states populated by intersystem crossing, charge recombination or spin polarization transfer, spin-correlated radical pairs created by photoinduced electron transfer, triplet pairs formed by singlet fission and multiplet states arising from photoexcitation in systems containing chromophores and stable radicals. In this paper, we highlight EasySpin’s capabilities for the simulation of spin-polarized EPR spectra on the basis of illustrative examples from the literature in a variety of fields ranging across chemistry, biology, material science and quantum information science

A Practical Catalytic Reductive Amination of Carboxylic Acids

We report reductive alkylation reactions of amines using carboxylic acids as nominal electrophiles. The two-step reaction exploits the dual reactivity of phenylsilane and involves a silane-mediated amidation followed by a Zn(OAc)2-catalyzed amide reduction. The reaction is applicable to a wide range of amines and carboxylic acids and has been demonstrated on a large scale (305 mmol of amine). The rate differential between the reduction of tertiary and secondary amide intermediates is exemplified in a convergent synthesis of the antiretroviral medicine maraviroc. Mechanistic studies demonstrate that a residual 0.5 equivalents of carboxylic acid from the amidation step is responsible for the generation of silane reductants with augmented reactivity, which allow secondary amides, previously unreactive in zinc/phenylsilane systems, to be reduced

QES-Fire: A dynamically coupled fast-response wildfire model

A microscale wildfire model, QES-Fire, that dynamically couples the fire front to microscale winds was developed using a simplified physics rate of spread (ROS) model, a kinematic plume-rise model and a mass-consistent wind solver. The model is three-dimensional and couples fire heat fluxes to the wind field while being more computationally efficient than other coupled models. The plume-rise model calculates a potential velocity field scaled by the ROS model\u27s fire heat flux. Distinct plumes are merged using a multiscale plume-merging methodology that can efficiently represent complex fire fronts. The plume velocity is then superimposed on the ambient winds and the wind solver enforces conservation of mass on the combined field, which is then fed into the ROS model and iterated on until convergence. QES-Fire\u27s ability to represent plume rise is evaluated by comparing its results with those from an atmospheric large-eddy simulation (LES) model. Additionally, the model is compared with data from the FireFlux II field experiment. QES-Fire agrees well with both the LES and field experiment data, with domain-integrated buoyancy fluxes differing by less than 17% between LES and QES-Fire and less than a 10% difference in the ROS between QES-Fire and FireFlux II data

Perfecting Policy with Pilots: New Mobility and AV Urban Delivery Pilot Project Assessment

149 pagesThe purpose of this study is to go beyond cataloging pilot projects to determine the lessons learned, emerging trends and considerations, and examples of promising practices from pilot projects in the United States and Canada. Researchers assessed 220 pilot projects and 11 case studies. Based on that assessment, they recommend 10 actions for pilot projects generally. The study resulted in 31 lessons learned organized by pilot goals, evaluation, implementation, outcomes, and policy and infrastructure implications

Early blood pressure, antihypotensive therapy and outcomes at 18–22 months’ corrected age in extremely preterm infants

Investigate relationships between early blood pressure (BP) changes, receipt of anti-hypotensive therapy, and 18 – 22 month corrected age (CA) outcomes for extremely preterm infants

Validation of ammonia diffusive and pumped samplers in a controlled atmosphere test facility using traceable Primary Standard Gas Mixtures

We report the determination of ammonia (NH3) diffusive sampling rates for six different designs of commercial diffusive samplers (CEH ALPHA sampler, Gradko diffusion tube, Gradko DIFRAM-400, Passam ammonia sampler,and ICS Maugeri Radiello radial sampler (blue and white turbulence barriers)), together with the validation test results for a pumped sampler (CEH DELTA denuder). The devices were all exposed in the UK's National Physical Laboratory's (NPL) controlled atmosphere test facility (CATFAC). For each of the seven diffusive sampler exposure tests there were traceable concentrations of ammonia (in the range 3–25 μgm−3) generated under well-defined conditions of temperature, relative humidity and wind speed, which are applicable to a variety of ambient monitoring environments. The sampler exposure time at each concentration was 28 days, except for the radial devices, which were exposed for 14 days. The work relied on the dilution of newly developed stable Primary Standard Gas Mixtures (PSMs) prepared by gravimetry in passivated gas cylinders as a method of improving the metrological traceability of ammonia measurements. The exposed diffusive samplers were sent blind to the participants for analysis and the reported NH3 concentrations were then compared against the known reference concentration. From the results for each sampler type a diffusive sampling rate was calculated and compared against the rate used routinely by the participants. Some measurement results were in good agreement with the known traceable reference concentration (particularly for one diffusive sampler design (ALPHA)), while other devices exhibited over-reading and under-reading (each with a clear bias). The new diffusive sampling rates determined in the laboratory study were then applied to measurements in a field comparison campaign, and this was found to deliver an improvement in agreement between the different devices deployed

Regulation of T Cell Priming by Lymphoid Stroma

The priming of immune T cells by their interaction with dendritic cells (DCs) in lymph nodes (LN), one of the early events in productive adaptive immune responses, occurs on a scaffold of lymphoid stromal cells, which have largely been seen as support cells or sources of chemokines and homeostatic growth factors. Here we show that murine fibroblastic reticular cells (FRCs), isolated from LN of B6 mice, play a more direct role in the immune response by sensing and modulating T cell activation through their upregulation of inducible nitric oxide synthase (iNOS) in response to early T cell IFNγ production. Stromal iNOS, which only functions in very close proximity, attenuates responses to inflammatory DC immunization but not to other priming regimens and preferentially affects Th1 cells rather than Th2. The resultant nitric oxide production does not affect T cell-DC coupling or initial calcium signaling, but restricts homotypic T cell clustering, cell cycle progression, and proliferation. Stromal feedback inhibition thus provides basal attenuation of T cell responses, particularly those characterized by strong local inflammatory cues

Fetal Growth and Risk of Stillbirth: A Population-Based Case–Control Study

Background: Stillbirth is strongly related to impaired fetal growth. However, the relationship between fetal growth and stillbirth is difficult to determine because of uncertainty in the timing of death and confounding characteristics affecting normal fetal growth. Methods and Findings: We conducted a population-based case–control study of all stillbirths and a representative sample of live births in 59 hospitals in five geographic areas in the US. Fetal growth abnormalities were categorized as small for gestational age (SGA) (90th percentile) at death (stillbirth) or delivery (live birth) using population, ultrasound, and individualized norms. Gestational age at death was determined using an algorithm that considered the time-of-death interval, postmortem examination, and reliability of the gestational age estimate. Data were weighted to account for the sampling design and differential participation rates in various subgroups. Among 527 singleton stillbirths and 1,821 singleton live births studied, stillbirth was associated with SGA based on population, ultrasound, and individualized norms (odds ratio [OR] [95% CI]: 3.0 [2.2 to 4.0]; 4.7 [3.7 to 5.9]; 4.6 [3.6 to 5.9], respectively). LGA was also associated with increased risk of stillbirth using ultrasound and individualized norms (OR [95% CI]: 3.5 [2.4 to 5.0]; 2.3 [1.7 to 3.1], respectively), but not population norms (OR [95% CI]: 0.6 [0.4 to 1.0]). The associations were stronger with more severe SGA and LGA (95th percentile). Analyses adjusted for stillbirth risk factors, subset analyses excluding potential confounders, and analyses in preterm and term pregnancies showed similar patterns of association. In this study 70% of cases and 63% of controls agreed to participate. Analysis weights accounted for differences between consenting and non-consenting women. Some of the characteristics used for individualized fetal growth estimates were missing and were replaced with reference values. However, a sensitivity analysis using individualized norms based on the subset of stillbirths and live births with non-missing variables showed similar findings. Conclusions: Stillbirth is associated with both growth restriction and excessive fetal growth. These findings suggest that, contrary to current practices and recommendations, stillbirth prevention strategies should focus on both severe SGA and severe LGA pregnancies