Patient preferences and satisfaction in the treatment of rheumatoid arthritis with biologic therapy

Significant advances in the treatment of rheumatoid arthritis (RA) have been made over the past 10 years with the introduction of biologic therapies, such as the TNF inhibitors. With these medications, many patients with RA have seen significant improvement in symptoms, function, and quality of life. However, with the introduction of the biologics, decision-making for this chronic disease that affects up to 1% of the population has become even more complex. Patient preferences for mode and frequency of administration, and for certain risks vs benefits as well as medication beliefs are central to uptake and adherence to these medications. This review examines the current literature on patient satisfaction, adherence, and preference for biologic therapy in RA

Recognition of DNA Base Pair Mismatches by a Cyclometalated Rh(III) Intercalator

Two cyclometalated complexes of Rh(III), rac-[Rh(ppy)_2chrysi]^+ and rac-[Rh(ppy)_2phi]^+, have been synthesized and characterized with respect to their binding to DNA. The structure of rac-[Rh(ppy)_2phi]Cl·H_2O·CH_2Cl_2 has been determined by X-ray diffraction (monoclinic, P2_1/c, Z = 4, a =18.447(3) Å, b = 9.770(1) Å, c = 17.661(3) Å, β = 94.821(11)°, V = 3172.0(8) Å^3) and reveals that the complex is a distorted octahedron with nearly planar ligands, similar in structure to the DNA mismatch recognition agent [Rh(bpy)_2chrysi]^(3+). The 2-phenylpyridyl nitrogen atoms are shown to be in the axial positions, as a result of trans-directing effects. This tendency simplifies the synthesis and purification of such complexes by limiting the number of possible isomers generated. The abilities of [Rh(ppy)_2chrysi]^+ and [Rh(ppy)_2phi]^+ to bind and, with photoactivation, to cleave DNA have been demonstrated in assays on duplex DNA in the absence and presence of a single CC mismatch. [Rh(ppy)_2chrysi]^+ was shown upon photoactivation to cleave DNA selectively at the base pair mismatch whereas [Rh(ppy)_2phi]^+ cleaves B-DNA nonspecifically. The reactivity of [Rh(ppy)_2chrysi]^+ was also compared to that of the known mismatch recognition agent [Rh(bpy)_2chrysi]^(3+). Competitive photocleavage studies revealed that a 14-fold excess of [Rh(ppy)_2chrysi]^+ was required to achieve the same level of binding as that of [Rh(bpy)_2chrysi]^(3+). However, the ratio of damage induced by [Rh(bpy)_2chrysi]^(3+) to that induced by [Rh(ppy)_2chrysi]^+ is considerably greater than this value, indicating that decreased photoefficiency for the cyclometalated complex must contribute to its significantly attenuated photoreactivity. These cyclometalated intercalators provide the starting points for the design of a new family of metal complexes targeted to DNA

Creating A Model For Graduate Student Inclusion And Success

Mentoring and advising are critical aspects of the graduate student experience, and can have a significant impact on the professional lives of future postsecondary faculty and staff and a rippling effect throughout higher education and the global economy. This paper describes the process a new department undertook to create a graduate program that puts the inclusion and success of students first

Cloning and functional characterization of the fatty acid elongase 1 (FAE1) gene from high erucic Crambe abyssinica cv. Prophet.

A genomic fatty acid elongation 1 (FAE1) clone was isolated from Crambe abyssinica. The genomic clone corresponds to a 1521-bp open reading frame, which encodes a protein of 507 amino acids. In yeast cells expression of CrFAE led to production of new very long chain monounsaturated fatty acids such as eicosenoic (20:1(delta11)) and erucic (22:1(delta13)) acids. Seed-specific expression in Arabidopsis thaliana resulted in up to a 12-fold increase in the proportion of erucic acid. On the other hand, in transgenic high-erucic Brassica carinata plants, the proportion of erucic acid was as high as 51.9% in the best transgenic line, a net increase of 40% compared to wild type. These results indicate that the CrFAE gene encodes a condensing enzyme involved in the biosynthesis of very long-chain fatty acids utilizing monounsaturated and saturated acyl substrates, with a strong capability for improving the erucic acid content

Individualized decision aid for diverse women with lupus nephritis (IDEA-WON): A randomized controlled trial.

BackgroundTreatment decision-making regarding immunosuppressive therapy is challenging for individuals with lupus. We assessed the effectiveness of a decision aid for immunosuppressive therapy in lupus nephritis.Methods and findingsIn a United States multicenter, open-label, randomized controlled trial (RCT), adult women with lupus nephritis, mostly from racial/ethnic minority backgrounds with low socioeconomic status (SES), seen in in- or outpatient settings, were randomized to an individualized, culturally tailored, computerized decision aid versus American College of Rheumatology (ACR) lupus pamphlet (1:1 ratio), using computer-generated randomization. We hypothesized that the co-primary outcomes of decisional conflict and informed choice regarding immunosuppressive medications would improve more in the decision aid group. Of 301 randomized women, 298 were analyzed; 47% were African-American, 26% Hispanic, and 15% white. Mean age (standard deviation [SD]) was 37 (12) years, 57% had annual income of <$40,000, and 36% had a high school education or less. Compared with the provision of the ACR lupus pamphlet (n = 147), participants randomized to the decision aid (n = 151) had (1) a clinically meaningful and statistically significant reduction in decisional conflict, 21.8 (standard error [SE], 2.5) versus 12.7 (SE, 2.0; p = 0.005) and (2) no difference in informed choice in the main analysis, 41% versus 31% (p = 0.08), but clinically meaningful and statistically significant difference in sensitivity analysis (net values for immunosuppressives positive [in favor] versus negative [against]), 50% versus 35% (p = 0.006). Unresolved decisional conflict was lower in the decision aid versus pamphlet groups, 22% versus 44% (p < 0.001). Significantly more patients in the decision aid versus pamphlet group rated information to be excellent for understanding lupus nephritis (49% versus 33%), risk factors (43% versus 27%), medication options (50% versus 33%; p ≤ 0.003 for all); and the ease of use of materials was higher in the decision aid versus pamphlet groups (51% versus 38%; p = 0.006). Key study limitations were the exclusion of men, short follow-up, and the lack of clinical outcomes, including medication adherence.ConclusionsAn individualized decision aid was more effective than usual care in reducing decisional conflict for choice of immunosuppressive medications in women with lupus nephritis.Trial registrationClinicaltrials.gov, NCT02319525

Prevalence of Fibromyalgia: A Population‐Based Study in Olmsted County, Minnesota, Utilizing the Rochester Epidemiology Project

Objective To estimate and compare the prevalence of fibromyalgia by 2 different methods in Olmsted County, Minnesota. Methods The first method was a retrospective review of medical records of potential cases of fibromyalgia in Olmsted County using the Rochester Epidemiology Project (from January 1, 2005, to December 31, 2009) to estimate the prevalence of diagnosed fibromyalgia in clinical practice. The second method was a random survey of adults in Olmsted County using the fibromyalgia research survey criteria to estimate the percentage of responders who met the fibromyalgia research survey criteria. Results Of the 3,410 potential patients identified by the first method, 1,115 had a fibromyalgia diagnosis documented in the medical record by a health care provider. The age‐ and sex‐adjusted prevalence of diagnosed fibromyalgia by this method was 1.1%. By the second method, of the 2,994 people who received the survey by mail, 830 (27.6%) responded and 44 (5.3%) met the fibromyalgia research survey criteria. The age‐ and sex‐adjusted prevalence of fibromyalgia in the general population of Olmsted County by this method was estimated at 6.4%. Conclusion To the best of our knowledge, this is the first report of the rate at which fibromyalgia is being diagnosed in a community. This is also the first report of prevalence as assessed by the fibromyalgia research survey criteria. Our results suggest that patients, particularly men, who meet the fibromyalgia research survey criteria are unlikely to have been given a diagnosis of fibromyalgia.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97488/1/21896_ftp.pd

NECROBIOME FRAMEWORK FOR BRIDGING DECOMPOSITION ECOLOGY OF AUTOTROPHICALLY AND HETEROTROPHICALLY DERIVED ORGANIC MATTER

Life arises from death through species that decompose dead biomass or necromass. This paper provides a synthesis of the species responsible for dead plant and animal decomposition and describes a conceptual perspective—the “necrobiome”— that defines the diverse and complex communities that interact to recycle necromass. The concept brings unification to the previously disparate fields of plant and animal decomposition by discussing the universal processes occurring across all forms of necromass. It highlights the factors that make each form of dead biomass different in a way that defines how unique necrobiomes drive decomposition and ultimately shape ecosystem structure and function

Necrobiome framework for bridging decomposition ecology of autotrophically and heterotrophically derived organic matter

Decomposition contributes to global ecosystem function by contributing to nutrient recycling, energy flow, and limiting biomass accumulation. The decomposer organisms influencing this process form diverse, complex, and highly dynamic communities that often specialize on different plant or animal resources. Despite performing the same net role, there is a need to conceptually synthesize information on the structure and function of decomposer communities across the spectrum of dead plant and animal resources. A lack of synthesis has limited cross-disciplinary learning and research in important areas of ecosystem and community ecology. Here we expound on the “necrobiome” concept and develop a framework describing the decomposer communities and their interactions associated with plant and animal resource types within multiple ecosystems.We outline the biotic structure and ecological functions of the necrobiome, along with how the necrobiome fits into a broader landscape and ecosystem context. The expanded necrobiome model provides a set of perspectives on decomposer communities across resource types, and conceptually unifies plant and animal decomposer communities into the same framework, while acknowledging key differences in processes and mechanisms. This framework is intended to raise awareness among researchers, and advance the construction of explicit, mechanistic hypotheses that further our understanding of decomposer community contributions to biodiversity, the structure and function of ecosystems, global nutrient recycling and energy flow

An Empirical Characterization of Extended Cool Gas Around Galaxies Using MgII Absorption Features

We report results from a survey of MgII absorbers in the spectra of background QSOs that are within close angular distances to a foreground galaxy at z<0.5, using the Magellan Echellette Spectrograph. We have established a spectroscopic sample of 94 galaxies at a median redshift of = 0.24 in fields around 70 distant background QSOs (z_QSO>0.6), 71 of which are in an 'isolated' environment with no known companions and located at rho <~ 120 h^-1 kpc from the line of sight of a background QSO. The rest-frame absolute B-band magnitudes span a range from M_B-5log h=-16.4 to M_B-5log h=-21.4 and rest-frame B_AB-R_AB colors range from B_AB-R_AB~0 to B_AB-R_AB~1.5. Of these 'isolated' galaxies, we find that 47 have corresponding MgII absorbers in the spectra of background QSOs and rest-frame absorption equivalent width W_r(2796)=0.1-2.34 A, and 24 do not give rise to MgII absorption to sensitive upper limits. Our analysis shows that (1) Wr(2796) declines with increasing distance from 'isolated' galaxies but shows no clear trend in 'group' environments; (2) more luminous galaxies possess more extended MgII absorbing halos with the gaseous radius scaled by B-band luminosity according to R_gas=75x(L_B/L_B*)^(0.35+/-0.03) h^{-1} kpc; (3) there is little dependence between the observed absorber strength and galaxy intrinsic colors; and (4) within R_gas, we find a mean covering fraction of ~70% for absorbers of Wr(2796)>=0.3 A and ~80% for absorbers of Wr(2796)>=0.1 A. The lack of correlation between Wr(2796) and galaxy colors suggests a lack of physical connection between the origin of extended MgII halos and recent star formation history of the galaxies. Finally, we discuss the total gas mass in galactic halos as traced by MgII absorbers. We also compare our results with previous studies.Comment: 20 pages, 13 figures; to appear in the Astrophysical Journal 2010 May 10 issue; a version with higher resolution figures can be found at http://lambda.uchicago.edu/public/tmp/mage_apj.pd