The comparative responsiveness of Hospital Universitario Princesa Index and other composite indices for assessing rheumatoid arthritis activity

Objective To evaluate the responsiveness in terms of correlation of the Hospital Universitario La Princesa Index (HUPI) comparatively to the traditional composite indices used to assess disease activity in rheumatoid arthritis (RA), and to compare the performance of HUPI-based response criteria with that of the EULAR response criteria. Methods Secondary data analysis from the following studies: ACT-RAY (clinical trial), PROAR (early RA cohort) and EMECAR (pre-biologic era long term RA cohort). Responsiveness was evaluated by: 1) comparing change from baseline (Delta) of HUPI with Delta in other scores by calculating correlation coefficients; 2) calculating standardised effect sizes. The accuracy of response by HUPI and by EULAR criteria was analyzed using linear regressions in which the dependent variable was change in global assessment by physician (Delta GDA-Phy). Results Delta HUPI correlation with change in all other indices ranged from 0.387 to 0.791); HUPI's standardized effect size was larger than those from the other indices in each database used. In ACT-RAY, depending on visit, between 65 and 80% of patients were equally classified by HUPI and EULAR response criteria. However, HUPI criteria were slightly more stringent, with higher percentage of patients classified as non-responder, especially at early visits. HUPI response criteria showed a slightly higher accuracy than EULAR response criteria when using Delta GDA-Phy as gold standard. Conclusion HUPI shows good responsiveness in terms of correlation in each studied scenario (clinical trial, early RA cohort, and established RA cohort). Response criteria by HUPI seem more stringent than EULAR''s

Incorporating the social dimension into hydrogeochemical investigations for rural development: the Bir Al-Nas approach for socio-hydrogeology

A replicable multidisciplinary approach is presented for science-based groundwater management practices: Bir Al-Nas (Bottom-up IntegRated Approach for sustainabLe grouNdwater mAnagement in rural areaS). This approach provides a practical example of the concept of “socio-hydrogeology”, a way of incorporating the social dimension into hydrogeological investigations, as reinforced by the translation of the Arabic bir al-nas: “the people’s well”. To achieve this, hydrogeologists act as “social hydrologists” during their monitoring activities, which often bring them into contact with local communities and end users (and polluters) of water. Not only can they retrieve reliable information about traditional know-how and local issues, but they can also change the public perception of science/scientists to create the basis for mutual collaboration and understanding in view of implementing improved integrated groundwater management. The final outcomes are expected to be an increased awareness of communities at the local level and a clear understanding of their water issues and needs from the very early stages of the investigation. Although the importance of using such methods in groundwater analysis and management is widely recognized, hydrogeological investigations are currently dominated by sectorial approaches that are easier to implement but less sustainable. The pressure of population growth, the shift towards more water-dependent economies, climate change and its impact on water availability will require scientists to use a more integrated approach, such as Bir Al-Nas, when dealing with increasing water pollution and water-scarcity issues.A replicable multidisciplinary approach is presented for science-based groundwater management practices: Bir Al-Nas (Bottom-up IntegRated Approach for sustainabLe grouNdwater mAnagement in rural areaS). This approach provides a practical example of the concept of "socio-hydrogeology", a way of incorporating the social dimension into hydrogeological investigations, as reinforced by the translation of the Arabic bir al-nas: "the people's well". To achieve this, hydrogeologists act as "social hydrologists" during their monitoring activities, which often bring them into contact with local communities and end users (and polluters) of water. Not only can they retrieve reliable information about traditional know-how and local issues, but they can also change the public perception of science/scientists to create the basis for mutual collaboration and understanding in view of implementing improved integrated groundwater management. The final outcomes are expected to be an increased awareness of communities at the local level and a clear understanding of their water issues and needs from the very early stages of the investigation. Although the importance of using such methods in groundwater analysis and management is widely recognized, hydrogeological investigations are currently dominated by sectorial approaches that are easier to implement but less sustainable. The pressure of population growth, the shift towards more water-dependent economies, climate change and its impact on water availability will require scientists to use a more integrated approach, such as Bir Al-Nas, when dealing with increasing water pollution and water-scarcity issues

The comparative responsiveness of Hospital Universitario Princesa Index and other composite indices for assessing rheumatoid arthritis activity

Objective To evaluate the responsiveness in terms of correlation of the Hospital Universitario La Princesa Index (HUPI) comparatively to the traditional composite indices used to assess disease activity in rheumatoid arthritis (RA), and to compare the performance of HUPI-based response criteria with that of the EULAR response criteria. Methods Secondary data analysis from the following studies: ACT-RAY (clinical trial), PROAR (early RA cohort) and EMECAR (pre-biologic era long term RA cohort). Responsiveness was evaluated by: 1) comparing change from baseline (Delta) of HUPI with Delta in other scores by calculating correlation coefficients; 2) calculating standardised effect sizes. The accuracy of response by HUPI and by EULAR criteria was analyzed using linear regressions in which the dependent variable was change in global assessment by physician (Delta GDA-Phy). Results Delta HUPI correlation with change in all other indices ranged from 0.387 to 0.791); HUPI's standardized effect size was larger than those from the other indices in each database used. In ACT-RAY, depending on visit, between 65 and 80% of patients were equally classified by HUPI and EULAR response criteria. However, HUPI criteria were slightly more stringent, with higher percentage of patients classified as non-responder, especially at early visits. HUPI response criteria showed a slightly higher accuracy than EULAR response criteria when using Delta GDA-Phy as gold standard. Conclusion HUPI shows good responsiveness in terms of correlation in each studied scenario (clinical trial, early RA cohort, and established RA cohort). Response criteria by HUPI seem more stringent than EULAR's