The dermatologists' role in managing psoriatic arthritis: results of a swiss delphi exercise intended to improve collaboration with rheumatologists.

BACKGROUND Psoriatic arthritis (PsA) substantially impacts the management of psoriatic disease. OBJECTIVE This study aimed to generate an interdisciplinary national consensus on recommendations of how PsA should be managed. METHODS Based on a systematic literature search, an interdisciplinary expert group identified important domains and went through 3 rounds of a Delphi exercise, followed by a nominal group discussion to generate specific recommendations. RESULTS A strong consensus was reached on numerous central messages regarding the impact of PsA, screening procedures, organization of the interaction between dermatologists and rheumatologists, and treatment goals. CONCLUSION These recommendations can serve as a template for similar initiatives in other countries. At the same time, they highlight the need to take into account the impact of the respective national health care system. © 2015 S. Karger AG, Basel.

The geomorphology and morphometry of the banded terrain in Hellas basin, Mars

Hellas basin is a large impact basin situated in the southern highlands of Mars. The north-western part of the basin has the lowest elevation (-7.5 km) on the planet and contains a possibly unique terrain type, which we informally call “banded terrain”. The banded terrain is made up of smooth-looking banded deposits that display signs of viscous behavior and a paucity of superimposed impact craters. In this study, we use newly acquired high spatial resolution images from the High Resolution Imaging Science Experiment (HiRISE) in addition to existing datasets to characterize the geomorphology, the morphometry and the architecture of the banded terrain. The banded terrain is generally confined to the NW edge of the Alpheus Colles plateau. The individual bands are ~3–15 km-long, ~0.3 km-wide and are separated by narrow inter-band depressions, which are ~65 m-wide and ~10 m-deep. The bands display several morphologies that vary from linear to concentric forms. Morphometric analysis reveals that the slopes along a given linear or lobate band ranges from 0.5° to 15° (average~6°), whereas the concentric bands are located on flatter terrain (average slope~2–3°). Crater-size frequency analysis yields an Amazonian-Hesperian boundary crater retention age for the terrain (~3 Gyr), which together, with the presence of very few degraded craters, either implies a recent emplacement, resurfacing, or intense erosion. The apparent sensitivity to local topography and preference for concentrating in localized depressions is compatible with deformation as a viscous fluid. In addition, the bands display clear signs of degradation and slumping at their margins along with a suite of other features that include fractured mounds, polygonal cracks at variable size-scales, and knobby/hummocky textures. Together, these features suggest an ice-rich composition for at least the upper layers of the terrain, which is currently being heavily modified through loss of ice and intense weathering, possibly by wind.

16p11.2 600 kb Duplications confer risk for typical and atypical Rolandic epilepsy

Rolandic epilepsy (RE) is the most common idiopathic focal childhood epilepsy. Its molecular basis is largely unknown and a complex genetic etiology is assumed in the majority of affected individuals. The present study tested whether six large recurrent copy number variants at 1q21, 15q11.2, 15q13.3, 16p11.2, 16p13.11 and 22q11.2 previously associated with neurodevelopmental disorders also increase risk of RE. Our association analyses revealed a significant excess of the 600 kb genomic duplication at the 16p11.2 locus (chr16: 29.5-30.1 Mb) in 393 unrelated patients with typical (n = 339) and atypical (ARE; n = 54) RE compared with the prevalence in 65,046 European population controls (5/393 cases versus 32/65,046 controls; Fisher's exact test P = 2.83 × 10(-6), odds ratio = 26.2, 95% confidence interval: 7.9-68.2). In contrast, the 16p11.2 duplication was not detected in 1738 European epilepsy patients with either temporal lobe epilepsy (n = 330) and genetic generalized epilepsies (n = 1408), suggesting a selective enrichment of the 16p11.2 duplication in idiopathic focal childhood epilepsies (Fisher's exact test P = 2.1 × 10(-4)). In a subsequent screen among children carrying the 16p11.2 600 kb rearrangement we identified three patients with RE-spectrum epilepsies in 117 duplication carriers (2.6%) but none in 202 carriers of the reciprocal deletion. Our results suggest that the 16p11.2 duplication represents a significant genetic risk factor for typical and atypical RE.

Challenge stressors: longitudinal effects on self attitudes, work attitudes, and health.

Recent research suggests that some stressors (i.e. hindrance stressors) have mainly negative consequences, whereas others (i.e. challenge stressors) can simultaneously have positive and negative consequences (e.g., LePine et al., 2005). Although a number of studies have dealt with potential outcomes of challenge stressors, some criteria have received only limited attention (e.g., positive self-attitudes; cf. Widmer et al., 2012), and some have been neglected altogether (i.e., physical health outcomes). Furthermore, while sophisticated methods – such as meta-analyses (e.g., LePine et al., 2005), diary studies (Ohly & Fritz, 2010), and multi-source analyses (Wallace et al., 2009) – have been applied to the framework, there are no longitudinal studies. We report results from a longitudinal study containing three waves, with two time-lags of one month each (N = 393). We analyzed relationships between challenge stressors and work attitudes (e.g. job satisfaction), self attitudes (e.g. self-esteem), and health indicators (e.g. sleep quality) using cross-lagged SEM. We expected positive effects of challenge stressors to appear only when their negative variance is controlled (e.g. by including hindrance stressors as a suppressor variable; cf. Cavanaugh et al., 2000). As the positive aspects of challenge stressors relate to self-affirming experiences, we also expected positive effects to be especially strong for self attitudes. Regarding work attitudes, the only significant paths found were from work attitudes to challenge stressors over both time lags. Regarding health, there was a significant cross-sectional association at time 1, which was negative, as expected. Longitudinally, a positive path from challenge stressors to health for both time lags was found only when hindrances stressors were controlled, confirming the expected suppressor effect. Hindrance stressors had a negative effect on health. For self-attitudes, there was a positive cross-sectional association at time one. In addition, a positive effect on self attitudes was found longitudinally for both time lags, but only when hindrance stressors were controlled. Additional analyses showed that the positive longitudinal effect on health was mediated by self attitudes. Although the lack of associations with work attitudes was surprising, our results indicate that challenge stressors contain aspects that provide an opportunity to develop self-esteem through demanding work situations, thereby contributing to personal growth and thriving at the workplace. They also confirm the ambiguous nature of challenge stressors, as, with one exception, positive effects were found only when hindrance stressors were controlled (cf. Widmer et al., 2012). Finally, our results confirm the importance of self-related attitudes in the stress process.

Implications of Imaging Criteria for the Management and Treatment of Intraductal Papillary Mucinous Neoplasms - Benign versus Malignant Findings

OBJECTIVES Evaluation of computed tomography (CT) and magnetic resonance imaging (MRI) for differentiation of pancreatic intraductal papillary mucinous neoplasm (IPMN) subtypes based on objective imaging criteria. METHODS Fifty-eight patients with 60 histologically confirmed IPMNs were included in this retrospective study. Eighty-three imaging studies (CT,n = 42; MRI,n = 41) were analysed by three independent blinded observers (O1-O3), using established imaging criteria to assess likelihood of malignancy (-5, very likely benign; 5, very likely malignant) and histological subtype (i.e., low-grade (LGD), moderate-grade (MGD), high-grade dysplasia (HGD), early invasive carcinoma (IPMC), solid carcinoma (CA) arising from IPMN). RESULTS Forty-one benign (LGD IPMN,n = 20; MGD IPMN,n = 21) and 19 malignant (HGD IPMN,n = 3; IPMC,n = 6; solid CA,n = 10) IPMNs located in the main duct (n = 6), branch duct (n = 37), or both (n = 17) were evaluated. Overall accuracy of differentiation between benign and malignant IPMNs was 86/92 % (CT/MRI). Exclusion of overtly malignant cases (solid CA) resulted in overall accuracy of 83/90 % (CT/MRI). The presence of mural nodules and ductal lesion size ≥30 mm were significant indicators of malignancy (p = 0.02 and p < 0.001, respectively). CONCLUSIONS Invasive IPMN can be identified with high confidence and sensitivity using CT and MRI. The diagnostic problem that remains is the accurate radiological differentiation of premalignant and non-invasive subtypes. KEY POINTS • CT and MRI can differentiate benign from malignant forms of IPMN. • Identifying (pre)malignant histological IPMN subtypes by CT and MRI is difficult. • Overall, diagnostic performance with MRI was slightly (not significantly) superior to CT.

The role of climate-driven chemical weathering on soil production

Climate plays an important role in controlling rates of weathering and weathered regolith production. Regolith production functions, however, seldom take climate parameters into account. Based on a climate-dependent weathered regolith production model, at low denudation rates, relative regolith thicknesses are less sensitive to changes in precipitation rates, while at high denudation rates, small changes in climatic parameters can result in complete stripping of hillslopes. This pattern is compounded by the long residence times and system response times associated with low denudation rates, and vice versa. As others have shown, the transition between regolith-mantled and bedrock slopes is dependent on the ratio of denudation to production. Here, we further suggest that this is itself a function of precipitation rate and temperature. We suggest that climatic parameters can be easily incorporated into existing soil production models and that such additions improve the predictive power of soil production models. (C) 2013 Elsevier B.V. All rights reserved.

Terrestrial Radar Interferometric Measurement of Hillslope Deformation and Atmospheric Disturbances in the Illgraben Debris-Flow Catchment, Switzerland

We describe a method for rapid identification and precise quantification of slope deformation using a portable radar interferometer. A rockslide with creep-like behavior was identified in the rugged and inaccessible headwaters of the Illgraben debris-flow catchment, located in the Central Swiss Alps. The estimated volume of the moving rock mass was approximately 0.5 x 10(6) m(3) with a maximum daily (3-D) displacement rate of 3 mm. Fast scene acquisition in the order of 6 s/scene led to uniquely precise mapping of spatial and temporal variability of atmospheric phase delay. Observations led to a simple qualitative model for prediction of atmospheric disturbances using a simple model for solar radiation, which can be used for advanced campaign planning for short observation periods (hours to days).

The late Miocene to Holocene erosion pattern of the Alpine foreland basin reflects Eurasian slab unloading beneath the western Alps rather than global climate change

We synthesized published data on the erosion of the Alpine foreland basin and apatite fission-track ages from the Alps to infer the erosional sediment budget history for the past 5 m.y. The data reveal that erosion of the Alpine foreland basin is highest in front of the western Alps (between 2 and 0.6 km) and decreases eastward over a distance of 700 km to the Austrian foreland basin (similar to 200 m). For the western Alps, erosion rates are >0.6 km/m.y., while erosion rates for the eastern foreland basin and the adjacent eastern Alps are <0.1 km/m.y., except for a small-scale signal in the Tauern Window. The results yield a large ellipsoidal, orogen-crossing pattern of erosion, centered along the western Alps. We suggest that accelerated erosion of the western Alps and their foreland basin occurred in response to regional-scale surface uplift, related to lithospheric unloading of the Eurasian slab along the Eurasian-Adriatic plate boundary. While we cannot rule out recent views that global climate change led to substantial erosion of the European Alps since 5 Ma, we postulate that regional-scale tectonic processes have driven erosion during this time, modulated by an increased erosional flux in response to Quaternary glaciations.