Brief report: Intestinal dysbiosis in ankylosing spondylitis

Objective Ankylosing spondylitis (AS) is a common, highly heritable immune-mediated arthropathy that occurs in genetically susceptible individuals exposed to an unknown but likely ubiquitous environmental trigger. There is a close relationship between the gut and spondyloarthritis, as exemplified in patients with reactive arthritis, in whom a typically self-limiting arthropathy follows either a gastrointestinal or urogenital infection. Microbial involvement in AS has been suggested; however, no definitive link has been established. The aim of this study was to determine whether the gut in patients with AS carries a distinct microbial signature compared with that in the gut of healthy control subjects. Methods Microbial profiles for terminal ileum biopsy specimens obtained from patients with recent-onset tumor necrosis factor antagonist-naive AS and from healthy control subjects were generated using culture-independent 16S ribosomal RNA gene sequencing and analysis techniques. Results Our results showed that the terminal ileum microbial communities in patients with AS differ significantly (P < 0.001) from those in healthy control subjects, driven by a higher abundance of 5 families of bacteria (Lachnospiraceae [P = 0.001], Ruminococcaceae [P = 0.012], Rikenellaceae [P = 0.004], Porphyromonadaceae [P = 0.001], and Bacteroidaceae [P = 0.001]) and a decrease in the abundance of 2 families of bacteria (Veillonellaceae [P = 0.01] and Prevotellaceae [P = 0.004]). Conclusion We show evidence for a discrete microbial signature in the terminal ileum of patients with AS compared with healthy control subjects. The microbial composition was demonstrated to correlate with disease status, and greater differences were observed between disease groups than within disease groups. These results are consistent with the hypothesis that genes associated with AS act, at least in part, through effects on the gut microbiome.

The window of opportunity: A relevant concept for axial spondyloarthritis

The window of opportunity is a concept critical to rheumatoid arthritis treatment. Early treatment changes the outcome of rheumatoid arthritis treatment, in that response rates are higher with earlier disease-modifying anti-rheumatic drug treatment and damage is substantially reduced. Axial spondyloarthritis is an inflammatory axial disease encompassing both nonradiographic axial spondyloarthritis and established ankylosing spondylitis. In axial spondyloarthritis, studies of magnetic resonance imaging as well as tumor necrosis factor inhibitor treatment and withdrawal studies all suggest that early effective suppression of inflammation has the potential to reduce radiographic damage. This potential would suggest that the concept of a window of opportunity is relevant not only to rheumatoid arthritis but also to axial spondyloarthritis. The challenge now remains to identify high-risk patients early and to commence treatment without delay. Developments in risk stratification include new classification criteria, identification of clinical risk factors, biomarkers, genetic associations, potential antibody associations and an ankylosing spondylitis-specific microbiome signature. Further research needs to focus on the evidence for early intervention and the early identification of high-risk individuals.

Major histocompatibility complex associations of ankylosing spondylitis are complex and involve further epistasis with ERAP1

Ankylosing spondylitis (AS) is a common, highly heritable, inflammatory arthritis for which HLA-B*27 is the major genetic risk factor, although its role in the aetiology of AS remains elusive. To better understand the genetic basis of the MHC susceptibility loci, we genotyped 7,264 MHC SNPs in 22,647 AS cases and controls of European descent. We impute SNPs, classical HLA alleles and amino-acid residues within HLA proteins, and tested these for association to AS status. Here we show that in addition to effects due to HLA-B*27 alleles, several other HLA-B alleles also affect susceptibility. After controlling for the associated haplotypes in HLA-B, we observe independent associations with variants in the HLA-A, HLA-DPB1 and HLA-DRB1 loci. We also demonstrate that the ERAP1 SNP rs30187 association is not restricted only to carriers of HLA-B*27 but also found in HLA-B*40:01 carriers independently of HLA-B*27 genotype.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

On the construction of costs: McDermott v Robinson Helicopter Company (No.2) [2014] QSC 213

The decision in McDermott v Robinson Helicopter Company (No 2) [2014] QSC 213 involves an extensive examination of authorities on the general principle relating to the awarding of costs to a successful party. The court concluded that there was a predilection in favour of distributing costs according to the outcome or 'event' of particular issues in the action.

Chromolaena odorata (L.) King and Robinson (Asteraceae)

Chromolaena, or Siam weed, is a serious problem in several tropical and sub-tropical areas around the world. In our own region, it is a serious weed in New Guinea, East Timor and Indonesia and is also under an eradication regime in North Queensland. The chapter summarises current knowledge about the taxonomy, biology, distribution, ecology, impacts and control of the weed. Biological control has been a major multinational initiative against this weed in recent years and these efforts are described in some detail. Interestingly agents have not been universally effective because of weed biotype differences and climate. Considerable success has been achieved in New Guinea, principally with the tephritid fly Cecidocares connex and by the efforts of Michael Day, Rachel McFadyen and Graham Donnelly from Alan Fletcher Research Station.

Konstruktiivisen linjakkuuden perusteita etsimässä : Systemaattinen analyysi John Biggsin esittämistä yliopisto-opetuksen lähtökohdista

The aim of this study is to explore by systematic textual analysis the crucial conceptions of constructive alignment and to reconstruct the concept of constructive alignment and examine the relation between conceptual relationships in John Biggs’s texts. In this study, I have also analyzed the presuppositions of the concept of constructive alignment and its possible implications. The research material includes Biggs’s (1996b; 2003) article entitled Enhancing Teaching through Constructive Alignment and book entitled Teaching for Quality Learning at University. The primary purpose of the systematic textual analysis is to reconstruct concepts and gain access to a new or more profound understanding of the concepts. The main purpose of the constructive alignment is to design a teaching system that supports and encourages students to adopt a deep approach learning. At the center of the constructive alignment are two concepts: constructivism in learning and alignment in teaching. A tension was detected between these concepts. Biggs assumes that students’ learning activities are primed by the teaching. Because of this it is not important what the teacher does. At the same time he emphasizes that teaching interacts with learning. The teacher’s task is to support student’s appropriate learning activities. On the basis of the analysis, I conclude these conceptions are not mutually exclusive. Interaction between teaching and learning has an effect on student’s learning activities. The most essential benefit of the model of constructive alignment is that Biggs brings together and considers teaching at the same level with learning. A weakness of Biggs’s model relates to the theoretical basis and positions of the concept of constructive alignment. There are some conflicts between conceptions of epistemology in Biggs’s texts. In addition, Biggs writes about constructivism also as conceptions of epistemology, but doesn’t consider implications of that position or what follows or doesn’t follow from that commitment. On the basis of the analysis, I suggest that constructivism refers in Biggs’s texts rather to constructivism in learning than philosophical constructivism. In light of this study, constructive alignment doesn´t lead to philosophical constructivism. That’s why constructive alignment stays out of idealism. Biggs’s way of thinking about teachers possibility to confronting students’ misconceptions and evaluate and assess students’ constructions support a realist purpose in terms of philosophical stance. Realism does not drift toward general problems of relativism, like lack of criteria for assessing or evaluate these constructions.

John and Ursula Schlosstein nee Gottschalk with their infant son Ralph. portraits family

Digital Image

Mary Robinson's declaration of climate justice: Climate change, human rights and fossil fuel divestment

In her biography, Everybody Matters: My Life Giving Voice, Mary Robinson explained how she became interested in the topic of human rights and climate change, after hearing testimony from African farmers, with Archbishop Desmond Tutu.

John Ettinger Collection 1941-1946

John Ettinger, 1987.

John and Ursula Schlosstein nee Gottschalk with their infant son Ralph. portraits family

Digital Image