Abatacept in the Treatment of Severe, Longstanding, and Refractory Uveitis Associated with Juvenile Idiopathic Arthritis.

OBJECTIVE Abatacept (ABA), a selective T cell costimulation modulator that binds to CD80 and CD86 on antigen-presenting cells, was investigated for its antiinflammatory effect in treating severe chronic uveitis associated with juvenile idiopathic arthritis (JIA). METHODS Our retrospective study was conducted by members of the Multinational Interdisciplinary Working Group for Uveitis in Childhood (MIWGUC). Patients with JIA who are receiving ABA treatment for active uveitis were included. In all patients, uveitis had been refractory to previous topical and systemic corticosteroids, immunosuppressives, and at least 1 tumor necrosis factor-α inhibitor. A standardized protocol was used to document uveitis (MIWGUC) and arthritis. Baseline visit and visits at 3, 6, 9, and 12 months before and after ABA start were evaluated. Primary outcome measure was defined as achievement of uveitis inactivity; secondary outcome measures were tapering of corticosteroid and/or immunosuppressive treatment, and occurrence of complications. RESULTS In all, 21 patients (16 female) with active uveitis (n = 21) and arthritis (n = 18) were included (mean age 11.8 ± 3.6 yrs). In 7 of 18 patients with active arthritis at baseline, inactivity was achieved following ABA treatment. Uveitis inactivity was achieved in 11 patients, but recurred later in 8 of them, and remained active in another 10 cases. Systemic corticosteroids or immunosuppression were tapered in 3 patients, but uveitis recurred in all of them during further followup. Ocular complications secondary to uveitis were present in 17 patients at baseline, while 3 patients developed new ocular complications during followup. CONCLUSION A sustained response to ABA was uncommon in patients with severe and refractory uveitis.

Análise de métodos de avaliação de eco eficiência.

Para que a sustentabilidade seja gerenciada e praticada de maneira efetiva, ela deve ser mensurada, utilizando-se de métodos de avaliação da sustentabilidade. Estão disponíveis diferentes métodos de avaliação, que geralmente reduzem o resultado desse levantamento à indicadores de desempenho ambiental, econômico e social (POPEA; ANNANDALE; MORISON-SAUNDERSB, 2004). Uma das denominações mais bem aceitas e difundidas para a conjunção da dimensão ambiental e econômica é conhecida por avaliação de eco eficiência (AEE). Eco eficiência é o \"aspecto da sustentabilidade que relaciona o desempenho ambiental de um sistema de produto ao valor do sistema de produto\" (ISO, 2012). Estão disponíveis diferentes métodos de AEE, porém sem evidência das suas semelhanças e particularidades e como essas características influenciam na escolha do método mais adequado de AEE em relação às potenciais aplicações O objetivo desta pesquisa é, portanto, analisar e indicar os tipos de métodos de avaliação de eco eficiência (AEE) mais adequados para ações gerenciais nas quais caibam tais abordagens. Foram selecionados onze métodos de AEE, a partir do estabelecimento de critérios de caracterização desses métodos, a saber: BASF, Bayer, EcoWater, Hahn et al., Kuosmanen e Kortelainen, MIPS, NRTEE, UN ESCAP, UN, TU Delft, e WBCSD. Identificaram-se, ainda, quatro potenciais aplicações: (i) Monitoramento de processo com vistas à melhoria contínua; (ii) Selecção e classificação de produtos; (iii) Atendimento a requisitos legais e outros requisitos; e, (iv) Marketing, rotulagem de produtos e comunicação ambiental. A partir dos elementos metodológicos estabelecidos pela norma ISSO 14045 (2012) e do conhecimento obtido dos métodos de AEE, determinaram-se quatro requisitos pelos quais os métodos e os potenciais aplicações foram avaliados: (i) Tipo de indicador de desempenho ambiental; (ii) Tipo de indicador de valor de sistema de produto; (iii) Abrangência de aplicação; e, (iv) Tipo de indicador de eco eficiência. Aplicando-se estes requisitos nos métodos de AEE e nos potenciais usos, concluiu-se que quanto à aplicações em termos de monitoramento de processos com vistas à melhoria continua os métodos de AEE recomendados foram Bayer, NRTEE, WBCSD e UN. Para situações de seleção e classificação de produtos os métodos BASF, EcoWater, Kuosmanen e Kortelainen, MIPS, Hahn et al., TU Delft, UN ESCAP e UN demonstraram ter boa aderência. No que se refere a usos voltados ao atendimento de requisitos legais e/ou de outras naturezas, os métodos NRTEE, WBCSD e UN são os mais indicados. Em aplicações de marketing, rotulagem e comunicação foram indicados os métodos BASF, EcoWater e MIPS. Finalmente, concluiu-se que, para a escolha adequada da metodologia para uma AEE, conhecimento prévio das características de cada abordagem é necessário.

Improving envelopment in Data Envelopment Analysis under variable returns to scale

In a Data Envelopment Analysis model, some of the weights used to compute the efficiency of a unit can have zero or negligible value despite of the importance of the corresponding input or output. This paper offers an approach to preventing inputs and outputs from being ignored in the DEA assessment under the multiple input and output VRS environment, building on an approach introduced in Allen and Thanassoulis (2004) for single input multiple output CRS cases. The proposed method is based on the idea of introducing unobserved DMUs created by adjusting input and output levels of certain observed relatively efficient DMUs, in a manner which reflects a combination of technical information and the decision maker's value judgements. In contrast to many alternative techniques used to constrain weights and/or improve envelopment in DEA, this approach allows one to impose local information on production trade-offs, which are in line with the general VRS technology. The suggested procedure is illustrated using real data. © 2011 Elsevier B.V. All rights reserved.

Costs and efficiency of higher education institutions in England:a DEA analysis

As student numbers in higher education in the UK have expanded during recent years, it has become increasingly important to understand its cost structure. This study applies Data Envelopment Analysis (DEA) to higher education institutions in England to assess their cost structure, efficiency and productivity. The paper complements an earlier study that used parametric methods to analyse the same panel data. Interestingly, DEA provides estimates of subject-specific unit costs that are in the same ballpark as those provided by the parametric methods. The paper then extends the previous analysis and finds that further student number increases of the order of 20–27% are feasible through exploiting operating and scale efficiency gains and also adjusting student mix. Finally the paper uses a Malmquist index approach to assess productivity change in the UK higher education. The results reveal that for a majority of institutions productivity has actually decreased during the study period.

Measuring House Price Bubbles

We thank John Clapp, Martijn Dröes, Mika Kortelainen, and Song Shi for helpful comments. Financial support from the Academy of Finland, the OP‐Pohjola Group Research Foundation, the Kluuvi Foundation, and the Emil Aaltonen Foundation is gratefully acknowledged.