Anti-TNF treatment in juvenile idiopathic arthritis and associated uveitis : Clinical perspectives on growth, uveitis, and drug survival

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of childhood chronic arthritides, associated with chronic uveitis in 20% of cases. For JIA patients responding inadequately to conventional disease-modifying anti-rheumatic drugs (DMARDs), biologic therapies, anti-tumor necrosis factor (anti-TNF) agents are available. In this retrospective multicenter study, 258 JIA-patients refractory to DMARDs and receiving biologic agents during 1999-2007 were included. Prior to initiation of anti-TNFs, growth velocity of 71 patients was delayed in 75% and normal in 25%. Those with delayed growth demonstrated a significant increase in growth velocity after initiation of anti-TNFs. Increase in growth rate was unrelated to pubertal growth spurt. No change was observed in skeletal maturation before and after anti-TNFs. The strongest predictor of change in growth velocity was growth rate prior to anti-TNFs. Change in inflammatory activity remained a significant predictor even after decrease in glucocorticoids was taken into account. In JIA-associated uveitis, impact of two first-line biologic agents, etanercept and infliximab, and second-line or third-line anti-TNF agent, adalimumab, was evaluated. In 108 refractory JIA patients receiving etanercept or infliximab, uveitis occurred in 45 (42%). Uveitis improved in 14 (31%), no change was observed in 14 (31%), and in 17 (38%) uveitis worsened. Uveitis improved more frequently (p=0.047) and frequency of annual uveitis flares was lower (p=0.015) in those on infliximab than in those on etanercept. In 20 patients taking adalimumab, 19 (95%) had previously failed etanercept and/or infliximab. In 7 patients (35%) uveitis improved, in one (5%) worsened, and in 12 (60%) no change occurred. Those with improved uveitis were younger and had shorter disease duration. Serious adverse events (AEs) or side-effects were not observed. Adalimumab was effective also in arthritis. Long-term drug survival (i.e. continuation rate on drug) with etanercept (n=105) vs. infliximab (n=104) was at 24 months 68% vs. 68%, and at 48 months 61% vs. 48% (p=0.194 in log-rank analysis). First-line anti-TNF agent was discontinued either due to inefficacy (etanercept 28% vs. infliximab 20%, p=0.445), AEs (7% vs. 22%, p=0.002), or inactive disease (10% vs. 16%, p=0.068). Females, patients with systemic JIA (sJIA), and those taking infliximab as the first therapy were at higher risk for treatment discontinuation. One-third switched to the second anti-TNF agent, which was discontinued less often than the first. In conclusion, in refractory JIA anti-TNFs induced enhanced growth velocity. Four-year treatment survival was comparable between etanercept and infliximab, and switching from first-line to second-line agent a reasonable therapeutic option. During anti-TNF treatment, one-third with JIA-associated anterior uveitis improved.

Effect of thione—thiol tautomerism on the inhibition of lactoperoxidase by anti-thyroid drugs and their analogues

The keto-enol type tautomerism in anti-thyroid drugs and their selenium analogues are described. The commonly used anti-thyroid drug methimazole exists predominantly in its thione form, whereas its selenium analogue exists in a zwitterionic form. To understand the effect of thione/thiol and selone/selenol tautomerism on the inhibition of peroxidase-catalysed reactions, we have synthesized some thiones and selones in which the formation of thiol/selenol forms are blocked by different substituents. These compounds were synthesized by a carbene route utilizing an imidazolium salt. The crystal structures of these compounds reveal that the C=Se bonds in the selones are more polarized than the C=S bonds in the corresponding thiones. The structures of selones were studied in solution by NMR spectroscopy and the 77Se NMR chemical shifts for the selones show large upfield shifts in the signals, confirming their zwitterionic structures in solution. The inhibition of lactoperoxidase by the synthetic thiones indicates that the presence of a free N-H moiety is essential for an efficient inhibition. In contrast, such moiety is not required for an inhibition by the selenium compounds.

NFPOs and their anti-corruption disclosure practices: Evidence from Australia

By focusing on major Australian overseas aid not-for-profit organisations (NFPOs), this study has found that NFPOs’ public disclosures lack appropriate commentary relating to anti-corruption measures. We found that this could be due to a break down in regulatory oversight caused by a lack of mandatory reporting standards. This finding reinforces the experience of NFPOs in terms of addressing anti-corruption issues. The key lesson is that there is a need for significant improvement in the anti-corruption regulations, hence associated disclosure practices within the NFPOs sector.

Effect of indium doping on the electrical switching behaviour of Ge-Te glasses

Bulk Ge15Te85-xInx (1 <= x <= 11) series of glasses have been found to exhibit a threshold switching behaviour for an input current of 2 mA. An initial decrease is seen in the switching voltages (V-T) with the addition of indium, which is due to the higher metallicity of indium. An increase is seen in V-T above 3 at.% of indium, which proceeds until 8 at.%, with a change in slope (lower to higher) seen around 7 at.%. Beyond x = 8, a reversal in trend is exhibited in the variation of V-T, with a well-defined minimum around x = 9 at.%. Based on the composition dependence of V-T, it is proposed that Ge15Te85-xInx glasses exhibit an extended rigidity percolation threshold. The composition, x = 3, at which the V-T starts to increase and the composition, x = 7, at which a slope change is exhibited correspond to the onset and completion, respectively, of the extended stiffness transition. Thermal studies and photoconductivity e85-xInx glasses. In addition, the minimum seen in V-T at x = 9 is associated with the chemical threshold (CT) of this glassy system.

Enantioselective syntheses of cis, syn, cis- and cis, anti, cis-linear triquinanes

Enantioselective syntheses of both cis, syn, cis- and cis, anti, cis-linear triquinanes, starting from the readily available (S)-campholenaldehyde, employing an RCM reaction-based cyclopentannulation strategy, are described.

Experimental study on shrinkage behaviour and prediction of shrinkage magnitudes of residual soils

The present study examines the shrinkage behaviour of residually derived black cotton (BC) soil and red soil compacted specimens that were subjected to air-drying from the swollen state. The soil specimens were compacted at varying dry density and moisture contents to simulate varied field conditions. The void ratio and moisture content of the swollen specimens were monitored during the drying process and relationship between them is analyzed. Shrinkage is represented as reduction in void ratio with decrease in water content of soil specimens. It is found to occur in three distinct stages. Total shrinkage magnitude depends on the type of clay mineral present. Variation in compaction conditions effect marginally total shrinkage magnitudes of BC soil specimens but have relatively more effect on red soil specimens. A linear relation is obtained between total shrinkage magnitude and volumetric water content of soil specimens in swollen state and can be used to predict the shrinkage magnitude of soils.

Influences on sleep-wake behaviour in older adults and community dementia care: Light exposure and partner impact

This project described sleep-wake behaviour in community-dwelling older adults and in community dementia care. It examined the applicability of a newly presented conceptual model (the Multifactorial Influences on Sleep Health model) to evaluate factors influencing sleep in ageing, with a particular focus on the importance of daytime light exposure and the impact of partners.

The influence of school smoking policy and school prevention programs on the smoking behaviour of high school students in Prince Edward Island, Canada

The aim of the study was to examine the influence of school smoking policy and school smoking prevention programs on the smoking behaviour of students in high schools in Prince Edward Island using the School Health Action Planning Evaluation System (SHAPES). A total sample included 13,131 observations of students in grades 10-12 in ten high schools in Prince Edward Island over three waves of data collection (1999, 2000, and 2001). Changes in prevalence of smoking and factors influencing smoking behaviour were analyzed using descriptive statistics and Chi-Square tests. Multi-level logistic regression analyses were used to examine how both school and student characteristics were associated with smoking behaviour (I, II, III, IV). Since students were located within schools, a basic 2-level nested structure was used in which individual students (level 1) were nested within schools (level 2). For grade 12 students, the combination of both school policies and programs was not associated with the risk of smoking and the presence of the new policy was not associated with decreased risk of smoking, unless there were clear rules in place (I). For the grade 10 study, (II) schools with both policies and programs were not associated with decreased risk of smoking. However, the smoking behaviour of older students (grade 12) at a school was associated with younger students’ (grade 10) smoking behaviour. Students first enrolled in a high school in grade 9, rather than grade 10, were at increased risk of occasional smoking. For students who transitioned from grade 10 to 12 (III), close friends smoking had a substantial influence on smoking behaviour for both males and females (III). Having one or more close friends who smoke (Odds Ratio (OR) = 37.46; 95% CI = 19.39 to 72.36), one or more smokers in the home (OR = 2.35; 95% CI = 1.67 to 3.30) and seeing teachers and staff smoking on or near school property (OR=1.78; 95% CI = 1.13 to 2.80), were strongly associated with increased risk of smoking for grade 12 students. Smoking behaviour increased for both junior (Group 1) and senior (Group 2) students (IV). Group 1 students indicated a greater decrease in smoking behaviour and factors influencing smoking behaviour compared to those of Group 2. Students overestimating the percentage of youth their age who smoke was strongly associated with increased likelihood of smoking. Smoking rates showed a decreasing trend (1999, 2000, and 2001). However, policies and programs alone were not successful in influencing smoking behaviour of youth. Rather, factors within the students and schools contextual environment influenced smoking behaviour. Comprehensive approaches are required for school-based tobacco prevention interventions. Keywords: schools, policy, programs, smoking prevention, adolescents Subject Terms: school-based programming, public health, health promotion

Experimental study on behaviour of concrete filled double skin tube columns under lateral impact loading

This paper presents an experimental investigation on the lateral impact response of axially loaded concrete filled double skin tube (CFDST) columns. A total of four test series are being conducted at Queensland University of Technology using a novel horizontal impact-testing rig. The test results reported in this paper are from the first test series, where the columns are pinned at both ends and impacted at mid-span. In the next three series, effects of support conditions, impact location and repeated impact will be treated. The main objectives of the current paper are to describe the innovative testing procedure and provide some insight into the lateral impact behavior and failure of simply supported axially pre-loaded CFDST columns. The results include time histories of impact forces, reaction forces, axial force and global lateral deflection. Based on the test data, the failure mode, peak impact force, peak reaction forces, maximum deflection and residual deflection, with and without axial load, are analyzed and discussed. The findings of this study will serve as a benchmark reference for future analysis and design of CFDST columns.

Hot deformation behaviour of Mg–3Al alloy—A study using processing map

The hot deformation behaviour of Mg–3Al alloy has been studied using the processing-map technique. Compression tests were conducted in the temperature range 250–550 °C and strain rate range 3 × 10−4 to 102 s−1 and the flow stress data obtained from the tests were used to develop the processing map. The various domains in the map corresponding to different dissipative characteristics have been identified as follows: (i) grain boundary sliding (GBS) domain accommodated by slip controlled by grain boundary diffusion at slow strain-rates (<10−3 s−1) in the temperature range from 350 to 450 °C, (ii) two different dynamic recrystallization (DRX) domains with a peak efficiency of 42% at 550 °C/10−1 s−1 and 425 °C/102 s−1 governed by stress-assisted cross-slip and thermally activated climb as the respective rate controlling mechanisms and (iii) dynamic recovery (DRV) domain below 300 °C in the intermediate strain rate range from 3 × 10−2 to 3 × 10−1 s−1. The regimes of flow instability have also been delineated in the processing map using an instability criterion. Adiabatic shear banding at higher strain rates (>101 s−1) and solute drag by substitutional Al atoms at intermediate strain rates (3 × 10−2 to 3 × 10−1 s−1) in the temperature range (350–450 °C) are responsible for flow instability. The relevance of these mechanisms with reference to hot working practice of the material has been indicated. The processing maps of Mg–3Al alloy and as-cast Mg have been compared qualitatively to elucidate the effect of alloying with aluminum on the deformation behaviour of magnesium.

Investigations on the influence of graphite filler on dry sliding wear and abrasive wear behaviour of carbon fabric reinforced epoxy composites

In this experimental study, the dry sliding wear and two-body abrasive wear behaviour of graphite filled carbon fabric reinforced epoxy composites were investigated. Carbon fabric reinforced epoxy composite was used as a reference material. Sliding wear experiments were conducted using a pin-on-disc wear tester under dry contact condition. Mass loss was determined as a function of sliding velocity for loads of 25, 50, 75, and 100 N at a constant sliding distance of 6000 m. Two-body abrasive wear experiments were performed under multi-pass condition using silicon carbide (SiC) of 150 and 320 grit abrasive papers. The effects of abrading distance and different loads have been studied. Abrasive wear volume and specific wear rate as a function of applied normal load and abrading distance were also determined. The results show that in dry sliding wear situations, for increased load and sliding velocity, higher wear loss was recorded. The excellent wear characteristics were obtained with carbon-epoxy containing graphite as filler. Especially, 10 wt.% of graphite in carbon-epoxy gave a low wear rate. A graphite surface film formed on the counterface was confirmed to be effective in improving the wear characteristics of graphite filled carbon-epoxy composites. In case of two-body abrasive wear, the wear volume increases with increasing load/abrading distance. Experimental results showed the type of counterface (hardened steel disc and SiC paper) material greatly influences the wear behaviour of the composites. Wear mechanisms of the composites were investigated using scanning electron microscopy. Wear of carbon-epoxy composite was found to be mainly due to a microcracking and fiber fracture mechanisms. It was found that the microcracking mechanism had been caused by progressive surface damage. Further, it was also noticed that carbon-epoxy composite wear is reduced to a greater extent by addition of the graphite filler, in which wear was dominated by microplowing/microcutting mechanisms instead of microcracking.

Thrombin regulation in newborn infants

The coagulation system of newborn infants differs markedly from that of older children and adults. The activities of most coagulation factors and anticoagulants are low, leading to altered regulation in the formation of the key enzyme, thrombin. Timely and adequate generation of thrombin is essential, as thrombin activates platelets and many coagulation factors, cleaves fibrinogen into fibrin and activates the antithrombotic and anti-inflammatory protein C pathway. On the other hand, excess thrombin may promote thrombotic complications and exacerbate harmful inflammatory reactions. Despite the characteristic features, the newborn coagulation system can be considered physiological, since healthy newborns rarely show haemorrhagic or thrombotic complications. Sick newborns, however, often encounter clinical situations that challenge their coagulation system. The aim of this study was to clarify the behaviour of the neonatal coagulation system in selected clinical situations, with a special emphasis on the generation of thrombin. Thrombin was measured by in vivo thrombin generation markers and by thrombin generation potential in vitro. The patient groups included sick newborns undergoing intensive care and receiving fresh-frozen plasma (FFP), requiring exchange transfusions (ET) or presenting with a congenital heart defect requiring open heart surgery. Additionally, healthy newborns with inherited heterozygous factor V Leiden (FVL) mutation were studied. Thrombin generation potential was also analysed in cord plasma of healthy infants and in adults. Healthy as well as sick newborn infants showed lower total thrombin generation potential in vitro but faster initiation of thrombin generation than adults. These findings were qualitatively similar when plasma was supplemented with platelets. Platelets, however, significantly altered the effect of the major anticoagulant, activated protein C (APC), on thrombin generation potential. In accordance with previous studies, thrombin generation in healthy newborn platelet-poor plasma was resistant to the anticoagulant effects of APC, but when the plasma was supplemented with platelets APC attenuated thrombin generation significantly more in newborns than in adults. In vivo generation of thrombin was elevated in nearly all of the sick newborn infants. The low-volume FFP transfusion as opposed to the change from neonatal to adult blood in ET exerted markedly different effects on neonatal thrombin generation. FFP reduced the in vivo generation of thrombin in those newborns with the highest pretransfusional thrombin generation, thus acting as an anticoagulant agent. In those infants with lower pretransfusional thrombin generation, the effect of FFP on thrombin generation was fairly neutral. On the other hand, the combination of red blood cells and FFP, used to perform ET, significantly increased the in vivo thrombin formation and shifted the balance in the newborn coagulation system to the procoagulant direction. Cardiopulmonary bypass (CPB) also significantly increased the in vivo thrombin generation, but the thrombin generation profile during CPB differed from that previously observed in adults. Escalation of thrombin at early reperfusion was not observed in newborns; in adults, its occurrence is associated with postoperative myocardial damage. Finally, in healthy newborns with FVL heterozygosity, faster initiation of thrombin generation was observed compared with controls. Interestingly, FV level was lower in FVL-heterozygous infants, possibly to counteract the procoagulant effects induced by FVL. In conclusion, unique features regarding thrombin regulation in newborn infants were observed. These features included a novel platelet effect on the regulation of the protein C pathway. The clinical challenges mainly seemed to shift the balance in the coagulation system of newborns to the procoagulant direction. Blood component transfusions markedly affected coagulation in a manner specific to the product but that could also be altered by the clinical situation. Overall, the results highlight the need for understanding developmental haemostasis for both diagnostic and therapeutic purposes.

The effects of manganese content and mould size on abrasion and slurry erosion behaviour of chromium-manganese iron systems investigated by positron lifetime spectroscopy

Abrasion and slurry erosion behaviour of chromium-manganese iron samples with chromium (Cr) in the range similar to 16-19% and manganese (Mn) at 5 and 10% levels have been characterized for hardness followed by microstructural examination using optical and scanning electron microscopy. Positron lifetime studies have been conducted to understand the defects/microporosity influence on the microstructure. The samples were heat treated and characterized to understand the structural transformations in the matrix. The data reveals that hardness decreased with increase in Mn content from 5 to 10% in the first instance and then increase in the section size in the other case, irrespective of the sample conditions. The abrasion and slurry erosion losses show increase with increase in the section size as well as with increase in Mn content. The positron results show that as hardness increases from as-cast to heat treated sample, the positron trapping rate and hence defect concentration showed opposite trend as expected. So a good correlation between defects concentration and the hardness has been observed. These findings also corroborate well with the microstructural features obtained from optical and scanning electron microscopy. (C) 2009 Elsevier B. V. All rights reserved.

Interrupted creep behaviour of Mg alloys developed for powertrain applications

A conventional magnesium alloy, AZ91D, and two creep resistant magnesium alloys, developed for powertrain applications, MRI 153M and MRI 230D, are prepared by high pressure die casting. These alloys are tested for their creep behaviour in the continuous manner, as is the Current practice, and in the interrupted manner, which represents the real life Situation more closely. It is observed that the interrupted creep tests give rise to a primary creep appearing at the beginning of each cycle resulting in a higher average strain rate than that encountered in the continuous creep tests. Further, the shorter the cycle time, higher is the average strain rate in the interrupted creep tests. A higher average strain rate will give rise to a higher strain over the same period. This is attributed to the recovery taking place during the cooling and heating between two cycles. The effect of additional precipitation during interrupted creep tests depends on the nature of the precipitates. The additional precipitation of beta phase during the cooling and heating between two cycles increases the steady state strain rate in the AZ91D and MRI 153M alloys. whereas the additional precipitation of C36 phase during the cooling and heating between two cycles decreases the steady state strain rate in the MRI 230D alloy. (C) 2009 Elsevier B.V. All rights reserved.

On the behaviour of some physical parameterization methods in high-resolution numerical weather prediction models

Modern-day weather forecasting is highly dependent on Numerical Weather Prediction (NWP) models as the main data source. The evolving state of the atmosphere with time can be numerically predicted by solving a set of hydrodynamic equations, if the initial state is known. However, such a modelling approach always contains approximations that by and large depend on the purpose of use and resolution of the models. Present-day NWP systems operate with horizontal model resolutions in the range from about 40 km to 10 km. Recently, the aim has been to reach operationally to scales of 1 4 km. This requires less approximations in the model equations, more complex treatment of physical processes and, furthermore, more computing power. This thesis concentrates on the physical parameterization methods used in high-resolution NWP models. The main emphasis is on the validation of the grid-size-dependent convection parameterization in the High Resolution Limited Area Model (HIRLAM) and on a comprehensive intercomparison of radiative-flux parameterizations. In addition, the problems related to wind prediction near the coastline are addressed with high-resolution meso-scale models. The grid-size-dependent convection parameterization is clearly beneficial for NWP models operating with a dense grid. Results show that the current convection scheme in HIRLAM is still applicable down to a 5.6 km grid size. However, with further improved model resolution, the tendency of the model to overestimate strong precipitation intensities increases in all the experiment runs. For the clear-sky longwave radiation parameterization, schemes used in NWP-models provide much better results in comparison with simple empirical schemes. On the other hand, for the shortwave part of the spectrum, the empirical schemes are more competitive for producing fairly accurate surface fluxes. Overall, even the complex radiation parameterization schemes used in NWP-models seem to be slightly too transparent for both long- and shortwave radiation in clear-sky conditions. For cloudy conditions, simple cloud correction functions are tested. In case of longwave radiation, the empirical cloud correction methods provide rather accurate results, whereas for shortwave radiation the benefit is only marginal. Idealised high-resolution two-dimensional meso-scale model experiments suggest that the reason for the observed formation of the afternoon low level jet (LLJ) over the Gulf of Finland is an inertial oscillation mechanism, when the large-scale flow is from the south-east or west directions. The LLJ is further enhanced by the sea-breeze circulation. A three-dimensional HIRLAM experiment, with a 7.7 km grid size, is able to generate a similar LLJ flow structure as suggested by the 2D-experiments and observations. It is also pointed out that improved model resolution does not necessary lead to better wind forecasts in the statistical sense. In nested systems, the quality of the large-scale host model is really important, especially if the inner meso-scale model domain is small.