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To assess the effectiveness and survival of ustekinumab (UST) among patients with psoriatic arthritis (PsA) treated under routine clinical care.Multicenter study. Epidemiological and clinical data was collected through electronic medical records of all patients with PsA who started UST in 15 hospitals of Spain.Two hundred and one patients were included, 130 (64.7%) with 45 mg and 71 (35.3%) with 90 mg. One hundred and thirty one patients (65.2%) had previously received another biological therapy. The median baseline DAS 28 ESR was 3.99, and Psoriasis Area and Severity Index (PASI) was 3. Overall, there was a significant decrease in DAS66/68 CRP, swollen joint count (SJC), tender joint count (TJC), and PASI in the first month of treatment, with earlier improvement in skin (PASI) than joints outcomes. Survival was numerically lower in patients with UST 45 mg (58.1%) than 90 mg (76.1%), although significant differences were not found (p = 0.147). When comparing naïve and 1 TNF blocker versus 2 TNF blocker-experienced patients, a significantly earlier response was seen in the former group regarding SJC (p = 0.029) at 1 month. Fifty-one patients (25.3%) stopped UST due to joint inefficacy and 4 patients due to adverse events (1.9%). Drug survival was significantly better in patients with fewer lines of previous biological agents (p = 0.003 for 1 TNF blocker versus 2 TNF blocker users).UST was effective in PsA patients in a routine clinical care setting. Patients with UST 90 mg and fewer lines of previous biologics achieved better and faster responses. Key Points • Largest cohort of patients with PsA in treatment with UST with specific rheumatological indication. • First cohort of patients with PsA comparing effectiveness of UST according to 45/90 mg dose.

Hand hygiene is one of the most important interventions in the quest to eliminate healthcare-associated infections, and rates in healthcare facilities are markedly low. Since hand hygiene observation and feedback are critical to improve adherence, we created an easy-to-use, platform-independent hand hygiene data collection process and an automated, on-demand reporting engine.A 3-step approach was used for this project: 1) creation of a data collection form using Google Forms, 2) transfer of data from the form to a spreadsheet using Google Spreadsheets, and 3) creation of an automated, cloud-based analytics platform for report generation using R and RStudio Shiny software.A video tutorial of all steps in the creation and use of this free tool can be found on our YouTube channel: https://www.youtube.com/watch?v=uFatMR1rXqUt. The on-demand reporting tool can be accessed at: https://crsp.louisville.edu/shiny/handhygiene.This data collection and automated analytics engine provides an easy-to-use environment for evaluating hand hygiene data; it also provides rapid feedback to healthcare workers. By reducing some of the data management workload required of the infection preventionist, more focused interventions may be instituted to increase global hand hygiene rates and reduce infection.

This report contains the findings of a synthesis study on the use of link slabs to eliminate intermediate joints in bridges of Indiana. The study was conducted under the sponsorship of the Joint Transportation Research Program. The motivation for the study was to investigate this promising technique to mitigate the damage associated with expansion joints that has long been recognized as a persistent and costly issue negatively impacting the bridge service life. The report summarizes the background information and motivation for the study. It also provides a description of the report organization. The results of an extensive literature review of DOTs’ experience related to the use of this system and main research findings are presented as well as construction practice and examples of application. The results of the analysis of a bridge in Indiana where the link slab system has been implemented are presented. The bridge connecting the State Road 68 over the Interstate 64 was selected as a representative bridge based on the analysis of the inspection. A parametric study on the effects of various parameters was conducted to evaluate the effect of support conditions and debonded length on the stress distribution and potential crack initiation in link slabs. Each variable was investigated separately to isolate its effect. Two bridge structures were investigated in this study. The first structure (Case 1) represents a bridge structure rehabilitated using link slabs. A second bridge structure (Case 2) with the same geometrical and material properties, but with a continuous and fully bonded deck, was also included in the parametric study for comparison purposes. This structure simulated new bridge construction.

Purpose: To report a case of cystoid macular edema (CME) secondary to juvenile idiopathic arthritis (JIA)-associated uveitis.Case report: 26-year-old female patient presented with CME in both eyes. CME became refractory and TCZ-IV was initiated. After 12 infusions was stopped because grade 1 neuropenia developed. On examination,visual acuity of the right eye was 20/80. Spectral domain optical coherence tomography (SD-OCT) of the right eye revealed CME. Subcutaneous (TCZ-SC) was initiated. After six injections of TCZ-SC, ophthalmic examination revealed no signs of active inflammation, and central foveal thickness decreased.Conclusion: TCZ-SC seems to have a role in the treatment of CME secondary to juvenile idiopathic arthritis (JIA)-associated uveitis.

We present the generation and 3D manipulation of microbubbles by thermal gradients, induced by low power nanosecond pulsed laser in non-absorbent liquids. Light absorption at photodeposited silver nanoparticles on the optical fiber tip heat up the surrounding liquid, which leads to optothermal effects. With each laser pulse a microbubble is detached from the optical fiber end, creating a microbubbles-stream. The microbubbles move away from the optical fiber end driven by non-spherical cavitation until they coalesce creating a main-bubble which is attracted towards the optical fiber end by Marangoni force. In addition, the main-bubbles are under the influence of buoyancy and gravity forces, which act upwards and downwards, respectively. The balance of these forces allows the 3D manipulation of the main-bubble. The main-bubble position can be controlled by careful control of the pulse energy. To our knowledge this is the first time that 3D manipulation of microbubbles using pulsed lasers is demonstrated.

Monitoring air quality is a topic of current interest, since poor quality has a negative impact on health. Air quality is affected by different pollutants, such as particulate matter and gases, produced by the growing industrial development. As a preventive measure, Mexico established different standards in order to control airborne pollution. In this paper, we propose a methodology based upon a recurrent long-term/short-term memory network for the prediction of exceedances of PM10 (particles of less or equal diameter than 10 micrometers) with time intervals of 72, 48 and 24 hours in advance. Obtaining a satisfactory percentage of prediction as a whole a minimum variability in repetitive experimental runs.

Breast cancer implies a very important health problem worldwide since it represents the cancer with the highest incidence and mortality rate among women in 2018. Traditional treatments are not always totally efficient, causing severe systemic side effects, therefore the search for alternative treatments such as photodynamic therapy (PDT) is of vital importance. In the present work, we show the in vitro effects of rose bengal (RB) as a photosensitizer (PS) and green light (500-550 nm) to eliminate two breast cancer cell lines: MDA-MB-231, a triple negative line highly aggressive and invasive, and T47D, a luminal line of the infiltrating ductal type. RB concentrations of 0.5, 1 and 5 μM and radiation fluences of 2.5, 5 and 10 J/cm2 were evaluated. Cell viability was evaluated with the MTT test, obtaining the best effect with 5 μM concentration and 10 J/cm2 light dose.

Background Early clinical response (ECR) is a new endpoint to determine whether a drug should be approved for community-acquired bacterial pneumonia in the United States. The Omadacycline for Pneumonia Treatment In the Community (OPTIC) phase III study demonstrated noninferiority of omadacycline to moxifloxacin using this endpoint. This study describes the performance of the ECR endpoint and clinical stability relative to a posttreatment evaluation (PTE) of clinical success. Methods ECR was defined as symptom improvement 72–120 hours after the first dose of study drug (ECR window), no use of rescue antibiotics, and patient survival. Clinical success at PTE was an investigator assessment of success. Clinical stability was defined based on vital sign stabilization, described in the American Thoracic Society and Infectious Diseases Society of America community-acquired pneumonia treatment guidelines. Results During the ECR window, ECR was achieved in 81.1% and 82.7% of omadacycline and moxifloxacin patients, respectively. Similar numbers of patients achieved clinical stability in each treatment group (omadacycline 74.6%, moxifloxacin 77.6%). The proportion of patients with improved symptoms who were considered clinically stable increased across the ECR window (69.2–77.6% for omadacycline; 68.0–79.7% for moxifloxacin). There was high concordance (>70%) and high positive predictive value (>90%) of ECR and clinical stability with overall clinical success at PTE. Conclusions Omadacycline was noninferior to moxifloxacin, based on a new ECR endpoint. Clinical stability was similarly high when measured in the same time frame as ECR. Both ECR and clinical stability showed high concordance and high positive predictive value with clinical success at PTE. Clinical Trials Registration NCT02531438.

Blood flow is a parameter used to diagnose vascular diseases based on flow speed, blood pressure, and vessel size. Different techniques have been developed to estimate the relative blood flow speed and to improve the visualization of deep blood vessels; one such technique is laser speckle contrast imaging (LSCI). LSCI images contain a high level of noise mainly when deep blood vessels are imaged. To improve their visualization, several approaches for contrast computation have been developed. However, there is a compromise between noise attenuation and temporal resolution. On the one hand, spatial approaches have low spatial resolution, high temporal resolution, and significant noise attenuation, while temporal approaches have the opposite. A recent approach combines a temporal base with a directional process that allows improving the visualization of blood vessels. Nevertheless, it still contains a high level of noise and requires a high number of raw frames for its base. We propose, a space-directional approach focused on improving noise attenuation and temporal resolution for contrast computation. The results of reference approaches and the proposed one are compared quantitatively. Moreover, it is shown that the visualization of blood vessels in LSCI images can be improved by a general morphological process when the noise level is reduced.

Background: Anti-carbamylated protein antibodies (Anti-CarP) represent a novel autoantibody family present in sera of patients with rheumatoid arthritis (RA) with high specificity. Objectives: To analyse the prevalence of Anti-CarP in an established RA cohort and evaluate their association with the presence of other autoantibodies and disease activity and severity. Methods: Cross-sectional study. Presence of Anti-CarP was analyzed in a cohort of patients with established RA (n: 158) by a home-made ELISA test using fetal calf serum. We investigated the demographic, radiological and current and at disease onset clinical features. Rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPA) status were also assessed. Results: Anti-CarP were positive in 46.2% of the patients in our cohort and in 15.1%, 19.2% and 9.1% of the patients negative for ACPA, RF and both respectively. Demographic and clinical features are shown in table 1. The mean titer of ACPA (1361±1054 U/mL vs. 918 ± 1092 U/mL) and RF (258 ± 255 AU vs. 174 ± 205 AU) were significantly higher in Anti-CarP positive patients. No difference in symptoms at RA onset was observed. Current (24.7% vs. 11.8%) and previous (54.8% vs. 37.6%) smoking consumption were significantly associated with Anti-CarP antibodies. Anti-CarP positive patients presented a higher CRP values (1. 0±1.6 mg/dL vs. 0.5 ±0.8 mg/dL), swollen joint count (1.3±2.2 vs 0.7 ±1.8) and patient global health assessment VAS (34.8 ±21.5 mm vs. 26.4 ±17.1 mm); although no between-group differences in disease activity (DAS28, CDAI, SDAI and RAPID3) or demographic features were observed. Anti-CarP positive patients presented significant higher scores in Larsen index (23.6 ± 15.7 vs. 15.7 ± 12.6) and disability (HAQ-DI >1) (23.3% vs. 8.3%). Conclusion: Anti-CarP were present in approximately half of the RA cohort and were also detected in seronegative (RF and/or ACPA) patients. In our cohort, patients with Anti-CarP antibodies presented higher tobacco consumption and poorer disease outcomes. Disclosure of Interests: Raul Castellanos-Moreira Speakers bureau: For Lilly and Merk Sharp and Dohme, Sebastian C Rodriguez-Garcia: None declared, Virginia Ruiz: None declared, Oscar Camacho: None declared, Julio Ramirez: None declared, Andrea Cuervo: None declared, Cristina Garcia-Moreno: None declared, Rosa Morla: None declared, Jose Gomez Puerta Speakers bureau: BMS, Pfizer, Amgen, Juan D. Canete: None declared, Isabel Haro: None declared, Raimon Sanmarti Speakers bureau: PFIZER, SANOFI, LILLY, MSD, UCB, NOVARTIS, JANSSEN

Background: Patients with Rheumatoid Arthritis (RA) in remission will present flares during the evolution of the disease.Definitive biomarkers have not been identified to predict flares and radiographic progression (RP) in this kind of patients Objectives: To search biomarkers of clinical relapse and RP in patients with RA in clinical remission Methods: RA patients in clinical remission (DAS28-ESR 6 months) were selected.Clinical,epidemiological and serological data were analyzed.MRI of dominant hand,ultrasound assessment of knees and hands and serum levels of inflammation and angiogenesis biomarkers were evaluated at 0 and 48 weeks.Synovial biopsy was performed in patients with subclinical synovitis.Patients were follow-up for 5 years.Radiological data were collected.Clinical relapse was defined as the loss of remission status involving a therapeutic intervention.RP was defined as the change in the Sharp van der Heijde (SvH) index at 5 years >10.47 [SDD (minimum detectable change)]. Results: 60 patients in DAS28 remission. 1/3 also met remission criteria for SDAI(33.3%),CDAI(31.6%) and ACR(35%).78% were women,mean age 53 years. 82% were ACPA+.26% were taking oral prednisone,76% DMARDs and 45% biological therapies.48% met criteria for subclinical synovitis(UdAS:SH>2+PD)1. After 5 years of follow-up, 44(73%), 11(18%), 9(15%) and 10(17%) patients remained in remission according to DAS28,SDAI, DAI and ACR criteria,respectively. 29 patients (48%) had flares at any time during the 5 years. In the multivariate analysis, the variables that were related to clinical relapse were the BMI (OR 1.6 CI 95% 1.1-2.3), bone edema at baseline (OR 1.2,CI 95% 1-1.5), PD signal at 48w (OR 9.2,CI 95% 1.2-66.7) and the change in levels of CXCL16 (OR 1.04 CI 95% 0.9-1) and ESR (OR 3.6,CI 95% 1.1-12.2) between the first and latest evaluation (Rate). In the subgroup of 23 patients undergoing synovial biopsy, the number of mast cells was higher in those patients (n=10) who flared (p=0.02). 20 patients (33%) changed DMARDs or biological therapy. In the logistic regression analysis, BMI (OR 1.3 CI 95% 1-1.6), biological therapy (OR 17.8 CI 95% 2-167.1),progression of erosions measured by MRI (OR 1.1, CI 95% 1-1.3) and the rate of progression of calprotectin levels during the first year (OR 4.4,CI 95% 1.1-17.2) were the main factors that predicted the change in baseline therapy after 5 years of follow-up. Finally, only 6 patients (10%) had RP according to the SvH index and 7 (12%) had erosion progression.This small number of “progressors” did not allowed more exhaustive analysis of factors predicting RP.However,the number of macrophages and T cells at sinovial tissue (ST) was much higher in patients with RP.Likewise,the first-year rate of bone edema was significantly higher in patients suffering structural progression (p=0.04). Conclusion: 27% of RA patients lost clinical remission (DAS28) after 5 years of follow-up.BMI,baseline bone edema,PD signal at 12m and first-year rate of CXCL16 and VSG levels were predictors of joint flares. Baseline BMI, use of biological therapy,MRI erosions and calprotectin levels predicted the change of baseline therapy for RA. Only 10% of patients had RP along the study.Sinovial mast cells were associated with disease flares. Macrophages and T cells in ST were higher in patients with RP in an exploratory analysis. Reference [1] Ramirez J, Ruiz-Esquide V, Pomes I, Celis R, Cuervo A, Hernandez MV, et al. Patients with rheumatoid arthritis in clinical remission and ultrasound-defined active synovitis exhibit higher disease activity and increased serum levels of angiogenic biomarkers. Arthritis Res Ther. 2014;16:R5. Disclosure of Interests: Julio Ramirez: None declared, Andrea Cuervo: None declared, Raquel Celis: None declared, Raul Castellanos-Moreira Speakers bureau: MSD, Lilly, Sebastian C Rodriguez-Garcia: None declared, Virginia Ruiz-Esquide: None declared, Jose Gomez Puerta Speakers bureau: BMS, Pfizer, Amgen, Raimon Sanmarti Speakers bureau: PFIZER, SANOFI, LILLY, MSD, UCB, NOVARTIS, JANSSEN, Juan D. Canete: None declared

Blood vessel diameter estimation is helpfully in areas such as medicine, dermatology, neuroscience or ophthalmology. Blood vessel estimation plays an important role in diagnosis of cardiovascular diseases, also its useful to validate blood flow dynamics of a blood vessel. This paper addresses a method based on region growing for blood vessel diameter and orientation estimation. The proposed methodology first pre-process a laser speckle contrast image to obtain a certain amount of seeds that grew among the blood vessels located. All the regions contribute information about the blood vessels and they serve to build a map representing the size of the located blood vessels.

Reconnaissance teams are charged with collecting perishable data after a natural disaster. In the field, these engineers typically record their observations through images. Each team takes ...

IMPORTANCE Preventive interventions are needed to protect residents and staff of skilled nursing and assisted living facilities from COVID-19 during outbreaks in their facilities. Bamlanivimab, a neutralizing monoclonal antibody against SARS-CoV-2, may confer rapid protection from SARS-CoV-2 infection and COVID-19. OBJECTIVE To determine the effect of bamlanivimab on the incidence of COVID-19 among residents and staff of skilled nursing and assisted living facilities. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, single-dose, phase 3 trial that enrolled residents and staff of 74 skilled nursing and assisted living facilities in the United States with at least 1 confirmed SARS-CoV-2 index case. A total of 1175 participants enrolled in the study from August 2 to November 20, 2020. Database lock was triggered on January 13, 2021, when all participants reached study day 57. INTERVENTIONS Participants were randomized to receive a single intravenous infusion of bamlanivimab, 4200mg (n = 588), or placebo (n = 587). MAIN OUTCOMES AND MEASURES The primary outcomewas incidence of COVID-19, defined as the detection of SARS-CoV-2 by reverse transcriptase���polymerase chain reaction and mild or worse disease severity within 21 days of detection, within 8 weeks of randomization. Key secondary outcomes included incidence of moderate or worse COVID-19 severity and incidence of SARS-CoV-2 infection. RESULTS The prevention population comprised a total of 966 participants (666 staff and 300 residents) who were negative at baseline for SARS-CoV-2 infection and serology (mean age, 53.0 [range, 18-104] years; 722 [74.7%] women). Bamlanivimab significantly reduced the incidence of COVID-19 in the prevention population compared with placebo (8.5%vs 15.2%; odds ratio, 0.43 [95%CI, 0.28-0.68]; P < .001; absolute risk difference, ���6.6 [95%CI, ���10.7 to ���2.6] percentage points). Five deaths attributed to COVID-19 were reported by day 57; all occurred in the placebo group. Among 1175 participants who received study product (safety population), the rate of participants with adverse events was 20.1% in the bamlanivimab group and 18.9% in the placebo group. The most common adverse events were urinary tract infection (reported by 12 participants [2%] who received bamlanivimab and 14 [2.4%] who received placebo) and hypertension (reported by 7 participants [1.2%] who received bamlanivimab and 10 [1.7%] who received placebo). CONCLUSIONS AND RELEVANCE Among residents and staff in skilled nursing and assisted living facilities, treatment during August-November 2020 with bamlanivimab monotherapy reduced the incidence of COVID-19 infection. Further research is needed to assess preventive efficacy with current patterns of viral strains with combination monoclonal antibody therapy.

Purpose There is a scarcity of studies assessing the patient population admitted to the intensive care unit (ICU) with opioid overdose. We sought to characterize the epidemiologic features and outcomes of this patient population. Materials and methods This is a retrospective cohort study of adult patients admitted to the ICU at University of Louisville Hospital for opioid overdose. We reviewed each patient's hospital record for demographic data, comorbidities, opioid used, coingestions, and outcomes. Results We included 178 adult patients, of which 107 (60%) were females. The median age was 41 years (interquartile range [IQR], 23). Oxycodone and hydrocodone were the 2 most commonly abused opioids. Benzodiazepines were the most common drug coingested, followed by amphetamines. Tobacco smoking, chronic pain, and alcoholism were the most frequent comorbidities identified. Mental disorders were also common. Most patients required invasive mechanical ventilation (84.8%). Median ICU length of stay was 3 days. Eighteen patients (10.1%) died in the hospital, whereas 6 patients (3.4%) were discharged to a nursing home. Patients who had any coingestion were significantly more likely to undergo invasive mechanical ventilation (91% vs 77%; P = .014) and had longer ICU length of stay (3 [IQR, 2] vs 2 [IQR, 1.8] days; P = .024). Conclusion Opioid overdose is a common cause of ICU admission and affects a relatively young population. Most have respiratory failure requiring mechanical ventilation. It is associated with a relatively high inhospital mortality. Coingestions appear to have an impact on outcomes.

Background and objectives: Antimicrobial photodynamic therapy (aPDT) is a technique that combines the photoactivation properties of an innocuous chromophore or photosensitizer (PS) and light, producing reactive oxygen molecules that trigger cell death processes. In this study the in-vitro application of aPDT to fight fungal infections was investigated using methylene blue (MB) as the PS. Materials and methods: The antimicrobial PDT process was carried out with MB and red laser light (λ=633 nm) to activate the PS. Testing was performed with suspensions of various species of dermatophyte fungi (Trichophyton mentagrophytes, Microsporum canis and Microsporum gypseum), including a fungus, which to our knowledge, has not been previously studied using this dye (Trichophyton tonsurans). For T. tonsurans further optimization tests were carried out. Results and discussion: The fungicidal effect of MB-aPDT was evident. Microsporum strains were slightly more sensitivity to the treatment than Trichophyton strains. The response of T. tonsurans to aPDT was less than to the other fungi tested under the same conditions, or even with higher fluence. However, repetitive aPDT treatment with very low doses of light can achieve a good effectiveness with this strain effecting total growth inhibition. Light may even disturb fungi growth in some circumstances, especially in strain such as T. tonsurans. Conclusion: This study with Trichophyton and Microsporum strains showed that MB was an effective PS to inhibit fungal growth through aPDT, reaching a total inhibition in most of the fungi tested. It was found that repeated exposure with low-power light within the framework of aPDT treatment can achieve better results than a single exposure at higher power.

The advent of PCR has improved the identification of viruses in patients with community-acquired pneumonia (CAP). Several studies have used PCR to establish the importance of viruses in the aetiology of CAP.We performed a systematic review and meta-analysis of the studies that reported the proportion of viral infection detectedviaPCR in patients with CAP. We excluded studies with paediatric populations. The primary outcome was the proportion of patients with viral infection. The secondary outcome was short-term mortality.Our review included 31 studies. Most obtained PCRvianasopharyngeal or oropharyngeal swab. The pooled proportion of patients with viral infection was 24.5% (95% CI 21.5–27.5%). In studies that obtained lower respiratory samples in >50% of patients, the proportion was 44.2% (95% CI 35.1–53.3%). The odds of death were higher in patients with dual bacterial and viral infection (OR 2.1, 95% CI 1.32–3.31).Viral infection is present in a high proportion of patients with CAP. The true proportion of viral infection is probably underestimated because of negative test results from nasopharyngeal or oropharyngeal swab PCR. There is increased mortality in patients with dual bacterial and viral infection.

A finite element (FE) model is used to simulate bond-zone behavior in a pullout test of a single bar embedded in concrete. The proposed FE model treats both the concrete and reinforcing bar in the bond-zone with refined solid elements to explicitly represent the deformations of rebar and the surrounding concrete and employs the surface-to-surface contact model on the concrete-rebar interface to simulate proper load transfer. In modeling of pullout tests, the significance of using a concrete model that can accurately simulate nonlinear response under high confining pressures is emphasized. Two concrete models are discussed and compared from a constitutive modeling perspective: (1) concrete damaged-plasticity (CDP) model and (2) concrete damage plasticity model 2 (CDPM2). Three pullout tests are simulated via the proposed modeling approach each with two concrete models. It is shown that the FE model with CDPM2 produced bond stress and slip responses comparable to test data, while the FE model with CDP model overpredicted bond stress due to concrete response overestimated under high confining stress states. The FE models with CDPM2 can capture different failure modes for different types of specimens: splitting failure for the specimen without confinement and pullout failure for the specimen with confinement.

Visualization of blood vessels is a fundamental task in the evaluation of the health and biological integrity of tissue. Laser speckle contrast imaging (LSCI) is a non-invasive technique to determine the blood flow in superficial or exposed vasculature. However, the high scattering of biological tissue hinders the visualization of those structures. In this paper, we propose the use of principal component analysis (PCA) in combination with LSCI to improve the visualization of deep blood vessels by selecting the most significant principal components. This analysis was applied to in vitro samples, and our results demonstrate that this approach allows for the visualization and localization of blood vessels as deep as 1000 μm.

Background: Community-acquired pneumonia (CAP) is an important complication in patients with chronic obstructive pulmonary disease (COPD). This study aimed to define incidence, and outcomes of COPD patients hospitalized with pneumonia in the city of Louisville, and to estimate the burden of disease in the U.S. population. Methods: This was a secondary analysis of a prospective population-based cohort study of residents in Louisville, Kentucky, 40 years old and older, from June 1st, 2014 to May 31st , 2016. All adults hospitalized with CAP were enrolled. The annual incidence of pneumonia in COPD patients in Louisville was calculated and the total number of adults with COPD hospitalized in the U.S. was estimated. Clinical outcomes included time to clinical stability (TCS), length of hospital stay (LOS), and mortality. Results: From a Louisville population of 18,246 patients living with COPD, 3,419 pneumonia hospitalizations were documented during the two-year study. The annual incidence was 9,369 patients hospitalized with pneumonia per 100,000 COPD population, corresponding to an estimated 506,953 adults with COPD hospitalized due to pneumonia in the US. Median TCS and LOS were 2 and 5 days respectively. Mortality during hospitalization was 5.6%. The mortality of COPD patients at 30-days, 6-months, and 1-year was 11.9%,24.3%, and 33.0%, respectively. Conclusions: There was an annual incidence of 9,369 cases of hospitalized CAP per 100,000 COPD patients in the city of Louisville. This was an approximately 18-fold greater incidence of CAP in COPD patients than in those without COPD, resulting in a high morbidity and financial burden. Funding: This work was supported primarily by the Division of Infectious Diseases, University of Louisville, Kentucky. Partial support was given by Pfizer Inc. Declaration of Interest: There are no conflicts of interest for any of the authors in this manuscript. Ethical Approval: The study was approved by the University of Louisville (UofL) Institutional Review Board (IRB #11.0613) and by the research offices at each participating hospital. Study consents were waived.

With the aim to develop and validate a clinical + ultrasound (US) inflammation score in rheumatoid arthritis (RA) for use in clinical practice, a mixed-method study was conducted. The theoretical development of the index was achieved with qualitative methodology (discussion group and Delphi survey). Subsequently, a cross-sectional study was carried out to analyse issues related to scoring and validation of the new index. RA patients underwent clinical [28 swollen and tender joints count, patient and physician global assessment (PhGA), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)], and US assessments [synovitis or tenosynovitis by grey-scale (GS) and power Doppler (PD) of 42 structures]. An index was created based on statistical models and expert interaction. Construct validity was tested by correlation with DAS28, SDAI, CDAI, and PhGA. Reliability was evaluated in a subgroup of patients with the intraclass correlation coefficient (ICC). US assessment, CRP, and swollen joints were the items that passed the prioritization phase (Delphi study). For the cross-sectional study, 281 patients were randomly divided into design (n = 141) and validation samples (n = 140). The combination of US sites chosen (7 bilaterally) detected the maximum proportion of synovitis and PD present. Three scoring methods were tested: semiquantitative (0-3 GS + 0-3 PD), dichotomous (0/1 GS + 0/1 PD), and qualitative (0/1 based on algorithm). All showed strong correlation with activity measures (? = 0.60), and reliability (ICC 0.89-0.93). The index with best parameters of validity, feasibility, and reliability was the qualitative. The final index chosen was the sum of swollen joint count, US qualitative score, and CRP. The UltraSound Activity score is a valid and reliable measure of inflammation in RA equal to the sum of 28 SJC, a simplified (0/1) US assessment of 11 structures and CRP. It is necessary further investigation to demonstrate additional value over existing indices.

This report investigates a new methodology for load rating of older reinforced concrete flat-slab and T-beam bridges in Indiana, using the tools of 3D finite element analysis. The Conventional Load Rating (CLR) method currently in use by INDOT relies on a simplified 2D analysis based on beam theory that may underestimate bridge capacity. Since the actual behavior of a bridge structure is 3D in nature, a 3D computational model is better suited to estimate bridge response for load rating. 3D finite elements models are capable of reflecting actual bridge dimensions, cross sections, and connection configurations. More importantly, with three-dimensional models, the load distribution in the transverse direction of the deck can be explicitly represented, and therefore optimized for maximum impact on load rating. Using 3D models, it is also possible to account for support continuity, variable cross sections, skew factor, edge railings, and other parameters that impact bridge behavior. It is therefore expected that load rating using 3D analysis can result in a more accurate assessment of bridge load carrying capacity compared to CLR by improving demand estimates. A sample of ten representative bridges (five of each type) is selected for this study. The representative bridges were identified based on the statistical distribution of older flat slab and T-beam RC bridges in Indiana. Load rating analysis results for the sample bridges using 3D analysis were compared to ratings obtained using CLR to identify factors contributing to bridge capacity that are not accurately represented with current rating standards. The results show significantly improved rating factors using 3D FE models. A sensitivity study was conducted to assess the impact of select parameters on load rating results and identify potential improvements to current load rating procedures using CLR.

Objective To analyse the prevalence of pre-existing palindromic rheumatism (PR) in patients with established rheumatoid arthritis (RA) and evaluate whether these patients have a distinctive clinical and serological phenotype. Methods Cross-sectional study in patients with established RA. Pre-existing PR was determined using a structured protocol and confirmed by retrospective review of medical records. Demographic, clinical, radiological, immunological and therapeutic features were compared in patients with and without PR. Results 158 patients with established RA (78% female) with a mean disease duration since RA onset of 5.1 ± 2.7 years were included. Pre-existing PR was recorded in 29 patients (18%). The median time from the onset of PR to progression to RA was 1.2 years. No between-group differences in demographic features, current disease activity radiographic erosive disease or disability were observed. Patients with PR had a higher prevalence of smoking (72% vs. 40%). Positive rheumatoid factor, anti-citrullinated peptide antibodies and anti-carbamylated protein antibodies were numerically higher in patients with PR. No differences in treatment were observed except for greater hydroxychloroquine use in patients with PR (38% vs. 6%). Palindromic flares persisted in a significant proportion of patients during the RA course, including patients in clinical remission or receiving biological DMARDs. Conclusion Eighteen percent of patients with RA had a history compatible with PR previous to RA onset. No specific clinical or serological phenotype was identified in these patients, although higher hydroxychloroquine use and smoking prevalence were identified. Palindromic flares may persist during the RA disease course despite treatment.

Visualization of blood vessels in contrast images is an important task as it is used to analyze the dynamics of the blood flow and the health status of biological tissue. However, this task becomes difficult due to the noise in the image, mainly at high depths. This work proposes a methodology based on the Discrete Wavelet Transform to improve in-vitro blood vessels visualization. It also addresses the segmentation of the regions of interest through morphological operations in improved contrast images. Results show that it is possible to visualize the blood vessels even at 700$\mu$m below an epidermis phantom.

Aims: To describe the methodology of REAPSER (Spanish Registry of Recent-onset Psoriatic Arthritis), its strengths and limitations. The aim of this study is to identify prognostic factors for the clinical and radiographic course in a cohort of patients with psoriatic arthritis (PsA) diagnosed within 2 years of symptom evolution. Methods: Multicenter, observational and prospective study (with 2-year follow-up including annual visits). Baseline visit intended to reflect patient situation before the disease course was modified by treatments prescribed in rheumatology departments. Patients were invited to participate consecutively in one of their routine visits to the rheumatologist. 211 patients were included. Following data were collected: sociodemographic variables; employment situation; family history; personal history and comorbidities; anthropometric data; lifestyle; use of healthcare services; clinical situation at the time of PsA diagnosis; joint involvement and spinal pain; pain and overall assessment; enthesitis, dactylitis and uveitis; skin and nail involvement; functional situation and quality of life; radiographic evaluation; analytical determinations; treatment; axial and peripheral flare-ups. Conclusions: The REAPSER study includes a cohort of patients with recent-onset PsA, before the disease course was modified by disease-modifying antirheumatic drugs prescribed in rheumatology departments. Exhaustive information collected in each visit is expected to be an important data source for future analysis. (C) 2018 Elsevier Espafia, S.L.U. and Sociedad Espailola de Reumatologia y Colegio Mexicano de Reumatologia. All rights reserved.

ObjectivePsoriatic arthritis (PsA) is a chronic inflammatory arthritis affecting up to 30% of patients with psoriasis (Ps). To date, most of the known risk loci for PsA are shared with Ps, and identifying disease-specific variation has proven very challenging. The objective of the present study was to identify genetic variation specific for PsA.MethodsWe performed a genome-wide association study in a cohort of 835 patients with PsA and 1558 controls from Spain. Genetic association was tested at the single marker level and at the pathway level. Meta-analysis was performed with a case–control cohort of 2847 individuals from North America. To confirm the specificity of the genetic associations with PsA, we tested the associated variation using a purely cutaneous psoriasis cohort (PsC, n=614) and a rheumatoid arthritis cohort (RA, n=1191). Using network and drug-repurposing analyses, we further investigated the potential of the PsA-specific associations to guide the development of new drugs in PsA.ResultsWe identified a new PsA risk single-nucleotide polymorphism at B3GNT2 locus (p=1.10e-08). At the pathway level, we found 14 genetic pathways significantly associated with PsA (pFDRConclusionThese findings provide insights into the biological mechanisms that are specific for PsA and could contribute to develop more effective therapies.

ObjectiveThe aim of this study was to evaluate the discriminant capability of the Patient Acceptable Symptom State (PASS) according to disease activity, remission/low disease activity indices and quality of life indices in patients with psoriatic arthritis (PsA).MethodsConsecutive patients with PsA were enrolled in this cross-sectional study. At each visit, the patients underwent a complete physical examination and their clinical/laboratory data were collected. Disease activity was assessed using the Disease Activity Score for Psoriatic Arthritis (DAPSA) and remission/low disease activity using the DAPSA minimal disease activity (MDA) and very low disease activity (VLDA) criteria. The Psoriatic Arthritis Impact of Disease (PsAID) and the Health Assessment Questionnaire-Disability Index scores were also collected. Finally, PASS was assessed by asking all patients to answer yes or no to a single question.ResultsPatients who answered yes to PASS showed a significantly better overall mean DAPSA score than those who were not in PASS. Furthermore, patients in PASS showed a significantly lower level of systemic inflammation, lower Leeds Enthesitis Index score, a significantly lower impact of disease (PsAID), lower pain and better function than patients who answered no to PASS. A moderate to good agreement was found between PASS, MDA, DAPSA low disease activity and PsAID score ≤4. Good sensitivity and specificity were found with PASS with respect to DAPSA low disease activity, and although PASS is sensitive in the identification of patients with MDA, DAPSA remission and VLDA it lacks of specificity.DiscussionThis study showed that PASS might be used as an alternative to determine disease activity in patients with PsA in real clinical practice, mainly in patients with low disease activity according to DAPSA criteria.

Future permanent habitats on the Moon may facilitate space exploration by serving as an outpost for manned missions to other planets. Safety and resilience of those habitats are the main concerns, especially given the existing dangerous conditions and hazards such as temperature fluctuation, radiation, seismic activity, and meteorite impacts. Underground habitats in the form of “lava tubes” are good candidates for permanent human shelters because they provide immediate protection from such hazards. Evidence for their existence under the surface of the Moon is provided by GRAIL, SELENE spacecraft, and the LRO. Data from GRAIL suggests that the width of the lava tubes can be as large as 1–2 km. However, the size and geometry configurations under which the lava tubes are stable are not well-defined and there are no well-established criteria for their stability. The paper provides analytical and numerical solutions to estimate the size and stability of lunar lava tubes. Analytical solutions use the flow characteristics of molten lava and the limit equilibrium analysis of the collapsed pits to estimate the size of the tubes. Numerical analyses are conducted for different geometries and for different material properties of the lava. Different sizes are considered, from 300 m, up to 4000 m in width. The results show that the key parameters for the stability of the tubes are the roof thicknesses and the strength of the lava, in particular, its tensile strength. As the lava tube gets wider, a larger tensile strength and roof thicknesses are needed for the tube to remain stable. The analyses show that 1 km wide lava tubes are likely to exist and remain stable, which agree with GRAIL observations. For larger widths, minimum roof thicknesses of few hundred meters might be necessary to preserve their stability.

Numerical simulations using the Finite-Difference Time-Domain method were used to study the propagation of an acoustic wave within a truncated ellipsoidal cavity. Based in our simulations, a fluidic device was designed and fabricated using a 3D printer in order to focus an acoustic wave more efficiently and expel a liquid jet. The device consists of an ellipsoidal shaped chamber filled with a highly absorbent solution at the operating wavelength (1064 nm) in order to create a vapor bubble using a continuous wavelength laser. The bubble rapidly expands and collapses emitting an acoustic wave that propagates inside the cavity, which was measured by using a needle hydrophone. The bubble collapse, and source of the acoustic wave, occurs in one focus of the cavity and the acoustic wave is focused on the other one, expelling a liquid jet to the exterior. The physical mechanism of the liquid jet generation is momentum transfer from the acoustic wave, which is strongly focused due to the geometry of the cavity. This mechanism is different to the methods that uses pulsed lasers for the same purpose. The maximum speed of the generated liquid microjets was approximately 20 m/s. One potential application of this fluidic device can be found for inkjet printing, coating and, maybe the most attractive, for drug delivery.

Objective Denosumab is an antiresorptive drug with demonstrated efficacy in the treatment of osteoporosis. However, discontinuation of this agent is associated with increased bone turnover and rapid bone loss, and more recently, with the development of vertebral fractures (VF) in some patients. Therefore, the aim of the study was to analyze the clinical characteristics, bone metabolism parameters and evolution of a group of patients who developed vertebral fractures after denosumab discontinuation. In addition, we reviewed the literature on this subject. Methods During a period of 28 months (September 2015–January 2018) 7 women presenting spontaneous vertebral fractures after denosumab discontinuation were attended in the Rheumatology Department of our centre. We analyzed their clinical characteristics, bone metabolism parameters and evolution and reviewed the literature related to this subject. Results The patients had received denosumab during 24–58 months (median 38), and developed a median of 5 VF per patient at 8–20 months (median 10) since the last dose of denosumab. Only 2 patients presented previous VF, and most (5 patients) received previous bisphosphonate treatment. After VF all restarted antiosteoporotic treatment with no further fractures during follow-up (median 19 months). Conclusions In this short series, previous bisphosphonate treatment does not seem to be a protective factor for the development of VF. The possible development of VF following discontinuation of denosumab must be taken into account in the clinical practice of physicians and dentists. Nonetheless, further studies are needed to improve the identification of patients at risk and the most adequate sequential treatment options.

A trustworthy speckle contrast calculation is fundamental in many applications, such as “laser speckle contrast Imaging” (LSCI), which is a non-invasive technique commonly employed to estimate relative blood speed. In LSCI, the local contrast of a speckle image is calculated using spatial, temporal analysis or a combination of both. In this work, we focus on the spatial analysis. To calculate the local spatial contrast, typically, a sliding window of 5x5 pixels is used to calculate the standard deviation (σs) and the mean intensity (s) of those 5x5 pixels and the calculated contrast KS=σs/(s) is assigned to the central pixel of the sliding window. In this work, we show that this experimental procedure to calculate the local speckle contrast does not match the corresponding spatial theoretical model and we propose an alternative method that considers correlations of the central pixel with the other ones. We have found a better agreement of the contrast measurement with our numerical calculation.

Speckle contrast analysis had been used for multiples purposes, for instance, laser speckle contrast imaging (LSCI) has been used to estimate the relative blood flow speed in a non-invasive way. The speckle contrast can be calculated using a spatial or temporal algorithm or a combination of both. Our work focuses into the contrast temporal algorithm. A contrast image calculated with the temporal contrast algorithm requires a sequence of L equal-sized frames. The contrast images are performed pixel by pixel, however, the experimental contrast calculation does not match with the current temporal theoretical model especially when the exposure time T is smaller than the correlation time τc. In this work, we propose to correlate neighboring pixels along the temporal axis to improve the contrast calculation. The contrast measurements using our proposal provide a better agreement than the current models.

Background Calprotectin is a biomarker of disease activity in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) and predicts relapse in juvenile idiopathic arthritis. Higher drug trough serum levels are associated with a good response in patients treated with tumor necrosis factor inhibitors (TNFi). Power Doppler ultrasound synovitis is predictive of relapse and structural damage progression in patients in clinical remission. The purpose of this study was to analyze the accuracy of serum calprotectin levels, drug trough serum levels (TSL), and power Doppler (PD) activity as predictors of relapse in RA and PsA patients in remission or with low disease activity receiving TNFi. Methods This was a longitudinal, prospective, 1-year single-center study of 103 patients (47 RA, 56 PsA) receiving TNFi in remission or with low disease activity (28-joint Disease Activity Score (DAS28) ≤ 3.2). The predictive value of serum calprotectin, TNFi TSL, and PD were assessed using receiver operating characteristic (ROC) analyses. To illustrate the predictive performance of calprotectin, TNFi TSL, and PD score, Kaplan-Meier curves were constructed from baseline to relapse. Associations between baseline factors and relapse were determined using Cox regression models. Multivariate models were constructed to analyze the effect of covariates and to fully adjust the association between calprotectin, TNFi TSL, and PD score with relapse. A generalized estimating equation model with an identity link for longitudinal continuous outcomes was used to assess the effect of covariates on TNFi TSL. Results Ninety-five patients completed 1 year of follow-up, of whom 12 experienced a relapse. At baseline, relapsers had higher calprotectin levels, lower TNFi TSL, and higher PD activity than nonrelapsers. ROC analysis showed calprotectin fully predicted relapse (area under the curve (AUC) = 1.00). TNFi TSL and PD had an AUC of 0.790 (95% confidence interval (CI) 0.691–0.889) and 0.877 (95% CI 0.772–0.981), respectively. Survival analyses and log rank tests showed significant differences between groups according to calprotectin serum levels (p

Background Denosumab (Dmab) is an antiresorptive treatment with demonstrated efficacy in osteoporosis. However, discontinuation of Dmab has been associated with rapid bone loss, and recently, the development of vertebral fractures (VF) in some patients. It is essential to identify the risk factors for these adverse events and follow its evolution. Objectives To analyse the clinical characteristics, parameters of bone metabolism and evolution of patients developing VF after Dmab discontinuation. Methods Six women with spontaneous VF after Dmab discontinuation were included (median age 66 years56–75). The clinical history, cause of osteoporosis, treatments received, fractures, Dmab treatment duration and discontinuation period were reviewed. Additionally, the clinical and densitometric evolution, and bone mineral parameters were also analysed after Dmab discontinuation. Results All the patients had postmenopausal osteoporosis, and one was receiving glucocorticoid treatment; 3/6 patients had previous fractures (2 VF and 1 calcaneus); 4/6 had previously received antiosteoporotic treatment (hormone replacement therapy, risedronate, alendronate, zoledronate [once or consecutively)] during 1–23 years. All had received Dmab for 24–53 months (median 37). The reasons for treatment discontinuation were: dental indication (1 patient), BMD improvement (T-score −1.2) (1 patient), poor adherence,1 prescription problems and/or delay in administration.3 The median bone mineral density T-scores prior to VF were −2.6 (-1.2/–4) at the lumbar spine and −3.0 (-0.6/–3.7) at the femoral neck. The mean time between the last Dmab dose and VF was 9.5 months,8–20 with a median of 5 VFs/patient.2–8 No patient showed 25-OH vitamin D Conclusions Discontinuation of Dmab is associated with an increase in bone turnover markers and bone loss which can be associated with the development of spontaneous VF. Previous bisphosphonate therapy does not seem to decrease this risk. Further studies are needed to assess the optimal antiresorptive treatment and its duration after Dmab discontinuation. Disclosure of Interest None declared

The Faculty for Undergraduate Neuroscience (FUN) has mounted many summer workshops since its first in 1995 held at Davidson College. An important outcome of the 1995 workshop was the development of four “blueprints” to help guide institutions in developing and maintaining undergraduate programs in neuroscience. Since then, at approximately ten-year intervals, participants at the FUN workshops have revisited and amended the Blueprints to better reflect best practices in undergraduate neuroscience education, including adding a fifth blueprint in 2005. In 2017, participants at the FUN workshop held at Dominican University again conducted a review of the blueprints and amended each of the five. A significant change resulting from the 2017 discussions was revision of the neuroscience minor blueprint to reflect the evolution of this program type across institutions.

To visualize blood vessels in Laser Speckle Imaging (LSI) is an important task since parameters such as blood pressure, relative blood flow and vessel size can be estimated through of them to then be used in medical diagnostics. LSI is the common method for visualizing blood vessels however, resulting images contain a high level of noise. For improving the visualization in LSI a contrast representation is computed in spatial or temporal way. Commonly, the spatial approach is used but it reduces the temporal resolution and vice versa. In this work, a space-directional approach that keeps a high resolution by computing contrast in an adaptive directional process while also deals with noise attenuation, is proposed.

Laser Speckle Imaging (LSI) is a useful technique in medical applications since it provides information about blood flow and vascular. Traditional LSI uses standard window sizes (5×5 or 7×7) for contrast computing without taking into account the size of the ROIs (blood vessels). The speckle noise affects the whole image, however, the blood vessel region is smoother. On the one hand, a small window preserves spatial resolution but it barely attenuates the speckle noise; on the other hand, a large window significantly reduces the noise at the expense of losing spatial resolution and small ROIs. Therefore, a window size that fits with the size of the blood vessel is the one that can deal with the noise/resolution trade-off adequately. This paper proposes an automatic methodology, based on granulometry analysis, to estimate the accurate window size for contrast computation in a speckle image. The results are compared with traditional techniques for LSI.

Blood vessels segmentation and visualization is an important task since it is used to analyze the health status of a biological tissue. However, this task becomes difficult because of the noise in the image, mainly at high depths. This paper addresses a method based on a morphological analysis of blood vessels for segmentation in LSI images. Moreover, the proposed methodology deals with the disconnection in the blood vessel region, caused by intense noise, restoring the structure to allow its visualization. Results demonstrate that it is possible to visualize blood vessels even at 600μm, and that the proposed reconnection map also is useful for contrast improvement.