Associations of baseline use of biologic or targeted synthetic DMARDs with COVID-19 severity in rheumatoid arthritis:Results from the COVID-19 Global Rheumatology Alliance physician registry

Objective To investigate baseline use of biologic or targeted synthetic (b/ts) disease-modifying antirheumatic drugs (DMARDs) and COVID-19 outcomes in rheumatoid arthritis (RA). Methods We analysed the COVID-19 Global Rheumatology Alliance physician registry (from 24 March 2020 to 12 April 2021). We investigated b/tsDMARD use for RA at the clinical onset of COVID-19 (baseline): abatacept (ABA), rituximab (RTX), Janus kinase inhibitors (JAKi), interleukin 6 inhibitors (IL-6i) or tumour necrosis factor inhibitors (TNFi, reference group). The ordinal COVID-19 severity outcome was (1) no hospitalisation, (2) hospitalisation without oxygen, (3) hospitalisation with oxygen/ventilation or (4) death. We used ordinal logistic regression to estimate the OR (odds of being one level higher on the ordinal outcome) for each drug class compared with TNFi, adjusting for potential baseline confounders. Results Of 2869 people with RA (mean age 56.7 years, 80.8% female) on b/tsDMARD at the onset of COVID-19, there were 237 on ABA, 364 on RTX, 317 on IL-6i, 563 on JAKi and 1388 on TNFi. Overall, 613 (21%) were hospitalised and 157 (5.5%) died. RTX (OR 4.15, 95% CI 3.16 to 5.44) and JAKi (OR 2.06, 95% CI 1.60 to 2.65) were each associated with worse COVID-19 severity compared with TNFi. There were no associations between ABA or IL6i and COVID-19 severity. Conclusions People with RA treated with RTX or JAKi had worse COVID-19 severity than those on TNFi. The strong association of RTX and JAKi use with poor COVID-19 outcomes highlights prioritisation of risk mitigation strategies for these people.</p

Creativity and Modularity in Architecture

The Modern Movement in Architecture put forward industrialization, mass production and standardization among its most important banners. At the end of the century those principles are partially applied. However, the overwhelming growing of exchanges and the purchase of artifacts coming from all over the world to be assembled in order to create new artifacts, determines that in the short span, a world wide standardization becomes unavoidable. Designers should be aware about this imminent issue. Working with standard objects means modular thinking. If modules are conceived as sort of constraining entities framing the mind, creative thinking is facing a gloomy prospect. Creativity and freedom seem to be jeopardized by ready made objects. In fact, from the beginning of design as a form- giving activity it exists a dialectic between creativity and feasibility. It is not surprising since designing is essentially the transformation of ideas into real world objects. Nonetheless, the increasing standardization and the indispensable use of computers are exasperating that dialectics. In this paper is argued that if the characteristics of modular procedures are used in the early stage of the design process to prompt the form for further adjustment, creative thinking is released from excessive awareness about dimensional constraints. The first part of the paper is devoted to the description of the contextural trends that make modular thinking relevant. In the second part some propositions about the use of computer systems to generate “modular freedomi are exposed together with examples illustrating the proposed process

Crystallization and preliminary crystallographic analysis of fragaceatoxin C, a pore-forming toxin from the sea anemone Actinia fragacea

Fragaceatoxin C, a newly characterized actinoporin from A. fragacea, has been crystallized. Diffraction data were collected to 1.8 Å resolution