The Scottish Early Rheumatoid Arthritis (SERA) Study:an inception cohort and biobank

Background: The Scottish Early Rheumatoid Arthritis (SERA) study is an inception cohort of rheumatoid (RA) and undifferentiated arthritis (UA) patients that aims to provide a contemporary description of phenotype and outcome and facilitate discovery of phenotypic and prognostic biomarkers Methods: Demographic and clinical outcome data are collected from newly diagnosed RA/UA patients every 6 months from around Scotland. Health service utilization data is acquired from Information Services Division, NHS National Services Scotland. Plain radiographs of hands and feet are collected at baseline and 12 months. Additional samples of whole blood, plasma, serum and filtered urine are collected at baseline, 6 and 12 months Results: Results are available for 1073 patients; at baseline, 76 % were classified as RA and 24 % as UA. Median time from onset to first review was 163 days (IQR97-323). Methotrexate was first-line DMARD for 75 % patients. Disease activity, functional ability and health-related quality of life improved significantly between baseline and 24 months, however the proportion in any employment fell (51 to 38 %, p = 0.0005). 24 % patients reported symptoms of anxiety and/or depression at baseline. 35/391 (9 %) patients exhibited rapid radiographic progression after 12 months. The SERA Biobank has accrued 60,612 samples Conclusions: In routine care, newly diagnosed RA/UA patients experience significant improvements in disease activity, functional ability and health-related quality of life but have high rates of psychiatric symptoms and declining employment rates. The co-existence of a multi-domain description of phenotype and a comprehensive biobank will facilitate multi-platform translational research to identify predictive markers of phenotype and prognosis

Комбинированная терапия диссеминированной формы кольцевидной гранулемы

Purpose. To present the results of the treatment of disseminated form of granuloma annulare with remote long-wave ultraviolet therapy and low level laser therapy. Material and methods. Two female patients at the age of 50 and 53 years with complaints of generalised eruptions on the skin of the trunk, upper and lower limbs and a histologically confirmed diagnosis were treated using a combination of remote long-wave ultraviolet therapy and low level laser therapy of infrared spectrum. 16 sessions of remote long-wave ultraviolet therapy and 10 sessions of low level laser therapy were conducted directly on the lesions. Considering the multidirectionality of the mechanisms of action of phototherapy and laser therapy, the procedures were carried out on different days or with many hours long intervals. Results. Combined use of the remote long-wave ultraviolet therapy and laser therapy led to a significant improvement by the 21st day of the treatment. No side effects were noticed during the treatment, tolerance of the sessions was good. Conclusion. Combined use of the remote long-wave ultraviolet therapy and low level laser therapy of infrared spectrum is effective in treatment of disseminated form of granuloma annulare.Цель. Представить результаты лечения диссеминированной формы кольцевидной гранулемы с применением дальней длинноволновой ультрафиолетовой терапии и низкоинтенсивной лазерной терапии. Материал и методы. 2 пациенткам в возрасте 50 и 53 лет, обратившимся с жалобами на распространенные высыпания на коже туловища, верхних и нижних конечностей и гистологически верифицированным диагнозом, проведено комбинированное лечение с применением дальней длинноволновой ультрафиолетовой терапии и низкоинтенсивной лазерной терапии инфракрасного спектра. Проведено 16 процедур общей дальней длинноволновой ультрафиолетовой терапии и 10 процедур низкоинтенсивной лазерной терапии контактно на очаги поражения. Учитывая разнонаправленность механизмов действия методов фототерапии и лазеротерапии, процедуры проводились в разные дни либо с многочасовым интервалом. Результаты. При использовании метода дальней длинноволновой ультрафиолетовой терапии в комбинации с лазерной терапией отмечено существенное улучшение к 21-му дню терапии. Побочных эффектов в процессе лечения не отмечалось, переносимость процедур была хорошая. Заключение. Комбинированное применение дальней длинноволновой ультрафиолетовой терапии и низкоинтенсивной лазерной терапии инфракрасного спектра является эффективным при лечении диссеминированной формы кольцевидной гранулемы

The clinical effectiveness and cost-effectiveness of treat-to-target strategies in rheumatoid arthritis: a systematic review and cost-effectiveness analysis

Background: Treat to target (TTT) is a broad concept for treating patients with rheumatoid arthritis (RA). It involves setting a treatment target, usually remission or low disease activity (LDA). This is often combined with frequent patient assessment and intensive and rapidly adjusted drug treatment, sometimes based on a formal protocol. Objective: To investigate the clinical effectiveness and cost-effectiveness of TTT compared with routine care. Data sources: Databases including EMBASE and MEDLINE were searched from 2008 to August 2016. Review methods: A systematic review of clinical effectiveness was conducted. Studies were grouped according to comparisons made: (1) TTT compared with usual care, (2) different targets and (3) different treatment protocols. Trials were subgrouped by early or established disease populations. Study heterogeneity precluded meta-analyses. Narrative synthesis was undertaken for the first two comparisons, but was not feasible for the third. A systematic review of cost-effectiveness was also undertaken. No model was constructed as a result of the heterogeneity among studies identified in the clinical effectiveness review. Instead, conclusions were drawn on the cost-effectiveness of TTT from papers relating to these studies. Results: Sixteen clinical effectiveness studies were included. They differed in terms of treatment target, treatment protocol (where one existed) and patient visit frequency. For several outcomes, mixed results or evidence of no difference between TTT and conventional care was found. In early disease, two studies found that TTT resulted in favourable remission rates, although the findings of one study were not statistically significant. In established disease, two studies showed that TTT may be beneficial in terms of LDA at 6 months, although, again, in one case the finding was not statistically significant. The TICORA (TIght COntrol for RA) trial found evidence of lower remission rates for TTT in a mixed population. Two studies reported cost-effectiveness: in one, TTT dominated usual care; in the other, step-up combination treatments were shown to be cost-effective. In 5 of the 16 studies included the clinical effectiveness review, no cost-effectiveness conclusion could be reached, and in one study no conclusion could be drawn in the case of patients denoted low risk. In the remaining 10 studies, and among patients denoted high risk in one study, cost-effectiveness was inferred. In most cases TTT is likely to be cost-effective, except where biological treatment in early disease is used initially. No conclusions could be drawn for established disease. Limitations: TTT refers not to a single concept, but to a range of broad approaches. Evidence reflects this. Studies exhibit substantial heterogeneity, which hinders evidence synthesis. Many included studies are at risk of bias. Future work: Future studies comparing TTT with usual care must link to existing evidence. A consistent definition of remission in studies is required. There may be value in studies to establish the importance of different elements of TTT (the setting of a target, the intensive use of drug treatments and protocols pertaining to those drugs and the frequent assessment of patients). Conclusion: In early RA and studies of mixed early and established RA populations, evidence suggests that TTT improves remission rates. In established disease, TTT may lead to improved rates of LDA. It remains unclear which element(s) of TTT (the target, treatment protocols or increased frequency of patient visits) drive these outcomes. Future trials comparing TTT with usual care and/or different TTT targets should use outcomes comparable with existing literature. Remission, defined in a consistent manner, should be the target of choice of future studies. Study registration: This study is registered as PROSPERO CRD42015017336. Assessment programme

Capability of Integer Programming Algorithms in Solving Water Resource Planning Problems

The feasibility of optimizing large regional water resource planning problems by means of integer programming algorithms is analyzed. Two types of integer programming models are developed: (1) A water supply model including 23 separate but geographically related community systems; and (2) a river basin water quality model including 15 point sources of wastewater, 4 types of pollutants, 6 surveillance points, and 7 alternative treatment processes. The water supply model was structured as a mixed integer problem (some continuous variables included) while the water quality model was an all integer problem. Four integer programming algorithms were tested on the sample problems as follows: (1) MXINT – The Burroughs B6700 TEMPO package algorithm; (2) FMPS-MIP – The UNIVAC 1108 MPS package algorithm; (3) GMINT – A proprietary algorithm authored by A. M. Geoggrion and R.D. McBride; and ($) AIP – A 0,1 algorithm which uses the Balas additive concept. Several versions (sizes) of both problems were successfully solved by one or more of the algorithms with computational efforts ranging from less than 1 to more than 40 minutes of CPU time

Practical consensus guidelines for the management of enuresis

Despite the high prevalence of enuresis, the professional training of doctors in the evaluation and management of this condition is often minimal and/or inconsistent. Therefore, patient care is neither optimal nor efficient, which can have a profound impact on affected children and their families. Once comprehensive history taking and evaluation has eliminated daytime symptoms or comorbidities, monosymptomatic enuresis can be managed efficaciously in the majority of patients. Non-monosymptomatic enuresis is often a more complex condition; these patients may benefit from referral to specialty care centers. We outline two alternative strategies to determine the most appropriate course of care. The first is a basic assessment covering only the essential components of diagnostic investigation which can be carried out in one office visit. The second strategy includes several additional evaluations including completion of a voiding diary, which requires extra time during the initial consultation and two office visits before treatment or specialty referral is provided. This should yield greater success than first-line treatment. Conclusion: This guideline, endorsed by major international pediatric urology and nephrology societies, aims to equip a general pediatric practice in both primary and secondary care with simple yet comprehensive guidelines and practical tools (i.e., checklists, diary templates, and quick-reference flowcharts) for complete evaluation and successful treatment of enuresis

Does intensive management improve remission rates in patients with intermediate rheumatoid arthritis? (the TITRATE trial): study protocol for a randomised controlled trial.

BACKGROUND: Uncontrolled active rheumatoid arthritis can lead to increasing disability and reduced quality of life over time. 'Treating to target' has been shown to be effective in active established disease and also in early disease. However, there is a lack of nationally agreed treatment protocols for patients with established rheumatoid arthritis who have intermediate disease activity. This trial is designed to investigate whether intensive management of disease leads to a greater number of remissions at 12 months. Levels of disability and quality of life, and acceptability and cost-effectiveness of the intervention will also be examined. METHODS: The trial is a 12-month, pragmatic, randomised, open-label, two-arm, parallel-group, multicentre trial undertaken at specialist rheumatology centres across England. Three hundred and ninety-eight patients with established rheumatoid arthritis will be recruited. They will currently have intermediate disease activity (disease activity score for 28 joints assessed using an erythrocyte sedimentation rate of 3.2 to 5.1 with at least three active joints) and will be taking at least one disease-modifying anti-rheumatic drug. Participants will be randomly selected to receive intensive management or standard care. Intensive management will involve monthly clinical reviews with a specialist health practitioner, where drug treatment will be optimised and an individualised treatment support programme delivered based on several principles of motivational interviewing to address identified problem areas, such as pain, fatigue and adherence. Standard care will follow standard local pathways and will be in line with current English guidelines from the National Institute for Health and Clinical Excellence. Patients will be assessed initially and at 6 and 12 months through self-completed questionnaires and clinical evaluation. DISCUSSION: The trial will establish whether the known benefits of intensive treatment strategies in active rheumatoid arthritis are also seen in patients with established rheumatoid arthritis who have moderately active disease. It will evaluate both the clinical and cost-effectiveness of intensive treatment. TRIAL REGISTRATION: Current Controlled Trials, ID: ISRCTN70160382 . Registered on 16 January 2014.MRC Funding: MC_UP_1302/3 NIHR Funding: RP-PG-0610-1006

Feasibility study of intelligent autonomous determination of the bladder voiding need to treat bedwetting using ultrasound and smartphone ML techniques

Unsatisfactory cure rates for the treatment of nocturnal enuresis (NE), i.e. bed-wetting, have led to the need to explore alternative modalities. New treatment methods that focus on preventing enuretic episodes by means of a pre-void alerting system could improve outcomes for children with NE in many aspects. No such technology exists currently to monitor the bladder to alarm before bed-wetting. The aim of this study is to carry out the feasibility of building, refining and evaluating a new, safe, comfortable and non-invasive wearable autonomous intelligent electronic device to monitor the bladder using a single-element low-powered low-frequency ultrasound with the help of Machine Learning techniques and to treat NE by warning the patient at the pre-void stage, enhancing quality of life for these children starting from the first use. The sensitivity and specificity values are 0.89 and 0.93 respectively for determining imminent voiding need. The results indicate that customised imminent voiding need based on the expansion of the bladder can be determined by applying a single-element transducer on a bladder in intermittent manner. The acquired results can be improved further with a comfortable non-invasive device by adding several more features to the current features employed in this pilot study

Történelemtanításban alkalmazott játékok intrapszichés hatása.

Szakdolgozatomban a játék hasznosítható szerepét kutatom, illetve a játék intrapszichés hatásait a tanítási-tanulási folyamat során. Két típusú tanulócsoportot hasonlítok össze. Az egyik tanulócsoport játékos módszereket alkalmaz a történelemtanulás során, a másik pedig hagyományos eszközöket használ. Látni fogjuk ezeknek a módszereknek az előnyeit és hátrányait. Kiderül, hogy milyen hatással vannak a teljesítményre, a diákok szoronganak-e számonkérés előtt, és végül, de nem utolsó sorban, melyik csoport rendelkezik pozitívabb jövőképpel, és az én-hatékonyság skálán hol helyezkedik el a két csoport?MSc/MAPszichológi