Background: Etanercept reduces disease activity in adults with chronic rheumatoid arthritis (RA) who are resistant to other therapies. Medicare Australia Pharmaceutical Benefit Scheme subsidized ...treatment (since August 2003) restricts etanercept availability to a most drug‐resistant RA population. The aim of the study was to assess the efficacy of etanercept in this unique group after 12 months of therapy.
Methods: A prospective study of the first 50 consecutive private practice, adult RA patients whom were commenced on etanercept. The primary efficacy measures included short form 36 scores, Disease Activity Score 28, American College of Rheumatology (ACR) response improvement in per cent and the ACR individual core set components at baseline, 3 and 12 months. Analysis was by intention to treat.
Results: There was significant improvement in all mean short form 36 component scores (P < 0.05) and all ACR core set component scores (P < 0.05) comparing 12 months to baseline. The disease activity score 28 also significantly fell from baseline at both 3 and 12 months (P < 0.05). The ACR 20% response significantly improved (P < 0.05) both at baseline to 3 months 92% (81.2, 96.9) and to 12 months 80% (67.0, 88.8). Serious adverse events occurred in 16%. At 12 months 88% completed treatment.
Conclusion: Etanercept therapy will, by 3 and 12 months, significantly improve the short form 36, disease activity score 28, ACR 20% response and core set components. Our results are similar to international studies using etanercept in efficacy and tolerance despite our cohort being more resistant to preceding drug therapy. Etanercept offers this unique active severe refractory late RA Australian population a new therapeutic option to control their disease.
Background: Prospective data describing the appropriateness of use of colonoscopy based on detailed panel-based clinical criteria are not available.
Methods: In a cohort of 553 consecutive patients ...referred for colonoscopy to two university-based Swiss outpatient clinics, the percentage of patients who underwent colonoscopy for appropriate, equivocal, and inappropriate indications and the relationship between appropriateness of use and the presence of relevant endoscopic lesions was prospectively assessed. This assessment was based on criteria of the American Society for Gastrointestinal Endoscopy and explicit American and Swiss criteria developed in 1994 by a formal panel process using the RAND/UCLA appropriateness method.
Results: The procedures were rated appropriate or equivocal in 72.2% by criteria of the American Society for Gastrointestinal Endoscopy, in 68.5% by explicit American criteria, and in 74.4% by explicit Swiss criteria (not statistically significant, NS). Inappropriate use (overuse) of colonoscopy was found in 27.8%, 31.5%, and 25.6%, respectively (NS). The proportion of appropriate procedures was higher with increasing age. Almost all reasons for using colonoscopy could be assessed by the two explicit criteria sets, whereas 28.4% of reasons for using colonoscopy could not be evaluated by the criteria of the American Society for Gastrointestinal Endoscopy (
p < 0.0001). The probability of finding a relevant endoscopic lesion was distinctly higher in the procedures rated appropriate or equivocal than in procedures judged inappropriate.
Conclusions: The rate of inappropriate use of colonoscopy is substantial in Switzerland. Explicit criteria allow assessment of almost all indications encountered in clinical practice. In this study, all sets of appropriateness criteria significantly enhanced the probability of finding a relevant endoscopic lesion during colonoscopy. (Gastrointest Endosc 1998;48:128-36.)
We examined foraging behavior (microhabitat use and feeding behavior) in a trophically polymorphic cichlid fish, Herichthys minckleyi, to address several questions regarding resource partitioning in ...this threatened species. These include: (1) do morphotypes demonstrate different foraging behaviors? (2) do individuals within a morphotype vary in their foraging behavior (e.g. are some individuals specialists, only using a subset of available resources, while other are generalists)? (3) do foraging behaviors vary between isolated pools? (4) do foraging behaviors vary across seasons? We quantified microhabitat use and feeding behavior for over 100 individuals (of two morphotypes) feeding freely in two isolated pools (populations) and across two seasons (winter and summer). We found differences in foraging behavior between morphotypes and individual specializations within morphotypes; i.e. some individuals specialize on certain food resources by using a few feeding behaviors within a subset of microhabitats, whereas others employ a range feeding behaviors across many microhabitats. Foraging behavior also varied between pools and across seasons. This spatial and temporal variation in foraging behavior and resource use may serve to maintain this polymorphism, as the relative fitness of the each morph may vary over space and time.
The present-day chemical and dynamical properties of the Milky Way are signatures of the Galaxy's formation and evolution. Using a self consistent chemodynamical evolution code we examine these ...properties within the currently favoured paradigm for galaxy formation - hierarchical clustering within a CDM cosmology. Our Tree N-body/Smoothed Particle Hydrodynamics code includes a self-consistent treatment of gravity, hydrodynamics, radiative cooling, star formation, supernova feedback and chemical enrichment. Two models are described which explore the role of small-scale density perturbations in driving the evolution of structure within the Milky Way. The relationship between metallicity and kinematics of halo stars are quantified and the implications for galaxy formation discussed. While high-eccentricity halo stars have previously been considered a signature of ``rapid collapse'', we suggest that many such stars may have come from recently accreted satellites.
The ratio of branching fractions of the radiative B decays B0 -> K*0 gamma and Bs0 phi gamma has been measured using an integrated luminosity of 1.0 fb-1 of pp collision data collected by the LHCb ...experiment at a centre-of-mass energy of sqrt(s)=7 TeV. The value obtained is BR(B0 -> K*0 gamma)/BR(Bs0 -> phi gamma) = 1.23 +/- 0.06(stat.) +/- 0.04(syst.) +/- 0.10(fs/fd), where the first uncertainty is statistical, the second is the experimental systematic uncertainty and the third is associated with the ratio of fragmentation fractions fs/fd. Using the world average value for BR(B0 -> K*0 gamma), the branching fraction BR(Bs0 -> phi gamma) is measured to be (3.5 +/- 0.4) x 10^{-5}. The direct CP asymmetry in B0 -> K*0 gamma decays has also been measured with the same data and found to be A(CP)(B0 -> K*0 gamma) = (0.8 +/- 1.7(stat.) +/- 0.9(syst.))%. Both measurements are the most precise to date and are in agreement with the previous experimental results and theoretical expectations.
Using 34.7 pb
−1
of data collected with the LHCb detector, the inclusive production of the
X
(3872) meson in
pp
collisions at
is observed for the first time. Candidates are selected in the
X
(3872)→
...J
/
ψπ
+
π
−
decay mode, and used to measure
where
σ
(
pp
→
X
(3872)+anything) is the inclusive production cross section of
X
(3872) mesons with rapidity in the range 2.5–4.5 and transverse momentum in the range 5–20 GeV/
c
. In addition the masses of both the
X
(3872) and
ψ
(2
S
) mesons, reconstructed in the
J
/
ψπ
+
π
−
final state, are measured to be
and
Experimental autoimmune encephalomyelitis (EAE), a demyelinating disease of the central nervous system that can be induced in susceptible strains of mice by immunization with myelin basic protein ...(MBP) or its immunodominant T cell determinants, serves as a model of human multiple sclerosis. Tolerance to MBP in adult mice was induced by intraperitoneal injection of synthetic peptides of immunodominant determinants of MBP and prevented MBP-induced EAE. Furthermore, tolerance-inducing regimens of peptides administered to mice after the disease had begun (10 days after induction with MBP) blocked the progression and decreased the severity of EAE. Peptide-induced tolerance resulted from the induction of anergy in proliferative, antigen-specific T cells.
We identified factors affecting the selection of roost sites by invasive white-vented (Acridotheres javanicus) and common (A. tristis) mynas in urban Singapore. In addition, we examined the effects ...of experimentally manipulating canopy cover and food abundance on roosting populations. Multivariate analysis, binary logistic regression, and the Akaike Information Criterion (AIC) showed that mynas selected roost trees with dense canopies that were closer by 603.5 m to food centers and surrounded by 2.6% more vegetation than random non-roost trees. Based on Wilks' Lambda, we ranked canopy density as the most important variable, followed by proximity to food centers. Canopy density and food abundance manipulation experiments showed that although both resulted in a decrease in the number of roosting mynas, canopy density reduction had a greater effect, as predicted by the roost-selection model. The canopy of existing roosts can be thinned to alleviate the problem caused by roosting mynas. Stringent control of refuse at food centers also should be implemented to make such areas less attractive to mynas. Planting large and densely covered trees, particularly angsana (Pterocarpus indicus) and tropical apple (Eugenia grandis), near food centers should be avoided by park and urban managers.
This study tested the hypothesis that prenatal androgen levels influence hand preferences and language lateralization, two manifestations of neural asymmetry. Participants were individuals with ...congenital adrenal hyperplasia (CAH, a genetic disorder that results in excess adrenal androgen production beginning prenatally) (40 females; 29 males) and their unaffected relatives (29 females; 30 males) who ranged in age from 12–45 years. The Edinburgh-Crovitz Inventory and the performance of five simple tasks (the Handedness Activities Test) were the measures of hand preferences, and a dichotic listening task composed of consonant-vowel nonsense syllables was the measure of language lateralization. No sex differences were observed among relative controls in hand preferences or language lateralization. Male participants with CAH were less consistently right-handed for writing than unaffected male relatives, when those who had been forced to switch writing hands from left to right were considered with left-handers as being not consistently right-handed. There were no other significant differences between individuals with CAH and unaffected relatives. These results do not support the hypothesis that prenatal androgens influence language lateralization, nor do they support the Geschwind-Behan-Galaburda model that posits a key role for testosterone in the development of cognitive problems in males, secondary to changes in hemispheric development and cognitive lateralization. Hormonal influences on handedness, although not always consistent, may be more likely. However, given that sex differences in both language lateralization and handedness are small, it is possible that limited sample size precludes the detection of consistent group differences.
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