Physical activity and osteoarthritis: a consensus study to harmonise self-reporting methods of physical activity across international cohorts

Physical activity (PA) is increasingly recognised as an important factor within studies of osteoarthritis (OA). However, subjective methods used to assess PA are highly variable and have not been developed for use within studies of OA, which creates difficulties when comparing and interpreting PA data in OA research. The aim of this study was, therefore, to gain expert agreement on the appropriate methods to harmonise PA data among existing population cohorts to enable the investigation of the association of PA and OA. The definition of PA in an OA context and methods of harmonization were established via an international expert consensus meeting and modified Delphi exercise using a geographically diverse committee selected on the basis of individual expertise in physical activity, exercise medicine, and OA. Agreement was met for all aims of study: (1) The use of Metabolic Equivalent of Task (MET) minutes per week (MET-min/week) as a method for harmonising PA variables among cohorts; (2) The determination of methods for treating missing components of MET-min/week calculation; a value will be produced from comparable activities within a representative cohort; (3) Exclusion of the domain of occupation from total MET-min/week; (4) The need for a specific measure of joint loading of an activity in addition to intensity and time, in studies of diseases, such as OA. This study has developed a systematic method to classify and harmonise PA in existing OA cohorts. It also provides minimum requirements for future studies intending to include subjective PA measures.

Screening for anxiety and depression in people with psoriasis: a cross-sectional study in a tertiary referral setting

BACKGROUND

National Institute for Health and Care Excellence guidance recommends assessment of psychological and social well-being in people with psoriasis.

OBJECTIVES

To screen systematically for depression and anxiety in patients with psoriasis in routine clinical practice and to identify at-risk groups for psychiatric morbidity.

METHODS

Consecutive patients attending a single, tertiary centre over a 10-month period were invited to complete the Patient Health Questionnaire Depression Scale (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7) and Dermatology Life Quality Index (DLQI) as part of IMPARTS: Integrating Mental and Physical Healthcare: Research, Training and Services. Information on demographics, treatment and clinical disease severity was collated from electronic patient records. Regression models were used to identify at-risk groups for psychiatric morbidity.

RESULTS

Of 607 patients included (56·2% on biologics), 9·9% (95% confidence interval 7·5-12·3%) screened positive for major depressive disorder (MDD) and 13·1% (79/604) (95% confidence interval 10·4-15·8%) for generalized anxiety disorder (GAD; GAD-7 score > 9). Suicidal ideation was reported in 35% of those with MDD; DLQI was < 10 in 38·3% and 45·6% cases of MDD and GAD, respectively. After adjusting for covariates, the risk of MDD or GAD was significantly higher in women and those with severe clinical disease, psoriatic arthritis and previous depression/anxiety. The risk of GAD was significantly increased with Asian ethnicity and use of topical treatments only.

CONCLUSIONS

Systematic screening for anxiety and depression identifies clinically important levels of depression and anxiety that may be missed using DLQI data alone. Women and those with severe disease, psoriatic arthritis and/or a prior history of psychiatric morbidity may be at particular risk.

Phase 3, open-label, randomized study of the pharmacokinetics, efficacy and safety of ixekizumab following subcutaneous administration using a prefilled syringe or an autoinjector in patients with moderate-to-severe plaque psoriasis (UNCOVER-A)

Background

The efficacy of ixekizumab, an anti‐interleukin‐17A (anti‐IL‐17A) monoclonal IgG4 antibody, was demonstrated in moderate‐to‐severe psoriasis patients when administered via prefilled syringe (PFS).

Objective

To evaluate the effect of two drug delivery devices on the pharmacokinetics (PK) of ixekizumab as well as efficacy and safety with both devices.

Methods

In the first 12 weeks of an open‐label, phase 3 study, moderate‐to‐severe psoriasis patients were randomized to ixekizumab delivery via PFS or autoinjector device. Randomization was stratified by weight (<80 kg, 80–100 kg, >100 kg), injection assistance (yes/no) and injection site (arm, thigh or abdomen). Following a 160‐mg initial dose at week 0, patients received subcutaneous 80‐mg ixekizumab as a single injection every 2 weeks for 12 weeks. Blood samples were collected following the initial 160‐mg dose on days 2, 4, 7, 10 and 14 for PK analysis. Primary PK parameters were maximum concentration (C_max) and area under the curve (AUC_0‐tlast) where t_last is the time of last sample (14 days ± 24 h). Efficacy was assessed by percent improvement on the Psoriasis Area and Severity Index (PASI) at week 12. Adverse event reporting, vital signs and clinical laboratory data were used to evaluate safety.

Results

Of 204 randomized patients, 192 were included in the PK analysis (PFS: 94; autoinjector: 98). The PFS and autoinjector showed similar geometric mean C_max (90% CI) [15.0 μg/mL (13.9–16.1) vs. 14.8 μg/mL (13.8–15.9)] and geometric mean AUC_0‐tlast (90% CI) [157 μg × day/mL (147–168) vs. 154 μg × day/mL (144–165)]. When comparing C_max and AUC_0‐tlast of the autoinjector to PFS, the geometric LS mean ratios were 0.97. At week 12, mean percent PASI improvement (via modified baseline observation carried forward) was similar with the PFS (89.3%) and autoinjector (86.9%). Both devices had safety results that were consistent with the known safety profile of ixekizumab.

Conclusion

The PK, efficacy and safety of ixekizumab administered subcutaneously by PFS and autoinjector were similar.

Clinicaltrials.gov number: NCT01777191 https://clinicaltrials.gov/ct2/show/NCT01777191

An effective view

The Victoria Infirmary National Health Service (NHS) Trust, Glasgow, UK has recently completed the pilot phase of implementing an internal Intranet system. The project was initially funded by the NHS Management Executive with the purpose of establishing an internal web to provide non-patient specific clinical and non-clinical information throughout the Trust. The pilot phase has been a great success, with the Intranet content currently consisting of departmental information, protocols, clinical guidelines and notices of meetings. The Intranet is now beginning to take on the function of a hospital handbook.

Murine Inter-Sex Difference in Methylcholanthrene Induced Tumor and its Correlation with NK Activity

Susceptibility to 3-methylcholanthrene (MC) induced tumor development between adult male and female C3H mice at 3–4 mo. old was examined. Animals that were injected (s.c.) with a tumorigenic dose (150 μg/mouse) of MC demonstrated a significant difference in the latent period of tumor development between both sexes. Female mice were more responsive and developed tumors at 3 wks after treatment, whereas, male mice were less responsive as indicated by the longer latent period (10 wks). In order to correlate these data with activity of natural killer (NK) cells, splenic NK activity was measured by 4 hr 51Cr-release assay. The results showed male mice having higher activity: 27 lytic units (LU) in comparison to female ones (3 LU). This was attributed to a decrease in the lytic effect of female NK cells (11%) compared to male mice (20%), since the binding capacity of effector cells to their targets was similar in both sexes (15%), as indicated by single cell assay. The possible role of an immunosuppressive factor (IF) in the sera of female mice was investigated. NK cells from young females demonstrated 33% suppression in activity post culture with sera from 3–4 mo. old female mice.

In conclusion, this study demonstrates a sex-linked tumor development by MC treatment, and correlates this phenomenon with differences of NK activity between young male and female mice as well as in the age-dependent decline of reactivity. A possible immunosuppressive mechanism may be operative in explaining as to why MC is more effective in tumorigenesis in female mice as opposed to males.

A service evaluation of the Eczema Education Programme: an analysis of child, parent and service impact outcomes

BACKGROUND

The systematic support of parents of children with eczema is essential in effective disease management. The few existing support models have a limited evidence base. This paper reports the outcome-orientated service evaluation of an original, extensive, social learning-theory based, nurse-led Eczema Education Programme (EEP).

OBJECTIVES

To evaluate the EEP using specified child and parental outcomes and service impact data.

METHODS

From a sample of 257 parent-child dyads attending the EEP, a pretest-post-test design evaluated its child impact using health-related quality of life measures (Infants' Dermatitis Quality of Life index, which includes a small dermatitis severity element, and Children's Dermatology Life Quality Index), severity measures (Patient Orientated Eczema Measure), a new parental measure (Parental Self-Efficacy in Eczema Care Index) and service impact data based on general practitioner (GP) attendance patterns pre- and postintervention.

RESULTS

Statistically significant impacts were observed on infant quality of life (P < 0·001), child quality of life (P = 0·027), disease severity (P < 0·001) and parental self-efficacy (P < 0·001). Improvements in child quality of life, parental efficacy and service impact were also evident from qualitative data. The cumulative total of all GP visits for selected participants post-EEP reduced by 62%.

CONCLUSIONS

The EEP appears to be an effective model of delivering structured education to parents of children with eczema, and one generalizable to other multiethnic metropolitan populations. As a noncontrolled study, this rigorous service evaluation highlights the model's significance and the case for an evaluative multicentre randomized controlled trial of this educational intervention to inform a nurse-led programme of care.

Anti-viral therapy for prevention of perinatal HBV transmission: extending therapy beyond birth does not protect against post-partum flare

BACKGROUND

Antepartum anti-viral therapy (AVT) is often administered to prevent perinatal transmission of hepatitis B virus (HBV) infection. Little is known about the effect of AVT on post-partum flare rates and severity.

AIM

To examine whether extending AVT beyond birth influences the post-partum course.

METHODS

One hundred and one pregnancies in 91 women with HBV DNA levels ≥log 7 IU/mL were included. AVT (initially lamivudine, later tenofovir disoproxil fumarate) was commenced from 32 weeks gestation and stopped soon after birth and at 12 weeks post-partum. Outcomes according to post-partum treatment duration were examined: Group 1 = AVT ≤4 weeks (n = 44), Group 2 = AVT >4 weeks (n = 43), Group 3 = no AVT (n = 14).

RESULTS

The majority of women were HBeAg+ (97%), median age 29 years, baseline HBV DNA log 8.0 IU/mL and follow-up 48 weeks post-partum. Post-partum treatment duration was 2 weeks for Group 1 and 12 weeks for Group 2, P < 0.01. Flare rates were not significantly different: Group 1 = 22/44 (50%), Group 2 = 17/43 (40%) and Group 3 = 4/14 (29%), P = 0.32. Onset of flare was similar at 8/10/9 weeks post-partum for Groups 1/2/3 respectively, P = 0.34. The majority of flares spontaneously resolved. HBeAg seroconversion (n = 1/5/1 in Groups 1/2/3, P = 0.27) was not associated with treatment duration or the occurrence of a post-partum flare.

CONCLUSIONS

Post-partum flares are common and usually arise early after delivery. They are often mild in severity and most spontaneously resolve. Extending anti-viral therapy does not protect against post-partum flares or affect HBeAg seroconversion rates.

Molecular virology of hepatitis B virus, sub-genotype C4 in northern Australian Indigenous populations

Indigenous Australians experience a significant health burden from chronic hepatitis B infection; however, the strain of hepatitis B virus (HBV) found among Indigenous Australians has not been well characterized. Blood samples were collected from 65 Indigenous Australians with chronic HBV infection from across the Top End of Australia's Northern Territory. Phylogenetic analysis of HBV from these samples revealed that 100% of the isolates were genotype C, sub-genotype C4, expressing the serotype ayw3. This strain is a divergent group within the HBV/C genotype, and has only been described in Indigenous Australians. Evidence of recombination was suggested by discordant phylogenetic clustering of the C4 sequences when comparing the full genome to the surface region and confirmed by recombination analysis which showed the surface gene region to be most closely related to genotype J, while the remaining regions of the genome were most similar to genotype C sequences. Mutational analysis revealed the presence of multiple mutations that have been linked with more rapid liver disease progression and an increased risk of hepatocellular carcinoma. These mutations were detected in the majority of sequences examined. Variants associated with vaccine failure were detected as the predominant viral quasi-species in 3/35 samples. In summary, the HBV C4 variant found in this population has a high potential to cause advanced liver disease and to escape vaccination programs. Further in vitro functional and natural history studies are warranted in order to determine the clinical and public health consequences of infection with the HBV C4 variant in these communities.

Static and predictive tomographic reconstruction for wide-field multi-object adaptive optics systems

Multi-object adaptive optics (MOAO) systems are still in their infancy: their complex optical designs for tomographic, wide-field wavefront sensing, coupled with open-loop (OL) correction, make their calibration a challenge. The correction of a discrete number of specific directions in the field allows for streamlined application of a general class of spatio-angular algorithms, initially proposed in Whiteley et al. [J. Opt. Soc. Am. A15, 2097 (1998)], which is compatible with partial on-line calibration. The recent Learn & Apply algorithm from Vidal et al. [J. Opt. Soc. Am. A27, A253 (2010)] can then be reinterpreted in a broader framework of tomographic algorithms and is shown to be a special case that exploits the particulars of OL and aperture-plane phase conjugation. An extension to embed a temporal prediction step to tackle sky-coverage limitations is discussed. The trade-off between lengthening the camera integration period, therefore increasing system lag error, and the resulting improvement in SNR can be shifted to higher guide-star magnitudes by introducing temporal prediction. The derivation of the optimal predictor and a comparison to suboptimal autoregressive models is provided using temporal structure functions. It is shown using end-to-end simulations of Raven, the MOAO science, and technology demonstrator for the 8 m Subaru telescope that prediction allows by itself the use of 1-magnitude-fainter guide stars.