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Abstract Background Glomerular filtration rate (GFR) is the gold standard in assessing renal function but is impractical. Serum creatinine (sCr) has limited sensitivity in identifying early chronic kidney disease (CKD), whereas symmetric dimethylarginine (SDMA) has been commercialized as more accurate biomarker. Studies comparing SDMA and sCr with GFR in cats are limited. Objectives To further investigate the diagnostic performance of SDMA in nonazotemic and azotemic cats. Animals Forty-nine client-owned cats: 17 cats with CKD, 15 cats with diabetes mellitus (DM), and 17 healthy cats. Methods Retrospective study using spare blood samples from cats with documented sCr and GFR results for SDMA analysis. Diagnostic performances of SDMA and sCr were evaluated using correlation coefficients, sensitivities, specificities, and receiver operator characteristic curves. Results Compared to healthy cats and cats with DM, CKD cats had significantly higher SDMAplasma (26.7 ± 9.9 μg/dL) and sCr (249.7 ± 71.6 μmol/L [2.8 ± 0.8 mg/dL]; both P < .001) values. SDMAplasma (τB = −0.57; P < .001) and sCr (τB = −0.56; P < .001) were significantly correlated with GFR. SDMAplasma (τB = 0.52; P < .001) had a significant relationship with sCr. SDMAplasma and sCr had similar sensitivity (76%-94% and 71%-88%, respectively) in detecting reduced renal function. Creatinine had higher specificity (94%-96%) than SDMAplasma (75%-76%) (P < .05). Conclusion and Clinical Importance In this study of azotemic and nonazotemic cats, SDMA was a reliable marker to identify decreased GFR. However, superiority of SDMA over sCr could not be confirmed.

Conservation scientists generally agree that many types of protected areas will be needed to protect tropical forests. But little is known of the comparative performance of inhabited and uninhabited reserves in slowing the most extreme form of forest disturbance: conversion to agriculture. We used satellite-based maps of land cover and fire occurrence in the Brazilian Amazon to compare the performance of large (>10,000 ha) uninhabited (parks) and inhabited (indigenous lands, extractive reserves, and national forests) reserves. Reserves significantly reduced both deforestation and fire. Deforestation was 1.7 (extractive reserves) to 20 (parks) times higher along the outside versus the inside of the reserve perimeters and fire occurrence was 4 (indigenous lands) to 9 (national forests) times higher. No strong difference in the inhibition of deforestation (p= 0.11) or fire (p= 0.34) was found between parks and indigenous lands. However, uninhabited reserves tended to be located away from areas of high deforestation and burning rates. In contrast, indigenous lands were often created in response to frontier expansion, and many prevented deforestation completely despite high rates of deforestation along their boundaries. The inhibitory effect of indigenous lands on deforestation was strong after centuries of contact with the national society and was not correlated with indigenous population density. Indigenous lands occupy one-fifth of the Brazilian Amazon--five times the area under protection in parks--and are currently the most important barrier to Amazon deforestation. As the protected-area network expands from 36% to 41% of the Brazilian Amazon over the coming years, the greatest challenge will be successful reserve implementation in high-risk areas of frontier expansion as indigenous lands are strengthened. This success will depend on a broad base of political support.

Patients with eating disorders (EDs) frequently report a history of childhood trauma (CT). We investigated whether certain subtypes of CT are associated with more severe features of EDs, independently of psychiatric comorbidity, and whether they act additively. One hundred and ninety-two patients with DSM-V-defined EDs were consecutively recruited. Five clinical characteristics were assessed: restraint, eating, shape and weight concerns on the EDE-Q, and daily functioning. CT was assessed by the childhood traumatism questionnaire. The clinical features were associated with at least one CT subtype (emotional, sexual or physical abuse, emotional neglect). Multivariate analyses adjusted for lifetime comorbid psychiatric disorders revealed that emotional abuse independently predicted higher eating, shape and weight concerns and lower daily functioning, whereas sexual and physical abuse independently predicted higher eating concern. A dose-effect relationship characterised the number of CT subtypes and the severity of the clinical features, suggesting a consistent and partly independent association between CT and more severe clinical and functional characteristics in EDs. Emotional abuse seems to have the most specific impact on ED symptoms. Last, not all CT subtypes have the same impact but they do act additively.

There are both fundamental and practical motivations for studying whether quantum entanglement can exist in macroscopic systems. However, multiparty entanglement is generally fragile and difficult to quantify. Dicke states are multiparty entangled states where a single excitation is delocalized over many systems. Building on previous work on quantum memories for photons, we create a Dicke state in a solid by storing a single photon in a crystal that contains many large atomic ensembles with distinct resonance frequencies. The photon is re-emitted at a well-defined time due to an interference effect analogous to multi-slit diffraction. We derive a lower bound for the number of entangled ensembles based on the contrast of the interference and the single-photon character of the input, and we experimentally demonstrate entanglement between over two hundred ensembles, each containing a billion atoms. We also illustrate the fact that each individual ensemble contains further entanglement.

Background:In psoriatic arthritis (PsA), treatment persistence is important for achieving optimal outcomes. The United States Food and Drug Administration (USFDA) approved guselkumab (a fully human interleukin [IL]-23p19-subunit inhibitor) for the treatment of active PsA in July 2020.Objectives:To provide real-world evidence comparing treatment persistence while following USFDA prescribing guidelines (i.e., on-label persistence) for guselkumab (100 mg administered by subcutaneous [SC] injection at Week [W] 0, W4, then Q8W) versus SC tumor necrosis factor inhibitors (TNFi).Methods:Adults with PsA newly initiated on guselkumab or the first observed SC TNFi (i.e., adalimumab, certolizumab pegol, etanercept, or SC golimumab) between 7/14/2020 and 3/31/2022 were selected from the IQVIATM Health Plan Claims Data. The first claim for guselkumab or a SC TNFi was defined as the index date; study cohorts included bio-naïve and bio-experienced patients. Baseline characteristics were assessed during the 12-month pre-index period; the follow-up period spanned from the index date until the earliest date between the end of the continuous insurance eligibility and the end of data availability (09/30/2022; Figure 1). On-label persistence of the index agent was defined as the absence of treatment discontinuation or any dose escalation/reduction relative to the USFDA label dosing instructions for each respective agent. Discontinuation was defined as having a gap in treatment between consecutive days of the index agent supply of twice the duration of days of supply for a claim (i.e., 2 x 56 = 112 days for guselkumab or 2 x 28 = 56 days for SC TNFi) during follow-up. Patients with any dose change were censored on the first observed date of the dose change. Guselkumab and SC TNFi cohorts were balanced for baseline characteristics, using propensity score weighting based on the standardized mortality ratio (SMR) weighting approach. On-label persistence was assessed using weighted Kaplan-Meier (KM) curves. A weighted Cox proportional hazards model, further adjusted for baseline biologic use, was used to compare on-label persistence between cohorts.Results:The guselkumab cohort included 526 patients (mean age: 49.8 years; 61.2% female) and the SC TNFi cohort included 1,953 patients (mean age: 48.5 years; 60.2% female). After IPTW, baseline characteristics were well balanced and the mean follow-up was 12.3 months for the guselkumab cohort and 12.4 months for the SC TNFi cohort. In the guselkumab cohort, 51.5% were bio-experienced versus 16.7% for SC TNFi. Median time to discontinuation was not reached for the guselkumab cohort versus 8.9 months for the SC TNFi cohort. Weighted KM rates of on-label persistence at 3, 6, 9, and 12 months were 91.2%, 84.1%, 75.9%, and 71.5%, for the guselkumab cohort, versus 77.3%, 61.6%, 50.0%, and 43.7%, for the SC TNFi cohort, respectively (all log-rank p<0.001). At 12 months, patients in the guselkumab cohort were approximately three times more likely to remain persistent on treatment than patients in the SC TNFi cohort (hazard ratio: 2.97; 95% confidence interval: 2.36-3.74; p<0.001; Figure 2).Conclusion:This real-world study assessing treatment persistence in PsA using administrative claims data demonstrated that guselkumab was associated with significantly longer on-label persistence through 12 months versus SC TNFi.Acknowledgements:NIL.Disclosure of Interests:Natalie J. Shiff Stockholder of Johnson & Johnson, of which Janssen Scientific Affairs, LLC is a wholly owned subsidiary, Employee of Janssen Scientific Affairs, LLC, Jessica A. Walsh Consultant for AbbVie, Janssen, Eli Lilly, Novartis, and UCB, Research funding from Pfizer, Merck, AbbVie, Iris Lin Stockholder of Johnson & Johnson, of which Janssen Scientific Affairs, LLC is a wholly owned subsidiary, Employee of Janssen Scientific Affairs, LLC, Ruizhi Zhao Stockholder of Johnson & Johnson, of which Janssen Scientific Affairs, LLC is a wholly owned subsidiary, Employee of Janssen Scientific Affairs, LLC, Laura Morrison Employee of Analysis Group, Inc., a consulting company that has received research funding from Janssen Scientific Affairs, LLC, Bruno Emond Employee of Analysis Group, Inc., a consulting company that has received research funding from Janssen Scientific Affairs, LLC, Louise H. Yu Employee of Analysis Group, Inc., a consulting company that has received research funding from Janssen Scientific Affairs, LLC, Samuel Schwartzbein Employee of Analysis Group, Inc., a consulting company that has received research funding from Janssen Scientific Affairs, LLC, Patrick Lefebvre Employee of Analysis Group, Inc., a consulting company that has received research funding from Janssen Scientific Affairs, LLC, Dominic Pilon Employee of Analysis Group, Inc., a consulting company that has received research funding from Janssen Scientific Affairs, LLC, Soumya D. Chakravarty Stockholder of Johnson & Johnson, of which Janssen Scientific Affairs, LLC is a wholly owned subsidiary, Employee of Janssen Scientific Affairs, LLC, Philip J. Mease Speaker fees from AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Consultant for AbbVie, Acelyrin, Aclaris, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Inmagene, Janssen, Novartis, Pfizer, Sun Pharma, UCB, and Ventyx, Research funding from AbbVie, Acelyrin, Amgen, Bristol Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, Sun Pharma, and UCB.

Results are presented of the GASS/EUCLIPSE single‐column model intercomparison study on the subtropical marine low‐level cloud transition. A central goal is to establish the performance of state‐of‐the‐art boundary‐layer schemes for weather and climate models for this cloud regime, using large‐eddy simulations of the same scenes as a reference. A novelty is that the comparison covers four different cases instead of one, in order to broaden the covered parameter space. Three cases are situated in the North‐Eastern Pacific, while one reflects conditions in the North‐Eastern Atlantic. A set of variables is considered that reflects key aspects of the transition process, making use of simple metrics to establish the model performance. Using this method, some longstanding problems in low‐level cloud representation are identified. Considerable spread exists among models concerning the cloud amount, its vertical structure, and the associated impact on radiative transfer. The sign and amplitude of these biases differ somewhat per case, depending on how far the transition has progressed. After cloud breakup the ensemble median exhibits the well‐known “too few too bright” problem. The boundary‐layer deepening rate and its state of decoupling are both underestimated, while the representation of the thin capping cloud layer appears complicated by a lack of vertical resolution. Encouragingly, some models are successful in representing the full set of variables, in particular, the vertical structure and diurnal cycle of the cloud layer in transition. An intriguing result is that the median of the model ensemble performs best, inspiring a new approach in subgrid parameterization. Key Points SCM simulations of low‐level cloud transitions are confronted with LES results Longstanding problems are identified along with encouraging progress The model‐ensemble median outperforms the individual models

Purpose: To describe factors that enable the routine use of long-acting injectable antipsychotics (LAIs) for appropriate patients in the current clinical practice, including changes in LAI prescribing due to the COVID-19 pandemic and expectations for prescribing in 2021 in the United States (US). Methods: Frequent LAI prescribers recruited from a nationwide panel in 2020 completed an online survey regarding practice characteristics, perspectives on healthcare system conditions enabling routine use of LAIs, and prescribing patterns and changes in patterns during the COVID-19 pandemic. Results: Of 408 prescribers who completed the survey, 77.7% were physicians and 59.1% had [greater than or equal to]10 years of psychiatry practice. More than half of frequent prescribers (57.1%) reported treating >20% of their patients with schizophrenia with LAIs. The American Psychiatric Association (APA) guideline was followed by 64.0% of prescribers. Most prescribers identified poor adherence to antipsychotics as a circumstance when LAIs are recommended (94.9%) and patient/caregiver involvement in treatment decisions as a key factor impacting the decision to prescribe LAIs (97.3%). Most prescribers reported that LAI prescribing rates were unchanged in 2020 (59.8%). Similar proportions of prescribers expected no change (44.1%) or an increase (42.9%) in LAI prescribing rates in 2021. The number of patients followed, cost of treatment, and availability of staff to administer LAIs were the main driving factors identified by prescribers expecting an increase in LAI prescribing rates. Conclusion: LAIs were commonly recommended to patients with poor adherence, and patient/caregiver involvement was an important factor affecting prescribers' treatment decisions. LAI prescribing rates remained unchanged during the COVID-19 pandemic in 2020. Keywords: COVID-19, healthcare providers, long-acting injectable antipsychotics, prescribing patterns, schizophrenia

To describe real-world persistence in bio-naïve and bio-experienced adults with ulcerative colitis (UC) treated with ustekinumab, a recently approved anti-interleukin 12/23 antibody, or adalimumab, an anti-TNF biologic. This is a descriptive, retrospective cohort study. Patients initiating ustekinumab or adalimumab (index date, between 10/21/2019 and 08/13/2021) were selected from the Komodo Health comprehensive dataset and stratified into bio-naïve and bio-experienced subgroups based on biologic use 12 months pre-index date. Endpoints evaluated at 12-months after maintenance phase start using Kaplan-Meier analysis included 1) persistence; 2) persistence while being corticosteroid-free (<14 consecutive days of corticosteroid supply after day 90 post-index); and, 3) persistence while on monotherapy (no immunomodulators/non-index biologics/advanced therapies). Ustekinumab cohort included 778 patients (236 bio-naïve, 542 bio-experienced) and adalimumab cohort included 1693 patients (1517 bio-naive, 176 bio-experienced). At 12 months after maintenance phase start, 75.5% and 50.5% of bio-naïve patients persisted on ustekinumab and adalimumab and 72.3% and 56.9% of bio-experienced patients persisted on ustekinumab and adalimumab, respectively. Further, 55.1% and 38.2% of bio-naïve patients were persistent and corticosteroid-free with ustekinumab and adalimumab; 43.7% and 33.4% of bio-experienced patients were persistent and corticosteroid-free with ustekinumab and adalimumab, respectively. Moreover, 68.1% and 44.5% of bio-naïve patients were persistent and on monotherapy with ustekinumab and adalimumab; 61.6% and 47.9% of bio-experienced patients were persistent and on monotherapy with ustekinumab and adalimumab, respectively. At 12 months after maintenance phase start, patients with UC treated with ustekinumab had numerically higher persistence, including persistence while corticosteroid-free and persistence while on monotherapy, than patients treated with adalimumab.

The utility of porous metals for the integration of orthopaedic implants with host bone has been well established. Quantification of the tissue response to cementless implants is laborious and time consuming process requiring tissue processing, embedding, sectioning, polishing, imaging and image analysis. Micro-computed tomography (μCT) is a promising three dimensional (3D) imaging technique to quantify the tissue response to porous metals. However, the suitability and effectiveness of μCT for the quantification of bone ingrowth remains unknown. The purpose of this study was to evaluate and compare bone growth within porous titanium implants using both μCT and traditional hard-tissue histology techniques. Cylindrical implants were implanted in the distal femora and proximal tibiae of a rabbit. After 6 weeks, bone ingrowth was quantified and compared by μCT, light microscopy and backscattered electron microscopy. Quantification of bone volume and implant porosity as determined by μCT compared well with data obtained by traditional histology techniques. Analysis of the 3D dataset showed that bone was present in the pores connected with openings larger 9.4 μm. For pore openings greater than 28.2 μm, the size of the interconnection had little impact on the bone density within the porosity for the titanium foams.

Purpose Eosinophilic otitis media (EOM) is a difficult-to-treat otitis media characterized by eosinophilic accumulation in the middle ear mucosa and effusion. It is refractory to conventional treatments and is strongly associated with asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). The diagnostic criteria for EOM were established by IINO in 2011. With the recognition of type 2 inflammatory diseases, the gold standard of treatment is the systemic and topical administration of corticosteroids. Recently, several retrospective studies have demonstrated the efficacy of biologic treatments in EOM. We aimed to share our experience regarding the response of EOM after the use of biologics. Methods This is a retrospective observational analysis including patients with refractory EOM treated with different biologics (benralizumab, omalizumab, mepolizumab, dupilumab) for concomitant severe asthma, urticaria and/or severe uncontrolled CRSwNP from 2011 to 2023. Treatment effectiveness in terms of EOM severity was measured using medical Global Evaluation of Treatment Effectiveness (GETE). Results We illustrated 4 clinical cases of uncontrolled comorbid EOM and demonstrated the complexity of multidisciplinary medical pathway with good response to biologics. We also observed that response to EOM and CRSwNP does not always follow that of asthma. Conclusions The results of our small sample were consistent with those found in the literature and showed control of EOM with biologics. We need a larger multicentric sample and methodology to confirm these results and to compare the efficacy of different biologics.