Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care

OBJECTIVE

The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis.

METHODS

We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded.

RESULTS

We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers.

CONCLUSION

In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.

Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry

BACKGROUND

Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months.

METHODS

We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed.

RESULTS

We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05).

CONCLUSION

While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.

Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis

BACKGROUND

Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry.

METHODS

In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months.

RESULTS

One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability.

CONCLUSION

High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.

Contemporary forest loss in Myanmar: Effect of democratic transition and subsequent timber bans on landscape structure and composition

This study addresses the effect of political transition and subsequent timber bans on forest loss in Myanmar, in the context of identified drivers. Cook's Distance (CD) was applied to remotely sensed time-series forest loss dataset to measure the effect of the events. Forest loss derived fragmentation metrics were linked to drivers at a landscape scale. Results show that at the national level, the political transition in 2011 had maximum effect (CD 0.935) on forest loss while the timber bans decreased forest loss by 612.04 km² and 213.15 km² in 2015 and 2017 (CD 0.146 and 0.035), respectively. The effect of the events varied for different States/Regions. The dominant drivers of change shifted from plantations in 2011 to infrastructure development in 2015. This study demonstrates the effects of policy on forest loss at various scales and can inform decision-makers for forest conservation, planning and development of mitigation measures.

Spatial and temporal variations of air pollution over 41 cities of India during the COVID-19 lockdown period

In this study, we characterize the impacts of COVID-19 on air pollution using NO₂ and Aerosol Optical Depth (AOD) from TROPOMI and MODIS satellite datasets for 41 cities in India. Specifically, our results suggested a 13% NO₂ reduction during the lockdown (March 25-May 3rd, 2020) compared to the pre-lockdown (January 1st-March 24th, 2020) period. Also, a 19% reduction in NO₂ was observed during the 2020-lockdown as compared to the same period during 2019. The top cities where NO₂ reduction occurred were New Delhi (61.74%), Delhi (60.37%), Bangalore (48.25%), Ahmedabad (46.20%), Nagpur (46.13%), Gandhinagar (45.64) and Mumbai (43.08%) with less reduction in coastal cities. The temporal analysis revealed a progressive decrease in NO₂ for all seven cities during the 2020 lockdown period. Results also suggested spatial differences, i.e., as the distance from the city center increased, the NO₂ levels decreased exponentially. In contrast, to the decreased NO₂ observed for most of the cities, we observed an increase in NO₂ for cities in Northeast India during the 2020 lockdown period and attribute it to vegetation fires. The NO₂ temporal patterns matched the AOD signal; however, the correlations were poor. Overall, our results highlight COVID-19 impacts on NO₂, and the results can inform pollution mitigation efforts across different cities of India.

Trends in Vegetation fires in South and Southeast Asian Countries

We assessed the fire trends from Moderate Resolution Imaging Spectroradiometer (MODIS) (2003–2016) and Visible Infrared Imaging Radiometer Suite (VIIRS) (2012–2016) in South/Southeast Asia (S/SEA) at a country level and vegetation types. We also quantified the fire frequencies, anomalies and climate drivers. MODIS data suggested India, Pakistan, Indonesia and Myanmar as having the most fires. Also, the VIIRS-detected fires were higher than MODIS (AQUA and TERRA) by a factor of 7 and 5 in S/SEA. Thirty percent of S/SEA had recurrent fires with the most in Laos, Cambodia, Thailand, and Myanmar. Statistically-significant increasing fire trends were found for India (p = 0.004), Cambodia (p = 0.001), and Vietnam (p = 0.050) whereas Timor Leste (p = 0.004) had a decreasing trend. An increasing trend in fire radiative power (FRP) were found for Cambodia (p = 0.005), India (0.039), and Pakistan (0.06) and declining trend in Afghanistan (0.041). Fire trends from VIIRS were not significant due to limited duration of data. In S/SEA, fires in croplands were equally frequent as in forests, with increasing fires in India, Pakistan, and Vietnam. Specific to climate drivers, precipitation could explain more variations in fires than the temperature with stronger correlations in Southeast Asia than South Asia. Our results on fire statistics including spatial geography, variations, frequencies, anomalies, trends, and climate drivers can be useful for fire management in S/SEA countries.

Land cover, land use changes and air pollution in Asia: a synthesis

A better understanding of land cover/land use changes (LCLUC) and their interactions with the atmospheric environment is essential for the sustainable management of natural resources, environmental protection, air quality, agricultural planning and food security. The 15 papers published in this focus issue showcase a variety of studies relating to drivers and impacts of LCLUC and air pollution in different South/Southeast Asian (S/SEA) countries. This synthesis article, in addition to giving context to the articles in this focus issue, also reviews the broad linkages between population, LCLUC and air pollution. Additionally, we identify knowledge gaps and research priorities that are essential in addressing air pollution issues in the region. We conclude that for effective pollution mitigation in S/SEA countries, quantifying drivers, sources and impacts of pollution need a thorough data analysis through ground-based instrumentation, models and integrated research approaches. We also stress the need for the development of sustainable technologies and strengthening the scientific and resource management communities through capacity building and training activities to address air pollution issues in S/SEA countries.

A 30+ year AVHRR Land Surface Reflectance Climate Data Record and its application to wheat yield monitoring

The Advanced Very High Resolution Radiometer (AVHRR) sensor provides a unique global remote sensing dataset that ranges from the 1980’s to the present. Over the years, several efforts have been made on the calibration of the different instruments to establish a consistent land surface reflectance time-series and to augment the AVHRR data record with data from other sensors such as the Moderate Resolution Imaging Spectroradiometer (MODIS). In this paper, we present a summary of all the corrections applied to the AVHRR Surface Reflectance and NDVI Version 4 Product, developed in the framework of the National Oceanic and Atmospheric Administration (NOAA) Climate Data Record (CDR) program. These corrections result from assessment of the geo-location, improvement of the cloud masking and calibration monitoring. Additionally, we evaluate the performance of the surface reflectance over the AERONET sites by a cross-comparison with MODIS, which is an already validated product, and evaluation of a downstream Leaf Area Index (LAI) product. We demonstrate the utility of this long time-series by estimating the winter wheat yield over the USA. The methods developed by [1] and [2] are applied to both the MODIS and AVHRR data. Comparison of the results from both sensors during the MODIS-era shows the consistency of the dataset with similar errors of 10%. When applying the methods to AVHRR historical data from the 1980’s, the results have errors equivalent to those derived from MODIS.

Preliminary analysis of the performance of the Landsat 8/OLI land surface reflectance product

The surface reflectance, i.e., satellite derived top of atmosphere (TOA) reflectance corrected for the temporally, spatially and spectrally varying scattering and absorbing effects of atmospheric gases and aerosols, is needed to monitor the land surface reliably. For this reason, the surface reflectance, and not TOA reflectance, is used to generate the greater majority of global land products, for example, from the Moderate Resolution Imaging Spectroradiometer (MODIS) and Visible Infrared Imaging Radiometer Suite (VIIRS) sensors. Even if atmospheric effects are minimized by sensor design, atmospheric effects are still challenging to correct. In particular, the strong impact of aerosols in the Visible and Near Infrared spectral range can be difficult to correct, because they can be highly discrete in space and time (e.g., smoke plumes) and because of the complex scattering and absorbing properties of aerosols that vary spectrally and with aerosol size, shape, chemistry and density. This paper presents the Landsat 8 Operational Land Imager (OLI) atmospheric correction algorithm that has been developed using the Second Simulation of the Satellite Signal in the Solar Spectrum Vectorial (6SV) model, refined to take advantage of the narrow OLI spectral bands (compared to Thematic Mapper/Enhanced Thematic Mapper (TM/ETM+)), improved radiometric resolution and signal-to-noise. In addition, the algorithm uses the new OLI Coastal aerosol band (0.433-0.450μm), which is particularly helpful for retrieving aerosol properties, as it covers shorter wavelengths than the conventional Landsat, TM and ETM+ blue bands. A cloud and cloud shadow mask has also been developed using the "cirrus" band (1.360-1.390 μm) available on OLI, and the thermal infrared bands from the Thermal Infrared Sensor (TIRS) instrument. The performance of the surface reflectance product from OLI is analyzed over the Aerosol Robotic Network (AERONET) sites using accurate atmospheric correction (based on in situ measurements of the atmospheric properties), by comparison with the MODIS Bidirectional Reflectance Distribution Function (BRDF) adjusted surface reflectance product and by comparison of OLI derived broadband albedo from United States Surface Radiation Budget Network (US SURFRAD) measurements.

Mapping global cropland and field size

A new 1 km global IIASA-IFPRI cropland percentage map for the baseline year 2005 has been developed which integrates a number of individual cropland maps at global to regional to national scales. The individual map products include existing global land cover maps such as GlobCover 2005 and MODIS v.5, regional maps such as AFRICOVER and national maps from mapping agencies and other organizations. The different products are ranked at the national level using crowdsourced data from Geo-Wiki to create a map that reflects the likelihood of cropland. Calibration with national and subnational crop statistics was then undertaken to distribute the cropland within each country and subnational unit. The new IIASA-IFPRI cropland product has been validated using very high-resolution satellite imagery via Geo-Wiki and has an overall accuracy of 82.4%. It has also been compared with the EarthStat cropland product and shows a lower root mean square error on an independent data set collected from Geo-Wiki. The first ever global field size map was produced at the same resolution as the IIASA-IFPRI cropland map based on interpolation of field size data collected via a Geo-Wiki crowdsourcing campaign. A validation exercise of the global field size map revealed satisfactory agreement with control data, particularly given the relatively modest size of the field size data set used to create the map. Both are critical inputs to global agricultural monitoring in the frame of GEOGLAM and will serve the global land modelling and integrated assessment community, in particular for improving land use models that require baseline cropland information. These products are freely available for downloading from the http://cropland.geo-wiki.org website.

NASA Land Cover and Land Use Change (LCLUC): an interdisciplinary research program

Understanding Land Cover/Land Use Change (LCLUC) in diverse regions of the world and at varied spatial scales is one of the important challenges in global change research. In this article, we provide a brief overview of the NASA LCLUC program, its focus areas, and the importance of satellite remote sensing observations in LCLUC research including future directions. The LCLUC Program was designed to be a cross-cutting theme within NASA's Earth Science program. The program aims to develop and use remote sensing technologies to improve understanding of human interactions with the environment. Since 1997, the NASA LCLUC program has supported nearly 280 research projects on diverse topics such as forest loss and carbon, urban expansion, land abandonment, wetland loss, agricultural land use change and land use change in mountain systems. The NASA LCLUC program emphasizes studies where land-use changes are rapid or where there are significant regional or global LCLUC implications. Over a period of years, the LCLUC program has contributed to large regional science programs such as Land Biosphere-Atmosphere (LBA), the Northern Eurasia Earth Science Partnership Initiative (NEESPI), and the Monsoon Area Integrated Regional Study (MAIRS). The primary emphasis of the program will remain on using remote sensing datasets for LCLUC research. The program will continue to emphasize integration of physical and social sciences to address regional to global scale issues of LCLUC for the benefit of society.

Analysis of Southeast Asian pollution episode during June 2013 using satellite remote sensing datasets

In this study, we assess the intense pollution episode of June 2013, in Riau province, Indonesia from land clearing. We relied on satellite retrievals of aerosols and Carbon monoxide (CO) due to lack of ground measurements. We used both the yearly and daily data for aerosol optical depth (AOD), fine mode fraction (FMF), aerosol absorption optical depth (AAOD) and UV aerosol index (UVAI) for characterizing variations. We found significant enhancement in aerosols and CO during the pollution episode. Compared to mean (2008-2012) June AOD of 0.40, FMF-0.39, AAOD-0.45, UVAI-1.77 and CO of 200 ppbv, June 2013 values reached 0.8, 0.573, 0.672, 1.77 and 978 ppbv respectively. Correlations of fire counts with AAOD and UVAI were stronger compared to AOD and FMF. Results from a trajectory model suggested transport of air masses from Indonesia towards Malaysia, Singapore and southern Thailand. Our results highlight satellite-based mapping and monitoring of pollution episodes in Southeast Asia.

Vegetation fires and air pollution in Vietnam

Forest fires are a significant source of air pollution in Asia. In this study, we integrate satellite remote sensing data and ground-based measurements to infer fire-air pollution relationships in selected regions of Vietnam. We first characterized the active fires and burnt areas at a regional scale from MODIS satellite data. We then used satellite-derived active fire data to correlate the resulting atmospheric pollution. Further, we analyzed the relationship between satellite atmospheric variables and ground-based air pollutant parameters. Our results show peak fire activity during March in Vietnam, with hotspots in the Northwest and Central Highlands. Active fires were significantly correlated with UV Aerosol Index (UVAI), aerosol extinction absorption optical depth (AAOD), and Carbon Monoxide. The use of satellite aerosol optical thickness improved the prediction of Particulate Matter (PM) concentration significantly.

Online- and offline- monitoring of stem cell expansion on microcarrier

In the biopharmaceutical industry, adherent growing stem cell cultures gain worldwide importance as cell products. The cultivation process of these cells, such as in stirred tank reactors or in fixed bed reactors, is highly sophisticated. Cultivations need to be monitored and controlled to guarantee product quality and to satisfy GMP requirements. With the process analytical technology (PAT) initiative, requirements regarding process monitoring and control have changed and real-time on-line monitoring tools are recommended. A tool meeting the new requirements may be the dielectric spectroscopy for online viable cell mass determination by measurement of the permittivity. To establish these tools, proper offline methods for data correlation are required. The cell number determination of adherent cells on microcarrier is difficult, as it requires cell detachment from the carrier, which highly increases the statistical error. As an offline method, a fluorescence assay based on SYBR(®)GreenI was developed allowing fast and easy total cell concentration determination without the need to detach the cells from the carrier. The assay is suitable for glass carriers used in stirred tank reactor systems or in fixed bed systems, may be suitable for different cell lines and can be applied to high sample numbers easily. The linear dependency of permittivity to cell concentration of suspended stem cells with the dielectric spectroscopy is shown for even very small cell concentrations. With this offline-method, a correlation of the cell concentration grown on carrier to the permittivity data measured by the dielectric spectroscopy was done successfully.

Memory conformity: exploring misinformation effects when presented by another person

Two experiments demonstrate that post-event information, when delivered by another person, can affect people's memory reports. In the first experiment participants were shown several cars, and later, in pairs, given an 'old'/'new' recognition test on these cars plus several lures. There was a small but reliable effect of memory conformity. When the person was given misinformation this lowered accuracy, while presenting accurate information increased accuracy. In the second experiment participants, in pairs, viewed an identical crime except that half saw an accomplice with the thief and half did not. Initial memories were very accurate, but after discussing the crime with the other person in the pair (who saw a slightly different sequence), most pairs conformed. Confidence ratings strongly predicted which person in the pair persuaded the other. Parallels with eyewitness testimony in the Oklahoma bombing case and implications for police interviewing more generally are discussed.

Changes in clinical pathology parameters during gestation in the New Zealand white rabbit

Hematology and serum chemistry parameters were analyzed in 2 groups of pregnant rabbits to assess changes in these parameters over the course of gestation. These data were used to generate a historical control reference range for embryofetal development regulatory toxicology studies. During the 28-day gestation period, the following major changes were observed. Red blood cell counts, hemoglobin, and hematocrit increased slightly up to day 13 and subsequently decreased progressively to a nadir for all parameters on day 25. Reticulocyte counts increased maximally by day 16 and then decreased to a minimum value on day 28. White blood cell counts progressively declined after day 7. Platelet counts increased slightly by day 10, were relatively stable until day 13, then progressively decreased to a nadir on day 25. Aspartate aminotransferase and alanine aminotransferease values increased steadily throughout the study to reach a maximum value on day 25. Triglycerides increased to their maximum value by day 19 and then steadily decreased until day 28, whereas cholesterol decreased progressively to reach a nadir on day 25. Urea and total protein decreased steadily from day 13 onward. Calcium values decreased throughout the study to reach a minimum value on day 28. Phosphorus values increased slightly on days 7 and 13 and then progressively decreased to reach a nadir on day 28. With a few exceptions, changes that occur in clinical pathology parameters during pregnancy in the rabbit are similar to those observed in pregnant women. Therefore, the rabbit can be considered a suitable species for embryofetal development toxicity studies with regard to clinical pathology.

Atrial natriuretic factor and sympathetic nervous output in response to volume shifts in the immature canine circulation

This study evaluated the immature circulation's response to acute shifts in intravascular volume with respect to atrial natriuretic factor and plasma catecholamines. Serial measurements were performed on thirteen beagle puppies during volume expansion with a saline and albumin solution followed by volume contraction with furosemide. Atrial natriuretic factor correlated with right (r = .73, p less than 0.001) and left (r = .62, p less than 0.001) atrial pressures and increased to much greater levels than previously reported for mature animals. Simultaneously, 10 puppies had a progressive decrease in plasma norepinephrine over the 60-minute infusion (p less than 0.05) while two puppies demonstrated a marked increase between the 30- and 60-minute samples. Furosemide increased urine output and reversed the hormonal changes caused by volume expansion. Thus a greatly augmented output of atrial natriuretic factor occurs in the immature canine circulation in response to increased atrial and pulmonary pressures, while sympathetic output remains unchanged or falls with increasing intravascular volume until a critical decrease in cardiac output triggers a catecholamine surge.

Microbial fouling of reverse-osmosis membranes used in advanced wastewater treatment technology: chemical, bacteriological, and ultrastructural analyses

Biofouling of reverse-osmosis membranes was investigated at an advanced wastewater treatment facility. Cellulose diacetate membranes operated for approximately 4,000 h became uniformly coated with a mucilaginous fouling layer. The fouling material was approximately 93% water by weight, and nearly 90% of the dehydrated residue was organic in composition. Calcium, phosphorous, sulfur, and chlorine were the major inorganic constituents detected. Protein and carbohydrate represented as much as 30 and 17%, respectively, of the dry weight of the biofilm. Bacteriological plate counts indicated up to 5.6 X 10(6) CFU/cm2 of membrane surface. Accumulation of [3H]glucose in the biofilm and measurement of ATP indicated that the fouling bacteria were metabolically active in situ. The genus Acinetobacter and the Flavobacterium-Moraxella group were the major generic groups associated with the feedwater surface of the membrane, whereas species of the generic groups Acinetobacter, Pseudomonas-Alcaligenes, and Bacillus-Lactobacillus predominated on the permeate water surface. Electron microscopy revealed that the biofilm on the feedwater surface of the membrane was 10 to 20 microns thick and was composed of several layers of compacted bacterial cells, many of which were partially or completely autolyzed. The bacteria were firmly attached to the membrane surface by an extensive network of extracellular polymeric fibrils. Polyester (Texlon) support fibers located on the permeate surface of the reverse osmosis membranes were sparsely colonized, suggesting bacterial regrowth in the product water collection system.