Risk of chronic kidney disease in 260 patients with lupus nephritis-analysis of a nationwide multicentre cohort with up to 35 years of follow-up

OBJECTIVES

To compare proliferative (PLN) and membranous (MLN) lupus nephritis (LN) regarding clinical and laboratory presentation and long-term outcomes; To investigate predictors of progression to chronic kidney disease (CKD).

METHODS

Multicentre observational study, with retrospective analysis of a prospective cohort, using data from the Rheumatic Diseases Portuguese Registry-Reuma.pt. Patients with biopsy-proven PLN, MLN and mixed LN were included. Cox regression survival analysis was used to investigate predictors of CKD.

RESULTS

260 patients were included. Median follow-up was 8 years (IQR 11; minimum 1, maximum 35 years). MLN patients presented with significantly lower serum creatinine (0.70 (IQR 0.20; minimum 0.50, maximum 1.30) mg/dl vs 0.80 (IQR 0.31; minimum 0.26, maximum 2.60) in PLN, p= 0.003). Proteinuria levels did not differ between groups (p= 0.641). Levels of complement were reduced in PLN but nearly normal in MLN patients, and there were fewer patients with positive anti-dsDNA antibodies in the MLN group (p< 0.001). One year after the beginning of treatment, 62% of the patients achieved EULAR/ERA-EDTA complete response, with further 5% achieving partial response. Patients with lower proteinuria at diagnosis were more likely to achieve a complete renal response at one year, however, proteinuria at diagnosis or at one year did not predict long term CKD. Estimated glomerular filtration rate (eGFR) ≤75 mL/min/1.73 m2 at one year was the strongest predictor of progression to CKD (HR 23 [95% CI 8-62], p< 0.001). Other possible predictors included the use of azathioprine for induction of remission, older age at diagnosis and male sex.

CONCLUSION

Proteinuria levels did not predict LN histologic class in our cohort. eGFR cutoff of 75 mL/min/1.73 m2 after one year of treatment was strongly predictive of progression to CKD.

Sex Differences in the Effectiveness of First-Line Tumor Necrosis Factor Inhibitors in Psoriatic Arthritis: Results From the European Spondyloarthritis Research Collaboration Network

OBJECTIVE

Women with psoriatic arthritis (PsA) may have reduced tumor necrosis factor inhibitor (TNFi) effectiveness compared to men. We examined sex differences in treatment response and retention rates during 24 months of follow-up among patients with PsA initiating their first TNFi.

METHODS

Data from patients with PsA across 13 European Spondyloarthritis Research Collaboration Network registries starting their first TNFi were pooled. Logistic regression was used to analyze the association between sex and treatment response using low disease activity (LDA) according to the Disease Activity Score in 28 joints using the C-reactive protein level (DAS28-CRP) (<3.2) at six months as the primary outcome. Analyses were adjusted for age, country, conventional synthetic disease-modifying antirheumatic drug treatment, and TNFi start year. Retention rates were explored using the Kaplan-Meier estimator.

RESULTS

We analyzed the treatment response of 7,679 patients with PsA (50% women) with available data on LDA at six months. At baseline, women and men had similar characteristics, including mean DAS28-CRP (women vs men, 4.4 [SD 1.2] vs 4.2 [SD 1.2]), though patient-reported outcome measures were worse in women. At six months, 64% of women and 78% of men had LDA (relative risk [RR] 0.82; 95% confidence interval [CI] 0.80-0.84). This difference was similar after adjustment (RR 0.83; 95% CI 0.81-0.85). TNFi retention rates were evaluated in 17,842 patients with PsA. Women had significantly lower retention rates than men at all time points (women 79%, 64%, and 50% vs men 88%, 77%, and 64% at 6, 12, and 24 months, respectively).

CONCLUSION

Despite comparable disease characteristics at baseline, women with PsA have reduced treatment response and retention rates to their first TNFi, highlighting the need to consider sex differences in PsA research and management.

Patient-Reported Outcomes (PROs) and PRO Remission Rates in 12,262 Biologic-Naïve Patients With Psoriatic Arthritis Treated With Tumor Necrosis Factor Inhibitors in Routine Care

OBJECTIVE

To evaluate patient-reported outcomes (PROs) after initiation of tumor necrosis factor inhibitor (TNFi) treatment in European real-world patients with psoriatic arthritis (PsA). Further, to investigate PRO remission rates across treatment courses, registries, disease duration, sex, and age at disease onset.

METHODS

Visual analog scale or numerical rating scale scores for pain, fatigue, patient global assessment (PtGA), and the Health Assessment Questionnaire-Disability Index (HAQ-DI) from 12,262 patients with PsA initiating a TNFi in 13 registries were pooled. PRO remission rates (pain ≤ 1, fatigue ≤ 2, PtGA ≤ 2, and HAQ-DI ≤ 0.5) were calculated for patients still on the treatment.

RESULTS

For the first TNFi, median pain score was reduced by approximately 50%, from 6 to 3, 3, and 2; as were fatigue scores, from 6 to 4, 4, and 3; PtGA scores, from 6 to 3, 3, and 2; and HAQ-DI scores, from 0.9 to 0.5, 0.5, and 0.4 at baseline, 6, 12, and 24 months, respectively. Six-month Lund Efficacy Index (LUNDEX)-adjusted remission rates for pain, fatigue, PtGA, and HAQ-DI scores were 24%, 31%, 36%, and 43% (first TNFi); 14%, 19%, 23%, and 29% (second TNFi); and 9%, 14%, 17%, and 20% (third TNFi), respectively. For biologic-naïve patients with disease duration < 5 years, 6-month LUNDEX-adjusted remission rates for pain, fatigue, PtGA, and HAQ-DI scores were 22%, 28%, 33%, and 42%, respectively. Corresponding rates for patients with disease duration > 10 years were 27%, 32%, 41%, and 43%, respectively. Remission rates were 33%, 40%, 45%, and 56% for men and 17%, 23%, 24%, and 32% for women, respectively. For patients aged < 45 years at diagnosis, 6-month LUNDEX-adjusted remission rate for pain was 29% vs 18% for patients ≥ 45 years.

CONCLUSION

In 12,262 biologic-naïve patients with PsA, 6 months of treatment with a TNFi reduced pain by approximately 50%. Marked differences in PRO remission rates across treatment courses, registries, disease duration, sex, and age at onset of disease were observed, emphasizing the potential influence of factors other than disease activity on PROs.

Oral glucocorticoid use in patients with rheumatoid arthritis initiating TNF-inhibitors, tocilizumab or abatacept: Results from the international TOCERRA and PANABA observational collaborative studies

OBJECTIVE

To evaluate and compare the use of oral glucocorticoids with three classes of bDMARDs in patients with rheumatoid arthritis (RA).

METHODS

We included patients from 13 observational registries treated with a TNF-inhibitor, abatacept or tocilizumab and with available information on the use of oral glucocorticoids. The main outcome was oral glucocorticoid withdrawal. A McNemar test was used to analyse the change in the use of glucocorticoids after 1 year. Kaplan-Meier estimates and Cox regressions, adjusted for patient, treatment, and disease characteristics, were used to evaluate glucocorticoid discontinuation in patients with glucocorticoids at baseline. Because of heterogeneity, analyses were done by registers and pooled using random-effects meta-analysis.

RESULTS

A total of 12,334 participants treated with TNF-inhibitors, 2100 with tocilizumab and 3229 with abatacept were included. At one-year, oral glucocorticoid use decreased in all treatment groups (odds ratio for stopping vs. starting of 2.19 [95% CI 1.58; 3.04] for TNF-inhibitors, 2.46 [1.39; 4.35] for tocilizumab; 1.73 [1.25; 2.21] for abatacept). Median time to glucocorticoid withdrawal was ≈2 years or more in most countries, with a gradual decrease over time. Compared to TNF-inhibitors, crude hazard ratios of glucocorticoid discontinuation were 0.65[0.48-0.87] for abatacept, and 1.04 [0.76-1.43] for tocilizumab, and adjusted hazard ratios were 1.1 [0.83-1.47] for abatacept, and 1.30 [0.96-1.78] for tocilizumab.

CONCLUSION

After initiation of a bDMARD, glucocorticoid use decreased similarly in all treatment groups. However, glucocorticoid withdrawal was much slower than advocated by current international guidelines. More effort should be devoted to glucocorticoid tapering when low disease activity is achieved.

Predictors of DAPSA28 remission in patients with psoriatic arthritis initiating a first TNF inhibitor: results from 13 European registries

OBJECTIVES

In bio-naïve patients with PsA initiating a TNF inhibitor (TNFi), we aimed to identify baseline predictors of Disease Activity index for PsA in 28 joints (DAPSA28) remission (primary objective) and DAPSA28 moderate response at 6 months, as well as drug retention at 12 months across 13 European registries.

METHODS

Baseline demographic and clinical characteristics were retrieved and the three outcomes investigated per registry and in pooled data, using logistic regression analyses on multiply imputed data. In the pooled cohort, selected predictors that were either consistently positive or negative across all three outcomes were defined as common predictors.

RESULTS

In the pooled cohort (n = 13 369), 6-month proportions of remission, moderate response and 12-month drug retention were 25%, 34% and 63% in patients with available data (n = 6954, n = 5275 and n = 13 369, respectively). Five common baseline predictors of remission, moderate response and 12-month drug retention were identified across all three outcomes. The odds ratios (95% CIs) for DAPSA28 remission were: age, per year: 0.97 (0.96-0.98); disease duration, years (<2 years as reference): 2-3 years: 1.20 (0.89-1.60), 4-9 years: 1.42 (1.09-1.84), ≥10 years: 1.66 (1.26-2.20); men vs women: 1.85 (1.54-2.23); CRP of >10 vs ≤10 mg/l: 1.52 (1.22-1.89) and 1 mm increase in patient fatigue score: 0.99 (0.98-0.99).

CONCLUSION

Baseline predictors of remission, response and adherence to TNFi therapy were identified, of which five were common for all three outcomes, indicating that the predictors emerging from our pooled cohort may be considered generalizable from country level to disease level.

Morphological and molecular characterization of Chloromyxum dasyatidis n. sp. (Myxosporea: Chloromyxidae) in the common stingray Dasyatis pastinaca (Linnaeus) from Tunisian waters (Central Mediterranean Sea)

A new species of Chloromyxum Mingazzini, 1890, C. dasyatidis n. sp., is described from the gallbladder of the elasmobranch fish Dasyatis pastinaca (Linnaeus) from the Mediterranean coast off Tunisia. Mature myxospores were subspherical measuring 13.0 ± 0.3 (12.5-13.9) µm in length, 11.3 ± 0.5 (10.2-12.2) µm in width, and 11.8 ± 0.5 (11.4-12.7) µm in thickness. Four pyriform polar capsules 4.4 ± 0.3 (4.0-4.9) µm long and 3.5 ± 0.3 (3.0-3.8) µm wide. Valves were ornamented by 5 to 7 elevated surface ridges and displayed short caudal filaments. Chloromyxum dasyatidis n. sp. had an overall prevalence of infection of 38.5%, with significant seasonal variation, being more prevalent during summer (60.0%) and autumn (70.8%). Phylogenetically, this species grouped within the Chloromyxum sensu stricto lineage, forming a small clade together with the genetically more similar species C. acuminatum and C. myolibati, both from stingray hosts.

Introducing desirable patches to initiate ecosystem transitions and accelerate ecosystem restoration

Meeting restoration targets may require active strategies to accelerate natural regeneration rates or overcome the resilience associated with degraded ecosystem states. Introducing desired ecosystem patches in degraded landscapes constitutes a promising active restoration strategy, with various mechanisms potentially causing these patches to become foci from which desired species can re-establish throughout the landscape. This study considers three mechanisms previously identified as potential drivers of introduced patch dynamics: autocatalytic nucleation, directed dispersal, and resource concentration. These mechanisms reflect qualitatively different positive feedbacks. We developed an ecological model framework that compared how the occurrence of each mechanism was reflected in spatio-temporal patch dynamics. We then analyzed the implications of these relationships for optimal restoration design. We found that patch expansion accelerated over time when driven by the autocatalytic nucleation mechanism, while patch expansion driven by the directed dispersal or resource concentration mechanisms decelerated over time. Additionally, when driven by autocatalytic nucleation, patch expansion was independent of patch position in the landscape. However, the proximity of other patches affected patch expansion either positively or negatively when driven by directed dispersal or resource concentration. For autocatalytic nucleation, introducing many small patches was a favorable strategy, provided that each individual patch exceeded a critical patch size. Introducing a single patch or a few large patches was the most effective restoration strategy to initiate the directed dispersal mechanism. Introducing many small patches was the most effective strategy for reaching restored ecosystem states driven by a resource concentration mechanism. Our model results suggest that introducing desirable patches can substantially accelerate ecosystem restoration, or even induce a critical transition from an otherwise stable degraded state toward a desired ecosystem state. However, the potential of this type of restoration strategy for a particular ecosystem may strongly depend on the mechanism driving patch dynamics. In turn, which mechanism drives patch dynamics may affect the optimal spatial design of an active restoration strategy. Each of the three mechanisms considered reflects distinct spatio-temporal patch dynamics, providing novel opportunities for empirically identifying key mechanisms, and restoration designs that introduce desired patches in degraded landscapes according to these patch dynamics.

Commonalities and differences in set-up and data collection across European spondyloarthritis registries - results from the EuroSpA collaboration

BACKGROUND

In European axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) clinical registries, we aimed to investigate commonalities and differences in (1) set-up, clinical data collection; (2) data availability and completeness; and (3) wording, recall period, and scale used for selected patient-reported outcome measures (PROMs).

METHODS

Data was obtained as part of the EuroSpA Research Collaboration Network and consisted of (1) an online survey and follow-up interview, (2) upload of real-world data, and (3) selected PROMs included in the online survey.

RESULTS

Fifteen registries participated, contributing 33,948 patients (axSpA: 21,330 (63%), PsA: 12,618 (37%)). The reported coverage of eligible patients ranged from 0.5 to 100%. Information on age, sex, biological/targeted synthetic disease-modifying anti-rheumatic drug treatment, disease duration, and C-reactive protein was available in all registries with data completeness between 85% and 100%. All PROMs (Bath Ankylosing Spondylitis Disease Activity and Functional Indices, Health Assessment Questionnaire, and patient global, pain and fatigue assessments) were more complete after 2015 (68-86%) compared to prior (50-79%). Patient global, pain and fatigue assessments showed heterogeneity between registries in terms of wording, recall periods, and scale.

CONCLUSION

Important heterogeneity in registry design and data collection across fifteen European axSpA and PsA registries was observed. Several core measures were widely available, and an increase in data completeness of PROMs in recent years was identified. This study might serve as a basis for examining how differences in data collection across registries may impact the results of collaborative research in the future.

Global change scenarios in coastal river deltas and their sustainable development implications

Deltas play a critical role in the ambition to achieve global sustainable development given their relatively large shares in population and productive croplands, as well as their precarious low-lying position between upstream river basin development and rising seas. The large pressures on these systems risk undermining the persistence of delta societies, economies, and ecosystems. We analyse possible future development in 49 deltas around the globe under the Shared Socio-economic and Representative Concentration Pathways until 2100. Population density, urban fraction, and total and irrigated cropland fraction are three to twelve times greater in these deltas, on average, than in the rest of the world. Maximum river water discharges are projected to increase by 11-33 % and river sediment discharges are projected to decrease 26-37 % on average, depending on the scenario. Regional sea-level rise reaches almost 1.0 m by 2100 for certain deltas in the worst-case scenario, increasing to almost 2.0 m of relative rise considering land subsidence. Extreme sea levels could be much higher still-reaching over 4.0 m by 2100 for six of the 49 deltas analysed. Socio-economic conditions to support adaptation are the weakest among deltas with the greatest pressures, compounding the challenge of sustainable development. Asian and African deltas stand out as having heightened socio-economic challenges-huge population and land use pressures in most Asian deltas and the Nile delta; low capacity for adaptation in most African deltas and the Irrawaddy delta. Although, deltas in other parts of the world are not immune from these and other pressures, either. Because of unique pressures and processes operating in deltas, as in other "hotspots" such as small islands, mountains, and semi-arid areas, we recommend greater consideration and conceptualisation of environmental processes in global sustainable development agendas and in the Integrated Assessment Models used to guide global policy.

Children with extended oligoarticular and polyarticular juvenile idiopathic arthritis have alterations in B and T follicular cell subsets in peripheral blood and a cytokine profile sustaining B cell activation

OBJECTIVES

The main goal of this study was to characterise the frequency and phenotype of B, T follicular helper (Tfh) and T follicular regulatory (Tfr) cells in peripheral blood and the cytokine environment present in circulation in children with extended oligoarticular juvenile idiopathic arthritis (extended oligo JIA) and polyarticular JIA (poly JIA) when compared with healthy controls, children with persistent oligoarticular JIA (persistent oligo JIA) and adult JIA patients.

METHODS

Blood samples were collected from 105 JIA patients (children and adults) and 50 age-matched healthy individuals. The frequency and phenotype of B, Tfh and Tfr cells were evaluated by flow cytometry. Serum levels of APRIL, BAFF, IL-1β, IL-2, IL-4, IL-6, IL-10, IL-17A, IL-21, IL-22, IFN-γ, PD-1, PD-L1, sCD40L, CXCL13 and TNF were measured by multiplex bead-based immunoassay and/or ELISA in all groups included.

RESULTS

The frequency of B, Tfh and Tfr cells was similar between JIA patients and controls. Children with extended oligo JIA and poly JIA, but not persistent oligo JIA, had significantly lower frequencies of plasmablasts, regulatory T cells and higher levels of Th17-like Tfh cells in circulation when compared with controls. Furthermore, APRIL, BAFF, IL-6 and IL-17A serum levels were significantly higher in paediatric extended oligo JIA and poly JIA patients when compared with controls. These immunological alterations were not found in adult JIA patients in comparison to controls.

CONCLUSIONS

Our results suggest a potential role and/or activation profile of B and Th17-like Tfh cells in the pathogenesis of extended oligo JIA and poly JIA, but not persistent oligo JIA.

Synopsis of the species of Henneguya Thélohan, 1892 (Cnidaria: Myxosporea: Myxobolidae) described since 2012

The genus Henneguya Thélohan, 1892 (Cnidaria: Myxosporea: Myxobolidae) encompasses a large number of species that mostly infect freshwater fish belonging to 71 families of Actinopterygii. A synopsis of Henneguya species described between 2012 and 2022 is herein presented. It includes 57 species described during the last decade, and one species missing from the previous synopses, adding to a total of 254 species that have been formally described within this genus. Biological characters and myxospore morphometry are presented for each species record.

Resin Composite Versus Amalgam Restorations Placed in United States Dental Schools

OBJECTIVES

To investigate the latest teaching policies for posterior resin composite placement versus amalgam and to determine the actual numbers of posterior resin composites versus amalgam restorations placed in American dental schools from 2008 to 2018.

METHODS

Emails were sent to the deans of all 66 dental schools in the United States to collect data in the forms of: 1) Questionnaire on current teaching policies of posterior composite and amalgam restorations; and 2) Data entry form to collect the actual numbers of posterior composite and amalgam restorations placed in their clinics. Descriptive statistics were used to summarize ratios of posterior restorations. Inferential analysis (chi-square test and z-test) was employed to compare posterior restoration proportions over time and within each year. Level of significance was set at 0.05.

RESULTS

For the teaching questionnaire, the response rate was 52% (n=34). Seventy-six per cent of the responding schools reported that they assign 50% or more of their preclinical restorative teaching time towards posterior resin composite placement, while 50% of the responding schools devoted 25% or less towards amalgam teaching. Data entry response rate was 26% (n=17). In 2008, amalgam and resin composite restorations were placed almost equally. However, resin composite restorations were placed significantly more frequently from 2009 onwards in all responding schools. The results revealed a significant ongoing increasing trend in placing posterior resin composites in all responding schools over time (p<0.05).

CONCLUSIONS

Data analysis revealed a clear trend towards an increase in posterior resin composite restoration placement and a decrease in the number of amalgam restorations. However, the time assigned for posterior resin composite teaching is not aligned with quantity of restorations placed. Review and adjustment of the time allocated for teaching and training of each material are suggested.

Myxidium tunisiensis n. sp. (Myxosporea: Myxidiidae) infecting the rough skate Raja radula Delaroche, 1908 (Rajiformes: Rajidae) from North East Tunisia

A new marine myxosporean, Myxidium tunisiensis n. sp. (Myxosporea: Myxidiidae), is described infecting the gallbladder of the rough skate Raja radula Delaroche, 1908 (Chondrichthyes: Rajidae) harvested from the Bay of Bizerte, Tunisia. Observed stages of the parasite were floating free in the bile. Plasmodia, disporic or polysporic, contain disporic pansporoblasts measuring 23.0-27.2 μm in maximum diameter and 21.0-25.5 μm in minimum diameter. Mature myxospores, which are elongated, typically fusiform measured 18.6 ± 1.7 (17.2-22.0) μm in length, 8.6 ± 1.2 (7.2-11.2) μm in width and 8.2 ± 0.9 (6.4-10.1) in thickness. Myxospore valves are symmetrical with 9-10 longitudinal striations. Two polar capsules, pyriform, were equal in size, measuring 5.8 ± 0.4 (5.2-6.7) μm in length and 3.1 ± 0.2 (3.0-3.2) μm in width, with 5-6 polar filament turns. The infection was prevalent throughout the year with the highest prevalence in autumn (81.8%) and the lowest in winter (32.3%). The seasonal prevalence of M. tunisiensis n. sp. in the Bay of Bizerte appeared to fluctuate according to seawater temperature. The morphological and morphometrical differences with all Myxidium spp. described so far, complemented by molecular data, prove clearly that the present species is a new member of the genus Myxidium. The SSU rDNA phylogenetic analyses revealed that Myxidium tunisiensis n. sp. clustered within the oligochaete-gallbladder clade in a basal position to the marine subclade of Myxidium baueri and Myxidium coryphaenoideum. While the new species branching pattern is stable in the ML and the BI analyses, it changed in the MP analysis. This is the first molecular study of a Myxidium species infecting an elasmobranch host inhabiting the Mediterranean Sea.

The Spectral Species Concept in Living Color

Biodiversity monitoring is an almost inconceivable challenge at the scale of the entire Earth. The current (and soon to be flown) generation of spaceborne and airborne optical sensors (i.e., imaging spectrometers) can collect detailed information at unprecedented spatial, temporal, and spectral resolutions. These new data streams are preceded by a revolution in modeling and analytics that can utilize the richness of these datasets to measure a wide range of plant traits, community composition, and ecosystem functions. At the heart of this framework for monitoring plant biodiversity is the idea of remotely identifying species by making use of the 'spectral species' concept. In theory, the spectral species concept can be defined as a species characterized by a unique spectral signature and thus remotely detectable within pixel units of a spectral image. In reality, depending on spatial resolution, pixels may contain several species which renders species-specific assignment of spectral information more challenging. The aim of this paper is to review the spectral species concept and relate it to underlying ecological principles, while also discussing the complexities, challenges and opportunities to apply this concept given current and future scientific advances in remote sensing.

Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study

Background

Differences in the distribution of individual-level clinical risk factors across regions do not fully explain the observed global disparities in COVID-19 outcomes. We aimed to investigate the associations between environmental and societal factors and country-level variations in mortality attributed to COVID-19 among people with rheumatic disease globally.

Methods

In this observational study, we derived individual-level data on adults (aged 18-99 years) with rheumatic disease and a confirmed status of their highest COVID-19 severity level from the COVID-19 Global Rheumatology Alliance (GRA) registry, collected between March 12, 2020, and Aug 27, 2021. Environmental and societal factors were obtained from publicly available sources. The primary endpoint was mortality attributed to COVID-19. We used a multivariable logistic regression to evaluate independent associations between environmental and societal factors and death, after controlling for individual-level risk factors. We used a series of nested mixed-effects models to establish whether environmental and societal factors sufficiently explained country-level variations in death.

Findings

14 044 patients from 23 countries were included in the analyses. 10 178 (72·5%) individuals were female and 3866 (27·5%) were male, with a mean age of 54·4 years (SD 15·6). Air pollution (odds ratio 1·10 per 10 μg/m3 [95% CI 1·01-1·17]; p=0·0105), proportion of the population aged 65 years or older (1·19 per 1% increase [1·10-1·30]; p<0·0001), and population mobility (1·03 per 1% increase in number of visits to grocery and pharmacy stores [1·02-1·05]; p<0·0001 and 1·02 per 1% increase in number of visits to workplaces [1·00-1·03]; p=0·032) were independently associated with higher odds of mortality. Number of hospital beds (0·94 per 1-unit increase per 1000 people [0·88-1·00]; p=0·046), human development index (0·65 per 0·1-unit increase [0·44-0·96]; p=0·032), government response stringency (0·83 per 10-unit increase in containment index [0·74-0·93]; p=0·0018), as well as follow-up time (0·78 per month [0·69-0·88]; p<0·0001) were independently associated with lower odds of mortality. These factors sufficiently explained country-level variations in death attributable to COVID-19 (intraclass correlation coefficient 1·2% [0·1-9·5]; p=0·14).

Interpretation

Our findings highlight the importance of environmental and societal factors as potential explanations of the observed regional disparities in COVID-19 outcomes among people with rheumatic disease and lay foundation for a new research agenda to address these disparities.

Funding

American College of Rheumatology and European Alliance of Associations for Rheumatology.

Dryland mechanisms could widely control ecosystem functioning in a drier and warmer world

Responses of terrestrial ecosystems to climate change have been explored in many regions worldwide. While continued drying and warming may alter process rates and deteriorate the state and performance of ecosystems, it could also lead to more fundamental changes in the mechanisms governing ecosystem functioning. Here we argue that climate change will induce unprecedented shifts in these mechanisms in historically wetter climatic zones, towards mechanisms currently prevalent in dry regions, which we refer to as 'dryland mechanisms'. We discuss 12 dryland mechanisms affecting multiple processes of ecosystem functioning, including vegetation development, water flow, energy budget, carbon and nutrient cycling, plant production and organic matter decomposition. We then examine mostly rare examples of the operation of these mechanisms in non-dryland regions where they have been considered irrelevant at present. Current and future climate trends could force microclimatic conditions across thresholds and lead to the emergence of dryland mechanisms and their increasing control over ecosystem functioning in many biomes on Earth.

Pollen-based reconstruction reveals the impact of the onset of agriculture on plant functional trait composition

The onset of agriculture improved the capacity of ecosystems to produce food, but inadvertently altered other vital ecosystem functions. Plant traits play a central role in determining ecosystem properties, therefore we investigated how the onset of agriculture in Europe changed plant trait composition using 78 pollen records. Using a novel Bayesian approach for reconstructing plant trait composition from pollen records, we provide a robust method that can account for trait variability within pollen types. We estimate an overall four-fold decrease in plant size through agriculture and associated decreases in leaf and seed size. We show an increase in niche space towards the resource-acquisitive end of the leaf economic spectrum. Decreases in leaf phosphorus might have been caused by nutrient depletion through grazing and burning. Our results show that agriculture, from its start, has likely been gradually impacting biogeochemical cycles through altered vegetation composition.

Seafood safety and food-borne zoonoses from fish: Examining the risk of Anisakis in the Portuguese Population and Consumer Risk Perceptions of Fish Consumption

Parasitic nematodes of the genus Anisakis are the causative agent of anisakiosis, an important fish‐borne zoonosis. Humans are infected through consumption of raw or undercooked fish, contaminated with the parasite. Infection can result in both gastrointestinal and allergic symptoms. There are few reports of anisakiosis in Portugal, but evidence of Anisakis allergy exists, indicating that exposure is occurring in the population. The European Food Risk Assessment Fellowship Programme (EU‐FORA) work programme, entitled: ‘Food safety of fish and zoonoses: fish consumption and microbiological risk assessment and perception, from fisherman to final consumers in Portugal’ was hosted by the Interdisciplinary Centre of Marine and Environmental Research (CIIMAR), in Porto, Portugal. It aimed to gather information on risk perception and attitudes in the Portuguese population to contamination of fish with Anisakis spp. and on their knowledge of methods to prevent infection. In addition, it aimed to examine the risk of anisakiosis in the Portuguese population.

Satellite data reveal differential responses of Swiss forests to unprecedented 2018 drought

Extreme events such as the summer drought of 2018 in Central Europe are projected to occur more frequently in the future and may cause major damages including increased tree mortality and negative impacts on forest ecosystem services. Here, we quantify the response of >1 million forest pixels of 10 × 10 m across Switzerland to the 2018 drought in terms of resistance, recovery, and resilience. We used the Normalized Difference Water Index (NDWI) derived from Sentinel-2 satellite data as a proxy for canopy water content and analyzed its relative change. We calculated NDWI change between the 2017 pre-drought and 2018 drought years (indicating resistance), 2018 and the 2019 post-drought (indicating recovery), and between 2017-2019 (indicating resilience). Analyzing the data from this large natural experiment, we found that for 4.3% of the Swiss forest the NDWI declined between 2017 and 2018, indicating areas with low resistance of the forest canopy to drought effects. While roughly 50% of this area recovered, in 2.7% of the forested area NDWI continued to decline from 2018 to 2019, suggesting prolonged negative effects or delayed damage. We found differential forest responses to drought associated with site topographic characteristics and forest stand characteristics, and to a lesser extent with climatic conditions and interactions between these drivers. Low drought resistance and high recovery were most prominent at forest edges, but also on south-facing slopes and lower elevations. Tree functional type was the most important driver of drought resilience, with most of the damage in stands with high conifer abundance. Our results demonstrate the suitability of satellite-based quantification of drought-induced forest damage at high spatial resolution across large areas. Such information is important to predict how local site characteristics may impact forest vulnerability to future extreme events and help in the search for appropriate adaptation strategies.

Preliminary Data on the Occurrence of Anisakis spp. in European Hake (Merluccius merluccius) Caught Off the Portuguese Coast and on Reports of Human Anisakiosis in Portugal

Parasitic nematodes of the genus Anisakis are among the most important biological hazards associated with seafood. A survey of Anisakis spp. in European hake (Merluccius merluccius) was undertaken as this species is a staple of the Portuguese diet. Moreover, a literature review of cases of anisakiosis reported from Portugal, a country with one of the highest levels of fish consumption in the world, was also carried out. Seventy-five European hake caught in the Atlantic Ocean off the northern coast of Portugal were analyzed to determine the infection levels and site distribution of Anisakis spp. Isolated nematode larvae were identified to species level by molecular analysis. Two sets of samples were collected. Firstly, a total of 46 Anisakis spp. L₃ larvae were collected with a prevalence of 76.7% (95% CI 61.5–91.8%) and intensity (mean ± SD, range) of 2.0 ± 1.2 (1–5). Most larvae were found on the liver (45.7%) and on the gonads (32.6%), but none in the muscle. The molecular analysis showed the presence of both A. simplex s.s. (70%) and A. pegreffii (30%). For the second sample, analyzed using the UV-Press method, a total of 473 Anisakis spp. were found, with a prevalence of 95.6% (95% CI 89.5–100.0%), intensity (mean ± SD, range) of 11.3 ± 9.7 (1–41), density of 0.05 ± 0.04 (0–0.16) worms/muscle weight in g, and density of 0.54 ± 0.50 (0–2.53) worms/viscera weight in g. Surprisingly, only three very recent cases of human anisakiosis in Portugal have been reported in the literature. Data from this study contribute towards an updating of the existing epidemiological picture in an area characterized by very high seafood consumption and changing eating habits.

Antigonon leptopus invasion is associated with plant community disassembly in a Caribbean island ecosystem

Invasions by non-native plant species are widely recognized as a major driver of biodiversity loss. Globally, (sub-)tropical islands form important components of biodiversity hotspots, while being particularly susceptible to invasions by plants in general and vines in particular. We studied the impact of the invasive vine A. leptopus on the diversity and structure of recipient plant communities on the northern Caribbean island St. Eustatius. We used a paired-plot design to study differences in species richness, evenness and community structure under A. leptopus-invaded and uninvaded conditions. Community structure was studied through species co-occurrence patterns. We found that in plots invaded by A. leptopus, species richness was 40–50% lower, and these plots also exhibited lower evenness. The magnitude of these negative impacts increased with increasing cover of A. leptopus. Invaded plots also showed higher degrees of homogeneity in species composition. Species co-occurrence patterns indicated that plant communities in uninvaded plots were characterized by segregation, whereas recipient plant communities in invaded plots exhibited random co-occurrence patterns. These observations suggest that invasion of A. leptopus is not only associated with reduced species richness and evenness of recipient communities in invaded sites, but also with a community disassembly process that may reduce diversity between sites. Given that A. leptopus is a successful invader of (sub-)tropical islands around the globe, these impacts on plant community structure highlight that this invasive species could be a particular conservation concern for these systems.

Composite versus Amalgam Restorations Placed in Canadian Dental Schools

OBJECTIVES

To investigate the latest teaching policies of posterior composite placement versus amalgam and to determine the actual numbers of posterior composites versus amalgam restorations placed in Canadian dental schools, over the years from 2008 to 2018.

METHODS

Emails were sent to Chairs/Heads of Restorative Departments and Clinic Directors of all 10 Canadian dental schools to collect data in the forms of: 1) Questionnaire on current teaching policies of posterior composite and amalgam restorations; 2) data entry form to collect the actual numbers of posterior composite and amalgam restorations placed in their clinics.

RESULTS

For the teaching questionnaire, the response rate was 90% (n=9). Seven (78%) of the responding schools reported that they assign 25%-50% of their preclinical restorative teaching time towards posterior composite placement. While, three (33%) of the responding schools allocated 50%-75% of their restorative teaching towards amalgam placement. Data entry response rate was 80% (n=8). Amalgam material was dominant in the restoration distribution from 2008 to 2012. While from 2013 to 2018, resin composite material was dominant in all eight responding schools. Linear regression analysis revealed a significant increasing trend in placing posterior composites in all the responding schools over time (p<0.05).

CONCLUSIONS

Data analysis revealed a clear trend towards an increase of posterior composite restoration placement and a decrease in the number of amalgam restorations placed. However, the teaching time assigned for posterior composite is not aligned with quantity placed. Review and adjustment of time allocated for teaching and training of each material are recommended.

Forests buffer against variations in precipitation

Atmospheric moisture recycling effectively increases the amount of usable water over land as the water can undergo multiple precipitation-evapotranspiration cycles. Differences in land cover and climate regulate the evapotranspiration flux. Forests can have deep roots that access groundwater facilitating transpiration throughout the dry season independent of precipitation. This stable transpiration buffers the forest against precipitation variability. However, it is not known whether the buffering effect, already modeled for tropical forests, is common to all forests globally. Here we apply a state-of-the-art Lagrangian moisture tracking model (UTrack) to study whether forest land cover in the upwind precipitationshed can lead to a reduction in monthly precipitation variability downwind. We found a significant buffering effect of forests in the precipitation variability of 10 out of 14 biomes globally. On average, if 50% of precipitation originates from forest, then we find a reduction in the coefficient of variation of monthly precipitation of 60%. We also observed that a high fraction of precipitation from non-forest land sources tends to have the opposite effect, that is, no buffering effect. The average variation of monthly precipitation was 69% higher in areas where 50% of precipitation originates from non-forest land sources in the precipitationshed. Our results emphasize the importance of land cover composition in the precipitationshed to buffer precipitation variability downwind, in particular forest cover. Understanding the influence of land cover in a precipitationshed on atmospheric moisture transport is key for evaluating an area's water-climate regulatory ecosystem services and may become increasingly important due to continued changes in land cover and climate change.

Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry

OBJECTIVES

To determine factors associated with COVID-19-related death in people with rheumatic diseases.

METHODS

Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category.

RESULTS

Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death.

CONCLUSION

Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.

Morphological and molecular characterization of a novel Myxobolus species from the gastrointestinal tract of brown trout (Salmo trutta) in Spain

The genus Myxobolus Bütschli, 1882 is the largest group within the class Myxosporea and includes 905 nominal species, 18 of which have been found to infect fish belonging to the family Salmonidae. In the present study, microscopic analysis enabled detection of myxospores in 43 of 613 (7.0%) gastrointestinal tracts from brown trout (Salmo trutta) captured in several rivers in the northwest of the Iberian Peninsula. Measurement of the whole myxospores, polar capsules and other morphological characteristics, together with identification of the site of infection, has led us to propose a novel salmonid-myxobolid species, Myxobolus compostellanus n. sp. Molecular analysis of the small subunit ribosomal RNA (SSU-rRNA) gene yielded the same consensus sequence of 2039 bp in 14 fish specimens. A BLAST search indicated 97.6% similarity to Myxobolus neurobius. Phylogenetic analysis revealed that M. compostellanus n. sp. is clustered with other salmonid-infecting myxobolids. The present findings contribute to the existing knowledge about the genus Myxobolus, providing both morphological and molecular data on a novel species of Myxobolus found to infect the gastrointestinal tract of salmonids, M. compostellanus n. sp. in the brown trout (S. trutta).

rasterdiv-An Information Theory tailored R package for measuring ecosystem heterogeneity from space: To the origin and back

Ecosystem heterogeneity has been widely recognized as a key ecological indicator of several ecological functions, diversity patterns and change, metapopulation dynamics, population connectivity or gene flow.In this paper, we present a new R package-rasterdiv-to calculate heterogeneity indices based on remotely sensed data. We also provide an ecological application at the landscape scale and demonstrate its power in revealing potentially hidden heterogeneity patterns.The rasterdiv package allows calculating multiple indices, robustly rooted in Information Theory, and based on reproducible open-source algorithms.

Spatially explicit removal strategies increase the efficiency of invasive plant species control

Effective management strategies are needed to control expansion of invasive alien plant species and attenuate economic and ecological impacts. While previous theoretical studies have assessed optimal control strategies that balance economic costs and ecological benefits, less attention has been paid to the ways in which the spatial characteristics of individual patches may mediate the effectiveness of management strategies. We developed a spatially explicit cellular automaton model for invasive species spread, and compared the effectiveness of seven control strategies. These control strategies used different criteria to prioritize the removal of invasive species patches from the landscape. The different criteria were related to patch size, patch geometry, and patch position within the landscape. Effectiveness of strategies was assessed for both seed dispersing and clonally expanding plant species. We found that, for seed-dispersing species, removal of small patches and removal of patches that are isolated within the landscape comprised relatively effective control strategies. For clonally expanding species, removal of patches based on their degree of isolation and their geometrical properties comprised relatively effective control strategies. Subsequently, we parameterized the model to mimic the observed spatial distribution of the invasive species Antigonon leptopus on St. Eustatius (northern Caribbean). This species expands clonally and also disperses via seeds, and model simulations showed that removal strategies focusing on smaller patches that are more isolated in the landscape would be most effective and could increase the effectiveness of a 10-yr control strategy by 30-90%, as compared to random removal of patches. Our study emphasizes the potential for invasive plant species management to utilize recent advances in remote sensing, which enable mapping of invasive species at the high spatial resolution needed to quantify patch geometries. The presented results highlight how this spatial information can be used in the design of more effective invasive species control strategies.

Zschokkella epinepheli n. sp. (Myxosporea: Myxidiidae) infecting the gallbladder of the white grouper Epinephelus aeneus (Serranidae) from Tunisian waters

A new coelozoic myxosporean species, Zschokkella epinepheli n. sp., collected from the gallbladder of the white grouper Epinephelus aeneus (Perciformes: Serranidae) from the bay of Bizerte, Tunisia, is described based on morphological and molecular characteristics. Myxospores and plasmodia were observed floating free in the bile. Mature plasmodia were polysporic and subspherical in shape, measuring 85.0-94.0 μm long and 70.0-82.0 μm wide. Mature myxospores were ovoid in valvular view, measuring 10.0 ± 1.7 (8.0-11.0) μm in length and 7.0 ± 0.3 (6.6-7.5) μm in width. Polar capsules were pyriform and equal in size, measuring 3.0 ± 0.2 (2.8-3.6) μm in length and 2.3 ± 0.3 (1.8-2.7) μm in width. Myxospore valves had 12-14 longitudinal striations. Based on the small subunit rDNA, the new species Z. epinepheli n. sp. differs from all other Zschokkella species for which there is a DNA sequence deposited in GenBank. Phylogenetic analysis revealed that Z. epinepheli n. sp. clustered in the marine subclade of Zschokkella species within the biliary tract IV clade. This is the first report of a Zschokkella species from the gallbladder of an epinephelin fishes.

Locked-in and living delta pathways in the Anthropocene

Delta systems are fundamental to the persistence of large human populations, food systems and ecosystem processes. Structural changes in natural and social components of deltas, emerging from past land-use changes, have led deltas to become locked-in loosing the ability to transform back into living deltas, and making them more at risk. We propose a framework to assess whether deltas become locked-in by changes in natural or social infrastructure, by examining the dynamic coupling between population and land-use development over 300 years for 48 deltas globally. We find that 46% of the deltas are defined as living, where population, irrigation, and cropland are correlated. Of the 54% locked-in deltas, 21% show changes in natural infrastructure to cropland (n = 6) or irrigation (n = 4), and 33% (n = 16) show changes in social infrastructure. Most locked-in deltas are in Europe but also in other continents due to decoupled development of population and cropland. While, locked-in deltas due to changes in natural infrastructure have highest average risks, those with changes in social infrastructure and the living deltas have highest risks from future relative sea level rise. These results show that deltas have varying natural and social components derived from a 300 years historical perspective, which are not taken into account in risk assessments for global deltas.

Catch-quota matching allowances balance economic and ecological targets in a fishery managed by individual transferable quota

Fishers with individual catch quota, but limited control over the mix of species caught, depend on trade and catch-quota balancing allowances to fully utilize their quota without discarding. However, these allowances can theoretically lead to overfishing if total allowable catches (TACs) are consistently exceeded. This study investigates usage of balancing allowances by the Icelandic demersal fleet over 2001-2017, for over 1,900 vessels. When a vessel's demersal catch exceeds owned and leased quota for a given species, the gap can be bridged by borrowing quota from the subsequent fishing period or transforming unutilized quota in other species, restricted by limits. Conversely, excess quota can be saved or transformed into quota for species where there is a shortfall. We found evidence that balancing behavior is frequently similar across the fleet. Transformations are consistent with indicators of a general quota shortage and potential for arbitrage caused by differences in conversion ratios used for transformation and lease prices. Larger companies contribute more to these patterns. Nevertheless, TAC overages are generally modest especially in recent years-key reasons appear to be the tightening of vessel transformation limits and the central role of Atlantic cod, which is the main target species but cannot be persistently overfished due to a specific prohibition on positive transformations into the species. These results show how the tailored design of the Icelandic catch-quota balancing system has helped in balancing economic and ecological goals of management. We suggest policy changes that could further reduce ecological risks, e.g., prioritizing between-year transfers over transformations.

Hepatitis C treatment outcome in former or current intravenous drug users coinfected with HIV, with or without directly observed therapy

BACKGROUND

Intravenous drug users (IDUs) with hepatitis C virus (HCV)/human immunodeficiency virus (HIV)-coinfection are recognised as a high-risk, vulnerable group.

METHODS

Between February 2015 and April 2018, a single-centre, non-interventional cohort study was conducted in an outpatient setting, to evaluate the sustained virologic response (SVR12) and assess treatment uptake models. The study included 385 former or recent IDUs divided into two groups: A-without use of opioid substitution treatment (OST) and B-patients taking opioid substitution; patients in group B received OST and self-administered therapy (B1) or OST and therapy under DOT (B2). Patients were characterised by demographic and clinical features and compared for treatment response. Correlations between SVR12 and independent variables were determined by logistic regression.

RESULTS

Patients were mostly males (88.3%) with a mean age of 46 ± 5 years and HCV genotype 1a (63.7%). Approximately 28% were treatment-experienced and 84.9% received sofosbuvir/ledipasvir. The mean CD4⁺T count was 649 cells/mm³, and most individuals were on antiretroviral therapy with undetectable viral loads (97.4%). SVR12 was achieved in 94.8%, and only eight patients relapsed. No significant differences were found in treatment effect between individuals taking opioid substitutes under different treatment models. Correlations were found between HCV viral response and both HIV suppression and albumin levels.

CONCLUSIONS

IDU with HCV/HIV coinfection, including individuals on self-administration of HCV therapy and opioid substitution treatments or in DOT programmes, are no longer considered a difficult-to-treat group, as they achieve high rates of SVR12.

Modelling the distribution of Mustela nivalis and M. putorius in the Azores archipelago based on native and introduced ranges

The aims of this study were to predict the potential distribution of two introduced Mustelidae, Mustela nivalis and M. putorius in the Azores archipelago (Portugal), and evaluate the relative contribution of environmental factors from native and introduced ranges to predict species distribution ranges in oceanic islands. We developed two sets of Species Distribution Models using MaxEnt and distribution data from the native and introduced ranges of the species to project their potential distribution in the archipelago. We found differences in the predicted distributions for the models based on introduced and on native occurrences for both species, with different most important variables being selected. Climatic variables were most important for the introduced range models, while other groups of variables (i.e., human-disturbance) were included in the native-based models. Most of the islands of the Azorean archipelago were predicted to have suitable habitat for both species, even when not yet occupied. Our results showed that predicting the invaded range based on introduced range environmental conditions predicted a narrower range. These results highlight the difficulty to transfer models from native to introduced ranges across taxonomically related species, making it difficult to predict future invasions and range expansion.

Morphology, seasonality and molecular characterization of Ceratomyxa draconis n. sp. parasite of Trachinus draco (L.) from the Bay of Bizerte, Tunisia

The specimens of Trachinus draco collected from the Bay of Bizerte were found to be infected with a new Ceratomyxa species described as Ceratomyxa draconis n. sp. The sequence of small subunit ribosomal RNA gene obtained in this study differs from other Ceratomyxa sequences available in GenBank. Mature spores of this species were elongated and crescent-shaped in sutural view, measuring 7.4 ± 0.77 (6.4-8.0) μm in thickness and 30.8 ± 1.65 (28.8-32.8) μm in width. The polar capsules were spherical, equal in size, and measuring 3.3 ± 0.2 (3.6-4.0) μm in diameter. The Ceratomyxa draconis n. sp. showed a clearly seasonal variation of prevalence with highest prevalence noted during summer months.

Reuma.pt/vasculitis - the Portuguese vasculitis registry

Background

The vasculitides are a group of rare diseases with different manifestations and outcomes. New therapeutic options have led to the need for long-term registries. The Rheumatic Diseases Portuguese Register, Reuma.pt, is a web-based electronic clinical record, created in 2008, which currently includes specific modules for 12 diseases and > 20,000 patients registered from 79 rheumatology centres. On October 2014, a dedicated module for vasculitis was created as part of the European Vasculitis Society collaborative network, enabling prospective collection and central storage of encrypted data from patients with this condition. All Portuguese rheumatology centres were invited to participate. Data regarding demographics, diagnosis, classification criteria, assessment tools, and treatment were collected. We aim to describe the structure of Reuma.pt/vasculitis and characterize the patients registered since its development.

Results

A total of 687 patients, with 1945 visits, from 13 centres were registered; mean age was 53.4 ± 19.3 years at last visit and 68.7% were females. The most common diagnoses were Behçet’s disease (BD) (42.5%) and giant cell arteritis (GCA) (17.8%). Patients with BD met the International Study Group criteria and the International Criteria for BD in 85.3 and 97.2% of cases, respectively. Within the most common small- and medium-vessel vasculitides registered, median [interquartile range] Birmingham Vasculitis Activity Score (BVAS) at first visit was highest in patients with ANCA-associated vasculitis (AAV) (17.0 [12.0]); there were no differences in the proportion of patients with AAV or polyarteritis nodosa who relapsed (BVAS≥1) or had a major relapse (≥1 major BVAS item) during prospective assessment (p = 1.00, p = 0.479). Biologic treatment was prescribed in 0.8% of patients with GCA, 26.7% of patients with AAV, and 7.6% of patients with BD. There were 34 (4.9%) deaths reported.

Conclusions

Reuma.pt/vasculitis is a bespoke web-based registry adapted for routine care of patients with this form of rare and complex diseases, allowing an efficient data-repository at a national level with the potential to link with other international databases. It facilitates research, trials recruitment, service planning and benchmarking.

Effect of governance structure on conservation land acquisition in California over the last 100 years

The process of expanding a network of conservation areas includes identifying valuable areas for conservation, devising policies and implementing conservation actions on the ground. While the first two components are often analyzed in conservation science, the literature seldom focuses on the implementation process, particularly, how the governance structure acts as driver of conservation outcomes. In this paper, we analyze the process of development of the conservation network in California between 1910 and 2010 to test whether governance structure explains the variation in the attribution of land for conservation over time. We find that governance structure does play an important role in the development of the conservation network over the century. We find evidence that polycentric and diverse governance structures result in better conservation outcomes (i.e. more area of land acquired for conservation). Arrangements that included multiple levels of agencies (e.g. Federal, State, and County) better predict the area of conservation land per decade. Location of conservation action per county had an effect on conservation outcomes over the last decades, and we also find a strong negative effect of per capita income in the implementation of conservation actions. These results suggest that it is possible to leverage governance structure to meet future conservation challenges through the maintenance of a diverse and polycentric governance structure.

Ceratomyxa mennani n. sp. (Myxosporea: Bivalvulida) parasitizing the gallbladder of the dusky grouper Epinephelus marginatus (Serranidae) from Tunisian waters

Ceratomyxa mennani n. sp. is a new coelozoic Ceratomyxa species found in the gallbladder of Epinephelus marginatus from the Gulf of Tunis, Tunisia. Mature plasmodia were disporic, ovoid in shape measuring 9-12 μm in width and 11-14 μm in length. Mature myxospores were slightly crescent-shaped with almost straight posterior margin, measuring 5.8 ± 0.2 (5.4-6.1) μm in length and 12.7 ± 0.3 (11.9-13.0) μm in thickness. The two valves were unequal with rounded ends. Polar capsules were spherical, equal in size with 2.1 ± 0.2 (1.9-2.6) μm in diameter. The binucleated sporoplasm filled the entire cavity of the myxospore. Molecular analysis of SSU rDNA sequences indicated that C. mennani n. sp. was distinct from all other Ceratomyxa sequences in GenBank. Phylogenetic analysis revealed that C. mennani n. sp. clustered with Ceratomyxa species infecting Epinephelinae fishes. Seasonal prevalence of infection over one year was significantly higher in winter and the lowest in autumn. This is the third report of Ceratomyxa species infecting the gallbladder of Epinephelus marginatus from Tunisia and the first study to include molecular data.

Influence of livelihood assets, experienced shocks and perceived risks on smallholder coffee farming practices in Peru

Smallholder farmers might adopt different farming practices to cope with multiple stressors depending on their livelihood assets, and with varying environmental and economic outcomes. Ongoing global change is triggering stronger and different stressors that threaten conventional farming practices; however, this could be resolved if livelihood assets that drive decision making are actionable and thus can be modified. This study assessed the influence of farmers' livelihood assets, risk perception, and shocks on the choice of non-conventional farming practices for smallholder coffee farmers in San Martín, Peru. Using household survey data, we collected data on 162 coffee plantations along an elevation gradient. We operationalized the sustainable livelihoods framework for the adoption of shade and input coffee farming strategies and explored farmers' motives to change them. Despite associated high risks with pest and disease pressure, coffee price volatility and climate change, these risks did not explain the current shade and input farming strategies. While in the past five years, farmers adapted shade and input management in response to pest and disease and climate change pressures, these occurred in diverging directions: we found higher human and social assets associated with higher shade levels, and a trend for higher physical and financial assets associated with higher input use. These findings illustrate that two main factors affect decisions on farming practices related to shade and input management and they relate to different livelihood capitals. This suggests a potential for conflicting decision-making, push-and-pulling decisions in different directions. Further the disconnect between livelihood assets and perceptions suggests that perception of risk and shocks might not be sufficient to motivate decision making under changing conditions. Such insights in decision-making typologies and drivers can inform the development of farming practices that enhance resilience and sustainability of smallholder coffee production in Peru and elsewhere in the tropics.

Drug retention of biological DMARD in rheumatoid arthritis patients: the role of baseline characteristics and disease evolution

Objective

To examine the association of the evolution in physician-reported and patient-reported outcomes with decision to stop biological DMARDs (bDMARDs) in RA. The contribution of baseline characteristics is well established, but little is known about how the disease evolution influences the decision to discontinue therapy.

Methods

RA patients who initiated a bDMARD treatment from 2009 and with information on date of visit were pooled from seven European RA registers. Each outcome was divided into baseline assessments (capturing the inter-individual differences at drug initiation) and changes from baseline at subsequent visits (capturing the individual evolution). Cox regression models were used to examine their association with drug discontinuation, adjusting for baseline patient and co-therapy characteristics and stratifying by register and calendar year of drug initiation.

Results

A total of 25 077 patients initiated a bDMARDs (18 507 a TNF-inhibitor, 3863 tocilizumab and 2707 abatacept) contributing an amount of 46 456.8 patient-years. Overall, drug discontinuation was most strongly associated with a poor evolution of the DAS28, with a hazard ratio of 1.34 (95% CI 1.29, 1.40), followed by its baseline value. A change of Physician Global Assessment was the next strongest predictor of discontinuation, then the Patient Global Assessment.

Conclusions

The decision to discontinue treatments appears to be mostly influenced by DAS28 and particularly its evolution over time, followed by Physician Global Assessment evolution, suggesting that the decision to stop bDMARDs relies more on the physician’s than on the patient’s global assessment.

Ceratomyxa gouletti n. sp. (Myxosporea: Ceratomyxidae), a parasite of the red scorpionfish Scorpaena scrofa (L.) from Tunisian waters

Ceratomyxa gouletti n. sp. is a new parasite described from the gallbladder of the red scorpionfish Scorpaena scrofa (Scorpaeniformes: Scorpaenidae) collected from La Goulette in the Northeast of Tunisia. The parasite develops disporic plasmodia, elliptical to ovoid in shape, measuring up to 33.1 ± 3.6 (28.0-38.2) μm in length and 12.5 ± 2.1 (11.3-14.0) μm in width. Mature spores are elongated transversely and crescent-shaped with rounded ends and unequal shell valves, measuring 8.1 ± 1.27 (7.2-9.0) μm in length and 32.0 ± 2.5 (27.0-38.2) μm in thickness. Sutural line is straight and visible between valves. Polar capsules are subspherical with 3.15 ± 0.63 (2.7-3.6) μm long and 1.9 ± 0.14 (1.8-2.0) μm wide. Posterior spore angle is slightly concave 160°-175°. Molecular analysis based on the small subunit 18S rDNA sequence shows that C. gouletti n. sp. is different from all other ceratomyxid species DNA sequences in GenBank. Phylogenetic trees clustered the new species with long-branching Ceratomyxa species, and it was closely related to the species Ceratomyxa longipes from two gadid fish hosts with 89% bootstrap support.