Current Flare Research Articles

The Evolution of Photospheric Current Density During an X9.3-Class Solar Flare

This paper deduced the temporal evolution of the magnetic field through a series of high-resolution vector magnetograms and calculated the fine distribution map of current density during an X9.3-class flare eruptions using Ampère’s law. The results show that a pair of conjugate current ribbons exist on both sides of the magnetic neutral line in this active region, and these conjugate current ribbons persist before, during, and after the flare. It was observed that the X9.3-class flare brightened in the form of a bright core and evolved into a double-ribbon flare over time. Importantly, the position of the double-ribbon flare matches the position of the current ribbons with high accuracy, and their morphologies are very similar. By investigating the complexity of current density and flare morphology, we discovered a potential connection between the eruption of major flares and the characteristics of current density.

Real-World Efficacy of Spesolimab: Reports from Four Patients with Generalized Pustular Psoriasis

Introduction: Generalized pustular psoriasis (GPP) is a rare, chronic, autoinflammatory skin disease characterized by widespread pustular eruptions that may be accompanied by systemic symptoms. GPP is painful, distressing, and adversely affects patient quality of life (QoL). Spesolimab is a first-in-class anti-IL-36 receptor monoclonal antibody approved for the treatment of GPP flares. Methods: We describe 4 cases from our respective clinical practices, where individuals with GPP were treated successfully with spesolimab. Results: Four patient cases of GPP were included; an 18-year-old male, a 58-year-old female; a 36-year-old male, and a 40-year-old female. One patient had a history of GPP, and had experienced 3 prior flares in the preceding year. Two patients had a history of plaque psoriasis. Events preceding the current GPP flare included hydroxychloroquine treatment (n=2), and corticosteroid treatment (n=3). All patients presented with sudden onset of worsening pustular rash (affecting lower extremities [n=1]; extremities and trunk [n=1]; whole body [n=2]). Two patients had systemic symptoms at presentation (1 case: fever, chills, malaise, fatigue; 1 case: severe weakness), and required hospitalization. Two patients received an initial mis-diagnosis of acute generalized exanthematous pustulosis (AGEP). Significant impacts on QoL were reported; all 4 patients were unable to perform normal daily activities; the 18-year-old patient was targeted at school because the skin lesions were perceived to be contagious. The 4 patients received multiple therapies prior to, and concomitantly with, spesolimab treatment, including topical agents, antibiotics, corticosteroids, retinoids, immunosuppressants, and biologics. All 4 patients received two 900 mg intravenous infusions of spesolimab with treatment intervals between 7 and 20 days. Treatment was given at an outpatient infusion center (n=3*), or using a home infusion service (n=1); *1 patient received their first infusion as an inpatient. Significant clinician-assessed improvement in pustules occurred within 1 week of the first spesolimab infusion in 3 patients; the remaining patient reported improvement 1-2 weeks after the second infusion. One of the hospitalized patients experienced 75% improvement in itching, pain, and pustules within 24 hours of the first spesolimab infusion, and was discharged the next day. Spesolimab treatment also improved QoL, with patients experiencing rapid improvements in pain, and their ability to resume their normal daily activities. Conclusions: These cases demonstrate the efficacy of spesolimab in the real-world, highlighting the ability of spesolimab treatment to rapidly improve GPP symptoms and patient QoL. Administration of spesolimab in an inpatient setting allowed for rapid patient improvement and discharge the next day. These cases also highlight the association of certain drugs as triggers for GPP flares, as well as the importance of AGEP in the differential diagnosis of GPP

Self-reported flares among people living with inflammatory bowel disease are associated with stress and worry but not associated with recent diet changes: The Manitoba Living with IBD Study.

In this matched case-control longitudinal study among people living with inflammatory bowel disease (IBD), we investigated beliefs about what triggers a flare. Adults with confirmed IBD and active disease within 2 years were enrolled in the Manitoba Living with IBD Study and followed biweekly with online surveys for 1 year. The 7-point IBD Symptom Change Indicator was used for participant identification of a flare. Flare cases were matched to non-flare controls by sex and disease type. Members of each matched pair completed supplementary information on diet changes and psychological functioning in the previous 2 weeks and provided stool samples to assess fecal calprotectin (FCAL). Of 128 enrolled participants, 95 matched flare/non-flare pairs were created. Those reporting a flare were more likely to have elevated FCAL (51% vs 34% among non-flares, P = 0.043). Although 61% of study participants believed at baseline that a food may trigger flares, and 25% of those in a flare believed that a food may have triggered their current flare, there was no difference in consumption of assessed foods between flares and non-flares in the previous 2 weeks. Patients with flares were more likely to be having difficulties in emotional state than controls (40% vs 18%, P = 0.001) and more likely to be stressed or worried (64% vs 33%, P = 0.001). Although a majority of individuals with IBD believe that specific foods trigger their disease flares, this was not supported by the current findings. Recent psychological functioning was associated with self-reported IBD flare.

An integrated flare minimization methodology for simultaneous turnaround operations of two chemical plants

Current flare minimization studies were exclusively focusing on single facility/plant under normal or abnormal operating conditions. Systematic studies are still lacking for simultaneous flare minimizations of multiple plants, which are all under their turnaround operations. In this paper, a novel methodology has been developed for simultaneous flare minimizations of two olefin plants under their turnarounds: one is to start up and the other is to shut down. Based on plant-wide dynamic modeling and simulation, new flare minimization opportunities coupling both start-up and shutdown operations have been explored and examined. Eventually, an integrated duo-plant flare minimization strategy has been identified and virtually demonstrated. A key merit of this study is that through the interplant material exchange, flaring sources from Plant A could be utilized by Plant B instead of being flared; meanwhile, flaring sources from Plant B could also be significantly reduced. Thus, the integrated flare minimization strategy has created a win-win situation that can simultaneously reduce flare emissions from both plants to their extreme potentials. Compared with conventional turnaround strategies, the case study performed in this paper shows that the total flaring amount for both olefin plants can be significantly reduced by 69.47%. Compared with a previous study, the flaring amount of the single plant has also been reduced by an extra of 18.18%. The development suggests potentially significant economic, environmental, and societal benefits. It has also laid a solid foundation for future studies and applications on simultaneous multi-plant flare minimizations through optimal design and scheduling of multi-plant interplant material exchanges.

Flare Rate Thresholds for Patient Assessment of Disease Activity States in Gout.

To determine the relationship between gout flare rate and self-categorization into remission, low disease activity (LDA), and patient acceptable symptom state (PASS). Patients with gout self-categorized as remission, LDA, and PASS, and reported number of flares over the preceding 6 and 12 months. Multinomial logistic regression was used to determine the association between being in each disease state (LDA and PASS were combined) and flare count, and self-reported current flare. A distribution-based approach and extended Youden index identified possible flare count thresholds for each state. Investigators from 17 countries recruited 512 participants. Remission was associated with a median recalled flare count of zero over both 6 and 12 months. Each recalled flare reduced the likelihood of self-perceived remission compared with being in higher disease activity than LDA/PASS, by 52% for 6 months and 23% for 12 months, and the likelihood of self-perceived LDA/PASS by 15% and 5% for 6 and 12 months, respectively. A threshold of 0 flares in preceding 6 and 12 months was associated with correct classification of self-perceived remission in 58% and 56% of cases, respectively. Flares are significantly associated with perceptions of disease activity in gout, and no flares over the prior 6 or 12 months is necessary for most people to self-categorize as being in remission. However, recalled flare counts alone do not correctly classify all patients into self-categorized disease activity states, suggesting that other factors may also contribute to self-perceived gout disease activity.

P355 Acceptability of treatment regimen in inflammatory bowel disease: Results from a prospective nationwide study (ACCEPT2)

Abstract Background The multiplication of therapeutic options with close efficacy and safety, leads to consider acceptability of treatment regimen as a key point for therapeutic decision in inflammatory bowel disease (IBD). We aimed to compare acceptability of IBD treatment regimen and to identify its associated factors. Methods From a nationwide prospective study conducted in 24 public or private centres, IBD patients were consecutively included for 6 weeks. A dedicated questionnaire was developed, tested and validated for the study. It was administered to each included patient and his/her related physician. Acceptability was graded with an acceptability numerical scale (ANS) from 0 (absolutely not acceptable) to 10 (totally acceptable). Results Overall, 1850 patients were included (65.9% with Crohn’s disease (CD), mean age = 41.0 ± 14.7, 22.2% experiencing IBD flare at inclusion). The medications at inclusion were none in 9.0%, oral (PO) monotherapy in 17.3%, subcutaneous (SC) injections in 29.2% and intra-venous (IV) infusions in 44.5% of the patients. The ANS were 8.68 ± 2.52 for PO, 7.67 ± 2.94 for SC and 6.79 ± 3.31 for IV (p < 0.001 for each comparison). The patients reported PO, SC and IV as their first choice in 65.8%, 21.4% and 12.8%, respectively. The reasons for reduced acceptability were the need to come to the hospital (63.0%) for IV infusion, none for SC injections and the fear to forget to take pills (30.5%), the number of daily dose (28.4%) and daily medication as a reminder of disease every day (24.8%) for PO therapy. In multivariable analyses, the following factors were associated with a better acceptability of IV infusion (current IBD flare: p = 0.003 and current IV therapy for IBD: p < 0.001), SC injections (Private practice: p = 0.006 and current SC injections for IBD: p < 0.001) and PO medication (male gender: p = 0.018, higher studies level: p < 0,001 and current oral medication: p = 0.002). The mean ANS for all IBD treatment regimen were compared in the 1850 patients (Figure 1). No difference was observed between CD and UC. In biologics-naïve patients (n = 315), the treatment regimens were ranked in the following order: PO once daily (8.8 ± 2.2), SC/12 weeks (week) (7.9 ± 3.0), SC/8 week and PO twice daily (7.2 ± 3.2 et 6.9 ± 3.4; ns), SC/4 week (6.2 ± 3.4), SC/2 week et IV/8 week (5.1 ± 3.4 and 5.0 ± 3.5; ns)(p < 0.001 except if ns was mentioned). For the patients, the acceptable loss of efficacy to receive a more convenient medication was 5.2% (non-inferiority trial limit). Conclusion While PO administration was preferred by most of IBD patients, the acceptability of treatment regimen is highly impacted by the interval between two doses and the previous medications. Our data could be helpful to guide therapeutic decision in daily practice in IBD.

Patient Perceptions of Unmet Medical Need in Rheumatoid Arthritis: A Cross-Sectional Survey in the USA.

IntroductionMany rheumatoid arthritis (RA) patients do not achieve their treatment goals and experience symptoms that affect psychosocial outcomes and daily activities. This study aimed to identify and quantify the unmet needs perceived by US patients with RA currently taking a disease-modifying antirheumatic drug (DMARD).MethodsA cross-sectional, web-based survey was conducted with RA patients recruited through CreakyJoints, an online patient support community, and ArthritisPower®, an online patient research registry, from December 2017 to January 2018. Participant patients were aged ≥ 21 years, failed ≥ 1 DMARDs, and were receiving their current DMARD(s) for ≥ 6 months; they answered 50 questions about treatment history, RA symptoms, and flares and completed the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire and the Treatment Satisfaction Questionnaire for Medication (TSQM). Treatment satisfaction was defined by a TSQM global satisfaction score ≥ 80.ResultsOf 415 patients screened, 258 (62%) were eligible and completed the survey; 87% were women, and 87% white, with mean (SD) age of 54.5 (11.4) years. A total of 232 patients (90%) had current or past biologic DMARD (bDMARD) use, with 67% currently on a bDMARD, 65% on ≥ 1 conventional synthetic DMARD, and 40% on methotrexate. Forty-three percent of patients reported daily/almost daily use of prescription pain medications, and 44% reported a current flare. Mean (SD) TSQM scores were 59 [20] for effectiveness, 59 [26] for side effects, 72 [18] for convenience, and 65 [21] for global satisfaction. The mean (SD) RAID overall score was 5.1 (2.0) on a 0–10 scale. Only 26% (67 patients) were satisfied with their RA treatment. Patients not satisfied with treatment reported higher RAID scores overall and by domain, and approximately half reported a current flare.ConclusionsResults from this real-world survey suggest that three-fourths of RA patients are not satisfied with treatments, which include bDMARDs. Patients continued to experience bothersome symptoms that impacted their daily activities and life. There remains a need for improved disease management among currently treated RA patients.FundingEli Lilly and Company (Indianapolis, IN, USA).Electronic Supplementary MaterialThe online version of this article (10.1007/s40744-019-00168-5) contains supplementary material, which is available to authorized users.

High Immunogenicity of the Pneumococcal Conjugated Vaccine in Immunocompromised Adults With Inflammatory Bowel Disease

Patients with inflammatory bowel disease (IBD) are predisposed to pneumococcal infections due to their underlying disease and iatrogenic immunosuppression. Vaccination with the 13-valent pneumococcal conjugated vaccine (PCV13) is recommended, but with poor take-up and few data available. We performed an open-label, phase IV, multicenter study to evaluate the safety and immunogenicity of PCV13 in adults with IBD and to analyze the influence of immunomodulating treatments on anti-pneumococcal seroresponses. We enrolled 306 patients with IBD from March 2014 through February 2016, with the following exclusion criteria: current IBD flare, pregnancy, pneumococcal immunization in the previous 5 years, and influenza immunization in the previous 4 weeks. PCV13 was administered intramuscularly. Serotype-specific vaccine responses were evaluated using an opsonophagocytic assay. Adverse events were monitored by diary cards and standardized phone interviews. The median seroprotection rate increased significantly from 43.9% (95% confidence interval [CI], 42.3-45.5) at inclusion to 90.4% (95% CI, 89.5-91.3%; P < 0.001) after vaccination. Patients receiving anti-tumor necrosis factor agents achieved a slightly lower seroprotection rate (from 44.5% [95% CI, 42.3%-46.8%] to 86.6% [95% CI, 84.9%-88.1%]) than patients treated with other types of immunosuppressive regimens (thiopurine, methotrexate, oral corticosteroids; from 44.7% [95% CI, 41.7%-47.7%] to 93.8% [95% CI, 92.1%-95.2%]) or nonimmunosuppressive treatment (5-aminosalicylate, topical corticosteroids, vedolizumab; from 41.3% [95% CI, 37.9%-44.8%] to 95.2% [95% CI, 93.4%-96.6%]). There were no safety issues. Overall, the administration of PCV13 was highly immunogenic and well tolerated, irrespective of the baseline treatment, and should be encouraged in all adults with IBD.

A longitudinal analysis of urological chronic pelvic pain syndrome flares in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network.

To describe the frequency, intensity and duration of urological chronic pelvic pain syndrome symptom exacerbations ('flares'), as well as risk factors for these features, in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Epidemiology and Phenotyping longitudinal study. Current flare status ('urological or pelvic pain symptoms that are much worse than usual') was ascertained at each bi-weekly assessment. Flare characteristics, including start date, and current intensity of pelvic pain, urgency and frequency (scales of 0-10), were assessed for participants' first three flares and at three randomly selected times when they did not report a flare. Generalized linear and mixed effects models were used to investigate flare risk factors. Of the 385 eligible participants, 24.2% reported no flares, 22.9% reported one flare, 28.3% reported 2-3 flares, and 24.6% reported ≥4 flares, up to a maximum of 18 during the 11-month follow-up (median incidence rate = 0.13/bi-weekly assessment, range = 0.00-1.00). Pelvic pain (mean = 2.63-point increase) and urological symptoms (mean = 1.72) were both significantly worse during most flares (60.6%), with considerable within-participant variability (26.2-37.8%). Flare duration varied from 1 to 150days (94.3% within-participant variability). In adjusted analyses, flares were more common, symptomatic, and/or longer-lasting in women and in those with worse non-flare symptoms, bladder hypersensitivity, and chronic overlapping pain conditions. In this foundational flare study, we found that pelvic pain and urological symptom flares were common, but variable in frequency and manifestation. We also identified subgroups of participants with more frequent, symptomatic, and/or longer-lasting flares for targeted flare management/prevention and further study.

INCREASING OF GLOW DISCHARGE STABILITY IN WELDING BY MEANS OF MULTISECTIONAL ELECTRODE SYSTEMS

Background. The glow discharge has been widespread as a source of surface heating for diffusion welding and soldering thanks to the possibility of regulation within a wide range of energy excursions in a heating spot. At the same time, due to the pressures inherent in these processes, certain violations have been identified, mainly due to the partial or complete loss of its stability and, as a result, its transition to a more stable form of gas discharge – an electric arc.Objective. The purpose of the paper is to provide stabilization of the burning process of a high-current glow discharge in regimes that are used in precision welding processes at discharge currents of 10 A, and gas pressures of 1.33–13.3 kPa.Methods. Using the methods of the theory of gas discharge physics, electrodynamics and electromagnetism, the main causes of the appearance of external perturbations and instabilities that lead to the emergence of a stable arc discharge on the local sections of the surfaces of the welded parts were determined.Results. It is established that at a constant current of discharge the application of a 5-section anode unit with a traveling electric field increases the region of stable existence of a glow discharge by 1.5–1.7 times in comparison with a similar electrode system with a stationary electric field. The application of this system, when heated by glow discharge, can also increase the energy density in the heating spot by a stable glow discharge by 2.6 to 2.9 times compared with the use of the anode of a continuous section.Conclusions. The stabilization of the power current flare discharge in the conditions of welding heat can be achieved by applying multisection electrode systems, namely by replacing the solid (contour) anode with a sectional one. However, such a system does not exclude the possibility of melting of parts due to the stabilization of the arc discharge on a separate anode section (and the corresponding section of the cathode).

Urinary fungi associated with urinary symptom severity among women with interstitial cystitis/bladder pain syndrome (IC/BPS).

To correlate the presence of fungi with symptom flares, pain and urinary severity in a prospective, longitudinal study of women with IC/BPS enrolled in the MAPP Research Network. Flare status, pelvic pain, urinary severity, and midstream urine were collected at baseline, 6 and 12months from female IC/BPS participants with at least one flare and age-matched participants with no reported flares. Multilocus PCR coupled with electrospray ionization/mass spectrometry was used for identification of fungal species and genus. Associations between "mycobiome" (species/genus presence, relative abundance, Shannon's/Chao1 diversity indices) and current flare status, pain, urinary severity were evaluated using generalized linear mixed models, permutational multivariate analysis of variance, Wilcoxon's rank-sum test. The most specific analysis detected 13 fungal species from 8 genera in 504 urine samples from 202 females. A more sensitive analysis detected 43 genera. No overall differences were observed in fungal species/genus composition or diversity by flare status or pain severity. Longitudinal analyses suggested greater fungal diversity (Chao1 Mean Ratio 3.8, 95% CI 1.3-11.2, p = 0.02) and a significantly greater likelihood of detecting any fungal species (OR = 5.26, 95% CI 1.1-25.8, p = 0.04) in high vs low urinary severity participants. Individual taxa analysis showed a trend toward increased presence and relative abundance of Candida (OR = 6.63, 95% CI 0.8-58.5, p = 0.088) and Malassezia (only identified in 'high' urinary severity phenotype) for high vs low urinary symptoms. This analysis suggests the possibility that greater urinary symptom severity is associated with the urinary mycobiome urine in some females with IC/BPS.

Annals for Educators - 15 January 2019.

Annals for Educators - 15 January 2019.

Thermo–Economical Evaluation of Producing Liquefied Natural Gas and Natural Gas Liquids from Flare Gases

In many industrial plants including petrochemicals and refineries, raw hydrocarbons (mostly flammable gas) are released during unplanned operations. These flammable gases (usually called flare gases) are sent to a combustor and the process is called flaring. Flaring wastes energy and produces environmental pollution. Consequently, recovering the flare gases is an important subject in these industries. In this work, an economical and technical analysis is presented for the production of valuable products, namely, liquefied natural gas and natural gas liquids from flare gas. The flare gas of Fajr Jam refinery, a refinery located in the south part of Iran, is selected as a case study. One of the issues in recovering flare gases is the nonconstant flow rate of these gases. For this reason, an auxiliary natural gas flow rate is employed to have a constant feed for the flare recovery process. The Poly Refrigerant Integrated Cycle Operations (PRICO) refrigeration cycle is employed for producing liquefied natural gas and natural gas liquids. In the PRICO cycle, the mixed refrigerant is used as the working fluid. The other issue is the existence of H2S in the flare gases. The main idea is that the flare gas components, including H2S, have different boiling points and it is possible to separate them. Consequently, flare gases are separated into several parts during a number of successive cooling and heating stages and passing through phase separators. It is shown that the proposed flare gas recovery process prevents burning of 12 million cubic meters of the gases with valuable hydrocarbons, which is almost 70% of the current flare gases. Furthermore, about 11,000 tons of liquefied natural gas and 1230 tons of natural gas liquids are produced in a year. Finally, the economic evaluation shows a payback period of about 1.6 years.

Quasi-periodic Oscillations in Flares and Coronal Mass Ejections Associated with Magnetic Reconnection

Abstract We propose a mechanism for quasi-periodic oscillations of both coronal mass ejections (CMEs) and flare loops as related to magnetic reconnection in eruptive solar flares. We perform two-dimensional numerical MHD simulations of magnetic flux rope eruption, with three different values of the global Lundquist number. In the low Lundquist number run, no oscillatory behavior is found. In the moderate Lundquist number run, on the other hand, quasi-periodic oscillations are excited both at the bottom of the flux rope and at the flare loop top. In the high Lundquist number run, quasi-periodic oscillations are also excited; in the meanwhile, the dynamics become turbulent owing to the formation of multiple plasmoids in the reconnection current sheet. In high and moderate Lundquist number runs, thin reconnection jets collide with the flux rope bottom or flare loop top and dig them deeply. Steep oblique shocks are formed as termination shocks where reconnection jets are bent (rather than decelerated) in the horizontal direction, resulting in supersonic backflows. The structure becomes unstable, and quasi-periodic oscillations of supersonic backflows appear at locally confined high-beta regions at both the flux rope bottom and flare loop top. We compare the observational characteristics of quasi-periodic oscillations in erupting flux ropes, post-CME current sheets, flare ribbons, and light curves with corresponding dynamical structures found in our simulation.

Clinical Predictors of Future Nonadherence in Inflammatory Bowel Disease.

Nonadherence to medical therapy is frequently encountered in patients with inflammatory bowel disease (IBD). We aimed to identify predictors for future (non)adherence in IBD. We conducted a multicenter prospective cohort study with adult patients with Crohn's disease (CD) and ulcerative colitis (UC). Data were collected by means of 3-monthly questionnaires on the course of disease and healthcare utilization. Medication adherence was assessed using a visual analogue scale, ranging from 0% to 100%. Levels <80% were considered to indicate nonadherence. The Brief Illness Perception Questionnaire was used to identify illness perceptions. We used a logistic regression analysis to identify patient- and disease-related factors predictive of nonadherence 3 months after the assessment of predictors. In total, 1558 patients with CD and 1054 patients with UC were included and followed for 2.5 years. On average, 12.1% of patients with CD and 13.3% of patients with UC using IBD-specific medication were nonadherent. Nonadherence was most frequently observed in patients using mesalazine (CD), budesonide (UC) and rectally administrated therapy (both CD and UC). A higher perceived treatment control and understanding of the disease were associated with adherence to medical therapy. Independent predictors of future nonadherence were age at diagnosis (odds ratio [OR]: 0.99 per year), nonadherence (OR: 26.91), a current flare (OR: 1.30) and feelings of anxiety/depression (OR: 1.17), together with an area under the receiver-operating-characteristics curve of 0.74. Lower age at diagnosis, flares, feelings of anxiety or depression, and nonadherence are associated with future nonadherence in patients with IBD. Altering illness perceptions could be an approach to improve adherence behavior.

Investigation of Relationship between High-energy X-Ray Sources and Photospheric and Helioseismic Impacts of X1.8 Solar Flare of 2012 October 23

Abstract The X-class solar flare of 2012 October 23 generated continuum photospheric emission and a strong helioseismic wave (“sunquake”) that points to an intensive energy release in the dense part of the solar atmosphere. We study properties of the energy release with high temporal and spatial resolutions, using photospheric data from the Helioseismic Magnetic Imager (HMI) on board Solar Dynamics Observatory, and hard X-ray observations made by RHESSI. For this analysis we use level-1 HMI data (filtergrams), obtained by scanning the Fe i line (6731 Å) with the time cadence of ∼3.6 s and spatial resolution of ∼0.″5 per pixel. It is found that the photospheric disturbances caused by the flare spatially coincide with the region of hard X-ray emission but are delayed by ≲4 s. This delay is consistent with predictions of the flare hydrodynamics RADYN models. However, the models fail to explain the magnitude of variations observed by the HMI. The data indicate that the photospheric impact and helioseismic wave might be caused by the electron energy flux, which is substantially higher than that in the current flare radiative hydrodynamic models.

New model for predicting thermal radiation from flares and high pressure jet fires for hydrogen and syngas

Current flare and jet fire models used in the process industry are primarily based on hydrocarbon gases and have been found not to be particularly effective for low luminosity gases such as hydrogen and syngas mixtures. This article presents a new model for such gases, for low to high pressure releases in both vertical and horizontal orientations. The model, which predicts flame geometry and thermal radiation, allowing for jet momentum, buoyancy, wind and flame radiant fraction, is based on extension of established models, with the addition of several new correlations. Validation against existing published data and new previously unpublished test data collected at both pilot and full scale is presented. This article provides the complete set of equations for the model. © 2016 American Institute of Chemical Engineers Process Saf Prog 36: 237–251, 2017

Prevention of Flares in Children with Atopic Dermatitis with Regular Use of an Emollient Containing Glycerol and Paraffin: A Randomized Controlled Study

Emollients are part of the standard treatment for atopic dermatitis (AD), although there is limited evidence that regular use of emollients as management therapy reduces the frequency of flares and corticosteroid consumption. The objective of this study was to evaluate the benefit of emollient use in the management of mild to moderate AD in children by assessing the ability of two different emollients (particularly V0034CR) to prevent flares and to reduce the use of corticosteroids. In this randomized, open-label study, patients with a current flare were treated with a potent topical corticosteroid. After flare resolution, patients were centrally randomized to V0034CR emollient, reference emollient, or no emollient (1:1:1 ratio) for 12 weeks. New flares were medically assessed before being treated with a moderately potent corticosteroid. A total of 335 children 2 to 6 years of age were randomized. At 12 weeks, the percentage of patients with one or more flares was statistically significantly lower with V0034CR (35.1%) than without emollient (67.6%; p < 0.001). Fewer patients treated with V0034CR required any corticosteroids or immunosuppressants (23.6%) than patients with no emollient (43.3%) at 12 weeks. The difference was significant at all time points (p = 0.002). Patients treated with emollients had a longer time to first flare, fewer flares, higher complete remission rates, less corticosteroid consumption, lower Investigator Global Assessment scores, and lower Scoring Atopic Dermatitis scores than those who were not. V0034CR was well tolerated, with no specific safety concerns. Regular emollient use in children with mild to moderate AD reduces flares and corticosteroid consumption.

Adaptation of the osteoarthritis-specific quality of life scale (the OAQoL) for use in Germany, Hungary, Italy, Spain and Turkey

The Osteoarthritis Quality of Life scale (OAQoL) is specific to individuals with osteoarthritis. The present study describes the adaptation of the OAQoL for use in the following five European languages: German, Hungarian, Italian, Spanish and Turkish. The study involved three stages in each language; translation, cognitive debriefing (face and content validity) and validation. The validation stage assessed internal consistency (Cronbach's alpha), reproducibility (test-retest reliability using Spearman's rank correlations), convergent and divergent validity (correlations with the Health Assessment Questionnaire, The Western Ontario and McMaster Universities Index of osteoarthritis and Nottingham Health Profile) and known group validity. The OAQoL was successfully translated into the target languages with minimal problems. Cognitive debriefing interviewees found the measures easy to complete and identified few problems with content. Internal consistency ranged from 0.94 to 0.97 and test-retest reliability (reproducibility) from 0.87 to 0.98. These values indicate that the new language versions produce very low levels of measurement error. Median OAQoL scores were higher for patients reporting a current flare of osteoarthritis in all countries. Scores were also related, as expected, to perceived severity of osteoarthritis. The OAQoL was successfully adapted for use in Germany, Hungary, Italy, Spain and Turkey. The addition of these new language versions will prove valuable to multinational clinical trials and to clinical practice in the respective countries.

Individualized patient decision-aid for immunosuppressive drugs in women with lupus nephritis: study protocol of a randomized, controlled trial

BackgroundSystemic Lupus erythematosus (SLE), also commonly referred to as lupus, is a rare, but sometimes, fatal disease, that primarily affects young women. Lupus nephritis, a common manifestation of lupus, is more common and more devastating in patients of minority race/ethnicity. Patients have negative views of immunosuppressive drugs for lupus nephritis due to a concern about side effects and under-appreciation of its benefit. We designed a study to assess the effectiveness of individualized, computerized patient decision-aid for immunosuppressive drugs for lupus nephritis compared to a standard pamphlet for patient decision-making.MethodsAdult women with lupus nephritis, with a current lupus nephritis flare or at risk of a future lupus nephritis flare will be randomized to individualized, computerized patient decision-aid for immunosuppressive drugs vs. standard pamphlet with information about lupus and its treatment including immunosuppressive drugs and outcomes. Patients will complete outcome assessments immediately after the intervention has been administered. Patients will be followed at 3-months with a brief survey, either in person or on the phone, and at 6-months with medical record review for exploratory outcomes. Co-primary outcomes are decisional conflict and informed choice regarding immunosuppressive drugs (combines values, knowledge and choice). Secondary outcomes include: (1) assessment of patient-physician communication by assessing audio-taped physician-patient communication after intervention administration; (2) concordance between patient’s desired and actual role in immunosuppressive drugs decision-making using the control preference scale (CPS); and (3) patient perception of physician interaction using the interpersonal process of care- short form (IPC-SF).DiscussionThis is one of the first studies to evaluate the effectiveness of an educational intervention targeting minorities with lupus nephritis. This patient-centered lupus nephritis decision-aid will be available in the public domain in English and Spanish.Trial registrationClinicalTrials.gov Identifier: NCT02319525; registered on November 5, 2014.