Fair Response Research Articles

Development and validation of a composite disease activity score for measurement of muscle and skin involvement in juvenile dermatomyositis.

To develop a composite DAS for JDM and provide preliminary evidence of its validity. The Juvenile DermatoMyositis Activity Index (JDMAI) is composed of four items: physician's global assessment of overall disease activity; parent's/child's global assessment of child's wellbeing; measurement of muscle strength; and assessment of skin disease activity. The score of the JDMAI is the arithmetic sum of the scores of each individual component. Six versions of the JDMAI were tested, which differed in the tools used to assess the third and fourth items. Validation procedures were conducted using three large multinational patient samples including a total of 627 patients. The JDMAI was found to possess face and content validity, good construct validity, satisfactory internal consistency (Cronbach's alpha = 0.58-0.89), fair responsiveness to clinically important change (standardized response mean = 0.82-3.12 among patients improved) and strong capacity to discriminate patients judged as being in the state of inactive disease or low, moderate or high disease activity by the physician (P < 0.001) or whose parents were satisfied or not satisfied with the course of their child's illness (P < 0.001). Overall, the six versions of the JDMAI showed similar metrological performances in validation analyses. The JDMAI was found to possess good measurement properties in a large population of patients with a wide range of disease activity, and is, therefore, suitable for use in both clinical and research settings. The final version of the JDMAI will be selected after its prospective validation.

A hospital based assessment of the effects of various topical agents in chronic plaque type psoriasis

Aim: To determine the effect of various topical agents in chronic plaque type psoriasis.Materials and Methods: The study was carried out on patients having chronic plaque type psoriasis vulgaris came to the Department of Dermatology, Chandulal Chandrakar Memorial Medical College, Durg, Chhattisgarh, India. Total 300 patients were enrolled and were divided into three groups comprising of 100 patients in each group. Group A patients were asked to apply ammonium lactate twice a day, Group B patients were asked to apply ammonium lactate in morning and clobetasol propionate in evening, Group C patients were asked to apply topical ammonium lactate in morning and calcipotriol in evening.Results: Physician global assessment scale shows that in Group A, 39% patients had excellent response, 15% patients had good response, and 21% patients had fair response whereas 25% patients had poor response. In group B, 35% patients had excellent response, 29% patients had good response, and 17% patients had fair response whereas 19% patients had poor response. In group C, 31% patients had excellent response, 28% patients had good response, and 22% patients had fair response whereas 19% patients had poor response.Conclusion: Combination therapy is effective, well tolerated with minimal side effects and better compliance was seen with patients. Ammonium lactate 12% can also be considered as one of the topical option as a monotherapy and also as a maintenance therapy.

A comparative study of topical 5% tranexamic acid and triple combination therapy for the treatment of melasma in Indian population

Introduction Melasma is an acquired hyperpigmentary disorder and poses great therapeutic challenge and has a high recurrence rate. Topical 5% tranexamic acid (TA) is a novel and safe alternative therapy for melasma. The aim of our study was to evaluate the efficacy of topical solution of 5% TA and compare it with triple combination therapy (hydroquinone, tretinoin, fluocinolone) in Indian population. Materials and Methods This was a prospective comparative study of 12 weeks. A total number of 25 patients between 18 and 50 years of age were included in the study. Patient’s face was divided into two halves (split face), and on one half of the face (i.e., on left), topical 5% TA and on the other half of the face (i.e., on right), topical triple combination therapy were applied. The melasma area severity index (MASI) and side effects were evaluated at baseline and every 15 days. Photographs were taken at alternate visits (i.e., 30 days) and compared with earlier one by an independent observer. Results The study was completed on 23 patients. The mean MASI scores decreased significantly in both the groups (P 0.05). However, the side effects of triple combination therapy were significant compared with TA. At the end of 12 weeks, in group 1, photographic evaluation showed excellent response in 26%, good response in 60.1%, fair response in 8.6%, and poor response in 4.3%. In group 2, there was excellent response in 34.7%, good response in 56.5%, fair response in 4.3%, and poor response in 4.3%. Conclusion This study revealed that the topical 5% TA is a safe effective, and better alternative with good patient acceptance for the treatment of melasma. The study revealed improved pigmentation in both tested sides, but topical 5% TA has less side effects such as erythema, irritation, and telangiectasia as compared to triple combination.

Sparing of injection sites in patients with extensive psoriasis treated with various biologics

Although biologic agents have emerged as the preferred strategy for moderate-to-severe psoriasis, sparing around injection sites may be an underreported effect and represent inadequate systemic efficacy with fair local response of biologic treatment for psoriasis. Herein, we report six cases of extensive psoriasis presenting injection site sparing at biologics administration sites.

A Study of Autologous Epidermal Non-cultured Cell Suspension in Stable Vitiligo Patients

Introduction To study the extent of repigmentation after autologous epidermal non-cultured cell suspension in stable vitiligo patients. Patients and Methods A prospective, longitudinal study was conducted to study the extent of repigmentation after autologous epidermal non-cultured cell suspension in 30 stable vitiligo patients Results By subjective assessment, 10% (3) patients showed poor response, 30% (9) showed good response and 60% (18) patients showed excellent response after follow-up at 6 months with good patient satisfaction. By objective assessment 10% (3) patients showed poor response, 13.3% (4) showed fair response and 23.3% (7) patients showed good response, 53.3% (16) patients showed excellent response after follow-up at 6 months. Extent of repigmentation was evaluated as-10% (3) showed poor response, 10% (3) showed fair response and 20% (6) patients showed good response, 60% (18) patients showed excellent response after follow-up at 6 months. Conclusion Autologous non-cultured epidermal cell suspension in stable vitiligo is a safe, effective, simple method, with superior quality of repigmentation.

Comparative analysis of closed reduction and percutaneous pinning versus conventional closed reduction with casting in extra-articular fractures of distal end radius

Background: Distal radius fractures are very common. Closed reduction and casting are the conventional non-operative treatment option available while plate fixation, external fixation and closed reduction with percutaneous pinning are a few surgical options available to the surgeon.Methods: A prospective comparative study of one year was conducted in the Department of Orthopaedic Surgery. A total of 40 patients of distal radial fracture fulfilling the inclusion criteria and giving their consent for inclusion in the study were randomly allocated to either closed reduction (n = 20) or closed reduction with percutaneous K-wire (20). Patients were followed up to 6 months and radiological and functional outcome was compared between two groups.Results: On global assessment using Gartland and Werley criteria, median score of K-wire group was 7.5 which indicated that majority of patients had score &lt;8, thus indicating a good outcome whereas in closed reduction cast group, median score was 13.50, thus indicating that majority of patients had scores in the fair to poor grade. None of the patients in K-wire group had score above 18, thus indicating that all the patients in this group had shown a fair treatment response. Statistically, the difference between two groups was significant too.Conclusions: The present study thus establishes that the immediate post-operative morphological/anatomical and 6 month functional and morphological outcome of closed reduction with K-wire is better as compared to closed reduction with cast.

Excited catatonia in a patient with fatal pulmonary embolism and a successful treatment strategy

BackgroundPatients with psychiatric disorders in critical condition are difficult to treat. In this study, we report on a patient with underlying schizoaffective disorder who developed catatonia, cardiac arrest, and pulmonary embolism, as well as a successful treatment strategy.Case presentationThe inpatient is a 41-year-old morbidly obese male with schizoaffective disorder whose clozapine dosage was titrated from 100 mg to 175 mg due to auditory hallucination and agitation. The patient abruptly developed acute cardiopulmonary symptoms associated with an elevated troponin-I level. He was transferred to a cardiac intensive care unit, where he remained for 3 days. He was also found to have excited catatonic symptoms, and the lorazepam-diazepam protocol was initiated to quickly relieve the catatonia. Once the coronary angiogram was read as normal, the patient was transferred back to the psychiatric ward. However, the patient then suffered from in-hospital cardiac arrest. He was resuscitated and again transferred to the medical intensive care unit. Computed tomography confirmed the diagnosis of a pulmonary embolism. The patient was treated with Rivaroxaban 30 mg/d for the first 21 days, followed by 20 mg daily for 3 months. To control his severe and refractory psychotic symptoms, the patient was re-prescribed clozapine. During the 15-month follow-up period, the patient demonstrated a fair response and tolerability to clozapine 150 mg without symptoms relapse and no thromboembolic event.ConclusionThis report can serve to remind psychiatrists and physicians to be aware of fatal conditions in patients with psychiatric diseases and physical illnesses.

Personalized real time pricing for efficient and fair demand response in energy cooperatives and highly competitive flexibility markets

This paper contributes to the well-known challenge of active user participation in demand side management (DSM). In DSM, there is a need for modern pricing mechanisms that will be able to effectively incentivize selfishly behaving users in modifying their energy consumption pattern towards system-level goals like energy efficiency. Three generally desired properties of DSM algorithms are: user satisfaction, energy cost minimization and fairness. In this paper, a personalized–real time pricing (P-RTP) mechanism design framework is proposed that fairly allocates the energy cost reduction only to the users that provoke it. Thus, the proposed mechanism achieves significant reduction of the energy cost without sacrificing at all the welfare (user satisfaction) of electricity consumers. The business model that the proposed mechanism envisages is highly competitive flexibility market environments as well as energy cooperatives.

Clinical Evaluation of Microneedling Therapy in the Management of Facial Scar: A Prospective Randomized Study.

To evaluate the therapeutic efficacy and complications of microneedling (dermaroller) therapy as a treatment modality in the treatment of facial scars resulting from acne, trauma and surgery. Fifty patients with facial acne scar, traumatic scar, hypertrophic scars and scars with skin discoloration reporting to our institute were included in the study. Microneedling procedure was performed with the help of dermaroller. Postoperative wound was evaluated by three evaluators by comparing preoperative and postoperative clinical photographs. Seven out of the total 50 patients (14%) showed an excellent response to dermaroller treatment, while 26 patients (52%) had a good response. Fourteen patients (28%) had fair response, and 3 patients (6%) had poor response. Microneedling therapy with dermaroller is one of the simplest, yet most effective skin treatments for scars, stretch marks, deep wrinkles, etc. The dermaroller is a definitive credit crunch skin rescue option. It is simple yet effective and suitable for all skin types and skin tones.

Enhanced Photocatalytic Performance of Hierarchical ZnFe2O4/g-C3N4 Heterojunction Composite Microspheres

Semiconductor photocatalysts with suitable band gap for fair response to visible light and efficient separation of electron–hole pairs, are the key to practical application of photocatalytic technology. Magnetically separable hierarchical ZnFe2O4/g-C3N4 composite photocatalysts were prepared by a facile solvothermal method combined with a subsequent annealing process. The composite microspheres were composed of ZnFe2O4 nanoparticles, whose diameter was restricted due to the confined space effect from g-C3N4 nanosheets. ZnFe2O4/g-C3N4 heterojunction structures led to the improvement of the efficiency for photodegrading methylene blue and rhodamine B under visible light, where the kinetic constant over ZnFe2O4/CN-150 photocatalyst was more than ten times larger than that over pure ZnFe2O4. The photogenerated electrons from g-C3N4 surfaces could easily migrate to ZnFe2O4, leading to efficient separation of electron–hole pairs. Also, the composite photocatalyst possessed a chemical stability against photocorrosion and a magnetic property, which made it magnetically separable and reusable conveniently.

Offender Risk Assessment Practices Vary across Canada

The dominant Canadian approach to offender rehabilitation, the risk-need-responsivity (RNR) model, requires assessing offenders' likelihood of recidivism and their criminogenic needs (i.e., risk/need assessments). The current study examines the risk/need assessments routinely used in Canadian corrections and compares their risk category labels. All Canadian jurisdictions used a risk/need tool for general recidivism, most used sex-crime-specific tools, and a few used tools specific to intimate partner violence. There was, however, considerable diversity in the names, number, and meaning of the risk category labels, which could result in different responses to the same individual based solely on the version of the risk tool used in any specific jurisdiction. Our results suggest that increased attention to the meaning of risk category labels could facilitate offenders receiving the most appropriate and fair correctional responses.

Clinical Evaluation of Efficacy and Safety of Combined Topical Timolol and Oral Propranolol in Children with Infantile Hemangioma

Objective: To evaluate the efficacy and safety of combined topical timolol and oral propranolol in treatment of infantile hemangioma. Patients and methods: This prospective study was conducted in Basra teaching hospital in Basra, Iraq, where a total of 23 infants with 34 lesions of different types of hemangioma were included. All lesions were in proliferation phase. The infants’ ages were less than one year. They were treated with topical timolol solution 0.5% combined with oral propranolol in a period of 12 weeks (8-16 weeks). The response to treatment was evaluated clinically by using hemangioma score and Visual analogue scale. All infants followed 4-12 months after cessation of drugs. Results: By using hemangioma score system; the combined therapy showed that, 28 (82.4%) lesions showed excellent response, two (5.9%) showed good response, four (11.8%) showed fair response and none of the lesions showed poor response at end of 16 weeks. At the end of 4 months superficial hemangioma showed 100% reduction in their score, while the ulcerative hemangioma showed 94.7% reduction in their score while mixed hemangioma showed only 76.7% reduction in their scores. Complete resolution occurred in 50% of lesions after 4 months of treatment. Neither included infants developed serious side effects nor, any of the regressed hemangioma recur during the follow up. Conclusion: Combined topical Timolol 0.5% solution and oral propranolol seems to be a well-tolerated, safe treatment option with a good to excellent responses. The most responsive type of hemangioma to this combination are the superficial and ulcerative types.

Non-Hodgkin Lymphoma of External Auditory Canal – Uncommon Location and Related Risk Factors

Objective: Presentation of rare case report of primary non-Hodgkin Lymphoma of temporal bone secondary to immunodeficiency after prolonged steroid administration in a diabetic patient. Then review the literature of similar case reports. Method: 49 years old female presented with hearing loss, facial paralysis and otalgia. Biopsy revealed high grade non Hodgkin’s B-lymphoma. She underwent chemotherapy and had remarkable response. Result: Rapidly progressive deafness, facial paralysis and otalgia are common presentations of external canal Non-Hodgkin lymphoma. The disease is common in middle age, females and has a fair response to chemotherapy, good to radiotherapy. Surgery is an alternative method in isolated lesions or recurrent cases. Conclusion: High dose steroid and type II diabetes are potential risks for acquired immunodeficiency. External Auditory canal lymphoma is uncommon sequel. Chemotherapy is very effective in treatment of isolated cases without B symptoms

Evaluation of narrowband ultraviolet B phototherapy in patients with generalized lichen planus

Background: Lichen planus (LP) is a chronic inflammatory pruritic dermatosis affecting people of all ages and both sexes. Various therapeutic modalities have been tried in acute generalized LP with limited success. Currently, narrowband ultraviolet B (NB-UVB) therapy is being used to treat various inflammatory diseases. There are limited published studies in the literature to evaluate the efficacy of NB-UVB therapy in LP. Aim: To evaluate the efficacy, tolerability, and safety of NB-UVB therapy in acute generalized LP in both children and adults clinically and to observe relapse on follow-up. Materials and Methods: This was a prospective, open, and nonrandomized study. The study group included 70 patients of both sexes with a mean age group of 5–65 years. For the purpose of the study, a template of 5 × 5 cm with a high density of lesions was taken in addition to general response and photographic evaluation before and after treatment. A starting dose of 150 mJ/cm2 was started given twice weekly on nonconsecutive days with a 20% increment on every third exposure. The clinical response was graded on a four-point scale (excellent to poor). All cases who responded were observed for a period of 6 months for relapse. Appropriate statistical methods were employed. Results: In this study, excellent response was seen in 35 patients (mean: 25.7 exposures), good response in 11 patients (25.3 exposures), fair response in 9 patients (50 exposures), and poor response in 5 patients (50 exposures) (P-value = 0.000). A relapse rate of 9% after 6 months of follow-up and 36% after 1-year follow-up was observed (P-value = –0.002). Limitations: As the sample size of this study is small, large studies are needed to establish the efficacy of NB-UVB therapy in acute generalized LP. Conclusion: NB-UVB therapy is an effective and safe modality of treatment for acute generalized LP in both children and adults. Approximately, 20–25 exposures are needed to get good response. Prolonged remission is obtained with NB-UVB therapy.

Fair Demand Response With Electric Vehicles for the Cloud Based Energy Management Service

Fluctuated penetration of electric vehicle (EV) loads and production capacities from distributed energy resource (DER) bring large impacts to power systems. To smooth fluctuations, financial incentives have to be maximized for customers controlling their consumption patterns. A fair demand response with electric vehicles (F-DREVs) is proposed for the cloud-based energy management service. Customers with EV, DER, storage and multiple loads form communities and obtain optimal choices (electricity usage and trading) from F-DREV. F-DREV aims to maximize incentives by minimizing global cost for each community within the given time period, and smooth fluctuations. In order to attract customers to actively participate, we propose the fairness as “customers with higher participation level can reduce their individual cost more than those with lower participation level within the same community,” which is attainable by customizing trading prices. A binary linear programming model is formulated, and performances are evaluated in experiments.

Comparative clinical evaluation of effect of topical verses systemic anti -allergic drug in allergic rhinitis: a prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Nasal passages form one of the chief sources of contact of the human with his environment. Hence, it is natural that the mucosa of the area is the victim of assault with multitudes of potential allergens. Allergic rhinitis is an inflammatory disease with worldwide prevalence of 10-40%. Allergic rhinitis is a disease with low mortality but significantly lowers the quality of life and functioning. Both oral and intranasal antihistamines are approved for the first-line treatment of allergic rhinitis and both formulations result in a reduction in symptoms and an improvement in quality of life. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The following study was designed to assess the efficacy and safety of the azelastine nasal spray in comparison to levocetrizine in patients with allergic rhinitis. Out of the 68 patients, 34 cases were treated with topical azelastine (group A), while remaining 34 with systemic levocetrizine (group B). The effects of anti-allergic drugs have been studied on the basis of relief of symptoms and change in histopathology. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The effect of levocetrizine has been studied on the basis of relief of symptoms and change in histopathology and found to have complete response in 58% and fair response in 23.5% patients of allergic rhinitis. The effect of topical azelastine nasal spray have complete response in 70.5% and fair response in 23.5% patients of allergic rhinitis. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Comparing the post therapy clinical and histopathological results in this study, azelastine nasal spray was found to be more effective and safe in the treatment of allergic rhinitis than levocetrizine.&lt;/span&gt;&lt;/p&gt;

A Regression Method Based on Noninvasive Clinical Data to Predict the Mechanical Behavior of Ascending Aorta Aneurysmal Tissue.

Goal: Ascending aorta aneurysms represent a severe life-threatening condition associated with asymptomatic risk of rupture. Prediction of aneurysm evolution and rupture is one of the hottest investigation topics in cardiovascular science, and the decision on when and whether to surgically operate is still an open question. We propose an approach for estimating the patient-specific ultimate mechanical properties and stress-stretch characteristics based on noninvasive data. Methods: As for the characteristics, we consider a nonlinear constitutive model of the aortic wall and assume patient-specific model coefficients. Through a regression model, we build the response surfaces of ultimate stress, ultimate stretch, and model coefficients in function of patient data that are commonly available in the clinical practice. We apply the approach to a dataset of 59 patients. Results: The approach is fair and accurate response surfaces can be obtained for both ultimate properties and model coefficients. Conclusion: Prediction errors are acceptable, even though a larger patient dataset will be required to stabilize the surfaces, making it possible to apply the approach in the clinical practice. Significance: A fair prediction of the patient aortic mechanical behavior, based on clinical information noninvasively acquired, would improve the decision process and lead to more effective treatments.Goal: Ascending aorta aneurysms represent a severe life-threatening condition associated with asymptomatic risk of rupture. Prediction of aneurysm evolution and rupture is one of the hottest investigation topics in cardiovascular science, and the decision on when and whether to surgically operate is still an open question. We propose an approach for estimating the patient-specific ultimate mechanical properties and stress-stretch characteristics based on noninvasive data. Methods: As for the characteristics, we consider a nonlinear constitutive model of the aortic wall and assume patient-specific model coefficients. Through a regression model, we build the response surfaces of ultimate stress, ultimate stretch, and model coefficients in function of patient data that are commonly available in the clinical practice. We apply the approach to a dataset of 59 patients. Results: The approach is fair and accurate response surfaces can be obtained for both ultimate properties and model coefficients. Conclusion: Prediction errors are acceptable, even though a larger patient dataset will be required to stabilize the surfaces, making it possible to apply the approach in the clinical practice. Significance: A fair prediction of the patient aortic mechanical behavior, based on clinical information noninvasively acquired, would improve the decision process and lead to more effective treatments.

Fairness and Customer Responses in the Process of Service Recovery

Fairness and Customer Responses in the Process of Service Recovery

Ilmenite phase nickel titanate nanowhiskers as highly sensitive LPG sensor at room temperature

The NiTiO3 nanoparticles with ilmenite phase were synthesized by the sol gel method and investigated for sensing of various volatile organic compounds. The resistive type sensing by NiTiO3 towards LPG was not reported earlier where the sensor showed fair response towards hydrogen sulfide gas, but the sensitivity towards LPG was very high. The response % for 150 ppm of LPG was approximately 3200% at room temperature. The high response towards LPG was due to the presence of some amount of rutile TiO2 in the composites. The response and recovery times of these sensors were very less (about 2 s) which could be attributed to the whiskers like structure of NiTiO3.

Medical Innovation in a Children's Hospital: 'Diseases desperate grown by desperate appliance are relieved, or not at all'.

A balance needs to be struck between facilitating compassionate access to innovative treatments for those in desperate need, and the duty to protect such vulnerable individuals from the harms of untested/unlicensed treatments. We introduced a principle-based framework (2009) to evaluate such requests and describe its application in the context of recently evolved UK, US and European regulatory processes. 24 referrals (20 individual; four group) were received by our quaternary children's hospital Clinical Ethics Committee (CEC) over the 5-year period (2011-16). The CEC-rapid response group evaluated individual cases within 48-hours; the main referrers being haematology/oncology, immunology or transplant services (14). Most requests were for drug/vaccine/pre-trial access (13) or biological/cellular therapies (8). The majority of individual requests were approved (19/20); neutral or negative opinions were given in 5, including 3 group requests. Recently evolved regulatory processes share common criteria and conditions to our framework including: demonstration of clinical need; sound scientific basis with lack of viable alternative; risks-benefit/best interests evaluation; arrangements for fully informed consent; no compromise of arrangements to test treatment for licensing purposes; consideration of resource implications. There are differences between individual processes and with our framework, with respect to procedures, scope, application format, costs and obligation to make available all outcome data. Our experience has emphasized the need for an independent, principled, consistent, fair and transparent response to the increasing demand for innovative treatment on a compassionate basis. We believe that there is a need for harmonization of the recent proliferation of regulation and legislation in this area.