Evaluation of a machine learning tool for the early identification of patients with undiagnosed psoriatic arthritis - A retrospective population-based study.

Background: Psoriatic arthritis (PsA), an immune-mediated chronic inflammatory skin and joint disease, affects approximately 0.27% of the adult population, and 20% of patients with psoriasis. Up to 10% of psoriasis patients are estimated for having undiagnosed PsA. Early diagnosis and treatment can prevent irreversible joint damage, disability and deformity. Questionnaires for screening to identify undiagnosed PsA patients require patient and physician involvement. Objective: To evaluate a proprietary machine learning tool (PredictAI™) developed for identification of undiagnosed PsA patients 1-4 years prior to the first time that they were suspected of having PsA (reference event). Methods: This retrospective study analyzed data of the adult population from Maccabi Healthcare Service between 2008 and 2020. We created 2 cohorts: The general adult population ("GP Cohort") including patients with and without psoriasis and the Psoriasis cohort ("PsO Cohort") including psoriasis patients only. Each cohort was divided into two non-overlapping train and test sets. The PredictAI™ model was trained and evaluated with 3 years of data predating the reference event by at least one year. Receiver operating characteristic (ROC) analysis was used to investigate the performance of the model, built using gradient boosted trees, at different specificity levels. Results: Overall, 2096 patients met the criteria for PsA. Undiagnosed PsA patients in the PsO cohort were identified with a specificity of 90% one and four years before the reference event, with a sensitivity of 51% and 38%, and a PPV of 36.1% and 29.6%, respectively. In the GP cohort and with a specificity of 99% and for the same time windows, the model achieved a sensitivity of 43% and 32% and a PPV of 10.6% and 8.1%, respectively. Conclusions: The presented machine learning tool may aid in the early identification of undiagnosed PsA patients, and thereby promote earlier intervention and improve patient outcomes.

Cost-free and sustainable incentive increases healthy eating decisions during elementary school lunch.

We aimed to develop a cost-free and sustainable program to influence healthier eating decisions during elementary school lunch. Baseline food and beverage choices were assessed for 9 days during lunch service at two racially and economically diverse elementary schools in Spartanburg County, SC, USA. After being informed that the labeled items on the daily lunch menu represented the healthiest choice, students were allowed to ring a call bell in the cafeteria for public recognition when they chose all of the identified healthiest food and beverage items during lunch service. Using menus matched to the baseline phase, food and beverage choices were measured during a 9-day intervention phase. After 30 days, food and beverage choices were reassessed during a 3-day follow-up phase. Healthiest food & beverage choices increased 49% with >60% of students choosing non-flavored milk over flavored milk during the intervention phase. There was no difference in the success of the program between the two schools. The program continued and healthy eating decisions were significantly sustained at a 30-day follow-up assessment. Public recognition through bell ringing appears to be an effective practice to sustain increases in healthy eating decisions during elementary school lunch and warrants expansion to larger scale, longitudinal trials.

Mutual antagonism of estrogen receptors alpha and beta and their preferred interactions with steroid receptor coactivators in human osteoblastic cell lines.

Estrogen is a major sex steroid that affects the growth, maintenance, and homeostasis of the skeleton. Two isoforms of the estrogen receptor (ERalpha and ERbeta) mediate the transcriptional effects of estrogen. Although both isoforms of ER are present and functional in some human osteoblast (OB) cell lines, there is minimal information on the differential regulation of transcription by ERalpha and ERbeta homo- or heterodimers. This report demonstrates that ERalpha and ERbeta coexpression decreases the transcriptional capacity (relative to each ER isoform alone) on an estrogen response element-dependent reporter gene in OBs but not in other non-osteoblastic cell lines. These data suggest that ERalpha and ERbeta coexpression can differentially influence the degree of transcriptional activation in certain cell types. Interestingly, the overexpression of the steroid hormone receptor coactivator-1 (SRC1) resulted in preferential transcriptional enhancement by ERbeta as well as coexpressed ERalpha and ERbeta, whereas SRC2 overexpression appeared to preferentially enhance ERalpha transactivation. SRC3 overexpression failed to enhance estrogen-dependent transcription of any ER combination in OBs. Similar overexpression experiments in COS7 cells exhibited preferential enhancement of ERalpha function with all SRCs, including SRC3. Our data also demonstrated that SRC3 mRNA is reduced in osteoblastic cells, suggesting that SRC3 may have only a minor role in these cells. These data suggest that the transactivation capacity of various ER isoforms is both SRC species and cell type dependent.

Bisphosphonates directly regulate cell proliferation, differentiation, and gene expression in human osteoblasts.

Bisphosphonates are widely used clinically to treat bone diseases in which bone resorption is in excess. However, the mechanism of bisphosphonate action on bone is not fully understood. Studies of direct action of bisphosphonates on bone have been limited mainly to their effects on bone-resorbing osteoclast cells, with implications that some activity may be mediated indirectly through paracrine factors produced by the bone-forming osteoblast cells. Little is known about the direct effects of bisphosphonates on osteoblasts. In this report, the direct actions of several bisphosphonates on cell proliferation, gene expression, and bone formation by cultured human fetal osteoblasts were examined. Osteoblast cell proliferation was decreased, and cytodifferentiation was increased in a dose-dependent manner in cultures treated with the bisphosphonate pamidronate. In addition, pamidronate treatment increased total cellular protein, alkaline phosphatase activity, and type I collagen secretion in osteoblasts. Consistent with the above-mentioned findings, the rate of bone formation was also increased in osteoblasts cultured with pamidronate. The actions of two other bisphosphonates, the weak-acting etidronate and the potent new analogue zoledronate, were also compared with the action of pamidronate on proliferation of immortalized human fetal osteoblast (hFOB) cells and rate of bone formation. Pamidronate and zoledronate decreased hFOB cell proliferation with equal potency, whereas etidronate decreased proliferation only at much higher concentrations. Studies comparing EDTA and etidronate indicate that etidronate may act indirectly on the hFOB cells by reducing free divalent ion concentrations, whereas pamidronate and zoledronate appear to act on the hFOB cells by a direct action. Both pamidronate and zoledronate increase hFOB cell bone formation, whereas no increase is observed with etidronate and EDTA. Taken together, these observations strongly suggest that treatment with pamidronate or zoledronate enhances the differentiation and bone-forming activities of osteoblasts.

Pathophysiology of anterior shoulder instability.

OBJECTIVE: To review some of the important biomechanical factors that provide glenohumeral stability, along with the pathologic mechanisms involved in glenohumeral instability of the shoulder. DATA SOURCES: Current English medical literature concerning the multiple pathologic factors involved in glenohumeral instability was reviewed. DATA SYNTHESIS: Multiple dynamic and static factors control glenohumeral instability. Knowledge of normal shoulder anatomy and biomechanics is necessary to interpret pathologic events. CONCLUSIONS/RECOMMENDATIONS: Dynamic and static factors collectively provide stability to the glenohumeral joint. Disruption or malfunction of these factors causes dysfunction in the shoulder.

Growth and nutritional status of rural South African children 3-10 years old: The Ellisras growth study.

This study presents cross-sectional data from an ongoing mixed-longitudinal study of growth of rural children from Ellisras, South Africa. The physical growth and nutritional status of 1,335 children (684 boys, 651 girls), 3-10 years of age, was determined using standard anthropometric techniques. Weight-for-age, height-for-age, and weight-for-height were expressed as Z-scores of the NHANES I and II or NCHS reference sample. A Z-score of less than -2 was used as the cut-off point to determine the prevalence of stunting and wasting. Mean heights increased parallel to the 50(th) centile up to 6 years of age, thereafter both sexes diverged from the NHANES reference by approximately 0.5 cm per year. Mean weights followed a more consistent pattern from 3-7 years for both sexes, which was parallel to just below the 10(th) centile, but diverged between 8 and 10 years of age. Z-scores of weight-for-height in both sexes varied between -1 to -2 throughout the age range and BMI values were lower than the 5(th) centile of NHANES, indicating a significant amount of wasting within the sample. The sample exhibited a high prevalence of stunting, rising from less than 10% at 7 years to more than 30% by 10 years of age. Increments of the mean heights and weights indicate that the effects of stress may be a gradually accumulating process and that the growth increments of these children became increasingly poor in contrast to those of the reference sample. Since stunting in childhood is permanent, it may lead to a loss of physical work capacity in adulthood. Therefore, further investigation of the cause of poor growth among these rural children is imperative. Am. J. Hum. Biol. 12:42-49, 2000. Copyright 2000 Wiley-Liss, Inc.

Clinical conversations: nurses who work with patients with interstitial cystitis.

Nurses who work with patients with interstitial cystitis agree these patients demand considerable clinician time. Interstitial cystitis is a chronic disease with several etiologic theories explaining the syndrome. Diagnosis and treatment are already updated in the preceding article by Dr. Peters. Conversations with nurses who practice in different areas of the United States extend this discussion by addressing patient issues and offering specific nursing advice.

Sex differences in the prevalence of obesity in rural African adolescents.

OBJECTIVE: To investigate the prevalence and gender differences in obesity in rural African adolescents. DESIGN: Cross-sectional analysis of a mixed-longitudinal study. SUBJECTS: Four hundred and forty-seven rural African adolescents (190 females; 257 males) aged 7.0-18.9 y. MEASUREMENTS: Anthropometric measurements of height, weight, and skinfolds at the bicep (BCP), tricep (TRCP), subscapular (SSCP) and suprailiac (SPIL) sites and derived ratios of fat distribution including trunk:limb ratios (SSTB = (SSCP + SPIL)/(TRCP + BCP) and ST = SSCP/TRCP), and the upper:lower truncal ratio (TRUNK = SSCP/SPIL). Obesity was defined as (1) a BMI greater than the NHANES III 85% centile or (2) the sum of TRCP and SSCP skinfolds greater than the NHANES III 85% centile. RESULTS: Skinfold measures were significantly greater in females throughout the age range but remarkably greater divergence was apparent after mean menarcheal age of 14.03 y (s.d. = 1.25). Centralization of body fat was consistently greater in males but only significantly so after 14 y of age for the ST ratio. Obesity, defined by BMI or sum of skinfolds, was greatest in females following menarche reaching a maximum of 16.7% by BMI and 11.1% by sum of skinfolds, and almost non-existent in males. CONCLUSIONS: Increased prevalence of obesity in African females did not occur throughout adolescence but was linked to the timing of menarche. Increased fatness and obesity appears to be a post-menarcheal phenomenon probably caused by the hormonal changes leading to and following first menstruation.

Blunt cardiac trauma resulting in right atrial rupture.

Between 50,000 and 60,000 persons in the United States die each year as a result of motor vehicle accidents. It is estimated that myocardial rupture occurs in 10% to 15% of victims of fatal accidents. We recently cared for five patients with atrial rupture in the Columbus, Ohio, metropolitan area, and this experience has prompted this report.