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Background The psoriatic arthritis (PsA) Observational Study of Persistence of Treatment (PRO-SPIRIT) assesses effectiveness and persistence of real-world PsA treatments. Ixekizumab (IXE) is an interleukin (IL)-17A inhibitor (i) (IL-17Ai), approved for the treatment of adult PsA.Methods The aim of this predefined interim analysis was to report baseline characteristics along with early (3-month) descriptive and comparative real-world effectiveness in patients with PsA prescribed with advanced treatment including IL-17Ai; IXE or secukinumab (SEC), IL-12/23i, IL-23i, tumour necrosis factor (TNFi) or Janus kinase (JAKi).Results 1192 patients across 6 countries were analysed. At baseline, patients receiving IXE had longer disease duration and higher previous biological/targeted-synthetic disease-modifying antirheumatic drugs experience than patients starting TNFi and SEC 150, and less concomitant conventional-synthetic DMARD use than TNFi and JAKi. Comparative analyses at 3 months showed that: (a) versus TNFi, IXE exhibited similar improvement in clinical Disease Activity in PsA (cDAPSA) but significantly greater improvement in body surface area affected by psoriasis (BSA) and global assessments (physician GA, patient GA (PatGA)); (b) versus IL-12/23i and IL-23i (pooled), IXE showed significantly greater improvement in cDAPSA and PatGA; (c) IXE was as fast as JAKi in improving joint disease activity. Ad hoc analysis indicated that more patients with active psoriasis (BSA ≥3%) achieved minimal disease activity with IXE than JAKi or IL-12/23i. The responses to SEC varied by dosage.Conclusions This study confirms the rapid 3-month effectiveness of IXE on joint disease activity—as fast as TNFi and JAKi (cDAPSA), and exceeding IL-12/23i and IL-23i—along with clear benefits to skin.

Objective This post hoc analysis of the FINCH 1–3 (NCT02889796, NCT02873936 and NCT02886728) studies assessed specific effects of filgotinib on pain control and their relationship with other aspects of efficacy in patients with rheumatoid arthritis (RA).Methods Assessments included: residual pain responses of ≤10 and ≤20 mm on a 100 mm visual analogue scale (VAS); the proportion of patients who achieved VAS pain responses in addition to remission or low disease activity by Disease Activity Score-28 with C-reactive protein (DAS28-CRP) or Clinical Disease Activity Index (CDAI) criteria.Results Across studies, filgotinib reduced pain from week 2, with responses sustained throughout the studies. In FINCH 1, at week 24, 35.8%, 25.0%, 24.6% and 11.6% of patients in the filgotinib 200 mg, filgotinib 100 mg, adalimumab and placebo arms (each plus methotrexate) achieved VAS pain ≤20 mm in addition to DAS28-CRP remission; 26.3%, 17.9%, 17.2% and 7.6% achieved VAS pain ≤10 mm in addition to DAS28-CRP remission. A similar pattern was seen for CDAI remission. Time during which VAS pain was ≤10 or ≤20 mm was longest with filgotinib 200 mg and comparable between adalimumab and filgotinib 100 mg. Similar findings were reported for filgotinib in FINCH 2 and 3.Conclusion In all RA populations studied, pain improvements occurred from week 2 and were sustained over time. In FINCH 1, filgotinib 100 mg provided similar pain amelioration to adalimumab, whereas filgotinib 200 mg resulted in greater pain improvement and higher proportion of patients with residual pain ≤10 or ≤20 mm and meeting DAS28-CRP remission criteria.

Objective Understanding preferences of patients with rheumatoid arthritis (RA) can facilitate tailored patient-centric care. This study elicited trade-offs that patients with RA were willing to make during treatment selection.Methods Patients with RA completed an online discrete choice experiment, consisting of a series of choices between hypothetical treatments. Treatment attributes were selected based on literature review and qualitative patient interviews. Eligible patients were ≥18 years old, diagnosed with RA, receiving systemic disease-modifying antirheumatic drug therapy, and residents of Europe or USA. Male patients were oversampled for subgroup analyses. Data were analysed using a correlated mixed logit model.Results Of 2090 participants, 42% were female; mean age was 45.2 years (range 18–83). Estimated effects were significant for all attributes (p

In this paper we study electronic driving license (EDL) for secure sharing of vehicles in wireless IoT networks. The process of authentication and data transmission to the server is a very challenging problem to solve. To solve this problem, we propose the use of a wireless IoT network to overcome the transmission speed from the vehicle to the server, and the use of EDL for the driver authentication process. Two devices are installed on the vehicle side and on the server side while the wireless IoT network is used to make data transmission efficient. EDL is used to authenticate drivers who rent vehicles. When the device authentication process on the vehicle will send geographic information obtained through the global positioning system (GPS) to the server. The server will verify the user, if it matches then the server will send a command to the vehicle to be used. To run the considered system, we proposed Algorithm 1 and 2 to run the vehicle device and server, respectively. Experiment result shows the proposed system has maximum accuracy in 95.5%, packet delivery ratio 90%, delay propagation less than 60 seconds. Thus, the security of the shared vehicle will be increases.

Abstract Introduction RA-BE-REAL is a 3-year, multinational, prospective, observational study of adult patients with rheumatoid arthritis (RA) evaluating time to discontinuation of initial RA treatment along with patient baseline characteristics. This study’s primary objective was to assess the time to discontinuation of initial baricitinib, any other targeted synthetic disease-modifying anti-rheumatic drug (tsDMARD), or any biologic disease-modifying anti-rheumatic drug (bDMARD) treatment for all causes (excluding sustained clinical response) over 24 months in a European population. Methods Patients initiated treatment with baricitinib (cohort A) or any bDMARD or tsDMARD (cohort B) for the first time. This study’s primary objective was to assess the time to discontinuation of initial baricitinib, any other targeted synthetic disease-modifying anti-rheumatic drug (tsDMARD), or any biologic disease-modifying anti-rheumatic drug (bDMARD) treatment for all causes (excluding sustained clinical response) over 24 months in a European population. Comparative effectiveness analyses, over 24 months, included time to treatment discontinuation for all causes (excluding sustained clinical response), percentage of patients achieving Clinical Disease Activity Index (CDAI) remission or low disease activity (LDA), as well as mean changes from baseline for CDAI, pain visual analogue scale, and the Health Assessment Questionnaire-Disability Index (HAQ-DI). For this European subpopulation, comparative analyses were performed using a frequentist model averaging (FMA) framework based on a data-driven machine learning causal inference approach to compare time to discontinuation, effectiveness, rates of remission or LDA, and patient-reported outcomes over 24 months comparing baricitinib with TNFi, as well as non-TNFi and tsDMARD grouped as other mechanism of action (OMA) drugs. Results In the European sample of RA-BE-REAL, patients with RA treated with baricitinib experienced fewer discontinuations in comparison to those treated with tumour necrosis factor inhibitors or OMA. Overall, patients naïve to b/tsDMARDs achieved a higher rate of LDA and remission compared with experienced patients. A significantly greater proportion of patients treated with baricitinib achieved LDA compared with b/tsDMARDs. Conclusion This real-world data can better inform clinicians about baricitinib effectiveness and drug survival when prescribing treatment for patients with RA across different subpopulations.

The wider spread of the use of smartphones is also very helpful for UMKM not only in terms of marketing or sales, but daily operations. On the Senyum Manis cafe the owner of the business owner conducts data on stocks of goods, materials, and prices for drinks manually. When doing the process of collecting the goods manually there is an error in stock calculation so that it takes a long time to check the stock of the item. With this innovation using the application of QR Code which can be used as a label in every stock of goods and beverage materials. In this case the implementation of the RFID tag is also used to get the customer queue number. From this researcher the system is considered successful because the data input can appear in the application , QOS (Quality of Service) test results when uploading data get a 33K throughput value that belongs to the medium category, Packet Loss produces a value of 0.097% which is classified in a very good category, average delay produces a value of 87.4 s which is classified in a very good category . This aims to anticipate changes that will occur, the review is useful to see the condition of whether the system is in accordance with the needs of a sweet smile cafe and whether it is necessary to add or change the existing system in order to keep up with development technology.

In order for underwater wireless sensor networks to communicate more efficiently, MAC protocols are needed to control the use of acoustic channels. With the high propagation delay and the limited bandwidth available on the acoustic channel, a specially designed MAC protocol is needed for UWASN (Underwater Acoustic Sensor Networks). In this research, the adaptation of Cooperative MAC for underwater (CoopMAC-U) will be further studied to test the protocol performance. In the previous research, CoopMAC-U was simulated yet the fairness of the transmission was not simulated and tested. In this research, CoopMAC-U will be studied further and improved. The simulation result shows that the Improved CoopMAC-U protocol produces better-normalized throughput than the initial version of CoopMAC-U. The protocol is also proven that it is backward compatible between conventional mode and cooperative mode. For offered load greater than 0.2, both the initial version of CoopMAC-U and the Improved CoopMAC-U result in stagnant normalized throughputs but the improved ones double the value of the initial version.

The development of technology in the field of security has a big impact on people's lives throughout the world. The security is threatened when there is a burglary in the neighborhood. One of the applications of image processing is the frame difference method, which used comparison of the captured image frame circuit according to time order. Frame difference algorithm applied to grayscale image computing using ESP32-CAM cameras for security cameras. This research was developed with a system that can monitor objects detected in real-time by streaming using a website. The ESP32-CAM camera and the PC have a packet loss value of 4.29% and an average delay of 0.3 seconds so that the images captured by the camera can be well received by the PC. The frame difference method with moving objects is used and detected well during the day due to solar lighting, but at night only depends on luminous objects. This method has the disadvantage that when moving objects inhabit the same field of view, the system will define it as movement so that the frame difference method is not adaptive from changes in the captured area.

Indonesia has been affected by COVID-19 since 2020. In order to stop the virus spreading, the government puts Large Scale Social Restrictions. There is no denying that during this pandemic, criminality is increasing, and this is due to nothing other than the need to survive. The stealing and invading of homes is one of the crimes that have increased. Additionally, the government has strengthened health procedures to require that individuals wear masks while doing activities outside. A system that can identify faces and identify the use of masks was developed in order to solve this issue. Face recognition is used to increase security, and mask detection systems work to enforce the wearing of masks when engaging in outside activities. Both of these technologies can be combined into a single smart door lock system for the home. The system will apply facial recognition identification when someone wants to enter the house and mask detection when they want to do activities outside the house. As a monitoring tool, data will be delivered in the form of an image via the user's Android. This is proven by the accuracy rates of facial identification of 95% and mask detection of 97.5% in this research.

Abstract Introduction The SmartClic®/ClicWise® autoinjector is a new reusable, multi-use, single-patient device for the administration of subcutaneously administered biologics in the treatment of chronic conditions, including rheumatoid arthritis. The device will be used in conjunction with a mobile application (app). The aim of this study was to collect feedback on the usability, functionality, and applicability of the device and the companion app from health care professionals (HCPs) who perform injections as part of their role and care for patients with rheumatic conditions. Methods The study was conducted from September to October 2020 in Germany. HCPs participated in a training session for the device and gained experience by performing simulated injections with water. Following the simulations, HCPs answered questions on the ease of use, feature design, effectiveness, and injection speed of the SmartClic/ClicWise device and estimate the patient training time required. They also answered questions on the functionality of the proposed app after attending a storyboard presentation. Responses were recorded as multiple-choice answers, Likert scale ratings (seven-point scale), or open-ended comments. The mean, median, and mode scores were recorded. Results Twenty-five HCPs (mean age, 38.2 years; females, n = 22 [88%]; registered nurses, n = 19 [76%]) participated in the study. HCP feedback on questions related to the SmartClic/ClicWise device was positive overall, with mean scores > 4.50 across questions; mean scores 5.70. Conclusions Initial feedback from HCPs on the SmartClic/ClicWise device and proposed app was generally favorable, suggesting they will provide an acceptable alternative for self-administration of biologics for patients with rheumatoid arthritis and other chronic conditions.

Abstract Introduction RA-BE-REAL has the overall aim of defining a profile of patients with rheumatoid arthritis (RA) starting baricitinib or any other targeted synthetic (ts) or any biologic (b) disease-modifying antirheumatic drug (DMARD) for the first time, and the primary objective of estimating time until discontinuation from any cause (excluding sustained response) of the initial treatment. Methods RA-BE-REAL is an ongoing, prospective, observational, 36-month study in patients with RA initiating treatment with baricitinib (cohort A) or any other tsDMARD or any bDMARD (cohort B) for the first time. The primary objective is to assess the time until treatment discontinuation from any cause (excluding sustained response) at 24 months, (i.e., the rate of discontinuation of initial baricitinib or ts/bDMARD). Patient profiles of each cohort are described and compared. Post-baseline data are descriptively analyzed. This manuscript presents baseline and interim (6-month) outcomes for European patients with RA participating in the global RA-BE-REAL study. Results Data from 1074 patients (cohort A: 509; cohort B: 565) were analyzed. For cohorts A and B, respectively, the 6-month cumulative incidence (95% confidence interval) of treatment discontinuation was 16.5 (12.9–21.1) and 23.3 (19.1–28.2), and the proportions of patients achieving remission were 25.6% and 18.5%. At baseline, mean patient age was 59.1 and 57.0 years (p = 0.010) and mean disease duration was 10.0 and 8.9 years (p = 0.047), respectively. The proportions of patients exposed to ts/bDMARDs at any time before study entry were 51.9% and 39.1%, and the proportions of patients initiated on monotherapy were 50.9% and 31.2%, respectively. Conclusion In real-world settings, patients with RA initiating treatment with baricitinib were older and had longer disease duration than those initiating treatment with any other tsDMARD or any bDMARD. Initial descriptive data regarding treatment discontinuation (including reasons for discontinuation), effectiveness, and treatment patterns will be enriched as the study progresses.

The development of information and communication technology is a major need in this advanced era with the aim of all computerized activities ranging from office work, banking, administration, libraries, education, government, organizations, and many more that are very dependent on the sophistication of computers and existing applications. inside it. In the AI ??Polinema Building in the component borrowing room, the component borrowing system and transaction checking for existing collateral-free letters still use the conventional system which causes ineffectiveness in component borrowing and free-of-liberty letter processing. Therefore, a research will be conducted to design a component loan application and check loan transactions for a Web-based free letter. Based on the problems above, in this study the researchers created a system that can support component lending and checking loan transactions for Web-based free letters. This system uses the Visual Studio Code application. From this study, it was found that the system that has been created by the researcher can run well and can help improve the performance of the technicians on duty in the loan room as well as the effectiveness of time for students in the loan process and managing free letters.

According to the results of a 2022 survey conducted by the Association of Indonesian Internet Service Providers (APJII), internet users in Indonesia continued to increase from 175 million to 220 million users of the total population of Indonesia. The increase was driven by the need for communication during the Covid-19 pandemic in the last two years. Most internet users are on the island of Java, followed by the islands of Sumatra, Kalimantan, Sulawesi, Bali-Nusa, and Maluku-Papua. PT. Tentrem Sejahtera is one of the Inter-City In-Province bus companies based on the island of Java, precisely in East Java. The ordering and payment process is still done manually or offline. Consumers who want to buy tickets must come directly to the terminal, to an authorized agent who has been appointed or do it directly when boarding the bus and make transactions in cash. Where when making manual or cash payments sometimes you have to wait a few minutes to issue money and wait for the ticket given by the conductor, while the level of security in payments is very less, so it is less efficient in this sophisticated era. In addition, there are still unscrupulous brokers at several bus departures who sell tickets that do not match the specified price. This study used the e-wallet electronic payment model method, with a mobile payment system for QRIS-based bus fares. With the National Mercant ID (NMID) listed on the QRIS display, a receipt will be issued on the Thermal Print for proof of payment.

BackgroundDuring the COVID-19 pandemic, local health authorities were responsible for managing and reporting current cases in Germany. Since March 2020, employees had to contain the spread of COVID-19 by monitoring and contacting infected persons as well as tracing their contacts. In the EsteR project, we implemented existing and newly developed statistical models as decision support tools to assist in the work of the local health authorities. ObjectiveThe main goal of this study was to validate the EsteR toolkit in two complementary ways: first, investigating the stability of the answers provided by our statistical tools regarding model parameters in the back end and, second, evaluating the usability and applicability of our web application in the front end by test users. MethodsFor model stability assessment, a sensitivity analysis was carried out for all 5 developed statistical models. The default parameters of our models as well as the test ranges of the model parameters were based on a previous literature review on COVID-19 properties. The obtained answers resulting from different parameters were compared using dissimilarity metrics and visualized using contour plots. In addition, the parameter ranges of general model stability were identified. For the usability evaluation of the web application, cognitive walk-throughs and focus group interviews were conducted with 6 containment scouts located at 2 different local health authorities. They were first asked to complete small tasks with the tools and then express their general impressions of the web application. ResultsThe simulation results showed that some statistical models were more sensitive to changes in their parameters than others. For each of the single-person use cases, we determined an area where the respective model could be rated as stable. In contrast, the results of the group use cases highly depended on the user inputs, and thus, no area of parameters with general model stability could be identified. We have also provided a detailed simulation report of the sensitivity analysis. In the user evaluation, the cognitive walk-throughs and focus group interviews revealed that the user interface needed to be simplified and more information was necessary as guidance. In general, the testers rated the web application as helpful, especially for new employees. ConclusionsThis evaluation study allowed us to refine the EsteR toolkit. Using the sensitivity analysis, we identified suitable model parameters and analyzed how stable the statistical models were in terms of changes in their parameters. Furthermore, the front end of the web application was improved with the results of the conducted cognitive walk-throughs and focus group interviews regarding its user-friendliness.

Objective To analyse the clinical profile of SARS-CoV-2 breakthrough infections in at least double-vaccinated patients with inflammatory rheumatic diseases (IRDs).Methods Data from the physician-reported German COVID-19-IRD registry collected between February 2021 and July 2022 were analysed. SARS-CoV-2 cases were stratified according to patients’ vaccination status as being not vaccinated, double-vaccinated or triple-vaccinated prior to SARS-CoV-2 infection and descriptively compared. Independent associations between demographic and disease features and outcome of breakthrough infections were estimated by multivariable logistic regression.Results In total, 2314 cases were included in the analysis (unvaccinated n=923, double-vaccinated n=551, triple-vaccinated n=803, quadruple-vaccinated n=37). SARS-CoV-2 infections occurred after a median of 151 (range 14–347) days in patients being double-vaccinated, and after 88 (range 14–270) days in those with a third vaccination. Hospitalisation was required in 15% of unvaccinated, 8% of double-vaccinated and 3% of triple-vaccinated/quadruple-vaccinated patients (p

Objectives To develop evidence-based points to consider for cost-effective use of biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in the treatment of inflammatory rheumatic diseases, specifically rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis.Methods Following EULAR procedures, an international task force was formed, consisting of 13 experts in rheumatology, epidemiology and pharmacology from seven European countries. Twelve strategies for cost-effective use of b/tsDMARDs were identified through individual and group discussion. For each strategy, PubMed and Embase were systematically searched for relevant English-language systematic reviews and, for six strategies, additionally for randomised controlled trials (RCTs). Thirty systematic reviews and 21 RCTs were included. Based on the evidence, a set of overarching principles and points to consider was formulated by the task force using a Delphi procedure. Level of evidence (1a–5) and grade (A–D) were determined for each point to consider. Individual voting on the level of agreement (LoA; between 0 (completely disagree) and 10 (completely agree)) was performed anonymously.Results The task force agreed on five overarching principles. For 10 of 12 strategies, the evidence was sufficient to formulate one or more points to consider, leading to 20 in total, regarding response prediction, drug formulary use, biosimilars, loading doses, low-dose initial therapy, concomitant conventional synthetic DMARD use, route of administration, medication adherence, disease activity–guided dose optimisation and non-medical drug switching. Ten points to consider (50%) were supported by level 1 or 2 evidence. The mean LoA (SD) varied between 7.9 (1.2) and 9.8 (0.4).Conclusion These points to consider can be used in rheumatology practices and complement inflammatory rheumatic disease treatment guidelines to incorporate cost-effectiveness in b/tsDMARD treatment.

This research aimed to find out whether there is a significant difference in achievement between extrovert and introvert students in speaking ability in the English Conversation subject for 2nd-semester students of the University of Bengkulu. This research was causal-comparative research. The subject of this research was students at the 2nd semester English Department Study Program of University Bengkulu who has taken the English conversation subject in the academic year 2019/2020. The researcher used a Questionnaire and achievement result as the instrument. The result of this research shows that there were no significant differences between introvert and extrovert personalitiesin English Conversation Class achievement. It was concluded that the student's personality does not affect the score achieved in the speaking class.

Background While treat-to-target (T2T) is endorsed for the management of rheumatoid arthritis (RA), data on the degree of implementation in clinical practice are limited. This study investigated the use of T2T for RA in a real-world setting across Europe.Methods The Adelphi RA Disease-Specific Programme was a point-in-time survey of rheumatologists and their consulting patients with RA conducted between January and October 2020 in Belgium, France, Germany, Italy, Spain and the UK. Rheumatologists completed an attitudinal survey, and a record form for their next 10–12 consulting patients, who were invited to voluntarily complete a patient-reported questionnaire. Data collected included clinical characteristics, treatment patterns and attitudes towards T2T.Results Overall, 316 rheumatologists provided data for 3120 patients, of whom 1108 completed the questionnaire. While 86.1% of rheumatologists estimated using T2T principles in clinical practice, only 66.6% of patients were reported by their physician to be managed using a T2T approach. Achieving disease remission was the most commonly reported treatment goal identified by rheumatologists (79.7%), followed by symptom control (47.8%) and reducing impact on quality of life (44.5%). 40.8% of rheumatologists and their patients were in agreement that a treatment goal had been set. When there was agreement on treatment goals, we observed better patient satisfaction, engagement and treatment success.Conclusions Despite recommendations, the T2T approach in RA appears to be suboptimally implemented in clinical practice. This highlights the importance of patient-centricity in the decision-making process to define meaningful targets and select appropriate treatments to improve disease outcomes.

Abstract Background/objective REFLECTIONS B538–02 is a randomized, double-blind comparative study of the adalimumab (ADL) biosimilar PF-06410293, (ADL-PF), and reference ADL sourced from the European Union (ADL-EU) in patients with active RA. Therapeutic equivalence was demonstrated based on ACR20 responses at week 12 (primary endpoint). We report long-term safety, immunogenicity, and efficacy of ADL-PF in patients who continued ADL-PF treatment throughout 78 weeks or who switched from ADL-EU to ADL-PF at week 26 or week 52. Methods Eligible patients (2010 ACR/EULAR RA diagnosis criteria for ≥ 4 months; inadequate response to MTX, ≤ 2 doses non-ADL biologic), stratified by geographic regions were initially randomized (1:1) in treatment period 1 (TP1) to ADL-PF or ADL-EU (40 mg subcutaneously, biweekly), both with MTX (10–25 mg/week). At week 26 (start of TP2), patients receiving ADL-EU were re-randomized to remain on ADL-EU or transition to ADL-PF for 26 weeks. At week 52 (start of TP3), all patients received open-label treatment with ADL-PF for 26 weeks and were followed after last treatment dose to week 92. To evaluate maintenance of response after switching or remaining on ADL-PF, ACR20, DAS28-4(CRP), and other measures of clinical response/remission were assessed through week 78 as secondary endpoints. Three groups were evaluated: biosimilar, week 26 switch, and week 52 switch. Results Overall, 507 patients participated in TP3. ACR20 response rates at week 52 were 88.4%, 88.2%, and 87.6% for the biosimilar, week 26, and week 52 switch groups, respectively. ACR20 response rates and DAS28-4(CRP) scores were sustained and comparable across groups in TP3. Incidence of treatment-emergent adverse events (AEs) during TP3 and follow-up was 42.6% (biosimilar), 37.0% (week 26 switch), and 50.8% (week 52 switch); 3 (0.6%) patients (all week 52 switch) reported treatment-related serious AEs. ADL-PF was generally well tolerated, with a comparable safety profile across groups. Overall, incidences of patients with anti-drug antibodies in TP3 and follow-up were comparable among groups (46.1%, 46.5%, and 54.2%, respectively). Conclusions There were no clinically meaningful differences in safety, immunogenicity, and efficacy for patients who were maintained on ADL-PF for 78 weeks and those who had switched from ADL-EU at week 26 or week 52. Trial registration ClinicalTrials.gov , NCT02480153. First posted on June 24, 2015; EU Clinical Trials Register; EudraCT number: 2014-000352-29. Start date, October 27, 2014

Anti-tumour necrosis factors (anti-TNFs) are established as first-line biological therapy for rheumatoid arthritis (RA) with over two decades of accumulated clinical experience. Anti-TNFs have well established efficacy/safety profiles along with additional benefits on various comorbidities. However, up to 40% of patients may respond inadequately to an initial anti-TNF treatment because of primary non-response, loss of response, or intolerance. Following inadequate response (IR) to anti-TNF treatment, clinicians can consider switching to an alternative anti-TNF (cycling) or to another class of targeted drug with a different mechanism of action, such as Janus kinase inhibitors, interleukin-6 receptor blockers, B-cell depletion agents, and co-stimulation inhibitors (swapping). While European League Against Rheumatism recommendations for pharmacotherapeutic management of RA, published in 2020, are widely regarded as helpful guides to clinical practice, they do not provide any clear recommendations on therapeutic choices following an IR to first-line anti-TNF. This suggests that both cycling and swapping treatment strategies are of equal value, but that the treating physician must take the patient’s individual characteristics into account. This article considers which patient characteristics influence clinical decision-making processes, including the reason for treatment failure, previous therapies, comorbidities, extra-articular manifestations, pregnancy, patient preference and cost-effectiveness, and what evidence is available to support decisions made by the physician.

Abstract Background A subcutaneous (SC) formulation of infliximab biosimilar CT-P13 is approved in Europe for the treatment of adult patients with rheumatoid arthritis (RA). It may offer improved efficacy versus intravenous (IV) infliximab formulations. Methods A network meta-regression was conducted using individual patient data from two randomised trials in patients with RA, which compared CT-P13 SC with CT-P13 IV, and CT-P13 IV with reference infliximab IV. In this analysis, CT-P13 SC was compared with CT-P13 IV, reference infliximab IV and pooled data for both reference infliximab IV and CT-P13 IV. Outcomes included changes from baseline in 28-joint Disease Activity Score based on C-reactive protein (DAS28-CRP), Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI), and rates of remission, low disease activity or clinically meaningful improvement in functional disability per Health Assessment Questionnaire–Disability Index (HAQ-DI). Results The two studies enrolled 949 patients with RA; pooled data for 840 and 751 patients were evaluable at weeks 30 and 54, respectively. For the CT-P13 SC versus pooled IV treatment arm comparison, differences in changes from baseline in DAS28-CRP (− 0.578; 95% confidence interval [CI] − 0.831, − 0.325; p

Abstrak Di penelitian ini telah dilakukan teknik pemilihan relay dengan metode single relay selection dikombinasikan dengan network coding yang diimplementasikan pada kanal real menggunakan modul Wireless Open-Access Research Platform (WARP) di lingkungan indoor. Tujuan penelitian untuk memilih relay terbaik dari beberapa relay sehingga memperpendek waktu pengiriman data dan dapat meningkatkan performansi melalui pengukuran throughput. Metode penelitian digunakan 4 WARP sebagai node, 2 sebagai node source dan destination dan 2 sebagai relay, penelitian dilakukan di lingkungan indoor. Pemilihan relay terbaik dari beberapa relay digunakan metode single relay selection. Pengukuran dilakukan dengan memvariasikan letak relay sehingga didapatkan hasil yang maksimal. Hasil penelitian didapatkan bahwa pemilihan relay terbaik didasarkan pada relay dengan BER terkecil dan jarak terpendek dari node sumber yang dipilih. Proses network coding juga dilakukan di sisi relay dan penerima. Hasil sesuai dengan tujuan penelitian bahwa network coding unggul dalam transmisi data, ditunjukkan dengan cycle time network coding lebih kecil dari pada cycle time tanpa network coding, karena network coding mempunyai 3 timeslot pada proses pengiriman data, sedangkan untuk tanpa network coding membutuhkan 4 timeslot dalam pengiriman data. Hasil penelitian juga didapatkan bahwa pengukuran throughput, network coding mempunyai throughput lebih besar 21.8% dibandingkan tanpa network coding. Abstract In this research, the relay selection technique by applying the single relay selection method is combined with network coding implemented in real channels using the WARP module in an indoor environment. The research objectives are to choose the best relay from several relays and can improve performance through measurement of throughput. The research method used 4 WARPs as nodes, 2 as source and destination and 2 as relays. The process of selecting the best relay from several relays uses the single relay selection method. Measurements are made by varying the location of the relays to get best results. The results show that the relay with the smallest BER and minimum distance will be selected. Network coding is applied in relays and receiver. Network coding cycle time is better than without network coding, because network coding has 3 timeslots in the data transmission, whereas without network coding it requires 4 timeslots in data transmission. The results of the study for measuring throughput that network coding throughput is 21.8% greater than without network coding.

Nitrogen dioxide (NO2) is a major air pollutant with diverse impacts on human health and the environment. In urban areas, road traffic is the main emission source for NO2. In Berlin, Germany, a network of measurement stations is operated by the state, fulfilling the monitoring requirements set by the European Union. To get a more detailed overview of the spatial distribution of NO2 concentrations in Berlin, a citizen science project allowed for collection of additional data and an increase in the number of sampling sites. Passive samplers (modified Palmes tubes) were distributed to participants to collect NO2 at a site of their choice. When returned, the samplers were analyzed based on the Griess–Ilosvay reaction and spectrophotometric detection. The results confirmed a seasonal trend of higher NO2 concentrations in winter and lower concentrations during the summer period. Furthermore, the spatially and monthly averaged NO2 concentrations observed in the study period from March 2019 to October 2020 were in good agreement with the average urban background concentration. At small spatial scales, a tendency of decreasing NO2 concentrations with increasing distance from roads was observed. Overall, this study shows the added benefit of extensive low-cost measurements of NO2 concentrations across urban environments in a citizen science project to complement stationary air pollution monitoring networks.

Abstract Background Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). We examined the degree to which Patient Global Assessment of Disease Activity (PtGA) was driven by patient-reported assessments of pain (Pain), physical function, and fatigue in patients receiving tofacitinib 5 mg twice daily or placebo, each with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Methods This post hoc analysis used data pooled from three randomized controlled trials in csDMARD-inadequate responder (csDMARD-IR) patients (ORAL Scan: NCT00847613; ORAL Standard: NCT00853385; ORAL Sync: NCT00856544). Using subgroup analysis from 2 × 2 tables, associations between PtGA and Pain, Health Assessment Questionnaire-Disability Index (HAQ-DI), and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) at month 3 were evaluated using Pearson’s Phi correlation coefficients. To support the main analysis, associations between select patient-reported outcomes (PROs) were also evaluated in csDMARD-naïve (ORAL Start; NCT01039688) and biologic (b)DMARD-IR (ORAL Step; NCT00960440) patients. Results Across csDMARD-IR treatment groups, low disease activity (defined as PtGA ≤ 20 mm), and moderate (≥ 30%) and substantial (≥ 50%) improvements from baseline in PtGA were associated with mild Pain (Visual Analog Scale score ≤ 20 mm), and moderate (≥ 30%) and substantial (≥ 50%) improvements from baseline in Pain; lack of Pain improvement was associated with little/no improvement in PtGA. In contrast, large proportions of csDMARD-IR patients who reported PtGA improvements did not report HAQ-DI or FACIT-F scores ≥ normative values (≤ 0.25 and ≥ 43.5, respectively) or changes in HAQ-DI or FACIT-F scores ≥ minimum clinically important difference (≥ 0.22 and ≥ 4.0, respectively). Generally, PtGA and Pain outcomes were moderately-to-strongly correlated at month 3 in csDMARD-IR patients, with weaker correlations evident between PtGA and HAQ-DI/FACIT-F outcomes. Similar findings were generally evident in csDMARD-naïve and bDMARD-IR patients. Conclusions This analysis supports the role of Pain as a key driver of PtGA in RA; physical function and fatigue play lesser roles in patients’ perceptions of disease activity. These findings corroborate the importance of improved PROs and attainment of low symptom states for optimizing patient care. Trial registration Clinicaltrials.gov: NCT00847613 (registered: February 19, 2009); NCT00853385 (registered: March 2, 2009); NCT00856544 (registered: March 5, 2009); NCT01039688 (registered: December 25, 2009); NCT00960440 (registered: August 17, 2009)

Abstract Objective To compare the efficacy, serum drug concentrations, immunogenicity, and safety of FKB327 with the adalimumab reference product (RP) in combination with methotrexate in patients with moderate-to-severe, active rheumatoid arthritis (RA). Methods Patients were randomized 1:1 in a double-blind study (NCT02260791), received 40 mg of FKB327 or RP by subcutaneous injection every other week for 24 weeks (Period I), then re-randomized 2:1, remaining on the same study drug or switching to the other up to week 54 in an open-label extension (Period II, NCT02405780). Efficacy was evaluated using American College of Rheumatology (ACR20) response rate difference at week 24 with equivalence margins of ± 13% and − 12% to + 15% using 95% and 90% confidence intervals (CIs), respectively. Efficacy, serum drug concentrations, immunogenicity, and safety were compared at week 54. Results A total of 730 patients were randomized in Period I (n = 367 FKB327, n = 363 RP), and 645 transitioned to Period II (n = 216 FKB327–FKB327, n = 108 FKB327–RP, n = 108 RP–FKB327, n = 213 RP–RP). At week 24, ACR20 response rates were 74.1% with FKB327 versus 75.7% with RP. 95% and 90% CI of the response rate difference were − 7.9 to 4.7% and − 7.3 to 3.6%, respectively, meeting predefined equivalence margins. The ACR20 response rate remained over 70% of patients to week 54 with all treatment sequences. In Period I, mean trough serum drug concentrations were slightly higher for patients receiving FKB327 than those receiving RP. Mean concentrations were stable over time and reflected steady state in Period II. The proportions of patients with samples positive for neutralizing antidrug antibodies (ADAs) were comparable (57.7% with FKB327 vs. 55.5% with RP) at week 24, and no consistent difference in ADA were seen between continuous and switched treatments in Period II. Efficacy was slightly reduced in the small proportion of patients with high ADA titers in all treatment groups. No clinically significant differences were observed in the incidence of commonly reported treatment-emergent adverse events between the treatments across Periods I and II. Conclusion FKB327 was equivalent to RP in clinical efficacy and demonstrated comparable safety and immunogenicity in patients with moderate-to-severe RA. No effect of switching between FKB327 and RP was observed. Trial registration ClinicalTrials.gov, NCT02260791, Registered 29 July 2014. ClinicalTrials.gov, NCT02405780, Registered 17 July 2015.

Company value is an assessment by investors of the company's overall performance which is often associated with stock prices. Maximizing the company value also means maximizing the prosperity of the shareholders. The purpose of this study is to find out the effect of Good Corporate Governance (GCG) Corporate Social Responsibility (CSR) on company value in the coal mining companies listed on the Indonesian Stock Exchange for the period of 2014-2018. Sample of 7 companies are determined by purposive sampling. The type of data used is secondary data using a panel data regression. The results of this study indicated that GCG and CSR have positive significant effect on company value, simultanously and partially. The implementation of GCG and CSR can increase company value, however, GCG has a bigger contribution and effect on it.