Visual perceptual learning is enhanced by training in the illusory far space.

Visual objects in the peripersonal space (PPS) are perceived faster than farther ones appearing in the extrapersonal space (EPS). This shows preferential processing for visual stimuli near our body. Such an advantage should favour visual perceptual learning occurring near, as compared with far from observers, but opposite evidence has been recently provided from online testing protocols, showing larger perceptual learning in the far space. Here, we ran two laboratory-based experiments investigating whether visual training in PPS and EPS has different effects. We used the horizontal Ponzo Illusion to create a lateralized depth perspective while participants completed a visual search task in which they reported whether or not a specific target object orientation (e.g., a triangle pointing upwards) was present among distractors. This task was completed before and after a training phase in either the (illusory) near or far space for 1 h. In Experiment 1, the near space was in the left hemispace, whereas in Experiment 2, it was in the right. Results showed that, in both experiments, participants were more accurate after training in the far space, whereas training in the near space led to either improvement in the far space (Experiment 1), or no change (Experiment 2). Moreover, we found a larger visual perceptual learning when stimuli were presented in the left compared with the right hemispace. Differently from visual processing, visual perceptual learning is more effective in the far space. We propose that depth is a key dimension that can be used to improve human visual learning.

Linking Women Experiencing Incarceration to Community-Based HIV Pre-Exposure Prophylaxis Care: A Qualitative Study.

Women experiencing incarceration (WEI) in the United States are disproportionately impacted by HIV, yet HIV pre-exposure prophylaxis (PrEP) is underutilized by women in the United States. In order to inform an intervention to promote PrEP initiation during incarceration and facilitate linkage to PrEP care following release from incarceration, we conducted individual, semistructured qualitative interviews with WEI (N = 21) and key stakeholders (N = 14). While WEI had little or no previous knowledge about PrEP, they viewed it as something that would benefit women involved in the criminal justice system. Participants stated that HIV-related stigma and underestimation of HIV risk might serve as barriers to PrEP initiation during incarceration. Participants reported that competing priorities, difficulty scheduling an appointment, and lack of motivation could interfere with linkage to PrEP care in the community. Further, cost, substance use, and difficulty remembering to take the medication were cited most commonly as likely barriers to adherence.

Dysbiosis in the oral microbiomes of anti-CCP positive individuals at risk of developing rheumatoid arthritis.

OBJECTIVES: An increased prevalence of periodontitis and perturbation of the oral microbiome has been identified in patients with rheumatoid arthritis (RA). The periodontal pathogen Porphyromonas gingivalis may cause local citrullination of proteins, potentially triggering anti-citrullinated protein antibody production. However, it is not known if oral dysbiosis precedes the onset of clinical arthritis. This study comprehensively characterised the oral microbiome in anti-cyclic citrullinated peptide (anti-CCP) positive at-risk individuals without clinical synovitis (CCP+at risk). METHODS: Subgingival plaque was collected from periodontally healthy and diseased sites in 48 CCP+at risk, 26 early RA and 32 asymptomatic healthy control (HC) individuals. DNA libraries were sequenced on the Illumina HiSeq 3000 platform. Taxonomic profile and functional capability of the subgingival microbiome were compared between groups. RESULTS: At periodontally healthy sites, CCP+at risk individuals had significantly lower microbial richness compared with HC and early RA groups (p=0.004 and 0.021). Microbial community alterations were found at phylum, genus and species levels. A large proportion of the community differed significantly in membership (523 species; 35.6%) and structure (575 species; 39.1%) comparing CCP+at risk and HC groups. Certain core species, including P. gingivalis, had higher relative abundance in the CCP+at risk group. Seventeen clusters of orthologous gene functional units were significantly over-represented in the CCP+at risk group compared with HC (adjusted p value <0.05). CONCLUSION: Anti-CCP positive at-risk individuals have dysbiotic subgingival microbiomes and increased abundance of P. gingivalis compared with controls. This supports the hypothesis that the oral microbiome and specifically P. gingivalis are important in RA initiation.

T-cell subset abnormalities predict progression along the Inflammatory Arthritis disease continuum: implications for management.

The presence of a disease continuum in inflammatory arthritis (IA) is a recognised concept, with distinct stages from at-risk stage (presence of anti citrullinated-peptide autoantibody) to diagnosis of rheumatoid arthritis (RA), including therapy-induced remission. Despite T-cell dysregulation being a key feature of RA, there are few reports of T-cell phenotyping along the IA-continuum. We investigated the disturbances of naïve, regulatory and inflammation related cell (IRC) CD4+ T-cell subsets in 705 individuals across the IA-continuum, developing a simple risk-score (summing presence/absence of a risk-associated with a subset) to predict progression from one stage to the next. In 158 at-risk individuals, the 3 subsets had individual association with progression to IA and the risk-score was highly predictive (p < 0.0001). In evolving IA patients, 219/294 developed RA; the risk-score included naïve and/or Treg and predicted progression (p < 0.0001). In 120 untreated RA patients, the risk-score for predicting treatment-induced remission using naïve T-cells had an odds ratio of 15.4 (p < 0.0001). In RA patients in treatment-induced remission, a score using naïve T-cells predicted disease flare (p < 0.0001). Evaluating the risk of progression using naïve CD4+ T-cells was predictive of progression along the whole IA-continuum. This should allow identification of individuals at high-risk of progression, permitting targeted therapy for improved outcomes.

The Impact of an Adolescent Gynecology Provider on Intrauterine Device and Subdermal Contraceptive Implant Use Among Adolescent Patients.

STUDY OBJECTIVE: To assess how the addition of a pediatric and adolescent gynecologist (PAG) in an area where one has not previously been available affects the use of long-acting reversible contraception (LARC) among adolescent and adult women 13-24 years of age. DESIGN: Retrospective chart review. SETTING: Academic practice including 12 general practice obstetric/gynecologists (GP) and 1 PAG, and Title X clinics in 3 neighboring counties in West Virginia. PARTICIPANTS: Patients receiving an intrauterine device (IUD) or implant during 2010-2016. INTERVENTIONS: Subject charts were reviewed for age and date at insertion, provider (GP, PAG, and Title X), device type, parity, discontinuation, and sequential LARC placement. MAIN OUTCOME MEASURES: Frequencies of LARC and relative risks (RR) with 95% confidence intervals were calculated for the 13- to 17-year and 18- to 24-year age groups and compared between provider type. RESULTS: The frequency of LARC increased over time for all providers for participants age 13-24; the PAG had the highest frequency of LARC among participants aged 13-17 years. The RR for IUD provision for the PAG provider among those aged 13-17 years was 3.1 and 32.5 times greater compared to GP and Title X (P < .001). Title X providers were 2.9 (2.27, 3.79) and 2.8 (2.06, 3.81) times more likely to provide implants to patients aged 13-17 years compared to PAG and GP, respectively (P < .001). CONCLUSIONS: A PAG provider can have a positive impact on LARC uptake among adolescents in a community where this specialist has not previously been available. This is most noted among 13- to 17-year-old patients receiving IUDs.

A Pilot Randomized Controlled Trial of Distress Tolerance Treatment for Weight Concern in Smoking Cessation Among Women.

INTRODUCTION: The majority of women who smoke cigarettes report that concern about weight gain is a barrier to quitting. We developed an intervention incorporating distress tolerance, appetite awareness, and mindful eating skills to target concerns about post-cessation weight gain and emotional eating (DT-W). In the current study, we conducted a pilot randomized controlled trial of DT-W versus a smoking health education (HE) intervention. METHODS: Participants (N = 69 adult female, weight-concerned smokers) were recruited in cohorts of 4-11. Cohorts were randomized to DT-W or HE. DT-W and HE were matched on format (single individual session followed by eight group sessions), inclusion of cognitive behavioral therapy for smoking cessation (CBT) content, and pharmacotherapy (nicotine patches). Follow-up assessments occurred at 1-, 3-, and 6-months post-treatment. RESULTS: The recruitment goal was met; 61 of the 69 participants attended at least one group session. There were no significant differences between DT-W and HE in the number of group sessions attended (DT-W adjusted M = 5.09, HE adjusted M = 5.03, p = .92), ratings of treatment effectiveness or usefulness of skills, or retention at 6-month follow-up (79% in DT-W vs. 78% in HE) (ps > .05), but comprehension ratings were lower in DT-W than in HE (p = .02). CONCLUSIONS: Overall, these results suggest that the study procedures and interventions were feasible and acceptable, but changes to the DT-W intervention content to improve comprehension should be considered prior to conducting a fully powered trial. IMPLICATIONS: A distress tolerance-based treatment targeting fear of weight gain after smoking cessation and post-cessation emotional eating was feasible and acceptable relative to a smoking HE comparison condition, but changes should be considered before conducting a larger trial. Continued innovation in treatment development for weight-concerned smokers is needed.

Pilot feasibility trial of dual contingency management for cigarette smoking cessation and weight maintenance among weight-concerned female smokers.

Many women who smoke cigarettes report that concern about weight gain is a barrier to quitting. Indeed, most quitters gain weight and some attribute relapses to weight gain concern. Contingency management (CM), which refers to reinforcing a target behavior with financial incentives, has been demonstrated effective for promoting smoking abstinence and weight management independently. We conducted a pilot trial to establish the feasibility of dual CM, in which both smoking cessation and weight maintenance were incentivized, as a smoking cessation intervention for female weight-concerned smokers. Participants (N = 10) received a 12-week intervention during which they earned financial incentives for smoking abstinence, verified by breath carbon monoxide (CO) testing, and for maintaining their weight (larger incentives for gaining less than five pounds, smaller incentives for 5-10 pound gain) while abstaining from smoking. They attended an end of intervention visit at week 13 and a follow-up visit at week 26. Total compensation was up to $550 ($255 for participation independent of smoking and weight, $145 for smoking abstinence incentives, and $150 for weight maintenance incentives). Results indicated that five of the 10 participants (50%) were continuously abstinent for at least 4 weeks and received at least 2 weight maintenance incentives. Three participants (33%) were abstinent at every visit they attended from quit date through week 26; 2 of these 3 had gained more than 10 pounds by week 26. Additional formative research to test alternative incentive schedules and modalities should be conducted before CM-W is evaluated in a larger trial. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Educational Brochures Influence Beliefs and Knowledge Regarding Exercise during Pregnancy: A Pilot Study.

Women who are pregnant report receiving little or no advice about physical activity during pregnancy from their obstetric provider. The purpose of this study was to assess the effectiveness of an evidence-based educational brochure on both immediate and two-week retention of knowledge about exercise during pregnancy. Thirty-two women of childbearing age (age: 25.0 ± 4.0 years, body mass index: 29.5 ± 6.5 kg/m2, 93.7% Caucasian, 83.4% had at least some college) completed a survey before exposure to an evidence-based educational brochure regarding exercise during pregnancy. Post surveys were taken immediately after viewing the educational brochure and again 2-weeks later. After exposure to educational brochures, survey scores on both surveys were significantly higher immediately-post and two-weeks post compared to baseline survey scores (Survey 1 (assessing beliefs) - pre: 79.2 ± 8.9%, post: 92.6 ± 7.4%, 2-weeks post: 92.0 ± 6.5%, p < 0.001; Survey 2 (assessing knowledge) - pre: 65.3 ± 16.4%, post: 81.3 ± 14.9%, 2-weeks post: 78.8 ± 12.4%, p < 0.001). No significant differences detected between immediate post and 2-weeks post for either Survey 1 (p = 0.72) or Survey 2 (p = 0.52); suggesting the information was retained. An evidence-based educational brochure is effective for improving and retaining information 2-weeks later regarding exercise during pregnancy. However, replication studies in more diverse populations are needed to confirm the results of this pilot study. The long-term goal for this line of research is to urge health care providers to consider providing patients with educational information in order to improve knowledge and patient-provider communication on this topic.

Prevalence of Periodontal Disease and Periodontopathic Bacteria in Anti-Cyclic Citrullinated Protein Antibody-Positive At-Risk Adults Without Arthritis.

Importance: The prevalence of periodontitis is increased in patients with rheumatoid arthritis (RA) and periodontopathic bacteria can citrullinate proteins. Periodontitis may, therefore, be an initiator of RA and a target for prevention. Periodontal disease and periodontal bacteria have not been investigated in at-risk individuals with RA autoimmunity but no arthritis. Objective: To examine periodontal disease and periodontopathic bacteria in anti-cyclic citrullinated protein (anti-CCP) antibody-positive at-risk individuals without arthritis. Design, Setting, and Participants: This cross-sectional study took place at a teaching hospital from April 27, 2015, to May 8, 2017. Forty-eight anti-CCP-positive individuals without arthritis (CCP+ at-risk) were recruited nationally. Twenty-six patients with early RA (ERA) and 32 healthy control individuals were recruited locally. Data were analyzed between June 1, 2017, and December 1, 2017. Interventions: Periodontal assessment and examination of joints using ultrasonography. Main Outcomes and Measures: Prevalence of diseased periodontal sites, clinical periodontitis, and periodontal inflamed surface area in CCP+ at-risk individuals compared with patients with ERA and healthy individuals matched for age and smoking. Paired-end sequencing of DNA from subgingival plaque from diseased and healthy periodontal sites was performed and DNA was profiled and analyzed. Results: A total of 48 CCP+ at-risk individuals (mean [SD] age, 51.9 [11.4] years; 31 [65%] female), 26 patients with ERA (mean [SD] age, 54.4 [16.7] years; 14 [54%] female), and 32 healthy individuals (mean [SD] age, 49.4 [15.3] years; 19 [59%] female) were recruited. Of 48 CCP+ at-risk individuals, 46 had no joint inflammation on ultrasonography. Thirty-five CCP+ at-risk individuals (73%), 12 healthy individuals (38%), and 14 patients with ERA (54%) had clinical periodontitis. The median (interquartile range) percentage of periodontal sites with disease was greater in CCP+ at-risk individuals compared with healthy individuals (3.3% [0%-11.3%] vs 0% [0%-0.7%]) and similar to patients with ERA (1.1% [0%-13.1%]). Median (interquartile range) periodontal inflamed surface area was higher in CCP+ at-risk individuals compared with healthy individuals (221 mm2 [81-504 mm2] vs 40 mm2 [12-205 mm2]). Patients with CCP+ at-risk had increased relative abundance of Porphyromonas gingivalis (but not Aggregatibacter actinomycetemcomitans) at healthy periodontal sites compared with healthy individuals (effect size, 3.00; 95% CI, 1.71-4.29) and patients with ERA (effect size, 2.14; 95% CI, 0.77-3.52). Conclusions and Relevance: This study found increased prevalence of periodontitis and P gingivalis in CCP+ at-risk individuals. This suggests periodontitis and P gingivalis are associated with disease initiation and could be targets for preventive interventions in RA.

S. cerevisiae Srs2 helicase ensures normal recombination intermediate metabolism during meiosis and prevents accumulation of Rad51 aggregates.

We investigated the meiotic role of Srs2, a multi-functional DNA helicase/translocase that destabilises Rad51-DNA filaments and is thought to regulate strand invasion and prevent hyper-recombination during the mitotic cell cycle. We find that Srs2 activity is required for normal meiotic progression and spore viability. A significant fraction of srs2 mutant cells progress through both meiotic divisions without separating the bulk of their chromatin, although in such cells sister centromeres often separate. Undivided nuclei contain aggregates of Rad51 colocalised with the ssDNA-binding protein RPA, suggesting the presence of persistent single-strand DNA. Rad51 aggregate formation requires Spo11-induced DSBs, Rad51 strand-invasion activity and progression past the pachytene stage of meiosis, but not the DSB end-resection or the bias towards interhomologue strand invasion characteristic of normal meiosis. srs2 mutants also display altered meiotic recombination intermediate metabolism, revealed by defects in the formation of stable joint molecules. We suggest that Srs2, by limiting Rad51 accumulation on DNA, prevents the formation of aberrant recombination intermediates that otherwise would persist and interfere with normal chromosome segregation and nuclear division.

MRI inflammation of the hand interosseous tendons occurs in anti-CCP-positive at-risk individuals and may precede the development of clinical synovitis.

Interosseous tendon inflammation (ITI) has been described in rheumatoid arthritis (RA). Whether ITI occurs in at-risk individuals before the onset of clinical synovitis is unknown. OBJECTIVES: To investigate, by MRI, ITI in anti-cyclic citrullinated peptide (CCP)-positive at-risk individuals (CCP +at risk) and to describe the anatomy, prevalence and clinical associations across the RA continuum. METHODS: Hand MRI was performed in 93 CCP + at risk, 47 early RA (ERA), 28 established 'late' RA (LRA) and 20 healthy controls (HC) and scored for ITI, flexor tenosynovitis (TSV) and RA MRI scoring at the metacarpophalangeal joints (MCPJs). Cadaveric and histological studies were performed to explore the anatomical basis for MRI ITI. RESULTS: The proportion of subjects with ITI and the number of inflamed interosseous tendons (ITs) increased along the disease continuum (p<0.001): 19% of CCP +at risk, 49% of ERA and 57% of LRA had ≥1 IT inflamed . ITI was not found in any HC. ITI was more frequently identified in tender MCPJs compared with nontender MCPJs (28% vs 12%, respectively). No IT tenosynovial sheath was identified in cadavers on dissection or histological studies suggesting MRI findings represent peritendonitis. Dye studies indicated no communication between the IT and the joint. CONCLUSIONS: ITI occurs in CCP + at-risk individuals and can precede the onset of clinical synovitis. The ITs may be important nonsynovial extracapsular targets in the development and progression of RA.

Billing Practices Among US Tobacco Use Treatment Providers.

OBJECTIVES: The US Affordable Care Act (ACA) now requires almost all health insurance plans to cover tobacco use treatment (TUT), but TUT remains underutilized. METHODS: We conducted an anonymous online survey of US TUT providers in 2016 regarding their billing practices. RESULTS: Participants (n = 131) provided services primarily in medical and behavioral health settings and were from a variety of professions. Most provided intensive individual (>15 minutes per session) and/or group counseling. Although most reported that their organization accepted at least 1 form of insurance, only 34% reported that TUT services were billed, with about equal proportions endorsing billing under their own independent tax ID and "incident to" billing under a supervisor. Half of billers (52%) reported using at least 1 Current Procedural Terminology code. The most common codes were 99406 and 99407, but 18 unique codes were specified. Themes of qualitative responses (n = 101) included concern about how to initiate and sustain adequate reimbursement, and experiences with billing not being "worth" the time or effort. CONCLUSIONS: Overall, results demonstrate a need for providers, administrators, and billing managers to work collaboratively. Even with the ACA mandate, and consistent with prior reports, reimbursement rates may be inadequate for intensive counseling. Areas for advocacy include recognizing that TUT requires similar intensity, expertise, and reimbursement as other substance use disorders and chronic medical conditions; giving Tobacco Treatment Specialists the ability to bill independently; and improving coordination between intensive therapies validated in research and "real-world" logistics.

Comorbidities in Anti-Cyclic Citrullinated Peptide Positive At-Risk Individuals Do Not Differ from Those Patients with Early Inflammatory Arthritis.

OBJECTIVES: To compare comorbidities in a cohort of cyclic citrullinated peptide (CCP) antibody positive patients without or prior to onset of inflammatory arthritis (IA) to those in patients with early IA. METHODS: Baseline data from two established cohorts were used. The first recruited people at risk of IA: CCP antibody positive cases without IA (CCP Cohort, n = 296). The second cohort [the Inflammatory Arthritis CONtinuum study (IACON)] recruited patients with early IA (n = 725). Proportions of patients with given comorbidities were compared between cohorts and then logistic regression was used to determine odds ratios (OR) for the CCP cohort having specific comorbidities, compared to IACON patients. Analyses adjusted for gender, age, smoking status, and body mass index. RESULTS: Patients from the CCP cohort were younger (mean age 50, compared to 53 years). The proportion of patients with at least one comorbidity was higher in the IACON than the CCP cohort: (40% compared to 24%, respectively). Results of logistic regression analyses suggested the odds of hypertension, taking a lipid-lowering agent, ischemic heart disease, cerebrovascular disease, lung disease, and diabetes were not increased in either cohort. However, patients in the CCP cohort were more likely to be taking an antidepressant (OR = 1.62, 95% CI 1.03, 2.56, p = 0.037). CONCLUSION: There was no significant difference in comorbidities among people with CCP antibodies but without IA, compared to those of patients with established IA.

Magnetic resonance imaging in individuals at risk of rheumatoid arthritis.

Individuals with rheumatoid arthritis (RA) benefit from early diagnosis and initiation of therapy. There can be delays in both due to diagnostic uncertainties. Imaging modalities, including magnetic resonance imaging (MRI), can detect inflammation earlier than clinical examination alone in early RA patients. Furthermore, the predictive role of MRI for the future development of RA has recently been explored in 'at-risk' individuals. This review details the use of MRI in early and undifferentiated arthritis and summarises the studies to date in individuals at risk of RA.

Comparison of Affect and Cardiorespiratory Training Responses Between Structured Gym Activities and Traditional Aerobic Exercise in Children.

Physical activities (PA) that are pleasurable are likely to be repeated. Structured gym activities (SGA) are defined as dodging, chasing, and fleeing games. Traditional aerobic exercises (TAE) are defined as treadmill, cycle ergometer, and elliptical exercise. The purpose of this investigation was to compare affect and cardiorespiratory training responses between SGA and TAE in children. Thirty-two participants (9.3±0.2) were randomized to either the SGA or TAE group. Exercise training was seven weeks, with two sessions per week, for 35 minutes per session. Affect was measured by the (+5 (pleasurable) to -5 (displeasurable)) feelings scale. Affect was recorded at the mid-point and end of each exercise session. The 20-meter pacer test was used to assess cardiorespiratory fitness at baseline and post intervention. Affect responses and heart rates were averaged across all exercise sessions. The SGA group scored 2.77±0.2 affect units higher than the TAE group (p < 0.0001). The TAE group significantly increased cardiorespiratory fitness (baseline 47.8±3.8; post 49.1±3.1 ml·kg-1·min-1; p = 0.023) with no change in the SGA group (baseline 46.3±3.5; post 47.2±2.7 ml·kg-1·min-1; p = 0.127). SGA reported more positive affect, suggesting they experienced greater pleasure during the exercise sessions than the TAE participants. SGA activities promote more positive affect, and therefore may increase children's PA participation.

Ultrasound findings predict progression to inflammatory arthritis in anti-CCP antibody-positive patients without clinical synovitis.

OBJECTIVES: To determine whether ultrasound can identify anti-cyclic citrullinated peptide (anti-CCP) antibody-positive patients without clinical synovitis (CS) who progress to inflammatory arthritis (IA). METHODS: In a prospective study, anti-CCP-positive patients without CS underwent ultrasound imaging of 32 joints (wrists, metacarpophalangeal joints, proximal interphalangeal joints and metatarsophalangeal joints (MTPs)) and were monitored for the development of IA. Associations between baseline ultrasound findings (grey scale (GS), power Doppler (PD) and erosions) and (1) progression to IA and (2) development of CS within an individual joint were measured. RESULTS: Consecutive anti-CCP-positive patients (n=136; mean age 51 years, 100 women) were followed up for median of 18.3 months (range 0.1-79.6). At baseline 96% had GS, 30% had PD and 21% had one or more erosions. IA developed in 57 patients (42%) after median of 8.6 months (range 0.1-52.4). Ultrasound abnormalities (GS ≥2, PD ≥1 or erosion ≥1) were found in 86% at baseline compared with 67% of non-progressors (χ2=6.3, p=0.012). Progression to IA was significantly higher in those with ultrasound findings in any joint (excluding MTPs for GS) (GS ≥2: 55% vs 24%, HR (95% CI) 2.3 (1.0 to 4.9), p=0.038; PD ≥2: 75% vs 32%, 3.7 (2.0 to 6.9), p<0.001 and erosion ≥1: 71% vs 34%, 2.9 (1.7 to 5.1), p<0.001). Furthermore, progression occurred earlier with PD ≥2 (median 7.1 vs 52.4 months) and erosion ≥1 (15.4 vs 46.5). At the individual joint level, the trend for progression to CS was more significant for GS and PD (GS ≥2: 26% vs 3%, 9.4 (5.1 to 17.5), p<0.001; PD ≥2: 55% vs 4%, 31.3 (15.6 to 62.9), p<0.001). CONCLUSION: Ultrasound features of joint inflammation may be detected in anti-CCP-positive patients without CS. Ultrasound findings predict progression (and rate of progression) to IA, with the risk of progression highest in those with PD signal. TRIAL REGISTRATION NUMBER: NCT02012764; Results.

Enriching case selection for imminent RA: the use of anti-CCP antibodies in individuals with new non-specific musculoskeletal symptoms - a cohort study.

OBJECTIVES: Around 1% of the population test positive for anti-cyclic citrullinated peptide (anti-CCP) antibodies. This biomarker predicts the progression to rheumatoid arthritis (RA) but over a variable time frame. To increase its clinical relevance, this study sought to determine (1) if the proportion of anti-CCP-positive individuals could be enriched by case selection of people attending primary care with new non-specific musculoskeletal (MSK) symptoms but without clinical synovitis (CS) and (2) whether these individuals progress rapidly to inflammatory arthritis (IA), in particular RA. METHODS: In this prospective cohort study, individuals aged ≥18 years with new non-specific MSK symptoms, without CS, were recruited from primary care in the UK. Anti-CCP-positive individuals were invited for follow-up in the rheumatology department, Leeds. Those who tested negative were sent questionnaires 12 months later. RESULTS: 2028 individuals were recruited. Of these, 2.8% (57/2028) were anti-CCP positive, of whom 47% (27/57) developed IA - 24 RA, 1 undifferentiated IA (UIA), 2 polymyositis; 92.6% (25/27) within 12 months, median 1.8 months (IQR 1.0-4.3, range 0.3-16.1). Of the anti-CCP-negative individuals, 1.3% (20/1559) developed IA (1 UIA, 13 RA, 6 psoriatic arthritis); 75% (15/20) within 12 months. The relative risk for developing RA within 12 months in the anti-CCP-positive group was 66.8 (95% CI 32.2 to 138.4, p<0.001); for IA, it was 45.5 (95% CI 25.4 to 81.6, p<0.001). CONCLUSIONS: Selecting individuals with new non-specific MSK symptoms without CS enriched the prevalence of anti-CCP positivity to 2.8%. Those who tested positive had a high risk of rapidly developing RA. The cost-effectiveness of this approach will need to be determined. TRIAL REGISTRATION NUMBER: NCT02012764.

Impact of Specialized Nursery Care for Late Preterm Infants on NICU Admission Rate and Length of Stay.

OBJECTIVE: To compare neonatal intensive care unit (NICU) admission rates and length of stay (LOS) of late preterm infants (LPIs) born before and after opening a specialized care nursery (SCN) at our academic, pediatric tertiary care center with ∼4,500 total deliveries annually. STUDY DESIGN: Retrospective chart review of inborn LPIs (35(0/7)-36(6/7) weeks) who were asymptomatic or minimally symptomatic at birth and delivered 7 months before the opening of the SCN (pre-SCN) or 7 months subsequently (post-SCN). Infants were excluded for major congenital anomalies or other conditions requiring immediate NICU admission. The pre-SCN options for care were standard couplet care or NICU. The post-SCN options for care were standard couplet care, SCN, or NICU. RESULTS: Pre-SCN (n = 109), 73 (67%) infants received standard couplet care, while 36 (33%) infants were ever admitted/transferred to the NICU. Post-SCN (n = 112), 59 (53%) infants received standard couplet care, while 20 (18%) were ever admitted/transferred to the NICU. A total of 33 (29%) infants were admitted/transferred to the SCN and avoided a NICU stay. Median LOS for all infants was 3 days. CONCLUSION: The frequency of LPIs admitted/transferred to the NICU decreased by ∼50% after the opening of the SCN. LOS did not differ by birth cohort, but did differ significantly by location of care (standard couplet care < SCN < NICU).

Defining populations at risk of rheumatoid arthritis: the first steps to prevention.

Preventing disease is a public health priority. In recent years, this focus has evolved to include noncommunicable chronic diseases such as cardiovascular disease and diabetes mellitus but is novel in rheumatic diseases such as rheumatoid arthritis (RA). In order to prevent RA, the 'at-risk' populations need to be defined. To date, a number of studies have attempted to clarify our understanding of these cohorts and how they could be identified. Suggested terminology has now been published to define individuals who might go on to develop RA. This Review considers categories of these 'at-risk' individuals, with a focus on those with systemic autoimmunity. Trials in very early RA demonstrate that disease outcomes can be reduced with early intervention. These principles are widely accepted in other diseases such as type 1 diabetes mellitus, in which steps have been taken to prevent disease in genetically predisposed individuals. Large population-based studies provide insights into potential interventions for RA prevention. By quantifying risk in different populations, the prospect of preventing this disease is feasible.