Characterization and Treatment of Mine Drainage.

The recent research and development on mine drainage published in 2017 was summarized in this review. In particular, this review was focused on three main aspects: 1) mine drainage and its environmental impact, 2) prediction and prevention, and 3) treatment technologies. The first section covers physiochemical characterization, microbiological characterization, and environmental impacts. The second section includes mine drainage prediction and prevention. The final section focuses physiochemical treatment, biological treatment, passive treatment, and beneficial uses of mine drainage and treatment wastes.

Mine Drainage: Research and Development.

This review summarizes the recent research and development pertaining to the topic of mine drainage which were published in 2016 and early 2017. The review includes three main sections: Mine Drainage and its Environmental Impact, Prediction and Prevention, and Treatment Technologies. The first section covers the characterization of mine drainage and its related environmental impacts, including three subsections focused on physiochemical characterization, microbiological characterization, and environmental impacts. The second section of the review is divided into two subsections focused on either the prediction or prevention of acid mine drainage. The final section focuses on treatment technologies for mine drainage, including physiochemical treatment, biological treatment, passive treatment, and beneficial uses of mine drainage and treatment wastes.

Mine Drainage Generation and Control Options.

This review provides a snapshot of papers published in 2015 relevant to the topic of mine drainage generation and control options. The review is broken into 3 sections: Generation, Prediction and Prevention, and Treatment Options. The first section, mine drainage generation, focuses on the characterization of mine drainage and the environmental impacts. As such, it is broken into three subsections focused on microbiological characterization, physiochemical characterization, and environmental impacts. The second section of the review is divided into two subsections focused on either the prediction or prevention of acid mine drainage. The final section focuses on treatment options for mine drainage and waste sludge. The third section contains subsections on passive treatment, biological treatment, physiochemical treatment, and a new subsection on beneficial uses for mine drainage and treatment wastes.

Convergence between the 1990 and 2010 ACR diagnostic criteria and validation of the Spanish version of the Fibromyalgia Survey Questionnaire (FSQ).

(1) To assess the degree of convergence between the 1990 and 2010 American College of Rheumatology (ACR) diagnostic criteria; (2) To evaluate the validity and reliability of the 2010 ACR criteria; (3) To validate the Spanish version of the Fibromyalgia Survey Questionnaire (FSQ); and (4) To assess the utility of the FSQ to differentiate fibromyalgia (FM) subgroups by disease severity. In the first study, agreement between the 1990 and 2010 ACR criteria for FM diagnosis was analyzed in a sample of 80 FM patients and 59 healthy controls. Algometry (mean threshold and tender points count) and the 2010 ACR indices [Symptom Severity Scale (SSS), Widespread Index (WPI) and Polysymptomatic Distress Scale (PSD)] were correlated with the key symptoms of FM and with indices of disease interference and quality of life. In a second study, we evaluated the validity and internal consistency of the Spanish version of the FSQ, as well as its ability to discriminate between groups of FM patients with low and high symptom severity. There is good agreement between the 1990 and 2010 ACR criteria for FM diagnosis. The 2010 ACR indices (SSS, WPI and PSD) demonstrated very adequate construct validity and appeared to be useful in the assessment of disease severity and global impact of FM. The FSQ had good internal consistency and validity and showed 100 % concordance with 2010 ACR criteria applied by a clinician. In addition, the FSQ proved to be useful in differentiating FM severity subgroups.

Mine Drainage and Oil Sand Water.

Mine drainage from the mining of mineral resources (coal, metals, oil sand, or industrial minerals) remains as a persistent environmental problem. This review summarizes the scientific literature published in 2014 on the technical issues related to mine drainage or mine water in active and abandoned coal/hard rock mining sites or waste spoil piles. Also included in this review is the water from oil sand operations. This review is divided into the four sections: 1) mine drainage characterization, 2) prediction and environmental impact, 3) treatment technologies, 4) oil sand water. Many papers presented in this review address more than one aspect and different sections should not be regarded as being mutuallyexclusive or all-inclusive.

Increased incidence of herpes zoster among patients with systemic lupus erythematosus.

Herpes zoster (HZ) is the painful reactivation of latent varicella zoster virus infection. The incidence of HZ may be increased in some autoimmune diseases, including systemic lupus erythematosus (SLE). We examined the incidence and risk factors for HZ in a prospective cohort of patients with physician-diagnosed SLE compared to those diagnosed with non-inflammatory musculoskeletal conditions (MSK). After excluding participants with a history of prior HZ at enrollment, we followed 1485 SLE patients and 2775 MSK with semi-annual mailed questionnaires for incident HZ between 2001 and 2010. Age-adjusted incidences were calculated for each group and Cox proportional hazard models were used to identify predictors of HZ. Zostavax® vaccination rates were compared between groups. Participants had a mean age of 60 years at enrollment, with 13.9 years of disease. SLE patients had more HZ at all ages, with an age-adjusted incidence of 12.0/1000 person-years compared to MSK (8.7/1000 person-years) and a hazard ratio of 1.7 (95% CI 1.08-2.71) for SLE. Increasing age and reduced functional status were independent predictors of HZ. In SLE, prednisone and mycophenolate mofetil use conferred additional risk. SLE had the lowest HZ vaccination rates among age-eligible subjects.

Diagnosis and diagnostic tests for fibromyalgia (syndrome).

OBJECTIVES: To present diagnostic criteria for the clinical diagnosis of fibromyalgia syndrome (FMS) and to offer a scheme for diagnostic work-up in clinical practice. METHODS: Narrative review of the literature, consensus documents by the American College of Rheumatology (ACR), evidence-based interdisciplinary German guidelines on the diagnosis and management of FMS. RESULTS: The ACR 1990 classification criteria emphasized tender points and widespread pain as the key features of FMS. In 2010, the ACR proposed preliminary diagnostic criteria for fibromyalgia that abandoned the tender point count and placed increased emphasis of patient symptoms. A later modification of the ACR 2010 criteria for use in surveys employed a self-report questionnaire (Fibromyalgia Survey Questionnaire FSQ) to assess patient symptoms. The FSQ can be used to assist physician's diagnosis of FMS. We recommend a stepwise diagnostic work-up of patients with chronic widespread pain (CWP) in primary care: Complete medical history including medication, complete medical examination, basic laboratory tests to screen for inflammatory or endocrinology diseases, referral to specialists only in case of suspected somatic diseases, assessment of limitations of daily functioning, screening for other functional somatic symptoms and mental disorders, and referring to mental health specialists in case of mental disorder. CONCLUSIONS: The diagnosis of FMS is easy in most patients with CWP and does not ordinarily require a rheumatologist. A rheumatologist's expertise might be needed to exclude difficult to diagnose or concomitant inflammatory rheumatic diseases. In the presence of mental illness referral to a mental health specialist for evaluation is recommended.

Patient perceptions concerning pain management in the treatment of rheumatoid arthritis.

Previous qualitative studies have revealed discrepancies between patients' and physicians' perceptions of rheumatoid arthritis (RA) and its treatment. Questionnaires were administered to 2795 patients with RA (756 from Europe; 2039 from the USA) to measure patients' perceptions regarding pain management in RA. Although the majority of patients reported their RA as somewhat-to-completely controlled, 75% of European and 82% of US patients reported their pain as moderate-to-severe in the previous 2 months. The majority of European (60%) and US (65%) patients reported dissatisfaction with their arthritis pain. Patients' pain levels corresponded with their disease severity. A higher percentage of patients who reported severe pain were being treated for depression than those who had moderate or mild pain. Patients in the USA rated pain relief as the top required benefit from their RA medication. A comprehensive examination of patients' perspectives regarding pain could lead to better patient care and pain management strategies.

Malignancies in the rheumatoid arthritis abatacept clinical development programme: an epidemiological assessment.

OBJECTIVE: To provide context for the malignancy experience in the rheumatoid arthritis (RA) abatacept clinical development programme (CDP) by performing comparisons with similar RA patients and the general population. METHODS: Malignancy outcomes included total malignancy (excluding non-melanoma skin cancer (NMSC)), breast, colorectal, lung cancers and lymphoma. Comparisons were made between the observed incidence in patients within the abatacept CDP and RA patients on disease-modifying antirheumatic drugs (DMARD) identified from five data sources: the population-based British Columbia RA Cohort, the Norfolk Arthritis Register, the National Data Bank for Rheumatic Diseases, the Sweden Early RA Register and the General Practice Research Database. Age and sex-adjusted incidence rates (IR) and standardised incidence ratios (SIR) were used to compare events in the abatacept trials with the RA DMARD cohorts and the general population. RESULTS: A total of 4134 RA patients treated with abatacept in seven trials and 41,529 DMARD-treated RA patients in the five observational cohorts was identified for study inclusion. In the abatacept-treated patients, the 51 malignancies (excluding NMSC), seven cases of breast, two cases of colorectal, 13 cases of lung cancer and five cases of lymphoma observed were not greater than the range of expected cases from the five RA cohorts. The SIR comparing RA patients with the general population were consistent with those reported in the literature. CONCLUSIONS: The IR of total malignancy (excluding NMSC), breast, colorectal, lung cancers and lymphoma in the abatacept CDP were consistent with those in a comparable RA population. These data suggest no new safety signals with respect to malignancies, which will continue to be monitored.

Validation of the Spanish, Portuguese and French versions of the Lupus Damage Index questionnaire: data from North and South America, Spain and Portugal.

We have previously developed and validated a self-administered questionnaire, modelled after the Systemic Lupus International Collaborating Clinics Damage Index (SDI), the Lupus Damage Index Questionnaire (LDIQ), which may allow the ascertainment of this construct in systemic lupus erythematosus (SLE) patients followed in the community and thus expand observations made about damage. We have now translated, back-translated and adapted the LDIQ to Spanish, Portuguese and French and applied it to patients followed at academic and non-academic centres in North and South America, Portugal and Spain while their physicians scored the SDI. A total of 887 patients (659 Spanish-speaking, 140 Portuguese-speaking and 80 French-speaking patients) and 40 physicians participated. Overall, patients scored all LDIQ versions higher than their physicians (total score and all domains). Infrequent manifestations had less optimal clinimetric properties but overall agreement was more than 95% for the majority of items. Higher correlations were observed among the Spanish-speaking patients than the Portuguese-speaking and French-speaking patients; further adjustments may be needed before the Portuguese and French versions of the LDIQ are applied in community-based studies. The relationship between the LDIQ and other outcome parameters is currently being investigated in a different patient sample.

Reporting disease activity in clinical trials of patients with rheumatoid arthritis: EULAR/ACR collaborative recommendations.

OBJECTIVE: To make recommendations on how to report disease activity in clinical trials of rheumatoid arthritis (RA) endorsed by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). METHODS: The project followed the EULAR standardised operating procedures, which use a three-step approach: (1) expert-based definition of relevant research questions (November 2006); (2) systematic literature search (November 2006 to May 2007); and (3) expert consensus on recommendations based on the literature search results (May 2007). In addition, since this is the first joint EULAR/ACR publication on recommendations, an extra step included a meeting with an ACR panel to approve the recommendations elaborated by the expert group (August 2007). RESULTS: Eleven relevant questions were identified for the literature search. Based on the evidence from the literature the expert panel recommended that each trial should report the following items: (1) disease activity response and disease activity states; (2) appropriate descriptive statistics of the baseline, the endpoints and change of the single variables included in the core set; (3) baseline disease activity levels (in general); (4) the percentage of patients achieving a low disease activity state and remission; (5) time to onset of the primary outcome; (6) sustainability of the primary outcome; (7) fatigue. CONCLUSIONS: These recommendations endorsed by EULAR and ACR will help harmonise the presentations of results from clinical trials. Adherence to these recommendations will provide the readership of clinical trials with more details of important outcomes, while the higher level of homogeneity may facilitate the comparison of outcomes across different trials and pooling of trial results, such as in meta-analyses.

Cost-effectiveness of abatacept in patients with moderately to severely active rheumatoid arthritis and inadequate response to methotrexate.

OBJECTIVE: To assess cost-effectiveness of abatacept in patients with moderately to severely active RA and inadequate response to MTX. METHODS: We developed a simulation model to depict progression of disability [in terms of the HAQ Disability Index (HAQ-DI)] in women aged 55-64 yrs with moderately to severely active RA and inadequate response to MTX. At model entry, patients were assumed to receive either only MTX or MTX plus abatacept. Patients were then tracked from model entry until death. Future health-state utilities and medical-care costs (except study therapy) were estimated based on predicted values of the HAQ-DI. The model was estimated using data from a Phase III clinical trial of abatacept plus various secondary sources. Cost-effectiveness was expressed in terms of incremental cost (2006 US$) per quality-adjusted life-year (QALY) gained over alternatively 10 yrs and a lifetime. Costs and health effects were both discounted at 3% annually. RESULTS: Over 10 yrs, abatacept would yield 1.2 additional QALYs (undiscounted) per patient (4.6 vs 3.4 for MTX) at an incremental (discounted) cost of $51,426 ($103,601 vs $52,175, respectively); over a lifetime, corresponding figures were 2.0 QALYS (6.8 vs 4.8) and $67,757 ($147,853 vs $80,096). Cost-effectiveness was [mean (95% CI)] $47,910 ($44,641, $52,136) per QALY gained over 10 yrs and $43,041 ($39,070, $46,725) per QALY gained over a lifetime. Findings were robust in sensitivity analyses. CONCLUSION: Abatacept is cost-effective by current standards of medical practice in patients with moderately to severely active RA and inadequate response to MTX.

Not all "quality-adjusted life years" are equal.

BACKGROUND: There is evidence that utility elicitation methods used in the calculation of quality-adjusted life years (QALYs) yield different results. It is not clear how these differences impact economic evaluations. METHODS: Using a mathematical model incorporating data on efficacy, costs, and utility values, we simulated the experiences of 100,000 hypothetical rheumatoid arthritis patients over 10 years (50,000 exposed to infliximab plus methotrexate [MTX] and 50,000 exposed to MTX alone). QALYs, were derived from the Health Utilities Index 2 and 3 (HUI2 and HUI3), the Short Form 6-D (SF-6D), and the Euroqol 5-D (EQ-5D). Incremental cost-utility ratios were determined using each instrument to calculate QALYs and the results were compared using cost-effectiveness acceptability curves. RESULTS: Using the different utility measurement methods, the mean difference in QALYs between the infliximab plus MTX and MTX groups ranged from a high of 1.95 QALYs (95% CI=1.93-1.97) using the HUI3 to 0.89 QALYs (95% CI=0.88-0.91) using the SF-6D. Adopting the commonly cited value of society's willingness to pay for a QALY of $50,000, 91% of the simulations favored the cost utility of infliximab plus MTX when using the HUI3 to calculate QALYs. However, when using the EQ-5D, HUI2, or the SF-6D utility values to calculate QALYS, the proportion of simulations that favored the cost utility of infliximab were 63%, 45%, and 12%, respectively. CONCLUSION: Depending on the method for determining utility values used in the calculation of QALYs, very different incremental cost-utility ratios are generated.

Chicken skeletal muscle has three Ca2+-dependent proteinases.

Chicken breast muscle has three Ca2+-dependent proteinases, two requiring millimolar Ca2+ (m-calpain and high m-calpain) and one requiring micromolar Ca2+ (mu-calpain). High m-calpain co-purifies with mu-calpain through successive DEAE-cellulose (steep gradient), phenyl-Sepharose, octylamine agarose, and Sephacryl S-300 columns, but elutes after mu-calpain when using a shallow KCl gradient to elute a DEAE-cellulose column. The mu- and m-calpains have 80 and 28 kDa polypeptides and are analogous to the mu- and m-calpains that have been purified from bovine, porcine and rabbit skeletal muscle. High m-calpain, which seems to be a new Ca2+-dependent proteinase, is still heterogeneous after the DEAE-cellulose column eluted with a shallow KCl gradient. Additional purification through two successive HPLC-DEAE columns and one HPLC-SW-4000 gel permeation column produces a fraction having six major polypeptides and 6-8 minor polypeptides on SDS-PAGE. A 74-76 kDa polypeptide in this fraction reacts in Western blots with monospecific, polyclonal anti-calpain antibodies that react with both the 80 kDa and the 28 kDa polypeptides of mu- or m-calpain. High m-calpain also is related to mu- and m-calpain in that it causes the same limited digestion of skeletal muscle myofibrils, has a similar pH optimum near pH 7.9-8.4, requires Ca2+ for activity, and reacts with the calpain inhibitor, calpastatin, and a variety of serine and cysteine proteinase inhibitors in a manner identical to mu- and m-calpain. High m-calpain differs from mu- and m-calpain in its elution off DEAE-cellulose columns and its requirement of 3800 microM Ca2+ for one-half maximal activity compared with 5.35 microM Ca2+ for mu-calpain and 420 microM Ca2+ for m-calpain. The physiological significance of high m-calpain in unclear. The presence of mu-calpain in chicken breast muscle suggests that all skeletal muscles contain both mu- and m-calpain, although the relative proportions of these two proteinases may vary in different species.

Why the HAQ-II can be an effective substitute for the HAQ.

The HAQ-II is a psychometrically improved 10-item version of the standard HAQ functional questionnaire. It is simpler and faster to administer and score, thereby reducing patient burden. HAQ-II is better correlated with clinical measures than the HAQ and is sensitive to change. The HAQ-II is suitable for use in the clinic and research studies.

A brief introduction to the National Data Bank for Rheumatic Diseases.

The National Data Bank for Rheumatic Diseases (NDB) is a research data bank with a broad agenda and approach to important clinical, regulatory, epidemiological, safety, effectiveness, outcome and patient care questions that cannot be answered by conventional data banks. It has systematic, ongoing quality control programs that assure high quality data. NDB-developed programs result in very efficient analytic capabilities and rapid publication.

The clinical syndrome of fibrositis.

Fibrositis is a disorder of musculoskeletal pain and aching with at least a five to one female-to-male ratio. It is most commonly seen between the ages of 40 and 60, and has a prevalence in the clinic of 6 to 15 percent. Its most common mode of presentation involves generalized musculoskeletal pain and aching, but articular pain, axial skeletal pain, myalgias, and neurovascular complaints sometimes predominate. All patients have multiple areas of local tenderness called "tender points" that are easily identified during physical examination, and are diagnostic. Essential symptoms of fibrositis are disturbed sleep, morning stiffness, and fatigue. Additional rheumatic symptoms include subjective swelling, paresthesias, and numbness. Headaches and irritable bowel syndrome are common nonrheumatic complaints. Modest improvement follows treatment by tricyclic agents such as low-dose cyclobenzaprine and amitriptyline, by physical measures, and by reduction in stress. Remission occurs in 20 percent of patients, but is generally short-lived.

Development of criteria for the diagnosis of fibrositis.

The essential symptoms of fibrositis--widespread aching and pain, disturbed sleep, morning stiffness, and fatigue--are common in both rheumatic and nonrheumatic patients. But the essential sign of fibrositis--widespread local tenderness over specific anatomic sites ("tender points")--is rare in any patients except those with fibrositis. Clinical criteria for the diagnosis of fibrositis rely heavily on a high tender point count in the presence of characteristic fibrositic symptoms. Multiple tender points are uncommon in normal subjects and in those with rheumatic and nonrheumatic disorders. The tender point count thus also serves to distinguish fibrositis from other musculoskeletal diseases.