Mapping the spatial variability of rainfall from a physiographic-based multilinear regression: model development and application to the Southwestern Iberian Peninsula.

A physiographic-based multilinear regression model supported by GIS was developed to estimate spatial rainfall variability in the Southwest Iberian Peninsula. The area study includes a wide diversity of landscape features and comprises four Portuguese regions and one Spanish province (totalizing 28,860 km2). The region suffers a very strong Mediterranean influence, with a major cleavage between winter and summer seasons. Thus, the analysis was carried out separately for the wet (October to March) and dry (April to September) semesters. From an initial set of 10 explanatory physiographic variables, five were selected to be used in the multilinear regression, as they allowed generating models by map algebra that fitted well with the last 40 years of monthly rainfall data records. These records were obtained from 163 weather stations, filtered from an initial set of 230 (142 stations in Portugal and 88 in Spain). The correlation between the physiographic-based multilinear regression model and a model obtained by interpolation from rainfall historical data showed to be good or very good in approximately 75% of the area under study. Results show that physiographic-based models can be effectively used to estimate rainfall where there is a lack of rain gauges, or to densify spatial resolution of rainfall between rain gauges.

GO-DACT: a phase 3b randomised, double-blind, placebo-controlled trial of GOlimumab plus methotrexate (MTX) versus placebo plus MTX in improving DACTylitis in MTX-naive patients with psoriatic arthritis.

OBJECTIVES: To assess the efficacy of golimumab in combination with methotrexate (MTX) versus MTX monotherapy in psoriatic arthritis (PsA) dactylitis. METHODS: Multicentre, investigator-initiated, randomised, double-blind, placebo-controlled, parallel-design phase 3b trial in 11 Portuguese rheumatology centres. Patients with PsA along with active dactylitis and naive to MTX and biologic disease-modifying antirheumatic drugs (bDMARDs) were randomly assigned to golimumab or placebo, both in combination with MTX. The primary endpoint was Dactylitis Severity Score (DSS) change from baseline to week 24. Key secondary endpoints included DSS and Leeds Dactylitis Index (LDI) response, and changes from baseline in the LDI and MRI dactylitis score. Analysis was by intention-to-treat for the primary endpoint. RESULTS: Twenty-one patients received golimumab plus MTX and 23 MTX monotherapy for 24 weeks. One patient from each arm discontinued. Patient inclusion was halted at 50% planned recruitment due to a favourable interim analysis. Median baseline DSS was 6 in both arms. By week 24, patients treated with golimumab plus MTX exhibited significantly greater improvements in DSS relative to MTX monotherapy (median change of 5 vs 2 points, respectively; p=0.026). In the golimumab plus MTX arm, significantly higher proportions of patients achieved at least 50% or 70% improvement in DSS and 20%, 50% or 70% improvement in LDI in comparison to MTX monotherapy. CONCLUSIONS: The combination of golimumab and MTX as first-line bDMARD therapy is superior to MTX monotherapy for the treatment of PsA dactylitis. TRIAL REGISTRATION NUMBER: NCT02065713.

Effectiveness and long-term retention of anti-tumour necrosis factor treatment in juvenile and adult patients with juvenile idiopathic arthritis: data from Reuma.pt.

OBJECTIVES: Assess the effectiveness and safety of biologic therapy as well as predictors of response at 1 year of therapy, retention rate in biologic treatment and predictors of drug discontinuation in JIA patients in the Portuguese register of rheumatic diseases. METHODS: We prospectively collected patient and disease characteristics from patients with JIA who started biological therapy. Adverse events were collected during the follow-up period. Predictors of response at 1 year and drug retention rates were assessed at 4 years of treatment for the first biologic agent. RESULTS: A total of 812 JIA patients [65% females, mean age at JIA onset 6.9 years (s.d. 4.7)], 227 received biologic therapy; 205 patients (90.3%) were treated with an anti-TNF as the first biologic. All the parameters used to evaluate disease activity, namely number of active joints, ESR and Childhood HAQ/HAQ, decreased significantly at 6 months and 1 year of treatment. The mean reduction in Juvenile Disease Activity Score 10 (JADAS10) after 1 year of treatment was 10.4 (s.d. 7.4). According to the definition of improvement using the JADAS10 score, 83.3% respond to biologic therapy after 1 year. Fourteen patients discontinued biologic therapies due to adverse events. Retention rates were 92.9% at 1 year, 85.5% at 2 years, 78.4% at 3 years and 68.1% at 4 years of treatment. Among all JIA subtypes, only concomitant therapy with corticosteroids was found to be univariately associated with withdrawal of biologic treatment (P = 0.016). CONCLUSION: Biologic therapies seem effective and safe in patients with JIA. In addition, the retention rates for the first biologic agent are high throughout 4 years.

DAS28, CDAI and SDAI cut-offs do not translate the same information: results from the Rheumatic Diseases Portuguese Register Reuma.pt.

OBJECTIVES: . The 28-joint DAS (DAS28), clinical disease activity index (CDAI) and simplified disease activity index (SDAI) are indices frequently used to assess disease activity in RA patients. Cut-off values were defined to classify the states of RA disease activity: remission, low, moderate and high. The aim of this work was to assess disease activity states classified by DAS28, CDAI and SDAI and to analyse their agreement in the Rheumatic Diseases Portuguese Register Reuma.pt. METHODS: . A total of 2795 patients and 14 440 visits were selected from Reuma.pt for analysis. Pearson's correlation coefficients (PCCs) were calculated for the three indices. McNemar's chi-squared tests, PCCs and kappa statistics were performed to analyse and compare the distribution of visits among all disease activity states and indices. RESULTS: A strong correlation was found between the three indices throughout the 14 440 visits: r = 0.874 for DAS28/CDAI, r = 0.877 for DAS28/SDAI and r = 0.984 for CDAI/SDAI (all PCCs with P < 0.0001). However, when categorization in the different disease activity states was analysed, McNemar's chi-squared tests and PCCs revealed significant disagreement between the cut-offs of the three indices. CONCLUSION: DAS28, CDAI and SDAI cut-offs do not translate into the same clinical information in Reuma.pt. Although this might be expected for the original DAS28 cut-offs, when compared with CDAI and SDAI significant disagreement was also found for the DAS28 modified cut-offs. For visits where patients are in CDAI or SDAI remission, we also find disagreement between these two indices, which may contradict previous conclusions that acute phase reactants add little to composite disease activity indices for RA.

The variability of the serve toss in tennis under the influence of artificial crosswind.

This study was made to analyze the variability and stability of the serve toss in tennis, on the x (side-to-side), y (back-to-front) and z (vertical) axes, with 12 experienced players under the influence of crosswind (induced aerodynamic flow) produced by an industrial ventilator. The players were analyzed individually after serving at maximum speed and accuracy to the intersection point of the centre line and service line ("T "point). The results allow us to conclude that the experienced players tend to stabilize the vertical dimension of the service (z axis). Additionally, this study confirms the invariability of the player height ratio: height of impact (1:1.5) in experienced players even when constrained by the "artificial crosswind. "Given the above, the vertical dimension of the tennis serve is assumed as a constant feature, which is guaranteed in the remaining varying dimensions (y and x axes) of the ball toss. Thus, the variability should be seen as part of the solution and not as something to be avoided by players and coaches. Key PointsAnalysis of the tennis serve variability under the effect of artificial crosswindTwelve experienced tennis players performed a set of 20 free serves (without wind constraints), and four other sets of 20 serves under different practice conditions (with different crosswind intensities)The players tend to stabilize in the z axis and vary in the y- (back-to-front) and x-axes (side-to-side) during the ball toss tennis serve in all the practice conditions (with and without crosswind)THE MAINTENANCE OF A PLAYER HEIGHT RATIO: impact height of approximately 1:1.5 in experienced players, even when constrained by "artificial crosswind".

Associations between functional movement screen scores and performance variables in surf athletes.

BACKGROUND: Functional movement screen (FMS) have been used to assess the movement patterns in daily sports practice. Some associations between FMS scores and physical variables have been found in some sports. Nevertheless, no study was conducted in surf. METHODS: Eighteen surf athletes (11 male) participated in the study (18.3±6.3 years; 60.0±9.6 kg; 168.6±8.1 cm). All participants completed anthropometrics, knee-to-wall test, Functional Movement Screen, Isometric Knee Extension, Handgrip, Squat and Countermovement Jump. Based on that, this study investigated: 1) the variance of FMS scores between gender; 2) the association between FMS scores and physical variables of strength of upper and lower limbs, power of lower limbs and anthropometric variables; and 3) which FMS scores best explain the physical performance variables. RESULTS: The analysis of comparison between gender of each item of FMS showed significant statistical differences only in trunk stability push-up (P=0.01, ES=0.141). Kendall's Tau b correlation test between FMS scores and physical variables, revealed significant associations. After performed the stepwise multiple linear regression, FMS deep squat and trunk stability push-up explain 57% of right side knee-to-wall test and the model is statistically significant (F(2,15)=13.097; P=0.001). In squat jump (height) the results show that FMS trunk stability push-up explains 50.3% of this dimension and the model is statistically significant (F(1,16)=18.182; P=0.001). CONCLUSIONS: FMS individual scores seems to better explain physical variables than total score. Only trunk stability push-up test seems to be a reliable indicator to predict physical performance in surf athletes.

The GO-DACT protocol: a multicentre, randomized, double-blind, parallel-group study to compare the efficacy of golimumab in combination with methotrexate (MTX) versus MTX monotherapy.

The GO-DACT is an investigator-initiated, national, multicentric randomized placebo-controlled double-blinded trial, that assesses dactylitis as primary endpoint. Psoriatic arthritis patients naïve to methotrexate and biologic disease modifying anti-rheumatic drugs, with at least one active dactylitis, were assigned to golimumab in combination with methotrexate or placebo in combination with methotrexate, for 24 weeks. Both clinical (dactylitis severity score and the Leeds dactylitis index) and imaging (high resolution magnetic resonance imaging), among others, were assessed as outcomes. The main objective of GO-DACT is to provide evidence to improve the treatment algorithm and care of psoriatic arthritis patients with active dactylitis. In this manuscript we describe the GO-DACT protocol and general concepts of the methodology of this trial.

Distance and slope constraints: adaptation and variability in golf putting.

The main objective of this study is to understand the adaptation to external constraints and the effects of variability in a golf putting task. We describe the adaptation of relevant variables of golf putting to the distance to the hole and to the addition of a slope. The sample consisted of 10 adult male (33.80 ± 11.89 years), volunteers, right handed and highly skilled golfers with an average handicap of 10.82. Each player performed 30 putts at distances of 2, 3 and 4 meters (90 trials in Condition 1). The participants also performed 90 trials, at the same distances, with a constraint imposed by a slope (Condition 2). The results indicate that the players change some parameters to adjust to the task constraints, namely the duration of the backswing phase, the speed of the club head and the acceleration at the moment of impact with the ball. The effects of different golf putting distances in the no-slope condition on different kinematic variables suggest a linear adjustment to distance variation that was not observed when in the slope condition.

Using the Juvenile Arthritis Disease Activity Score based on erythrocyte sedimentation rate or C-reactive protein level: results from the Portuguese register.

OBJECTIVE: Our aims were to evaluate the correlation between Juvenile Arthritis Disease Activity Score 27-joint reduced count (JADAS27) with erythrocyte sedimentation rate (ESR) and JADAS27 with C-reactive protein (CRP) scores and to test the agreement of both scores on classifying each disease activity state. We also aimed at verifying the correlation of the 2 scores across juvenile idiopathic arthritis (JIA) categories and to check the correlation between JADAS27-ESR and clinical JADAS27 (JADAS27 without ESR). METHODS: A nationwide cohort of patients with JIA registered in the Portuguese Register, Reuma.pt, was studied. JADAS27-CRP was adapted by replacing ESR with CRP level as the inflammatory marker. JADAS27-CRP was calculated similarly to JADAS27-ESR as the simple linear sum of its 4 components. Pearson's correlations and K statistics were used in the analyses. RESULTS: A total of 358 children had full data to calculate JADAS27; 65.4% were female and the mean ± SD disease duration was 11.8 ± 9.1 years. The correlation coefficient between JADAS27-ESR and JADAS27-CRP was 0.967 (P < 0.0001), although the correlation coefficient between ESR and CRP level was 0.335 (P < 0.0001). The strong correlation between JADAS27-ESR and JADAS27-CRP was maintained when compared within each JIA category. The agreement between JADAS27-ESR and JADAS27-CRP across the 4 activity states was very good, showing 91.1% of the observations in agreement; K = 0.867 (95% confidence interval 0.824-0.91). The correlation between JADAS27 with ESR and JADAS27 without ESR was high (r = 0.97, P < 0.0001). CONCLUSION: JADAS27 based on CRP level correlated closely with JADAS27-ESR across all disease activity states and JIA categories, indicating that both measures can be used in clinical practice. Moreover, the correlation of JADAS27 with and without ESR was also high, suggesting that this tool might be useful even in the absence of laboratorial measures.