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The structure of fluvial sediments in streams has environmental implications to contaminant fate, nutrient budgeting and the carbon flux associated with fine particulate organic matter (FPOM). However, the influence of sediment structure is lacking in environmental predictive models. To this end, the present study links field-based results of sediment aggregate structure to seasonal biological functions in the surface fine-grained laminae (SFGL) of a low-gradient stream. Fluvial sediment collection, microscopy and image analysis are used to show that aggregates collected over a 20 month time period support the concept that aggregate structure can vary seasonally in low-gradient streams where temporarily stored sediment is prominent. Results show that the structure of the transported aggregates is more irregular in the summer with the structure being elongated about the long axes. In the winter, the aggregate structure is compacted and more spherical. Statistical analysis and results suggest that heterotrophic and autotrophic biological activity within the SFGL exhibits seasonal control upon the morphology of transported sediments. Implications of this research are highlighted through calculations of the reactive surface area of the transported suspended sediment load. The surface area of transported sediment is estimated to be 40% greater in the summer as compared to the winter time period, which implies that (i) the affinity of sediments to sorb contaminants is higher in summer months and (ii) the downstream reactivity of FPOM in large rivers, lakes and estuaries is not just a function of microbial drivers but also the seasonally dependent structure of transported FPOM derived from low-order streams. Copyright

Background/purpose Interstitial lung disease (ILD) is an important problem for patients with rheumatoid arthritis (RA). However, current approaches to ILD case finding in real-world data have been evaluated only in limited settings and identify only prevalent ILD and not new-onset disease. Our objective was to develop, refine, and validate a claims-based algorithm to identify both prevalent and incident ILD in RA patients compared to the gold standard of medical record review. Methods We used administrative claims data 2006–2015 from Medicare to derive a cohort of RA patients. We then identified suspected ILD using variations of ILD algorithms to classify both prevalent and incident ILD based on features of the data that included hospitalization vs. outpatient setting, physician specialty, pulmonary-related diagnosis codes, and exclusions for potentially mimicking pulmonary conditions. Positive predictive values (PPV) of several ILD algorithm variants for both prevalent and incident ILD were evaluated. Results We identified 234 linkable RA patients with sufficient data to evaluate for ILD. Overall, 108 (46.2%) of suspected cases were confirmed as ILD. Most cases (64%) were diagnosed in the outpatient setting. The best performing algorithm for prevalent ILD had a PPV of 77% (95% CI 67–84%) and for incident ILD was 96% (95% CI 85–100%). Conclusion Case finding in administrative data for both prevalent and incident interstitial lung disease in RA patients is feasible and has reasonable accuracy to support population-based research and real-world evidence generation.

In this article, an overview of current pharmacological therapies used in the treatment of relapsing-remitting multiple sclerosis (MS) will be provided. MS is the most common neurological disease affecting young adults in the Western world. While there is no cure, recent advancements in drug therapy may alter the long-term outcome of this disease, offering more hope to individuals living with MS. This article will focus on natalizumab (Tysabri), a monoclonal antibody (mAb) that significantly reduces relapses and disease progression in relapsing-remitting MS. However, it has been associated with increased risk of a potentially fatal brain infection, progressive multifocal leukoencephalopathy (PML). The MS nurse's role in educating, administering and monitoring patients on this drug will be considered. In the future, mAb therapy will alter the way in which MS is treated, and therefore the skills and knowledge of the MS nurse will have to continually evolve in order to care for patients on this therapy and administer these drugs safely.