Triple therapy with adalimumab, ustekinumab and methotrexate for induction of remission in moderate to severe ileocolonic Crohn’s disease with upper gastrointestinal involvement in a biologic-experienced individual

Induction of remission in biologic-experienced individuals with moderate to severe Crohn’s disease (CD) can be a challenge. We hereby present a case of CD with secondary non-response to infliximab. Adding methotrexate and switching to ustekinumab plus methotrexate did not stop the inflammatory process. Therefore, combination therapy with two classes of biologics consisting of ustekinumab and adalimumab plus methotrexate was initiated. He achieved clinical remission in 4 weeks and remained on triple therapy for 6 months which was subsequently tailored to adalimumab/methotrexate combination therapy due to insurance restriction on ustekinumab. He remained in remission for the duration of follow-up, 14 months after initiation of triple therapy and 8 months after switching to methotrexate/adalimumab biologic monotherapy. Triple therapy with anti-TNF, IL-12/23 inhibitor and methotrexate could potentially be an option for induction of remission in biologic-experienced individuals with good initial clinical response to anti-TNF agents.

THE IMPORTANCE OF THE MUSEUM IN ANTEBELLUM U.S. WESTERN TERRITORIAL EXPLORATION: PART 2. THE ROLES OF HAYDEN AND MEEK IN A PARADIGM SHIFT IN GEOLOGIC AND PALEONTOLOGIC STUDIES

Established under the antebellum leadership of Joseph Henry and Spencer Baird, the respect given the Smithsonian Institution had far-reaching effects on budding geological careers and the conservation and curation of fossils at national and state levels. Specifically, F. V. Hayden received sufficient perceived encouragement in his geological and natural history endeavors to prevail under no less than hardship conditions. Consequently, Hayden triumphed on his return from the field in 1856, with specimens that would quickly alter his immediate destiny and that of F. B. Meek. The five documents accepted for publication in 1856 by the Academy of Natural Sciences of Philadelphia produced not only a large number of new species, but Hayden’s northern Great Plains stratigraphy and a biostratigraphic/biochronologic catalog of species original to western studies. Others were now also repeatedly citing Hayden with Meek for non-molluscan specimens based on his collections, with new species named in his honor. The nature of western geological exploration changed because of Hayden’s successful employment as geologist and naturalist to the G. K. Warren and W. F. Raynolds Missouri and Yellowstone expeditions. Onsite, ‘fact-based’ mapping with fossils in stratigraphic sections were arguably now required. No more qualified or experienced individual left the western territories as the Civil War commenced. Meek’s deathbed monograph provided a redescription and the first figures of Meek and Hayden 1856 taxa. Although there are reasons suggested herein, a conundrum exists as to why Meek replaced many 1856 ‘types’ with different specimens, sometimes from different localities. The specimens used in the 1856 Meek and Hayden papers were first unpacked for study by Meek and Hayden in Albany. Shipment of fossils from field to museum, however, was not without peril. The presumption is that the specimens accompanied Meek when he moved to Washington in 1858. A National Museum sponsored and implemented program fostered an ever-expanding ‘duplicate’ distribution of specimens to national and international institutions. Henry and Baird were dedicated to this program. Starting in 1861, surplus fossil invertebrates were removed from National Museum holdings. Many thousands of specimens were transferred, with nearly one thousand specimens documented in a single shipment to one institution. How much of the Hayden collection was affected and how many types were redistributed is as of yet unknown. The remaining Hayden collection in the National Museum is pared-down to type and figured specimens. Hayden’s ‘buckets’ of specimens are being, in some cases, slowly virtually repatriated.

The Role of MEMS in In-Vitro-Fertilization

The assisted reproduction has been considered a viable solution for the infertility of humankind for more than four decades. In-Vitro-Fertilization (IVF) is one of the most successful assisted reproduction techniques, where the reproductive cell of the female partner is fertilized outside of her body. Initially, the IVF process has been conducted manually by an experienced embryologist. However, even with a highly experienced individual, the operation had extremely lower success rates due to the limited control in environmental conditions and the requirement of precise movements. Therefore, to address this technological deficit, the feasibility of the mechatronics devices for IVF procedures has been investigated. Among the different mechatronics concepts, micro-electromechanical system (MEMS) technologies have been gradually attracted to the IVF process and improved its capabilities. The purpose of this paper is to present a brief overview of the role of MEMS technologies in IVF. The article classifies the MEMS technologies in IVF based on their application in order to emphasize its contribution. In addition, the article extensively discusses the state-of-the-art mechatronic techniques utilized in Intracytoplasmic Sperm Injection (ICSI), one of the most popular techniques used in IVF. This review article expects to become extremely beneficial for the engineering researchers new to this field who seek critical information on IVF in simple terms with highlights on the possible advancements and challenges that may emerge in the future.

Can a virtual on-line nation-wide mentorship-matching process meet the need?

In Homer’s 8th century BC Greek epic poem “Odyssey”, Odysseus, upon leaving town to do battle for an extended period, could not have done better than to leave his son, Telemachus, in the care of a trusted friend, Mentor. Thus, “mentorship” can be seen as a key process, whereby a more experienced individual takes on an advisor role for a less-experienced colleague.

Surface Defect Identification and Grouping of Intermittent Leather Images using Linear Discriminant Model

Scrutiny of intermittent leather is accepted through visual analysis on the natural material by an experienced individual based on many parameters which includes surface defects as a parameter. Such results comprising of base color, other than base color, share of regions, share of cutting area, share of cutting value, position wise length and position wise breadth will determine the value of the leather and surprisingly the result will vary form one experienced person to another. Hence, a new method for grouping of intermittent leather is proposed for a better or suitable decision making. Feature extraction technique, Grey Level Co-occurrence Matrix (GLCM) has been implemented to understand the features of color and area by extracting the texture features like Entropy, Energy, Contrast, Variance, Mean, Dissimilarity, Correlation and Homogeneity. A total of 428 intermittent leather imagesare used to understand the classification. The classifiers, Linear Discriminant Analysis (LDA) model and Support Vector Machine (SVM) are used to find out the accuracy. Further, linear discriminant model confirms 92% of accuracy over the support vector machine which is confirms 89.65% of accuracy. The proposed LDA model clearly shows that the approach is successful in classifying the variations among the defects and non-defects in intermittent leather images.

The Traumatized Older Individual and Society

As life expectancy increases and the baby-boom generation ages, clinicians will see a growing aging population, many of whom have experienced individual or mass psychic trauma. In these individuals, a personal history of trauma can compound the expected traumas of aging. This chapter provides the epidemiology of older adults who have experienced trauma and discusses issues such individuals face, as well as measures clinicians can use to avoid retraumatization. There is a relatively high prevalence of posttraumatic stress disorder (PTSD) among older persons generally. Fragile elders with a history of helplessness, trauma, and massive loss are vulnerable to reactivation of posttraumatic symptomatology through the experience of pain, fear, or helplessness that can accompany even ordinary aging, especially in nursing homes. Aging persons show varying levels of resilience in the face of trauma due to genetic factors and/or life experience. Clinicians and researchers need to take into account individual, family, and communal histories of trauma and respect patients’ autonomy in order to implement an informed-consent process within a trusting patient–family–clinician alliance.

Are migratory behaviours of bats socially transmitted?

To migrate, animals rely on endogenous, genetically inherited programmes, or socially transmitted information about routes and behaviours, or a combination of the two. In long-lived animals with extended parental care, as in bats, migration tends to be socially transmitted rather than endogenous. For a young bat to learn migration via social transmission, they would need to follow an experienced individual, most likely one roosting nearby. Therefore, we predicted that bats travelling together originate from the same place. It is also likely that young bats would follow their mothers or other kin, so we predicted that bats travelling together are more closely related to each other than bats not travelling together. To test our predictions, we used microsatellite genotypes and stable isotope values of δ 13 C, δ 15 N and δ 2 H to analyse the relatedness and geographical origins of migrating hoary bats ( Lasiurus cinereus/Aeorestes cinereus (Baird et al. 2015 J. Mammal . 96, 1255–1274 ( doi:10.1093/jmammal/gyv135 )); n = 133) and silver-haired bats ( Lasionycteris noctivagans ; n = 87) killed at wind turbines over two consecutive autumn migrations. Contrary to our predictions, there was no evidence that related dyads of hoary bats or silver-haired bats were killed on the same night more frequently than expected by chance, or that the number of days between the fatalities of dyad members was influenced by relatedness or latitude of origin. Our data suggest that these bats do not socially transmit migration routes and behaviours among close kin.