American College of Rheumatology Provisional Criteria for Clinically Relevant Improvement in Children and Adolescents With Childhood-Onset Systemic Lupus Erythematosus

10.1002/acr.23834ARTHRITIS CARE & RESEARCH715579-59

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Etude du mouvement de l'eau et du transfert réactif du nitrate dans les sols volcaniques du bassin versant élémentaire de la Loma, Mexique

La compréhension des processus qui participent au devenir du nitrate dans les sols volcaniques du bassin élémentaire de la Loma , est essentielle afin de répondre aux interrogations concernant l'impact des activités agricoles sur la qualité des eaux et définir des stratégies de protection des ressources en eau du bassin de Valle de Bravo. Ce dernier, à activités majoritairement agricoles, approvisionne pour 15% des besoins en eau potable de la zone métropolitaine de la ville de Mexico. Le sol de la Loma est un Andosol, avec une minéralogie caractérisée par des composants amorphes comme l'allophane. Le sol présente une charge variable, dont sont responsables les allophanes et la matière organique. L'adsorption du nitrate dans le sol, étudiée de façon statique et dynamique, est linéaire et instantanée dans l'intervalle de concentrations étudiées (4 à 20 mM). La structure du sol et la géométrie du réseau poral influent fortement le transport des solutés. Le labour affecte la structure et le réseau poral des 30 premiers cm du profil de sol. Les essais d'infiltrométrie ont mis en évidence deux comportements différents dans le profil de sol: en surface aucune méthode d'analyse n'a marché du fait de la forte variation spatiale des propriétés de sol suite aux activités agricoles; en profondeur la conductivité hydraulique varie de 0.006<K<0.02 mm S.1 à 30 cm à K<0.01 mm 5.1 à partir de 55 cm. Les activités agricoles diminuent la capacité d'adsorption anionique du sol. Dans les horizons profonds où la capacité naturelle de retenir le nitrate n'est pas altérée, la présence de flux préférentiel accélère le transport du nitrate.GRENOBLE1-BU Sciences (384212103) / SudocPARIS-BIUSJ-Sci.Terre recherche (751052114) / SudocSudocFranceF

Assessment of Sulfamethoxazole mobility in natural soils and of the risk of contamination of water resources at the catchment scale

International audienceSulfamethoxazole (SMX) is one of the antibiotics most commonly detected in aquatic and terrestrial environments and is still widely used, especially in low income countries. SMX is assumed to be highly mobile in soils due to its intrinsic molecular properties. Ten soils with contrasting properties and representative of the catchment soil types and land uses were collected throughout the watershed, which undergoes very rapid urban development. SMX displacement experiments were carried out in repacked columns of the 10 soils to explore SMX reactive transfer (mobility and reactivity) in order to assess the contamination risk of water resources in the context of the Bolivian Altiplano. Relevant sorption processes were identified by modelling (HYDRUS-1D) considering different sorption concepts. SMX mobility was best simulated when considering irreversible sorption as well as instantaneous and rate-limited reversible sorption, depending on the soil type. SMX mobility appeared lower in soils located upstream of the watershed (organic and acidic soils-Regosol) in relation with a higher adsorption capacity compared to the soils located downstream (lower organic carbon content-Cambisol). By combining soil column experiments and soil profiles description, this study suggests that SMX can 32 be classified as a moderately to highly mobile compound in the studied watershed, depending principally on soil properties such as pH and OC. Potential risks of surface and groundwater pollution by SMX were thus identified in the lower part of the studied catchment, threatening Lake Titicaca water quality

Supplemental Material - Risk factors for mortality in 1528 Brazilian childhood-onset systemic lupus erythematosus patients

Supplemental Material for Risk factors for mortality in 1528 Brazilian childhood-onset systemic lupus erythematosus patients by Ana P Sakamoto, Clovis A Silva, Ana C Pita, Vitor C Trindade, Aline G Islabao, Fernanda J Fiorot, Sandra RM Lopes, Rosa MR Pereira, Claudia Saad-Magalhaes, Gleice CS Russo, Claudio A Len, Rogerio do Prado, Lucia MA Campos, Nadia E Aikawa, Simone Appenzeller, Virginia PL Ferriani, Marco F Silva, Marta Felix, Adriana R Fonseca, Ana PL Assad, Flavio R Sztajnbok, Maria C Santos, Blanca E Bica, Evaldo G Sena, Ana J Moraes, Melissa M Fraga, Teresa C Robazzi, Paulo F Spelling, Iloite M Scheibel, Andre S Cavalcanti, Erica N Matos, Luciano J Guimaraes, Flavia P Santos, Licia MH Mota, Eloisa Bonfa and Maria T Terreri in Lupus</p

American college of rheumatology provisional criteria for clinically relevant improvement in children and adolescents with childhood-onset systemic Lupus erythematosus

To develop a Childhood Lupus Improvement Index (CHILI) as a tool to measure response to therapy in childhood-onset systemic lupus erythematosus (cSLE), with a focus on clinically relevant improvement (CRIcSLE). Methods Pediatric nephrology and rheumatology subspecialists (n = 213) experienced in cSLE management were invited to define CRIcSLE and rate a total of 433 unique patient profiles for the presence/absence of CRIcSLE. Patient profiles included the following cSLE core response variables (CRVs): global assessment of patient well-being (patient-global), physician assessment of cSLE activity (MD-global), disease activity index score (here, we used the Systemic Lupus Erythematosus Disease Activity Index), urine protein-to-creatinine ratio, and Child Health Questionnaire physical summary score. Percentage and absolute changes in these cSLE-CRVs (baseline versus follow-up) were considered in order to develop candidate algorithms and validate their performance (sensitivity, specificity, area under the receiver operating characteristic curve [AUC]; range 0-1). Results During an international consensus conference, unanimous agreement on a definition of CRIcSLE was achieved; cSLE experts (n = 13) concurred (100%) that the preferred CHILI algorithm considers absolute changes in the cSLE-CRVs. After transformation to a range of 0-100, a CHILI score of >= 54 had outstanding accuracy for identifying CRIcSLE (AUC 0.93, sensitivity 81.1%, and specificity 84.2%). CHILI scores also reflect minor, moderate, and major improvement for values exceeding 15, 68, and 92, respectively (all AUC >= 0.92, sensitivity >= 93.1%, and specificity >= 73.4%). Conclusion The CHILI is a new, seemingly highly accurate index for measuring CRI in cSLE over time. This index is useful to categorize the degree of response to therapy in children and adolescents with cSLE.715579590CNPQ - Conselho Nacional de Desenvolvimento Científico e TecnológicoFAPESP – Fundação de Amparo à Pesquisa Do Estado De São Paulo303422/2015-7; 7/2016-9; 304255/2015-7215/03756-