Recomendaciones de la Sociedad Argentina de Reumatología para el tratamiento de las vasculitis asociadas a ANCA

Las vasculitis asociadas a ANCA representan un grupo de enfermedades autoinmunes, multisistémicas, que afectan principalmente a los vasos de pequeño calibre, pudiendo comprometer el tracto respiratorio superior e inferior, el aparato otorrinolaringológico, riñón y piel, aunque eventualmente cualquier órgano puede estar involucrado. Son enfermedades con potencial y severo compromiso de órganos y elevada morbimortalidad. El objetivo de estas guías fue desarrollar las primeras recomendaciones argentinas para su tratamiento, basadas en la revisión de la literatura mediante metodología GRADE. Un panel de expertos en vasculitis elaboró las preguntas en formato PICO (población, intervención, comparador y outcomes), y luego un panel de expertos en metodología efectuó la revisión de la bibliografía con la extracción de la evidencia para cada una de las preguntas. Se realizó un focus group de pacientes para conocer sus preferencias y experiencias. Finalmente, con la información recabada, el panel de expertos en vasculitis procedió a la votación de las recomendaciones que a continuación se presentan

Work package 6: Evaluation of the digital multilingual information and communication platform in practice

The objective of this WP is to evaluate the open access digital platform in terms of enhancing access to mental healthcare for LLP TCNs, through increasing LLP TCNs’ and mental healthcare providers’ knowledge, understanding and competencies regarding (communication) strategies to overcome the language barrier in mental healthcare. Based on the materials created in WP2 (resource repository), WP4 (patient educational videos) and WP5 (educational videos for healthcare providers), the design of the digital multilingual information and communication platform will be finalised and subsequently evaluated in healthcare practice to ensure readiness of the platform for implementation for any LLP TCN group in European mental healthcare settings. A pretest-posttest design will be employed to evaluate the open access digital platform with regard to the process of implementing it in healthcare practice, and its effects in increasing access to mental healthcare services among LLP TCNs. A training manual will be developed to train healthcare providers how to make use of the digital platform in practice and a training will be delivered to participating healthcare providers. The training manual will be uploaded on the platform and will be developed in such a manner that the platform can also be easily used without face-to-face training (e.g. by using visuals/screenshots, etc.). The effects of the digital platform will be tested among approximately 52 healthcare providers (see section 3.2.1 for power analysis). For each provider, we strive to include at least 5 LLP TCN patients (total N=260). For the process-evaluation we will include the following measures that will be assessed among all healthcare providers and LLP TCNs, either by written surveys or orally administered surveys in the mother tongue of the patients: ease of use, comprehensibility of information and usefulness of the contents. In addition, tracking statistics will be used to assess the frequency with which the digital platform is visited. For the effect-evaluation, validated scales will be used (either written or orally administered) to assess changes in the following four dimensions of access before and after having accessed the digital platform (i.e. pretest measures will be collected just before the training, posttest measures about 1 month after the training; process measures will be collected at the same time as posttest effect measures): 1. availability of healthcare and language services (e.g. increased ease of access to existing services through the resource repository). 2. approachability of healthcare and language services (e.g. increased knowledge, awareness and understanding about language services and rights available). 3. acceptability of healthcare and language services (e.g. increased intercultural and communicative competencies of healthcare providers). 4. appropriateness of healthcare and language services (e.g. increased match between LLP TCNs needs and actual services provided)

Work package 4: Co-creation of patient educational narratives

The objective of this WP is to co-create a minimum of four multilingual culturally-sensitive patient educational narrative videos in liaison with migrant healthcare organisations in order to educate and support LLP TCNs’ access to mental healthcare services. The rationale for including audiovisual educational material is twofold. First, a relatively high proportion of LLP TCNs has low literacy skills and will not be able to comprehend written materials and are thus in need of audio materials. In addition, audiovisual information is often better understood and recalled than written information, also among literate populations. Second, videos are more easily disseminated through online media channels beyond country borders than written materials and can therefore reach more LLP TCNs in Europe

Work package 3: Barriers, needs and communication strategies

The first objective of this WP is to identify the most severe barriers to accessing mental healthcare services for LLP TCNs and to conduct an analysis of the communication, educational/training and practical needs arising for LLP TCNs and healthcare providers to promote this access. Building on this analysis, the second objective is to identify different communication strategies that can potentially mitigate the identified barriers and fulfil the identified needs effectively. Consideration will be given to (1) strategies addressing LLP TCNs’ and providers’ educational needs; (2) macro-strategies enabling access (e.g. use of a second language or lingua franca, individuals providing language support, translation tools); and (3) micro-strategies supporting effective communication and interaction within the afore-mentioned macro-options, in different communicative events and at different stages in the clinical care process. Given the increasing use of technology in healthcare settings as an emerging macro-strategy to access language support, especially automated translation such as Google Translate, our work on the second objective will include a small-scale simulated examination of the use of this technology in supporting access to mental healthcare services for LLP TCNs

Work package 5: Co-creation of educational videos for healthcare providers

The objective of this WP is to co-create - in close collaboration with stakeholders (e.g. healthcare providers, interpreters/intercultural mediators, migrant organisations) - online educational videos for healthcare professionals to enhance their intercultural and communicative competencies, thereby promoting access to mental healthcare for LLP TCNs. As training in this field is often limited to providing narrow knowledge without actual clinical work with the migrant patient community or a link to broader patient management (Chiarenza et al. 2019), we will develop and present our educational videos as a tool to solve problems healthcare providers encounter in everyday clinical practice, based on the outcomes of WP3 (i.e. salient needs, severest barriers, and recommended communication strategies). Furthermore, we will base the content of the videos on the concept of storytelling and address real-life issues through providers’ personal testimonies, because these techniques have shown to be effective in generating changes in knowledge, skills and behaviour (Singhal et al., 2004)

Mhealth4All Project

During a three-year multidisciplinary trajectory, leading academics and non-academics (e.g. linguists, clinical and social psychologists, communication scientists, migrant and healthcare provider organisations, public service interpreters), will develop, implement and evaluate an evidence-based multilingual culturally-sensitive sustainable digital information and communication platform to enhance access to mental healthcare for third-country nationals (TCNs) with low language proficiency (LLP) in the host country’s language across various European countries. The following target groups will be included: refugees, asylum seekers, other migrant patient groups suffering from mental health issues, healthcare providers, interpreters and cultural mediators, policy makers and NGOs

The EChO science case

The discovery of almost two thousand exoplanets has revealed an unexpectedly diverse planet population. We see gas giants in few-day orbits, whole multi-planet systems within the orbit of Mercury, and new populations of planets with masses between that of the Earth and Neptune—all unknown in the Solar System. Observations to date have shown that our Solar System is certainly not representative of the general population of planets in our Milky Way. The key science questions that urgently need addressing are therefore: What are exoplanets made of? Why are planets as they are? How do planetary systems work and what causes the exceptional diversity observed as compared to the Solar System? The EChO (Exoplanet Characterisation Observatory) space mission was conceived to take up the challenge to explain this diversity in terms of formation, evolution, internal structure and planet and atmospheric composition. This requires in-depth spectroscopic knowledge of the atmospheres of a large and well-defined planet sample for which precise physical, chemical and dynamical information can be obtained. In order to fulfil this ambitious scientific program, EChO was designed as a dedicated survey mission for transit and eclipse spectroscopy capable of observing a large, diverse and well-defined planet sample within its 4-year mission lifetime. The transit and eclipse spectroscopy method, whereby the signal from the star and planet are differentiated using knowledge of the planetary ephemerides, allows us to measure atmospheric signals from the planet at levels of at least 10[Superscript: −4] relative to the star. This can only be achieved in conjunction with a carefully designed stable payload and satellite platform. It is also necessary to provide broad instantaneous wavelength coverage to detect as many molecular species as possible, to probe the thermal structure of the planetary atmospheres and to correct for the contaminating effects of the stellar photosphere. This requires wavelength coverage of at least 0.55 to 11 μm with a goal of covering from 0.4 to 16 μm. Only modest spectral resolving power is needed, with R ~ 300 for wavelengths less than 5 μm and R ~ 30 for wavelengths greater than this. The transit spectroscopy technique means that no spatial resolution is required. A telescope collecting area of about 1 m[Superscript: 2] is sufficiently large to achieve the necessary spectro-photometric precision: for the Phase A study a 1.13 m2 telescope, diffraction limited at 3 μm has been adopted. Placing the satellite at L2 provides a cold and stable thermal environment as well as a large field of regard to allow efficient time-critical observation of targets randomly distributed over the sky. EChO has been conceived to achieve a single goal: exoplanet spectroscopy. The spectral coverage and signal-to-noise to be achieved by EChO, thanks to its high stability and dedicated design, would be a game changer by allowing atmospheric composition to be measured with unparalleled exactness: at least a factor 10 more precise and a factor 10 to 1000 more accurate than current observations. This would enable the detection of molecular abundances three orders of magnitude lower than currently possible and a fourfold increase from the handful of molecules detected to date. Combining these data with estimates of planetary bulk compositions from accurate measurements of their radii and masses would allow degeneracies associated with planetary interior modelling to be broken, giving unique insight into the interior structure and elemental abundances of these alien worlds. EChO would allow scientists to study exoplanets both as a population and as individuals. The mission can target super-Earths, Neptune-like, and Jupiter-like planets, in the very hot to temperate zones (planet temperatures of 300–3000 K) of F to M-type host stars. The EChO core science would be delivered by a three-tier survey. The EChO Chemical Census: This is a broad survey of a few-hundred exoplanets, which allows us to explore the spectroscopic and chemical diversity of the exoplanet population as a whole. The EChO Origin: This is a deep survey of a subsample of tens of exoplanets for which significantly higher signal to noise and spectral resolution spectra can be obtained to explain the origin of the exoplanet diversity (such as formation mechanisms, chemical processes, atmospheric escape). The EChO Rosetta Stones: This is an ultra-high accuracy survey targeting a subsample of select exoplanets. These will be the bright “benchmark” cases for which a large number of measurements would be taken to explore temporal variations, and to obtain two and three dimensional spatial information on the atmospheric conditions through eclipse-mapping techniques. If EChO were launched today, the exoplanets currently observed are sufficient to provide a large and diverse sample. The Chemical Census survey would consist of > 160 exoplanets with a range of planetary sizes, temperatures, orbital parameters and stellar host properties. Additionally, over the next 10 years, several new ground- and space-based transit photometric surveys and missions will come on-line (e.g. NGTS, CHEOPS, TESS, PLATO), which will specifically focus on finding bright, nearby systems. The current rapid rate of discovery would allow the target list to be further optimised in the years prior to EChO’s launch and enable the atmospheric characterisation of hundreds of planets