A Multisite Preregistered Paradigmatic Test of the Ego-Depletion Effect

We conducted a preregistered multilaboratory project (k = 36; N = 3,531) to assess the size and robustness of ego-depletion effects using a novel replication method, termed the paradigmatic replication approach. Each laboratory implemented one of two procedures that was intended to manipulate self-control and tested performance on a subsequent measure of self-control. Confirmatory tests found a nonsignificant result (d = 0.06). Confirmatory Bayesian meta-analyses using an informed-prior hypothesis (δ = 0.30, SD = 0.15) found that the data were 4 times more likely under the null than the alternative hypothesis. Hence, preregistered analyses did not find evidence for a depletion effect. Exploratory analyses on the full sample (i.e., ignoring exclusion criteria) found a statistically significant effect (d = 0.08); Bayesian analyses showed that the data were about equally likely under the null and informed-prior hypotheses. Exploratory moderator tests suggested that the depletion effect was larger for participants who reported more fatigue but was not moderated by trait self-control, willpower beliefs, or action orientation.</p

Progressive skin fibrosis is associated with a decline in lung function and worse survival in patients with diffuse cutaneous systemic sclerosis in the European Scleroderma Trials and Research (EUSTAR) cohort.

Objectives To determine whether progressive skin fibrosis is associated with visceral organ progression and mortality during follow-up in patients with diffuse cutaneous systemic sclerosis (dcSSc). Methods We evaluated patients from the European Scleroderma Trials and Research database with dcSSc, baseline modified Rodnan skin score (mRSS) ≥7, valid mRSS at 12±3 months after baseline and ≥1 annual follow-up visit. Progressive skin fibrosis was defined as an increase in mRSS &gt;5 and ≥25% from baseline to 12±3 months. Outcomes were pulmonary, cardiovascular and renal progression, and all-cause death. Associations between skin progression and outcomes were evaluated by Kaplan-Meier survival analysis and multivariable Cox regression. Results Of 1021 included patients, 78 (7.6%) had progressive skin fibrosis (skin progressors). Median follow-up was 3.4 years. Survival analyses indicated that skin progressors had a significantly higher probability of FVC decline ≥10% (53.6% vs 34.4%; p&lt;0.001) and all-cause death (15.4% vs 7.3%; p=0.003) than non-progressors. These significant associations were also found in subgroup analyses of patients with either low baseline mRSS (≤22/51) or short disease duration (≤15 months). In multivariable analyses, skin progression within 1 year was independently associated with FVC decline ≥10% (HR 1.79, 95% CI 1.20 to 2.65) and all-cause death (HR 2.58, 95% CI 1.31 to 5.09). Conclusions Progressive skin fibrosis within 1 year is associated with decline in lung function and worse survival in dcSSc during follow-up. These results confirm mRSS as a surrogate marker in dcSSc, which will be helpful for cohort enrichment in future trials and risk stratification in clinical practice

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Provincia de Santiago del Estero

Por primera vez a nivel nacional, se describen en un trabajo las principales buenas prácticas para las distintas ecorregiones y provincias del país. En la presente obra se incluyen aquellas prácticas de manejo del suelo y del agua relevante para el buen uso y conservación del suelo en áreas de secano, es decir, en tierras que solamente se benefician con el agua de lluvia. Se incluyen también las prácticas que consideran el uso de vegetación como base para la conservación del suelo. El manual contiene 25 capítulos redactados por especialistas referentes de las instituciones oficiales y privadas del país, los que en forma generosa han aportado la valiosa información y experticia que permitió plasmar la presente obra. Las prácticas se describen tomando como base el mapa de regionalización ecológica-productiva que los equipos técnicos han propuesto para cada provincia. Las mismas han sido referidas a las climosecuencias del área, los tipos de suelos más representativos, los procesos de degradación identificados y la normativa legal vigente, siguiendo el formato de ficha técnica: i) Nombre, ii) Definición, iii) Objetivo, iv) Condiciones para su aplicación, v) Superficie estimada de aplicación, vi) Normas técnicas, vii) Equipo necesario, y viii) Mantenimiento. En esta obra queda demostrado que existen actualmente en la Argentina los conocimientos y tecnologías disponibles para desarrollar una producción agropecuaria sustentable. Ello asegurará un rol estratégico como país productor de alimentos, con respeto a las normas ambientales y de seguridad agroalimentaria. En un futuro inmediato se constituirán en exigencias del comercio internacional, evaluando el camino de la trazabilidad -huellas de carbono e hídrica- de los diferentes productos agropecuarios y la emisión de gases de efecto invernadero. La conservación del suelo y del agua constituye un deber inexcusable, ya que se trata de recursos naturales estratégicos para la Nación Argentina, que cumplen funciones de alcance social y que trascienden las generaciones. Este capítulo describe la zona de la provincia de Santiago del Estero: La provincia de Santiago del Estero posee una superficie de 145.690 km2 se encuentra ubicada entre los 25° 35´ y los 30° 41´ de latitud sur y entre los 61° 34´ y los 65° 34´ de longitud oeste. Su territorio es una planicie que presenta una pequeña inclinación en dirección noroeste-sureste, interrumpida por los ríos que corren en sentido diagonal y por elevaciones ubicadas en la zona sur, oeste y noroeste; donde se registran las mayores altitudes provinciales, que no superan los 700 m de altura (sierras de Guasayán, Sumampa y Ambargasta).Fil: Sanchez, María C.. Instituto Nacional de Tecnología Agropecuaria; Argentina. Universidad Nacional de Santiago del Estero. Facultad de Agronomía y Agroindustrias; ArgentinaFil: Lopez Rivilli, Marisa Juana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Duffau, Alejandro R.. Universidad Nacional de Santiago del Estero. Facultad de Agronomía y Agroindustrias; ArgentinaFil: Galizzi, Fernando A.. Universidad Nacional de Santiago del Estero. Facultad de Agronomía y Agroindustrias; ArgentinaFil: Barraza, Gabriela A.. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Amarilla, Mabel Elizabeth. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Prieto Angueira, Salvador. Instituto Nacional de Tecnología Agropecuaria; Argentina. Universidad Nacional de Santiago del Estero. Facultad de Agronomía y Agroindustrias; ArgentinaFil: Berton, María Clara. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; Argentina. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Tucumán-Santiago del Estero. Estación Experimental Agropecuaria Quimilí; ArgentinaFil: Ventura, Javier. Establecimiento Monte Buey Agropecuaria S.R.L.; ArgentinaFil: Lescano, Marcelo D.. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Storniolo, Angel del Rosario. Universidad Nacional de Santiago del Estero. Facultad de Ciencias Exactas y Tecnologías. Departamento de Geología y Geotecnia; ArgentinaFil: Terribile, Elsa Marcela. Universidad Nacional de Santiago del Estero. Facultad de Ciencias Exactas y Tecnologías. Departamento de Geología y Geotecnia; ArgentinaFil: Thir, Juan Martin. Universidad Nacional de Santiago del Estero. Facultad de Ciencias Exactas y Tecnologías. Departamento de Geología y Geotecnia; ArgentinaFil: Trejo, Walter Mario. Universidad Nacional de Santiago del Estero. Facultad de Ciencias Exactas y Tecnologías. Departamento de Geología y Geotecnia; ArgentinaFil: Pavón, Julio A.. Universidad Nacional de Santiago del Estero. Facultad de Ciencias Exactas y Tecnologías. Departamento de Geología y Geotecnia; ArgentinaFil: Contreras, Sofia Guadalupe. Universidad Nacional de Santiago del Estero. Facultad de Ciencias Exactas y Tecnologías. Departamento de Geología y Geotecnia; ArgentinaFil: Silberman, Juan Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Santiago del Estero. Facultad de Agronomía y Agroindustrias; ArgentinaFil: Albanesi de Garay, Ada Susana. Universidad Nacional de Santiago del Estero. Facultad de Agronomía y Agroindustrias; ArgentinaFil: Anriquez, Analia Liliana. Universidad Nacional de Santiago del Estero. Facultad de Agronomía y Agroindustrias; ArgentinaFil: Kunst, Carlos Roberto Guillermo. Instituto Nacional de Tecnología Agropecuaria; Argentina. Universidad Nacional de Santiago del Estero. Facultad de Agronomía y Agroindustrias; ArgentinaFil: Domínguez Nuñez, José. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación de Recursos Naturales. Instituto de Suelos; ArgentinaFil: Suarez, Ariel. Universidad Nacional de Santiago del Estero. Facultad de Agronomía y Agroindustrias; ArgentinaFil: Ledesma, Roxana. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Grasso, Daniel. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación de Recursos Naturales. Instituto de Suelos; ArgentinaFil: Navall, Jorge Marcelo. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Vizgarra, Lidia Amanda. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Tucumán-Santiago del Estero. Estación Experimental Agropecuaria Quimilí; ArgentinaFil: Venier, Maria Paula. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigaciones Agropecuarias. Unidad de Estudios Agropecuarios - Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Unidad de Estudios Agropecuarios; ArgentinaFil: Kowaljow, Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Vaieretti, Maria Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Ferreras, Ana Elisa. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Gómez, Adriana T.. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Tamer, Ariel. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Tucumán-Santiago del Estero. Estación Experimental Agropecuaria Quimilí; ArgentinaFil: Puig, Omar. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Tucumán-Santiago del Estero. Estación Experimental Agropecuaria Quimilí; ArgentinaFil: Coronel, Gustavo. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Tucumán-Santiago del Estero. Estación Experimental Agropecuaria Quimilí; ArgentinaFil: Prieto, Daniel. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Angueira, Cristina. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Angella, Gabriel Augusto. Instituto Nacional de Tecnología Agropecuaria; Argentina. Universidad Nacional de Santiago del Estero. Facultad de Agronomía y Agroindustrias; ArgentinaFil: Cornacchione, Monica Viviana. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Ledesma, Martín. Empresa Sucesores de Antonio Lladhon SL..R.; ArgentinaFil: Bolañez, Luciana. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Tucumán-Santiago del Estero. Estación Experimental Agropecuaria Quimilí; ArgentinaFil: Mas, Laura Inés. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Tucumán-Santiago del Estero. Estación Experimental Agropecuaria Quimilí; ArgentinaFil: Alvarez, Carina Rosa. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Osinaga, Natalia Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Salvatierra, José I.. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Tomsic, Pablo D.. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Lizzi, José. Establecimiento El Mangrullo S.A.; ArgentinaFil: Perez Farhat, Walter. Empresa PASA Fertilizantes; Argentin

Smoking in Systemic Sclerosis: a Longitudinal European Scleroderma Trials and Research Group Study

Objective: Data on the role of tobacco exposure in systemic sclerosis (SSc; scleroderma) severity and progression are scarce. We aimed to assess the effects of smoking on the evolution of pulmonary and skin manifestations, based on the European Scleroderma Trials and Research group database. Methods: Adult SSc patients with data on smoking history and a 12\u201324-month follow-up visit were included. Associations of severity and progression of organ involvement with smoking history and the Comprehensive Smoking Index were assessed using multivariable regression analyses. Results: A total of 3,319 patients were included (mean age 57 years, 85% female); 66% were never smokers, 23% were ex-smokers, and 11% were current smokers. Current smokers had a lower percentage of antitopoisomerase autoantibodies than previous or never smokers (31% versus 40% and 45%, respectively). Never smokers had a higher baseline forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio than previous and current smokers (P &lt; 0.001). The FEV1/FVC ratio declined faster in current smokers than in never smokers (P = 0.05) or ex-smokers (P = 0.01). The baseline modified Rodnan skin thickness score (MRSS) and the MRSS decline were comparable across smoking groups. Although heavy smoking (&gt;25 pack-years) increased the odds of digital ulcers by almost 50%, there was no robust adverse association of smoking with digital ulcer development. Conclusion: The known adverse effect of smoking on bronchial airways and alveoli is also observed in SSc patients; however, robust adverse effects of smoking on the progression of SSc-specific pulmonary or cutaneous manifestations were not observed. \ua9 2018, American College of Rheumatolog

Incidence and predictors of cutaneous manifestations during the early course of systemic sclerosis: a 10-year longitudinal study from the EUSTAR database

Objectives: To longitudinally map the onset and identify risk factors for skin sclerosis and digital ulcers (DUs) in patients with systemic sclerosis (SSc) from an early time point after the onset of Raynaud's phenomenon (RP) in the European Scleroderma Trials and Research (EUSTAR) cohort. Methods: 695 patients with SSc with a baseline visit within 1 year after RP onset were followed in the prospective multinational EUSTAR database. During the 10-year observation period, cumulative probabilities of cutaneous lesions were assessed with the Kaplan–Meier method. Cox proportional hazards regression analysis was used to evaluate risk factors. Results: The median modified Rodnan skin score (mRSS) peaked 1 year after RP onset, and was 15 points. The 1-year probability to develop an mRSS ≥2 in at least one area of the arms and legs was 69% and 25%, respectively. Twenty-five per cent of patients developed diffuse cutaneous involvement in the first year after RP onset. This probability increased to 36% during the subsequent 2 years. Only 6% of patients developed diffuse cutaneous SSc thereafter. The probability to develop DUs increased to a maximum of 70% at the end of the 10-year observation. The main factors associated with diffuse cutaneous SSc were the presence of anti-RNA polymerase III autoantibodies, followed by antitopoisomerase autoantibodies and male sex. The main factor associated with incident DUs was the presence of antitopoisomerase autoantibodies. Conclusion: Early after RP onset, cutaneous manifestations exhibit rapid kinetics in SSc. This should be accounted for in clinical trials aiming to prevent skin worsening

A Multisite Preregistered Paradigmatic Test of the Ego-Depletion Effect

We conducted a preregistered multilaboratory project (k = 36; N = 3,531) to assess the size and robustness of ego-depletion effects using a novel replication method, termed the paradigmatic replication approach. Each laboratory implemented one of two procedures that was intended to manipulate self-control and tested performance on a subsequent measure of self-control. Confirmatory tests found a nonsignificant result (d = 0.06). Confirmatory Bayesian meta-analyses using an informed-prior hypothesis (delta = 0.30, SD = 0.15) found that the data were 4 times more likely under the null than the alternative hypothesis. Hence, preregistered analyses did not find evidence for a depletion effect. Exploratory analyses on the full sample (i.e., ignoring exclusion criteria) found a statistically significant effect (d = 0.08); Bayesian analyses showed that the data were about equally likely under the null and informed-prior hypotheses. Exploratory moderator tests suggested that the depletion effect was larger for participants who reported more fatigue but was not moderated by trait self-control, willpower beliefs, or action orientation

Update of EULAR recommendations for the treatment of systemic sclerosis

The aim was to update the 2009 European League against Rheumatism (EULAR) recommendations for the treatment of systemic sclerosis (SSc), with attention to new therapeutic questions. Update of the previous treatment recommendations was performed according to EULAR standard operating procedures. The task force consisted of 32 SSc clinical experts from Europe and the USA, 2 patients nominated by the pan-European patient association for SSc (Federation of European Scleroderma Associations (FESCA)), a clinical epidemiologist and 2 research fellows. All centres from the EULAR Scleroderma Trials and Research group were invited to submit and select clinical questions concerning SSc treatment using a Delphi approach. Accordingly, 46 clinical questions addressing 26 different interventions were selected for systematic literature review. The new recommendations were based on the available evidence and developed in a consensus meeting with clinical experts and patients. The procedure resulted in 16 recommendations being developed (instead of 14 in 2009) that address treatment of several SSc-related organ complications: Raynaud's phenomenon (RP), digital ulcers (DUs), pulmonary arterial hypertension (PAH), skin and lung disease, scleroderma renal crisis and gastrointestinal involvement. Compared with the 2009 recommendations, the 2016 recommendations include phosphodiesterase type 5 (PDE-5) inhibitors for the treatment of SSc-related RP and DUs, riociguat, new aspects for endothelin receptor antagonists, prostacyclin analogues and PDE-5 inhibitors for SSc-related PAH. New recommendations regarding the use of fluoxetine for SSc-related RP and haematopoietic stem cell transplantation for selected patients with rapidly progressive SSc were also added. In addition, several comments regarding other treatments addressed in clinical questions and suggestions for the SSc research agenda were formulated. These updated data-derived and consensus-derived recommendations will help rheumatologists to manage patients with SSc in an evidence-based way. These recommendations also give directions for future clinical research in SSc