Telehealth and Telemedicine in Latin American Rheumatology, a New Era After COVID-19

Q3Q3Telemedicine is the delivery of health care services by health care professionals using information and communication technologies to exchange valid information for the diagnosis, treatment, and prevention of diseases. Telemedicine was further developed in Latin America during the COVID-19 (coronavirus disease 2019) pandemic, becoming the first line of defense for health professionals to stop the spread of infections and allow them to continue the care of their patients. During the pandemic, 79% of rheumatologists in Latin America reported the use of remote communication, the most frequent being the use of phone calls and WhatsApp voice messages. In contrast, 84% of the patients reported that telemedicine was appropriate for them during the pandemic, but only 54% considered telemedicine to be a valid option for rheumatic health care after the pandemic. Telemedicine and telehealth have advantages such as lower costs, improved access in rural areas, shortage of care providers, and reduction in waiting time for appointments. However, it also has some challenges, such as legal, technological, and organizational barriers. In this review, we explore the current state of telemedicine in Latin America and discuss its future.https://orcid.org/0000-0003-1490-1822Revista Internacional - IndexadaBN

The Long-Baseline Neutrino Experiment: Exploring Fundamental Symmetries of the Universe

The preponderance of matter over antimatter in the early Universe, the dynamics of the supernova bursts that produced the heavy elements necessary for life and whether protons eventually decay --- these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our Universe, its current state and its eventual fate. The Long-Baseline Neutrino Experiment (LBNE) represents an extensively developed plan for a world-class experiment dedicated to addressing these questions. LBNE is conceived around three central components: (1) a new, high-intensity neutrino source generated from a megawatt-class proton accelerator at Fermi National Accelerator Laboratory, (2) a near neutrino detector just downstream of the source, and (3) a massive liquid argon time-projection chamber deployed as a far detector deep underground at the Sanford Underground Research Facility. This facility, located at the site of the former Homestake Mine in Lead, South Dakota, is approximately 1,300 km from the neutrino source at Fermilab -- a distance (baseline) that delivers optimal sensitivity to neutrino charge-parity symmetry violation and mass ordering effects. This ambitious yet cost-effective design incorporates scalability and flexibility and can accommodate a variety of upgrades and contributions. With its exceptional combination of experimental configuration, technical capabilities, and potential for transformative discoveries, LBNE promises to be a vital facility for the field of particle physics worldwide, providing physicists from around the globe with opportunities to collaborate in a twenty to thirty year program of exciting science. In this document we provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess.Comment: Major update of previous version. This is the reference document for LBNE science program and current status. Chapters 1, 3, and 9 provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess. 288 pages, 116 figure

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Uma promenade nos trópicos: os barões do café sob as palmeiras-imperiais, entre o Rio de Janeiro e São Paulo

This paper proposes to discuss the transformation of urban landscapes in the Paraíba River Valley as members of the coffee elite emerged in this area and a specific landscape configuration was projected there based on the use of imperial palms (Roystonea oleracea). Chronologically speaking, the paper covers a period from 1808 to 1911; with regard to space, it focuses on the stretch between Rio de Janeiro and São Paulo, with a closer look at the case of the city of Lorena (SP), so as to encompass all the changes that took place in this region from the introduction to the decline of coffee growing as an economic activity. The urban changes during this period were accompanied by the advent and consolidation of landscapes typical of the society of coffee growers: streets lined with palm trees, a token of their close connections with the royal court, a display of their adherence to "Frenchified customs". Such configurations were used to characterize public areas and raise them to the same status as the new buildings that gradually replaced those built in colonial style. The paper is structured around three key moments, namely: the introduction of imperial palms in Rio de Janeiro and their association with the idea of nobility and rank, and consequently with neoclassical architecture, which was brought to the colony by the 1816 French Mission; the dissemination of the use of imperial palms as a landscaping resource typical of public spaces from the royal court to the capital of São Paulo, particularly by the coffee barons during the second period of monarchic rule; and, finally, the hypothesis that the use of imperial palms to embellish public areas in São Paulo may have been introduced by a Lorena citizen associated with the coffee elite, albeit later, when Brazil was already a republic.O presente trabalho propõe-se a discutir a transformação da paisagem urbana das cidades vale-paraibanas, a partir do estabelecimento de uma elite ligada à cultura do café nessa região e do surgimento de uma configuração paisagística específica, apoiada na utilização da palmeira-imperial (Roystonea oleracea). Seu recorte cronológico abrange o período entre 1808 e 1911, enquanto espacialmente seu foco direciona-se para o eixo Rio de Janeiro-São Paulo, com estudo mais aproximado do caso da cidade de Lorena, São Paulo, de modo a cobrir as transformações aí ocorridas desde a chegada do café até o esgotamento dessa cultura. Acompanhando as transformações urbanas do período, surgiram e consolidaram-se exemplos paisagísticos próprios da sociedade do café: ruas arborizadas com renques de palmeiras, a demonstrar a proximidade com a Corte, a sinalizar os novos "modos afrancesados". Utilizaram-se tais configurações com o propósito de qualificar os logradouros públicos, a fim de equipará-los aos novos edifícios que substituíam aqueles da tradição colonial. O texto desenvolve-se em três momentos principais: a introdução da palmeira-imperial no Rio de Janeiro, sua vinculação à idéia de nobreza e classe, e conseqüente aproximação com a arquitetura neoclássica trazida pela Missão Francesa de 1816; a difusão de sua utilização como recurso paisagístico qualificador dos espaços públicos desde a Corte até a capital paulista, principalmente pelo baronato do Segundo Império; e, finalmente, a possibilidade de sua introdução nos espaços públicos paulistanos ter sido viabilizada por um lorenense, vinculado à elite cafeeira, embora já sob a República

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)

APOIO AO ENSINO DE MÉTODOS TERMOANALÍTICOS: USO DA TÉCNICA COMBINADA SDT (TGA E DSC)

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APOIO AO ENSINO DE MÉTODOS TERMOANALÍTICOS: USO DA TÉCNICA COMBINADA SDT (TGA E DSC)

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