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| 3. |
- Sen, P, et al.
(författare)
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Vaccine hesitancy decreases in rheumatic diseases, long-term concerns remain in myositis: a comparative analysis of the COVAD surveys
- 2023
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Ingår i: Rheumatology (Oxford, England). - : Oxford University Press (OUP). - 1462-0332 .- 1462-0324. ; 62:10, s. 3291-3301
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveCOVID-19 vaccines have a favorable safety profile in patients with autoimmune rheumatic diseases (AIRDs) such as idiopathic inflammatory myopathies (IIMs); however, hesitancy continues to persist among these patients. Therefore, we studied the prevalence, predictors and reasons for hesitancy in patients with IIMs, other AIRDs, non-rheumatic autoimmune diseases (nrAIDs) and healthy controls (HCs), using data from the two international COVID-19 Vaccination in Autoimmune Diseases (COVAD) e-surveys.MethodsThe first and second COVAD patient self-reported e-surveys were circulated from March to December 2021, and February to June 2022 (ongoing). We collected data on demographics, comorbidities, COVID-19 infection and vaccination history, reasons for hesitancy, and patient reported outcomes. Predictors of hesitancy were analysed using regression models in different groups.ResultsWe analysed data from 18 882 (COVAD-1) and 7666 (COVAD-2) respondents. Reassuringly, hesitancy decreased from 2021 (16.5%) to 2022 (5.1%) (OR: 0.26; 95% CI: 0.24, 0.30, P < 0.001). However, concerns/fear over long-term safety had increased (OR: 3.6; 95% CI: 2.9, 4.6, P < 0.01). We noted with concern greater skepticism over vaccine science among patients with IIMs than AIRDs (OR: 1.8; 95% CI: 1.08, 3.2, P = 0.023) and HCs (OR: 4; 95% CI: 1.9, 8.1, P < 0.001), as well as more long-term safety concerns/fear (IIMs vs AIRDs – OR: 1.9; 95% CI: 1.2, 2.9, P = 0.001; IIMs vs HCs – OR: 5.4 95% CI: 3, 9.6, P < 0.001). Caucasians [OR 4.2 (1.7–10.3)] were likely to be more hesitant, while those with better PROMIS physical health score were less hesitant [OR 0.9 (0.8–0.97)].ConclusionVaccine hesitancy has decreased from 2021 to 2022, long-term safety concerns remain among patients with IIMs, particularly in Caucasians and those with poor physical function.
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| 4. |
- Abellán, C., et al.
(författare)
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Challenging Local Realism with Human Choices
- 2018
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Ingår i: Nature. - : Nature Publishing Group. - 0028-0836 .- 1476-4687. ; 557, s. 212-216
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Tidskriftsartikel (refereegranskat)abstract
- A Bell test is a randomized trial that compares experimental observations against the philosophical worldview of local realism , in which the properties of the physical world are independent of our observation of them and no signal travels faster than light. A Bell test requires spatially distributed entanglement, fast and high-efficiency detection and unpredictable measurement settings. Although technology can satisfy the first two of these requirements, the use of physical devices to choose settings in a Bell test involves making assumptions about the physics that one aims to test. Bell himself noted this weakness in using physical setting choices and argued that human 'free will' could be used rigorously to ensure unpredictability in Bell tests. Here we report a set of local-realism tests using human choices, which avoids assumptions about predictability in physics. We recruited about 100,000 human participants to play an online video game that incentivizes fast, sustained input of unpredictable selections and illustrates Bell-test methodology. The participants generated 97,347,490 binary choices, which were directed via a scalable web platform to 12 laboratories on five continents, where 13 experiments tested local realism using photons, single atoms, atomic ensembles and superconducting devices. Over a 12-hour period on 30 November 2016, participants worldwide provided a sustained data flow of over 1,000 bits per second to the experiments, which used different human-generated data to choose each measurement setting. The observed correlations strongly contradict local realism and other realistic positions in bi-partite and tri-partite 12 scenarios. Project outcomes include closing the 'freedom-of-choice loophole' (the possibility that the setting choices are influenced by 'hidden variables' to correlate with the particle properties), the utilization of video-game methods for rapid collection of human-generated randomness, and the use of networking techniques for global participation in experimental science.
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| 6. |
- Andreoli, L., et al.
(författare)
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COVID-19 VACCINE SAFETY DURING PREGNANCY AND BREASTFEEDING IN WOMEN WITH AUTOIMMUNE DISEASES : RESULTS FROM THE COVAD STUDY
- 2023
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Ingår i: Annals of the Rheumatic Diseases. - : HighWire Press. - 0003-4967 .- 1468-2060. ; 82:Suppl. 1, s. 56-57
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: COVID-19 vaccine hesitancy among pregnant and breastfeeding women with autoimmune diseases (AID) is often attributed to the fear of adverse events (AE) and disease flares (DF). No data are available regarding COVID-19 vaccine safety in this population.Objectives: We aimed at describing delayed-onset (>7 days) vaccine-related AE (minor and major), DF, and related AID treatment modifications from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study.Methods: Among complete responses from 9201 participants as of June 21, 2022, 6787 (73.8%) were women. Six subgroups were identified upon diagnosis of AID vs healthy controls (HC) and their pregnancy/breastfeeding status at the time of any dose of vaccine (Figure 1).Results: Forty pregnant and 52 breastfeeding AID patients were identified and their vaccination rates (at least one dose) was 100% and 96.2%, respectively (Table 1). Overall AE, minor AE, and major AE were reported significantly more frequently by pregnant than non-pregnant patients (45% vs. 26%, p=0.01; 40% vs. 25.9%, p=0.03; 17.5% vs. 4.6%, p<0.01), but no difference was found in comparison with pregnant HC. No difference was observed between breastfeeding patients and HC. Post-vaccination DF were reported by 17.5% of pregnant and 20% of breastfeeding patients, and by 18% of age- and disease-matched control patients (n=2315). All DF in pregnant/breastfeeding patients were managed with glucocorticoids and a fifth of them required initiation or change in immunosuppressive treatment.Conclusion: This study provides the first insights into the safety of COVID-19 vaccination during the antenatal period in women with AID. While AEs were more commonly reported by pregnant patients with AID, these were no higher than among pregnant healthy controls without AID. These observations are reassuring, likely to strengthen physician-patient communication and overcome hesitancy as the benefits for the mother and fetus by passive immunization are likely to overweigh the potential risks of AE and DF.Reference: [1]Fazal ZZ, et al; COVAD Study Group. COVAD survey 2 long-term outcomes: unmet need and protocol. Rheumatol Int 2022; 42:2151-2158.
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| 9. |
- Tektonidou, MG, et al.
(författare)
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EULAR recommendations for the management of antiphospholipid syndrome in adults
- 2019
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Ingår i: Annals of the rheumatic diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 78:10, s. 1296-1304
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Tidskriftsartikel (refereegranskat)abstract
- The objective was to develop evidence-based recommendations for the management of antiphospholipid syndrome (APS) in adults. Based on evidence from a systematic literature review and expert opinion, overarching principles and recommendations were formulated and voted. High-risk antiphospholipid antibody (aPL) profile is associated with greater risk for thrombotic and obstetric APS. Risk modification includes screening for and management of cardiovascular and venous thrombosis risk factors, patient education about treatment adherence, and lifestyle counselling. Low-dose aspirin (LDA) is recommended for asymptomatic aPL carriers, patients with systemic lupus erythematosus without prior thrombotic or obstetric APS, and non-pregnant women with a history of obstetric APS only, all with high-risk aPL profiles. Patients with APS and first unprovoked venous thrombosis should receive long-term treatment with vitamin K antagonists (VKA) with a target international normalised ratio (INR) of 2–3. In patients with APS with first arterial thrombosis, treatment with VKA with INR 2–3 or INR 3–4 is recommended, considering the individual’s bleeding/thrombosis risk. Rivaroxaban should not be used in patients with APS with triple aPL positivity. For patients with recurrent arterial or venous thrombosis despite adequate treatment, addition of LDA, increase of INR target to 3–4 or switch to low molecular weight heparin may be considered. In women with prior obstetric APS, combination treatment with LDA and prophylactic dosage heparin during pregnancy is recommended. In patients with recurrent pregnancy complications, increase of heparin to therapeutic dose, addition of hydroxychloroquine or addition of low-dose prednisolone in the first trimester may be considered. These recommendations aim to guide treatment in adults with APS. High-quality evidence is limited, indicating a need for more research.
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| 10. |
- Andreoli, L, et al.
(författare)
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EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome
- 2017
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Ingår i: Annals of the rheumatic diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 76:3, s. 476-485
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Tidskriftsartikel (refereegranskat)abstract
- Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS).MethodsSystematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus.ResultsFamily planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease.ConclusionsRecommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus.
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| 11. |
- Bianchi, F., et al.
(författare)
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Novel sample-substrates for the determination of new psychoactive substances in oral fluid by desorption electrospray ionization-high resolution mass spectrometry
- 2019
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Ingår i: Talanta. - : Elsevier B.V.. - 0039-9140 .- 1873-3573. ; 202, s. 136-144
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Tidskriftsartikel (refereegranskat)abstract
- A reliable screening and non invasive method based on the use of microextraction by packed sorbent coupled with desorption electrospray ionization-high resolution mass spectrometry was developed and validated for the detection of new psychoactive substances in oral fluid. The role of different sample substrates in enhancing signal intensity and stability was evaluated by testing the performances of two polylactide-based materials, i.e. non-functionalized and functionalized with carbon nanoparticles, and a silica-based material compared to commercially available polytetrafluorethylene supports. The best results were achieved by using the non-functionalized polylactide substrates to efficiently ionize compounds in positive ionization mode, whereas the silica coating proved to be the best choice for operating in negative ionization mode. LLOQs in the low μg/L, a good precision with CV% always lower than 16% and RR% in the 83(±4)-120(±2)% range, proved the suitability of the developed method for the determination of the analytes in oral fluid. Finally, the method was applied for screening oral fluid samples for the presence of psychoactive substances during private parties, revealing mephedrone in only one sample out of 40 submitted to analysis.
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| 12. |
- Giannopoulou, N., et al.
(författare)
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COVID-19 VACCINE SAFETY DURING PREGNANCY IN WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS
- 2023
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Ingår i: Annals of the Rheumatic Diseases. - : HighWire Press. - 0003-4967 .- 1468-2060. ; 82:Suppl. 1, s. 1495-1496
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Vaccinations comprise a part of the antenatal care of pregnant women, including patients with systemic lupus erythematosus (SLE) who are at increased risk of adverse pregnancy outcomes (APOs). While COVID-19 vaccination has been shown to be safe in patients with SLE, data on vaccine-associated adverse events (AEs) during the antenatal and lactation period are scarce or lacking.Objectives: To investigate the association between COVID-19 vaccination and AEs in pregnant SLE patients.Methods: A total of 9201 complete responses were extracted on June 21st, 2022 from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) 2 database, a global e-survey involving 157 collaborators from 106 countries. Among respondents, 6787 (73.8%) were women. We identified 70 (1.1%) women who were exposed to at least one COVID-19 vaccine dose during pregnancy, among those 11 with SLE. Delayed onset (>7 days) vaccine-related AEs were extracted and triangulated with disease activity, treatment changes due to flare after vaccination, and COVID-19 infections in vaccinated pregnant women with SLE. Additionally, information on health-related quality of life and physical function was recorded using PROMIS at the time of survey completion.Results: The age of patients ranged from 28 to 39 years; 5/11 women were of Asian origin. None of these patients reported major vaccine AEs, including four patients with self-reported active SLE prior to the vaccination. None of them reported any change in the status of their autoimmune disease, and no hospitalisation or special treatment was recorded. Six women experienced minor vaccine AEs; two of them had active disease prior to vaccination. Four patients reported COVID-19 infection; two of them while they were pregnant and post-vaccination and two prior to pregnancy and vaccination. All four patients experienced symptoms of their disease, but no overt SLE flare was reported. At the time of survey completion, all patients reported their general health as being good to excellent in all aspects evaluated. Importantly, no APOs were reported.None of the patients reported thrombotic events post-vaccination, which provides some reassurance regarding COVID-19 vaccination in a patient population with a high risk for cardiovascular comorbidity and thrombosis, especially in the presence of antiphospholipid antibodies or in patients diagnosed with the antiphospholipid syndrome, a considerable portion within SLE populations. Moreover, it was reassuring to note an absence of association between experienced vaccine AEs and active disease prior to vaccination. Although minor AEs were common, they did not impair daily functioning, and the symptoms resolved in all patients after a median of 3 (IQR: 2.5–5.0) days.Conclusion: Our report adds relevant evidence concerning the sensitive issue of COVID-19 vaccine AEs and flares in SLE patients during the antenatal and lactation period. Despite the small sample size, the findings provide some reassurance and can contribute to informed decisions regarding vaccination in patients with SLE and high-risk pregnancies due to their background autoimmune disease. Based on the present data, the risk/benefit ration of COVID-19 vaccination appears favourable, with vaccines both providing passive immunisation to the fetus and active immunisation to the mother with no signals of exacerbation of the mother’s autoimmune disease.
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| 15. |
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| 16. |
- Barregård, Lars, 1948, et al.
(författare)
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Human and Methodological Sources of Variability in the Measurement of Urinary 8-Oxo-7,8-dihydro-2 '-deoxyguanosine
- 2013
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Ingår i: Antioxidants and Redox Signaling. - : Mary Ann Liebert Inc. - 1523-0864 .- 1557-7716. ; 18:18, s. 2377-2391
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Urinary 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) is a widely used biomarker of oxidative stress. However, variability between chromatographic and ELISA methods hampers interpretation of data, and this variability may increase should urine composition differ between individuals, leading to assay interference. Furthermore, optimal urine sampling conditions are not well defined. We performed inter-laboratory comparisons of 8-oxodG measurement between mass spectrometric-, electrochemical- and ELISA-based methods, using common within-technique calibrants to analyze 8-oxodG-spiked phosphate-buffered saline and urine samples. We also investigated human subject- and sample collection-related variables, as potential sources of variability. Results: Chromatographic assays showed high agreement across urines from different subjects, whereas ELISAs showed far more inter-laboratory variation and generally overestimated levels, compared to the chromatographic assays. Excretion rates in timed 'spot' samples showed strong correlations with 24 h excretion (the 'gold' standard) of urinary 8-oxodG (r(p) 0.67-0.90), although the associations were weaker for 8-oxodG adjusted for creatinine or specific gravity (SG). The within-individual excretion of 8-oxodG varied only moderately between days (CV 17% for 24 h excretion and 20% for first void, creatinine-corrected samples). Innovation: This is the first comprehensive study of both human and methodological factors influencing 8-oxodG measurement, providing key information for future studies with this important biomarker. Conclusion: ELISA variability is greater than chromatographic assay variability, and cannot determine absolute levels of 8-oxodG. Use of standardized calibrants greatly improves intra-technique agreement and, for the chromatographic assays, importantly allows integration of results for pooled analyses. If 24 h samples are not feasible, creatinine- or SG-adjusted first morning samples are recommended.
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| 17. |
- Céron, Wilmar L., et al.
(författare)
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Multiscale Interactions of Climate Variability and Rainfall in the Sogamoso River Basin : Implications for the 1998–2000 and 2010–2012 Multiyear La Niña Events
- 2022
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Ingår i: Water. - : MDPI AG. - 2073-4441. ; 14:22
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Tidskriftsartikel (refereegranskat)abstract
- In this research, we explored rainfall variability in the Sogamoso River Basin (SRB), its relationship with multiple scales of variability associated with El Niño–Southern Oscillation (ENSO), and the implications for rainfall prolongation during multiyear La Niña events. First, we examined time-frequency rainfall variations in the SRB based on the standardized precipitation index (SPI) from 1982 to 2019, using wavelet transform and principal component analysis (PCA). In addition, we applied wavelet analysis to investigate the links at different time scales between ENSO and the main mode of rainfall variability in the SRB. Finally, we explored the role that each scale of variability played in the prolongation and intensity of rainfall in the SRB during the 1998–2000 and 2010–2012 multiyear La Niña events. The results of the wavelet analyses revealed significant ENSO relationships affecting SRB rainfall at three different scales: quasi-biennial (2–3-years) between 1994 and 2002, as well as from 2008 to 2015; interannual (5–7 years) from 1995 to 2011; and quasi-decadal (9–12 years) from 1994 to 2012. This indicates that multiyear events are a consequence of the interaction of several scales of variability rather than a unique scale. During the 1998–2000 event, El Niño conditions were observed during the first half of 1998; subsequently, a cooling of the central and eastern tropical Pacific (western tropical Pacific) on the quasi-biennial (interannual) scale was observed during 1999; in 2000, only La Niña conditions were observed on the interannual scale. Therefore, during this event, the quasi-biennial (interannual) scale promoted wet conditions in the Caribbean, the Andes, and the Colombian Pacific from June–August (JJA) 1998 to JJA 1999 (during 1999–2000). During the 2010–2012 La Niña event, the interbasin sea surface temperature gradient between the tropical Pacific and tropical North Atlantic contributed to strengthening (weakening) of the Choco jet (Caribbean low-level jet) on the quasi-biennial scale during 2010, and the interannual scale prolonged its intensification (weakening) during 2011–2012, acting to extend the rainy periods over most of the Colombian territory. Variations on quasi-decadal scales were modulated by the Pacific decadal oscillation (PDO), resulting in a further intensification of the 2010–2012 La Niña event, which developed under conditions of the cold PDO (CPDO) phase, whereas the 1998–2000 La Niña occurred during the transition from warm (WPDO, 1977–1998) to cold (CPDO, 2001–2015) conditions. These results indicate that the interaction of quasi-biennial to quasi-decadal scales of variability could play a differential role in the configuration and prolongation of rainfall events in the SRB.
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| 18. |
- Chavatza, K, et al.
(författare)
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EULAR RECOMMENDATION-BASED QUALITY INDICATORS (QIS) FOR SYSTEMIC LUPUS ERYTHEMATOSUS (SLE): ELABORATION, FINAL SET, PERFORMANCE AND INITIAL VALIDATION
- 2021
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Ingår i: ANNALS OF THE RHEUMATIC DISEASES. - : BMJ. - 0003-4967 .- 1468-2060. ; 80, s. 635-636
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Targets of therapy and quality of care are receiving increased attention in systemic lupus erythematosus (SLE).Objectives:To develop Quality Indicators (QIs) for the care of SLE patients based on the EULAR recommendations, and assess their performance.Methods:Using the published EULAR recommendations for SLE, we developed 44 candidate QIs. These were independently rated for validity and feasibility by 12 experts, analysed by a modified RAND/UCLA model and further scrutinized based on the scorings and expert opinion. (Fig.1) Adherence to the final set of QIs was tested in a cohort of 220 SLE patients combined with an assessment on its impact on disease outcomes such as flares, hospitalizations and organ damage.Results:The panel rated 18 QIs as valid and feasible. These involve diagnosis; disease and damage assessment; monitoring for lupus nephritis and drug toxicity; therapy and targets of therapy; fertility and pregnancy; and adjunct therapy (preventive measures for osteoporosis, vaccination, cardiovascular disease). On average, SLE patients received 54% (95%CI 52–56%) of the indicated care with adherence ranging from 41% for QIs related to monitoring to 88% for treatment-related QIs. Regarding targets of therapy, sustained remission or low disease activity were achieved in 27%, while 94% of patients received low-dose glucocorticoids, and 92% the recommended hydroxychloroquine dose. Dependent upon individual QI tested, adherence for lupus nephritis-related QIs was 88% for receiving appropriate adjunct therapy (ACE inhibitors) to 100% for being treated with the indicated immunosuppressive treatment. In contrast, adherence to QIs related to preventive measures and other adjunct therapies was moderate to low. Notably, patients who were eligible for cardiovascular risk modification, vaccination, and osteoporosis management received lower quality of care (40.5%, 47.7% and 45.5% respectively) while 91.4% had sunscreen protection. In reference to laboratory work-up and monitoring, complete laboratory work-up at diagnosis was performed in 48%, while disease activity and damage, were fully assessed only in 14.1% (in three consecutive visits) and 28.6% (annually) respectively, Similarly, reproductive health and pregnancy counselling adherence rates were modest estimated at 50% and 62% respectively. Higher adherence to the indicated care during follow-up (monitoring QIs) was associated with reduced risk for adverse outcomes during the last year of observation (OR 0.97, 95%CI 0.96-0.99). Patients who achieved sustained remission or LLDAS, exhibited fewer flares (OR=0.15, p-value<0.001) and damage accrual (OR=0.35, p-value<0.001). Of interest, patients who received low-dose of GCs or were appropriately vaccinated, had a lower risk of experiencing a flare (OR=0.23 and 0.46 respectively).Conclusion:A set of 18 QIs based on the EULAR recommendations for SLE was developed to be used towards improving care in SLE. Initial real-life data suggest variable degree of adherence with higher adherence resulting in reduced adverse outcomes.References:[1]Fanouriakis, et al., 2019 Update of the EULAR recommendations for the management of systemic lupus erythematosus. In Annals of the Rheumatic Diseases (Vol. 78, Issue 6, pp. 736–745). BMJ Publishing Group. https://doi.org/10.1136/annrheumdis-2019-215089.[2]Nikolopoulos, D., et al., Evolving phenotype of systemic lupus erythematosus in Caucasians: low incidence of lupus nephritis, high burden of neuropsychiatric disease and increased rates of late-onset lupus in the ‘Attikon’ cohort. Lupus, 29(5), 514–522. https://doi.org/10.1177/0961203320908932.Acknowledgements:This project has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No 742390)Disclosure of Interests:None declared
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| 19. |
- Chavatza, K, et al.
(författare)
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Quality indicators for systemic lupus erythematosus based on the 2019 EULAR recommendations: development and initial validation in a cohort of 220 patients
- 2021
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Ingår i: Annals of the rheumatic diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 80:9, s. 1175-1182
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Tidskriftsartikel (refereegranskat)abstract
- Quality of care is receiving increased attention in systemic lupus erythematosus (SLE). We developed quality indicators (QIs) for SLE based on the 2019 update of European League Against Rheumatism recommendations.MethodsA total of 44 candidate QIs corresponding to diagnosis, monitoring and treatment, were independently rated for validity and feasibility by 12 experts and analysed by a modified Research and Development Corporation/University of California Los Angeles model. Adherence to the final set of QIs and correlation with disease outcomes (flares, hospitalisations and organ damage) was tested in a cohort of 220 SLE patients with a median monitoring of 2 years (IQR 2–4).ResultsThe panel selected a total of 18 QIs as valid and feasible. On average, SLE patients received 54% (95% CI 52.3% to 56.2%) of recommended care, with adherence ranging from 44.7% (95% CI 40.8% to 48.6%) for diagnosis-related QIs to 84.3% (95% CI 80.6% to 87.5%) for treatment-related QIs. Sustained remission or low disease activity were achieved in 26.8% (95% CI 21.1% to 33.2%). Tapering of prednisone dose to less than 7.5 mg/day was achieved in 93.6% (95% CI 88.2% to 97.0%) while 73.5% (95% CI 66.6% to 79.6%) received the recommended hydroxychloroquine dose. Higher adherence to monitoring-related QIs was associated with reduced risk for a composite adverse outcome (flare, hospitalisation or damage accrual) during the last year of observation (OR 0.97 per 1% adherence rate, 95% CI 0.96 to 0.99).ConclusionWe developed QIs for assessing and improving the care of SLE patients. Initial real-life data suggest face validity, but a variable degree of adherence and a need for further improvement.
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| 20. |
- de Souza, Itamara Parente, et al.
(författare)
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Seasonal precipitation variability modes over South America associated to El Niño-Southern Oscillation (ENSO) and non-ENSO components during the 1951–2016 period
- 2021
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Ingår i: International Journal of Climatology. - : Wiley. - 0899-8418 .- 1097-0088. ; 41:8, s. 4321-4338
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Tidskriftsartikel (refereegranskat)abstract
- Anomalous seasonal patterns of precipitation variability over South America (SA) associated with El Niño-Southern Oscillation (ENSO) and non-ENSO (residual) conditions were assessed during 1951–2016. Patterns were obtained from empirical orthogonal functions analysis of total and residual precipitation seasonal anomalies. In austral spring and summer, precipitation variability is dominated by a dipolar anomaly mode with a centre extending from northwestern to northeastern SA and another in central-eastern Brazil and part of southeastern SA (SESA) during spring, and a centre in northwestern SA and another extending from northeastern SA to central and eastern Brazil and central SESA, during summer. These modes are associated with ENSO to a greater extent during spring than summer. In summer, there is a strong association of the dipolar precipitation pattern with sea surface temperature (SST) anomalies on the east coast of Brazil, which indicates local influence. In austral fall, SST anomalies in the tropical South Atlantic relate to precipitation anomalies in northeast SA, and those in the tropical north Atlantic (TNA) to precipitation anomalies in northwestern SA, through the intertropical convergence zone anomalous position modulated by SST anomalies. In this same condition, the ENSO acts only to intensify or weaken the dominant precipitation pattern, depending on its phase, mainly over SESA. In contrast, the second variability mode in fall is characterized by positive SST anomalies in the Indian Ocean and equatorial and southern Atlantic Ocean and negative in the TNA. The importance of ENSO and the Indian Ocean in the characterization of the SST dipole in the tropical Atlantic explains the main changes in precipitation patterns over northeastern Brazil not been discussed in previous studies.
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| 24. |
- Rudke, A. P., et al.
(författare)
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Landscape changes over 30 years of intense economic activity in the upper Paraná River basin
- 2022
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Ingår i: Ecological Informatics. - : Elsevier BV. - 1574-9541. ; 72
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Tidskriftsartikel (refereegranskat)abstract
- In this study, we show the complexity associated with the recent land cover changes by elucidating the paths of 30 years of changes in the Upper Paraná River Basin (UPRB), a region severely impacted by agricultural activity, one of the areas with the highest density in the production of hydroelectricity, biofuels and food in the world. In this sense, a post-classification comparison approach based on Landsat images was used to identify detailed ‘from-to’ paths behind those land cover changes. The most expressive changes were the expansion of Cropland and Forest areas and the reduction in savannas, with a net change of 17.9%, 4.1%, and −16.9% of the UPRB area, respectively. Cropland areas showed an expressive increase between 1985 and 2015, rising from 249,439 km2 (27.7%) to 412,909 km2 (45.9%). Forest areas increased from 149,389 km2 to 185,839 km2 in the period. Notably, for this class, an intense spatial dynamic of losses (7.5%) and gains (11.6%) took place between 1985 and 2015. This behavior is related to the disappearance of native vegetation fragments in some sub-basins, as well as to afforestation, reforestation, and/or forest restoration in others. The Cerrado (a typical tropical savanna in South America), the most impacted natural biome of the Basin, decreased from 21.9% of the UPRB in 1985 (196,746 km2) to only about 5% of the whole UPRB area in 2015. Grassland areas, mostly used for livestock, decreased from 271,827 km2 (30.2%) to 229,007 km2 (25.5%). This net decrease was associated with a reduction of 160,830 km2 (17.8%) and the appearance of 118,010 km2 (13.2%) in new areas, previously occupied by tropical savannas in 1985. In conclusion, economic factors were the main drivers for land cover changes, especially agriculture and livestock activities, besides forestry and hydroelectric energy production. In addition, Grassland areas that predominated on the left banks of the UPRB in 1985 retreated with the advance of Cropland areas, mainly due to the expansion of sugarcane for ethanol production, a biofuel widely used in Brazil. In turn, pasture areas migrated to the right bank and occupied a significant part of the Cerrado. Finally, our results demonstrate that the transition dynamics among land cover classes can involve complex political-economical mechanisms that are not always captured by remote sensing.
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- Westgate, Michael, et al.
(författare)
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A reappraisal of legacy reflection seismic data from the western margin of the Kaapvaal craton, South Africa, with implications for Mesozoic-Cenozoic regional tectonics
- 2021
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Ingår i: Tectonophysics. - : Elsevier. - 0040-1951 .- 1879-3266. ; 813
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Tidskriftsartikel (refereegranskat)abstract
- The 150 km long, 6 s TWT, 2D seismic profile KBF03A, which was acquired in 1994 and lies near the western edge of the Kaapvaal craton in South Africa, has been reprocessed using standard reflection seismic processing methods. The results exhibit a significant improvement in the imaging quality of the subsurface features and an evident boost in the signal-to-noise ratio. The improved seismic data, combined with application of seismic attributes, integration with surficial geological and geophysical maps, and computation of velocity tomograms, has revealed previously undetected structural features within the supracrustal sequences underlying the profile. In particular, the Phanerozoic sediments found along the profile, comprising exclusively Kalahari Group and Dwyka Group deposits, are disrupted by multiple folds of varying wavelengths (similar to 1 similar to 10 km) and variably oriented normal and thrust faults. Additionally, the effect of the Moshaweng fault, previously characterised as a listric fault extending to depths of >10 km, on the Phanerozoic sediments has been further constrained to suggest repeated extensional reactivations and a more recent (<1 Ma) inversion. Considerations of the eastern end of the profile have suggested links between some of the observed structural features and the nearby similar to 146 Ma Morokweng impact structure, the lateral expanse of which is poorly constrained in the literature. The collection of these newly imaged features is interpreted as evidence for multiple Late Mesozoic to Cenozoic tectonic events, including polyphasic reactivation of basement structures, under both extensional and compressional stress regimes. By analysing these newly detected features, our study not only provides new insight into the neotectonic evolution of the Phanerozoic sediments along the western margin of the Kaapvaal craton, but also demonstrates the utility in reprocessing legacy data and reveals its untapped potential.
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