Pan American League of Associations for Rheumatology Recommendations for the Treatment of Psoriatic Arthritis.

OBJECTIVE: Psoriatic arthritis (PsA) is chronic disease that compromises multiple domains and might be associated with progressive joint damage, increased mortality, functional limitation, and considerably impaired quality of life. Our objective was to generate evidence-based recommendations on the management of PsA in Pan American League of Associations for Rheumatology (PANLAR) countries. METHODS: We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach to adapt the 2019 recommendations of the European Alliance of Associations for Rheumatology. A working group consisting of rheumatologists from various countries in Latin America identified relevant topics for the treatment of PsA in the region. The methodology team updated the evidence and synthesized the information used to generate the final recommendations. These were then discussed and defined by a panel of 31 rheumatologists from 15 countries. RESULTS: Theses guidelines report 15 recommendations addressing therapeutic targets, use of antiinflammatory agents and corticosteroids, treatment with disease-modifying antirheumatic drugs (conventional synthetic, biologic, and targeted synthetic), therapeutic failure, optimization of biologic therapy, nonpharmacological interventions, assessment tools, and follow-up of patients with PsA. CONCLUSION: Here we present a set of recommendations to guide decision making in the treatment of PsA in Latin America, based on the best evidence available, considering resources, medical expertise, and the patient's values and preferences. The successful implementation of these recommendations should be based on clinical practice conditions, healthcare settings in each country, and a tailored evaluation of patients.

Correction: Garcia-Gonzalez, D.; Rivero, D.; Fernandez-Blanco, E.; Luaces, M.R. A Public Domain Dataset for Real-Life Human Activity Recognition Using Smartphone Sensors. Sensors 2020, 20, 2200.

The authors wish to make the following corrections to this paper [...].

A Public Domain Dataset for Real-Life Human Activity Recognition Using Smartphone Sensors.

In recent years, human activity recognition has become a hot topic inside the scientific community. The reason to be under the spotlight is its direct application in multiple domains, like healthcare or fitness. Additionally, the current worldwide use of smartphones makes it particularly easy to get this kind of data from people in a non-intrusive and cheaper way, without the need for other wearables. In this paper, we introduce our orientation-independent, placement-independent and subject-independent human activity recognition dataset. The information in this dataset is the measurements from the accelerometer, gyroscope, magnetometer, and GPS of the smartphone. Additionally, each measure is associated with one of the four possible registered activities: inactive, active, walking and driving. This work also proposes asupport vector machine (SVM) model to perform some preliminary experiments on the dataset. Considering that this dataset was taken from smartphones in their actual use, unlike other datasets, the development of a good model on such data is an open problem and a challenge for researchers. By doing so, we would be able to close the gap between the model and a real-life application.

Gas-Phase Photolysis of Hg(I) Radical Species: A New Atmospheric Mercury Reduction Process.

The efficient gas-phase photoreduction of Hg(II) has recently been shown to change mercury cycling significantly in the atmosphere and its deposition to the Earth's surface. However, the photolysis of key Hg(I) species within that cycle is currently not considered. Here we present ultraviolet-visible absorption spectra and cross-sections of HgCl, HgBr, HgI, and HgOH radicals, computed by high-level quantum-chemical methods, and show for the first time that gas-phase Hg(I) photoreduction can occur at time scales that eventually would influence the mercury chemistry in the atmosphere. These results provide new fundamental understanding of the photobehavior of Hg(I) radicals and show that the photolysis of HgBr increases atmospheric mercury lifetime, contributing to its global distribution in a significant way.

Ab initio quantum-chemical computations of the absorption cross sections of HgX2 and HgXY (X, Y = Cl, Br, and I): molecules of interest in the Earth's atmosphere.

The electronic-structure properties of the low-lying electronic states and the absorption cross sections (σ(E)) of mercury halides HgCl2, HgBr2, HgI2, HgBrCl, HgClI, and HgBrI have been determined within the UV-vis spectrum range (170 nm ≤ λphoton ≤ 600 nm) by means of the DKH3-MS-CASPT2/SO-RASSI quantum-chemical methodology (with the ANO-RCC basis set) and a semi-classical computational strategy based on nuclear sampling for simulating the band shapes. Computed band energies show a good agreement with the available experimental data for HgX2 with errors around 0.1-0.2 eV; theoretical and σ(E) are within the same order of magnitude. For the mixed HgXY compounds, the present computed data allow us to interpret previously proposed absorption bands estimated from the spectra of the parent molecules HgX2 and HgY2, measured in methanol solution. The analyses performed on the excited-state electronic structure and its changes around the Franck-Condon region provide a rationale on the singlet-triplet mixing of the absorption bands and the heavy-atom effect of the Hg compounds. Furthermore, the present benchmark of HgX2 and HgXY absorption σ values together with the previous benchmark of the electronic-structure properties of HgBr2 [see S. P. Sitkiewicz, et al., J. Chem. Phys., 2016, 145, 244304] has been helpful to set up a methodological and computational protocol which shall be used for predicting the atmospheric absorption and photolysis properties of several Hg compounds present in the atmospheric cycle of Hg.

Optomechanical Control of Quantum Yield in Trans-Cis Ultrafast Photoisomerization of a Retinal Chromophore Model.

The quantum yield of a photochemical reaction is one of the most fundamental quantities in photochemistry, as it measures the efficiency of the transduction of light energy into chemical energy. Nature has evolved photoreceptors in which the reactivity of a chromophore is enhanced by its molecular environment to achieve high quantum yields. The retinal chromophore sterically constrained inside rhodopsin proteins represents an outstanding example of such a control. In a more general framework, mechanical forces acting on a molecular system can strongly modify its reactivity. Herein, we show that the exertion of tensile forces on a simplified retinal chromophore model provokes a substantial and regular increase in the trans-to-cis photoisomerization quantum yield in a counterintuitive way, as these extension forces facilitate the formation of the more compressed cis photoisomer. A rationale for the mechanochemical effect on this photoisomerization mechanism is also proposed.

Pan American League of Associations for Rheumatology recommendations for the management of axial spondyloarthritis.

Axial spondyloarthritis (axSpA) comprises a spectrum of chronic inflammatory manifestations affecting the axial skeleton and represents a challenge for diagnosis and treatment. Our objective was to generate a set of evidence-based recommendations for the management of axSpA for physicians, health professionals, rheumatologists and policy decision makers in Pan American League of Associations for Rheumatology (PANLAR) countries. Grading of Recommendations, Assessment, Development and Evaluation-ADOLOPMENT methodology was used to adapt existing recommendations after performing an independent systematic search and synthesis of the literature to update the evidence. A working group consisting of rheumatologists, epidemiologists and patient representatives from countries within the Americas prioritized 13 topics relevant to the context of these countries for the management of axSpA. This Evidence-Based Guideline article reports 13 recommendations addressing therapeutic targets, the use of NSAIDs and glucocorticoids, treatment with DMARDs (including conventional synthetic, biologic and targeted synthetic DMARDs), therapeutic failure, optimization of the use of biologic DMARDs, the use of drugs for extra-musculoskeletal manifestations of axSpA, non-pharmacological interventions and the follow-up of patients with axSpA.

The spread of agriculture in Iberia through Approximate Bayesian Computation and Neolithic projectile tools.

In the present article we use geometric microliths (a specific type of arrowhead) and Approximate Bayesian Computation (ABC) in order to evaluate possible origin points and expansion routes for the Neolithic in the Iberian Peninsula. In order to do so, we divide the Iberian Peninsula in four areas (Ebro river, Catalan shores, Xúquer river and Guadalquivir river) and we sample the geometric microliths existing in the sites with the oldest radiocarbon dates for each zone. On this data, we perform a partial Mantel test with three matrices: geographic distance matrix, cultural distance matrix and chronological distance matrix. After this is done, we simulate a series of partial Mantel tests where we alter the chronological matrix by using an expansion model with randomised origin points, and using the distribution of the observed partial Mantel test's results as a summary statistic within an Approximate Bayesian Computation-Sequential Monte-Carlo (ABC-SMC) algorithm framework. Our results point clearly to a Neolithic expansion route following the Northern Mediterranean, whilst the Southern Mediterranean route could also find support and should be further discussed. The most probable origin points focus on the Xúquer river area.

Design of an algorithm for the diagnostic approach of patients with joint pain.

BACKGROUND: Rheumatic diseases are a reason for frequent consultation with primary care doctors. Unfortunately, there is a high percentage of misdiagnosis. OBJECTIVE: To design an algorithm to be used by primary care physicians to improve the diagnostic approach of the patient with joint pain, and thus improve the diagnostic capacity in four rheumatic diseases. METHODS: Based on the information obtained from a literature review, we identified the main symptoms, signs, and paraclinical tests related to the diagnosis of rheumatoid arthritis, spondyloarthritis with peripheral involvement, systemic lupus erythematosus with joint involvement, and osteoarthritis. We conducted 3 consultations with a group of expert rheumatologists, using the Delphi technique, to design a diagnostic algorithm that has as a starting point "joint pain" as a common symptom for the four diseases. RESULTS: Thirty-nine rheumatologists from 18 countries of Ibero-America participated in the Delphi exercise. In the first consultation, we presented 94 items to the experts (35 symptoms, 31 signs, and 28 paraclinical tests) candidates to be part of the algorithm; 74 items (25 symptoms, 27 signs, and 22 paraclinical tests) were chosen. In the second consultation, the decision nodes of the algorithm were chosen, and in the third, its final structure was defined. The Delphi exercise lasted 8 months; 100% of the experts participated in the three consultations. CONCLUSION: We present an algorithm designed through an international consensus of experts, in which Delphi methodology was used, to support primary care physicians in the clinical approach to patients with joint pain. Key Points • We developed an algorithm with the participation of rheumatologists from 18 countries of Ibero-America, which gives a global vision of the clinical context of the patient with joint pain. • We integrated four rheumatic diseases into one tool with one common symptom: joint pain. It is a novel tool, as it is the first algorithm that will support the primary care physician in the consideration of four different rheumatic diseases. • It will improve the correct diagnosis and reduce the number of paraclinical tests requested by primary care physicians, in the management of patients with joint pain. This point was verified in a recently published study in the journal Rheumatology International (reference number 31).

The exceptional finding of Locus 2 at Dehesilla Cave and the Middle Neolithic ritual funerary practices of the Iberian Peninsula.

There is a significant number of funerary contexts for the Early Neolithic in the Iberian Peninsula, and the body of information is much larger for the Late Neolithic. In contrast, the archaeological information available for the period in between (ca. 4800-4400/4200 cal BC) is scarce. This period, generally called Middle Neolithic, is the least well-known of the peninsular Neolithic sequence, and at present there is no specific synthesis on this topic at the peninsular scale. In 2017, an exceptional funerary context was discovered at Dehesilla Cave (Sierra de Cádiz, Southern Iberian Peninsula), providing radiocarbon dates which place it at the beginning of this little-known Middle Neolithic period, specifically between ca. 4800-4550 cal BC. Locus 2 is a deposition constituted by two adult human skulls and the skeleton of a very young sheep/goat, associated with stone structures and a hearth, and a number of pots, stone and bone tools and charred plant remains. The objectives of this paper are, firstly, to present the new archaeological context documented at Dehesilla Cave, supported by a wide range of data provided by interdisciplinary methods. The dataset is diverse in nature: stratigraphic, osteological, isotopic, zoological, artifactual, botanical and radiocarbon results are presented together. Secondly, to place this finding within the general context of the contemporaneous sites known in the Iberian Peninsula through a systematic review of the available evidence. This enables not only the formulation of explanations of the singular new context, but also to infer the possible ritual funerary behaviours and practices in the 5th millennium cal BC in the Iberian Peninsula.

Photoreduction of gaseous oxidized mercury changes global atmospheric mercury speciation, transport and deposition.

Anthropogenic mercury (Hg(0)) emissions oxidize to gaseous Hg(II) compounds, before deposition to Earth surface ecosystems. Atmospheric reduction of Hg(II) competes with deposition, thereby modifying the magnitude and pattern of Hg deposition. Global Hg models have postulated that Hg(II) reduction in the atmosphere occurs through aqueous-phase photoreduction that may take place in clouds. Here we report that experimental rainfall Hg(II) photoreduction rates are much slower than modelled rates. We compute absorption cross sections of Hg(II) compounds and show that fast gas-phase Hg(II) photolysis can dominate atmospheric mercury reduction and lead to a substantial increase in the modelled, global atmospheric Hg lifetime by a factor two. Models with Hg(II) photolysis show enhanced Hg(0) deposition to land, which may prolong recovery of aquatic ecosystems long after Hg emissions are lowered, due to the longer residence time of Hg in soils compared with the ocean. Fast Hg(II) photolysis substantially changes atmospheric Hg dynamics and requires further assessment at regional and local scales.

Mechanochemical Tuning of Pyrene Absorption Spectrum Using Force Probes.

Control of absorption spectra in chromophores is a fundamental aspect of many photochemical and photophysical processes as it constitutes the first step of the global photoinduced process. Here we explore the use of mechanical forces to modulate the light absorption process. Specifically, we develop a computational formalism for determining the type of mechanical forces permitting a global tuning of the absorption spectrum. This control extends to the excitation wavelength, absorption bands overlap, and oscillator strength. The determination of these optimal forces permits us to rationally guide the design of new mechano-responsive chromophores. Pyrene has been chosen as the case study for applying these computational tools because significant absorption spectra information is available for the chromophore as well as for different strained derivatives. Additionally, pyrene presents a large flexibility, which makes it a good system to test the inclusion of force probes as the strategy to exert forces on the system.

Publicaciones científicas de profesionales villaclareños de la salud del municipio Sagua la Grande. (2019-2020) / Scientific publications of health professionals from Villa Clara in the municipality of Sagua la Grande. (2019-2020)

RESUMEN Fundamento: de conjunto con la formación de profesionales, las universidades de ciencias médicas cubanas tienen como misión generar y divulgar conocimientos, lo cual se logra mediante la investigación y su difusión a través de publicaciones. Objetivo: caracterizar las publicaciones científicas de los autores villaclareños de la salud del municipio de Sagua la Grande durante el periodo 2019-2020. Métodos: se realizó un estudio descriptivo longitudinal retrospectivo sobre la producción científica de los profesionales de la salud del municipio. Se aplicaron métodos teóricos y empíricos. Para la recogida de la información se revisó una base de datos sobre la producción científica, especificando en el indicador publicaciones científicas, diseñada y actualizada por miembros del departamento de posgrado e investigación de la Facultad de Ciencias Médicas de Sagua la Grande. Resultados: se constató que las unidades donde más profesionales han publicado fueron el Hospital Docente "Mártires del 9 de Abril" y la Facultad de Ciencias Médicas. Predominaron los autores con categorías docentes de Profesor Asistente y Profesor Auxiliar, médicos y enfermeros, y escasas cifras de profesionales con categorías investigativas. Los que menos han publicado son los que laboran en las unidades de la atención primaria de salud y los que no son médicos o enfermeros. Conclusiones: la caracterización realizada a los profesionales de la salud del municipio permitió constatar que son insuficientes las publicaciones científicas en el territorio; a pesar de que existen varias revistas científicas donde publicar, algunos aún no divulgan sus resultados científicos.

ABSTRACT Background: together with the training of professionals, Cuban universities of medical sciences have the mission of generating and disseminating knowledge, which is achieved through research and its dissemination through publications. Objective: to characterize the scientific publications of the Villa Clara health authors of the municipality of Sagua la Grande during the 2019-2020 period. Methods: a retrospective longitudinal descriptive study was carried out on the scientific production of health professionals in the municipality. Theoretical and empirical methods were applied. To collect the information, a database on scientific production was reviewed, specifying scientific publications in the indicator, designed and updated by members of the postgraduate and research department of the Faculty of Medical Sciences of Sagua la Grande. Results: it was found that the institutions where more professionals have published were the "Mártires del 9 de Abril" Teaching Hospital and the Faculty of Medical Sciences. Authors with teaching ranks of Assistant Professor and Associate Professor, M.Ds and nurses predominated, and few figures of professionals with researching ranks. Those who have published the least are those who work in primary health care units and those who are not doctors or nurses. Conclusions: the characterization to the health professionals of the municipality allowed to verify that the scientific publications in the territory are insufficient; Although there are several scientific journals to publish, some still do not disclose their scientific results.

Conocimientos sobre el diagnóstico del dolor torácico agudo: una necesidad en los internos de Medicina / Knowledge on the diagnosis of acute chest pain: a necessity in medical interns

RESUMEN Fundamento: el dominio y la aplicación del método clínico en el contexto del dolor torácico agudo son fundamentales, pues resulta uno de los síntomas más frecuentes en las consultas de servicios médicos de urgencia hospitalaria. Objetivo: evaluar el nivel de conocimientos sobre el diagnóstico de dolor torácico agudo en internos de Medicina. Métodos: se realizó un estudio descriptivo, transversal en estudiantes internos que cursaban su rotación por Medicina Interna en el Hospital Universitario "Mártires del 9 de Abril" en la provincia Villa Clara, Cuba durante el año 2018. Se aplicaron métodos teóricos: análisis-síntesis, inducción-deducción e histórico-lógico; y empíricos: la encuesta en forma de cuestionario. Resultados: la mayoría de los estudiantes obtuvieron evaluación de Regular en cuanto a las habilidades para la identificación etiológica del dolor torácico a través de la anamnesis. De igual forma se comportó el resultado en la evaluación en cuanto a la exploración física. Por su parte la identificación del examen complementario de elección ante cada situación arrojó mejores resultados, al obtener calificaciones de Excelente 20 internos. Conclusiones: el nivel de conocimientos sobre diagnóstico del dolor torácico agudo en internos de Medicina resultó insuficiente, preferentemente en la interpretación los datos aportados por la anamnesis y la exploración física.

ABSTRACT Background: mastery and application of the clinical method in the context of acute chest pain are essential, as it is one of the most frequent symptoms in hospital emergency medical services. Objective: to assess the level of knowledge on the diagnosis of acute chest pain in medical interns. Methods: a descriptive, cross-sectional study was carried out in internal students who were studying Internal Medicine at the "Mártires del 9 de Abril" University Hospital in Villa Clara province, Cuba during 2018. Theoretical methods were applied: analysis-synthesis, induction-deduction and historical-logical; and empirical ones: the survey in questionnaire form. Results: the majority of the students obtained a so-so mark in the evaluation regarding the abilities for the etiological identification of chest pain through the history-taking pain. In the same way behaved the result in the assessment in terms of physical examination. On the other hand, the identification of the complementary examination of choice in each situation yielded better results, 20 interns got excellent qualifications. Conclusions: the level of knowledge about the diagnosis of acute chest pain in medical interns was insufficient, preferably in the interpretation of the data provided by the history-taking pain and physical examination.

Mechanical Forces Alter Conical Intersections Topology.

Photoreactivity can be influenced by mechanical forces acting over a reacting chromophore. Nevertheless, the specific effect of the external forces in the photoreaction mechanism remains essentially unknown. Conical intersections are key structures in photochemistry, as they constitute the funnels connecting excited and ground states. These crossing points are well known to provide valuable information on molecular photoreactivity, including crucial aspects as potential photoproducts which may be predicted by just inspection of the branching plane vectors. Here, we outline a general framework for understanding the effect of mechanical forces on conical intersections and their implications on photoreactivity. Benzene S1/S0 conical intersection topology can be dramatically altered by applying less than 1 nN force, making the peaked pattern of the intersection become a sloped one, also provoking the transition state in the excited state to disappear. Both effects can be related to an increase in the photostability as the conical intersection becomes more accessible, and its topology in this case favors the recovery of the initial reactant. The results indicate that the presence of external forces acting over a chromophore have to be considered as a potential method for photochemical reactivity control.

Factores asociados con malignidad en pacientes con nódulos de tiroides / Factors associated with malignancy in patients with thyroid nodules

RESUMEN Introducción: la enfermedad nodular tiroidea es uno de los problemas endocrinos más frecuentes; constituye un reto para cirujanos, endocrinólogos y oncólogos por su asociación con el cáncer de la glándula tiroidea. Objetivos: determinar los factores asociados con malignidad en pacientes con nódulos de tiroides que han recibido tratamiento quirúrgico. Métodos: se realizó un estudio observacional-analítico de tipo casos y controles, en pacientes que ingresaron con diagnóstico de nódulo de tiroides y recibieron tratamiento quirúrgico en el Hospital «Mártires del 9 de Abril¼, del municipio Sagua la Grande, en el período de enero de 2015 a abril de 2018. La muestra quedó conformada por un total de 80 pacientes (n=80), de los cuales, el grupo caso tuvo un total de 20 (n1 = 20), y el grupo control 60 (n2 = 60). Resultados: entre los tipos histológicos de tumores malignos más frecuentes se encontró el carcinoma papilar en 16 pacientes (80 %) y 4 fueron diagnosticados con carcinoma folicular (20 %). Entre los predictores más fuertemente asociados con malignidad se pueden mencionar las adenopatías (VPP: 88,89, IC: 62,80-100,00) y la consistencia pétrea (VPP: 85,71, IC: 52,65-100,00) como variables clínicas, seguidas por el sexo masculino como variable sociodemográfica (VPP: 72,73, IC: 41,86-100,00). Conclusiones: las características clínicas, sociodemográficas y ultrasonográficas de los pacientes con nódulo tiroideo son útiles para identificar el riesgo de malignidad. Los predictores más fuertemente asociados con malignidad fueron las adenopatías, la consistencia pétrea y el sexo masculino.

ABSTRACT Introduction: thyroid nodular disease is one of the most common endocrine problems; it constitutes a challenge for surgeons, endocrinologists and oncologists because of its association with thyroid gland cancer. Objectives: to determine factors associated with malignancy in patients with thyroid nodules who have received surgical treatment. Methods: an observational, analytical, case-control study was carried out in patients who were admitted with a diagnosis of a thyroid nodule and received surgical treatment at "Mártires del 9 de Abril" Hospital, in Sagua la Grande municipality, from January 2015 to April 2018. The sample consisted of a total of 80 patients (n = 80), of which, case group 20 (n1= 20), and control group 60 (n2= 60). Results: papillary carcinoma was found among the most frequent histological types of malignant tumors in 16 patients (80%), and 4 were diagnosed with follicular carcinoma (20%). Adenopathies were among the predictors most strongly associated with malignancy, (PPV: 88.89, CI: 62.80-100.00) and stony consistency (PPV: 85.71, CI: 52.65-100.00) as clinical variables, followed by male gender as a socio-demographic variable (PPV: 72.73, CI: 41.86-100.00). Conclusions: clinical, socio-demographic and ultrasonographic characteristics of patients with thyroid nodule are useful to identify the risk of malignancy. The predictors most strongly associated with malignancy were adenopathies, stony consistency and male gender.

Phylogenetic analysis shows that Neolithic slate plaques from the southwestern Iberian Peninsula are not genealogical recording systems.

Prehistoric material culture proposed to be symbolic in nature has been the object of considerable archaeological work from diverse theoretical perspectives, yet rarely are methodological tools used to test the interpretations. The lack of testing is often justified by invoking the opinion that the slippery nature of past human symbolism cannot easily be tackled by the scientific method. One such case, from the southwestern Iberian Peninsula, involves engraved stone plaques from megalithic funerary monuments dating ca. 3,500-2,750 B.C. (calibrated age). One widely accepted proposal is that the plaques are ancient mnemonic devices that record genealogies. The analysis reported here demonstrates that this is not the case, even when the most supportive data and techniques are used. Rather, we suspect there was a common ideological background to the use of plaques that overlay the southwestern Iberian Peninsula, with little or no geographic patterning. This would entail a cultural system in which plaque design was based on a fundamental core idea, with a number of mutable and variable elements surrounding it.