Diboron reagents in the deoxygenation of nitrones.

B2nep2 efficiently promotes the N-O cleavage of nitrones to form imines in very high yields via a simple, efficient, sustainable, functional group tolerant and scalable protocol. The reaction occurs in the absence of additives through a concerted mechanism. We demonstrated that DMPO and TEMPO, typically used as radical traps, are also deoxygenated by diboron reagents, which demonstrates their limitation as mechanistic probes.

Cost of lost productivity from acute respiratory infections in South America.

Objectives: To estimate the burden of permanent productivity losses caused by acute respiratory infections in South American countries in 2019. Methods: Mortality data from the Global Burden of Disease Study 2019 were analyzed to estimate the burden of disease attributable to acute respiratory infections. An approach based on the human capital method was used to estimate the cost of permanent productivity losses associated with respiratory diseases. To calculate this cost, the sum of the years of productive life lost for each death was multiplied by the proportion in the workforce and the employment rate, and then by the annual minimum wage or purchasing power parity in United States dollars (US$) for each country in the economically active age groups. Separate calculations were done for men and women. Results: The total number of deaths from acute respiratory infections in 2019 was 30 684 and the years of productive life lost were 465 211 years. The total cost of permanent productivity loss was about US$ 835 million based on annual minimum wage and US$ 2 billion in purchasing power parity, representing 0.024% of the region's gross domestic product. The cost per death was US$ 33 226. The cost of productivity losses differed substantially between countries and by sex. Conclusion: Acute respiratory infections impose a significant economic burden on South America in terms of health and productivity. Characterization of the economic costs of these infections can support governments in the allocation of resources to develop policies and interventions to reduce the burden of acute respiratory infections.

Risk of caesarean delivery in labour induction: a systematic review and external validation of predictive models.

BACKGROUND: Despite the existence of numerous published models predicting the risk of caesarean delivery in women undergoing induction of labour (IOL), validated models are scarce. OBJECTIVES: To systematically review and externally assess the predictive capacity of caesarean delivery risk models in women undergoing IOL. SEARCH STRATEGY: Studies published up to 15 January 2021 were identified through PubMed, CINAHL, Scopus and ClinicalTrials.gov, without temporal or language restrictions. SELECTION CRITERIA: Studies describing the derivation of new models for predicting the risk of caesarean delivery in labour induction. DATA COLLECTION AND ANALYSIS: Three authors independently screened the articles and assessed the risk of bias (ROB) according to the prediction model risk of bias assessment tool (PROBAST). External validation was performed in a prospective cohort of 468 pregnancies undergoing IOL from February 2019 to August 2020. The predictive capacity of the models was assessed by creating areas under the receiver operating characteristic curve (AUCs), calibration plots and decision curve analysis (DCA). MAIN RESULTS: Fifteen studies met the eligibility criteria; 12 predictive models were validated. The quality of most of the included studies was not adequate. The AUC of the models varied from 0.520 to 0.773. The three models with the best discriminative capacity were those of Levine et al. (AUC 0.773, 95% CI 0.720-0.827), Hernández et al. (AUC 0.762, 95% CI 0.715-0.809) and Rossi et al. (AUC 0.752, 95% CI 0.707-0.797). CONCLUSIONS: Predictive capacity and methodological quality were limited; therefore, we cannot currently recommend the use of any of the models for decision making in clinical practice. TWEETABLE ABSTRACT: Predictive models that predict the risk of cesarean section in labor inductions are currently not applicable.

Psychosocial risk in healthcare workers after one year of COVID-19.

BACKGROUND: The COVID-19 pandemic overwhelmed the capacity of the healthcare system, affecting the volume of demands and the care tasks of healthcare workers. AIMS: To examine the health indicators and exposure to psychosocial risks of Spanish healthcare workers 1 year into the COVID-19 pandemic and compare them with the results of the first wave. METHODS: We conducted a cross-sectional study using an online questionnaire (April-May 2020 and 2021). The data stem from the COTS 1 project database, corresponding to the first wave of COVID-19 (n = 1989) and COTS 2 (n = 1716) corresponding to 1 year later. The samples were independent. The prevalence of exposure to psychosocial risks and adverse health indicators was estimated for every occupational group, segregating the data by sex. RESULTS: Professionals of all types presented worse perception of health. In general, the results were worse for women, while geriatric assistants presented the greatest exposure to psychosocial risk in COTS 2 compared to COTS 1. Sleep problems, high quantitative demands and high concern about becoming infected and spreading COVID-19 were cross-disciplinary in COTS 1, while worse perception of health, high pace of work, high work-life conflict and low development opportunities stood out in COTS 2. CONCLUSIONS: Exposure to psychosocial risks was already high during the first wave and a significant decline in working conditions was observed. The prolongation of the pandemic exacerbated these results and seems to have multiplied the pre-existing inequalities between the axes of segregation in the labour market.

Effectiveness of a decision aid for patients with knee osteoarthritis: a randomized controlled trial.

OBJECTIVE: To assess the effectiveness of a Patient Decision Aid (PtDA) for knee osteoarthritis. METHOD: Randomized controlled trial, in which 193 patients were allocated to the PtDA or usual care. Outcome measures were the Decisional Conflict Scale (DCS), knowledge of osteoarthritis and arthroplasty, satisfaction with the decision-making process (SDMP) and treatment preference, assessed immediately after the intervention. At 6 months, the same measures were applied in non-operated patients, whereas those who underwent arthroplasty completed the SDMP and the Decisional Regret Scale (DRS). RESULTS: The PtDA produced a significant immediate improvement of decisional conflict (MD = -11.65, 95%CI: -14.93, -8.37), objective knowledge (MD = 10.37, 99%IC: 3.15, 17.70) and satisfaction (MD = 6.77, 99%CI: 1.19, 12.34), and a different distribution of preferences (χ2 = 8.74, p = 0.033). Patients with less than secondary education obtained a stronger effect on decisional conflict (p = 0.015 for the interaction) but weaker for knowledge (p = 0.051). At 6 months, there were no significant differences in any variable, including the rate of total knee replacement. Operated patients showed a low level of regret, which was not affected by the intervention. CONCLUSION: The PtDA is effective immediately after its application, but it shows no effects in the medium-term. Future research should investigate which subgroups of patients could benefit more from this intervention, as well as the longitudinal evolution of decision-related psychological variables.

Sulfadiazine removal using green zero-valent iron nanoparticles: A low-cost and eco-friendly alternative technology for water remediation.

In this work, the effectiveness of green zero-valent iron nanoparticles (gnZVIs) for the removal of the antibiotic sulfadiazine (SDZ) from water via adsorption and reduction was tested. Additionally, the effectiveness of this material as a catalyst for the Fenton and photo-Fenton processes was also investigated. This represents the first study concerning the use of gnZVIs for the degradation of a sulfonamide antibiotic. The results obtained indicate that gnZVIs were able to remove up to 58% of SDZ via adsorption and up to 69% via adsorption plus reduction using a SDZ/Fe3+ molar ratio of 1:61.6. Furthermore, gnZVIs showed strong effectiveness as a catalyst for the Fenton and photo-Fenton reactions, with complete SDZ removal in 8 h and 5 min, respectively, using a SDZ/Fe3+/H2O2 molar ratio of 1:38.4:38.4. These results demonstrate that the use of gnZVIs constitutes an attractive and potential alternative technology for water remediation, reducing environmental impact and operational costs.

Sulfadiazine, sulfamethazine and sulfachloropyridazine removal using three different porous materials: Pine bark, "oak ash" and mussel shell.

This work focuses on studying the efficacy of three different by-products to adsorb three antibiotics (sulfadiazine, SDZ; sulfamethazine, SMT; sulfachloropyridazine, SCP). These antibiotics can be considered pollutants of the environment when they reach water, as well as in cases where they are spread on soils through irrigation or contained in sewage sludge or livestock manure. In this study, batch-type adsorption/desorption experiments were performed for each of the three sulfonamides, adding 7 different concentrations of the antibiotics, going from 1 to 50 µmol L-1, and with contact time of 24 h. The results indicate that pine bark is the most efficient bioadsorbent among those studied, as it adsorbs up to 95% of the antibiotics added, while desorption is always less than 11%. However, for "oak ash" and mussel shell the adsorption is always lower than 45 and 15%, respectively, and desorption is high, reaching up to 49% from "oak ash" and up to 81% from mussel shell. Adsorption data showed good fitting to the Linear and Freundlich models, with R2 values between 0.98 and 1.00 in both cases. Kd and KF adsorption parameters showed similar values for the same sorbent materials but were much higher for pine bark than for the other two bioadsorbents. The Freundlich's n parameter showed values in the range 0.81-1.28. The highest KF values (and therefore the highest adsorption capacities) were obtained for the antibiotic SCP in pine bark. Pine bark showed the highest capacity to adsorb each of the antibiotics, increasing as a function of the concentration added. When the concentration of sulfonamide added was 50 µM, the amounts adsorbed were 780 µmol kg-1 for SDZ, 890 µmol kg-1 for SMT, and 870 µmol kg-1 for SCP. "Oak ash" and mussel shell have low adsorption capacity for all three sulfonamides, showing values always lower than 150 µmol kg-1 (oak ash) and 20 µmol kg-1 (mussel shell) when a concentration of 50 µmol L-1 of antibiotic is added. The results of this study could aid to make an appropriate management of the by-products studied, in order to facilitate their valorization and recycling in the treatment of environmental compartments polluted with sulfonamide antibiotics.

Environmental relevance of adsorption of doxycycline, enrofloxacin, and sulfamethoxypyridazine before and after the removal of organic matter from soils.

In this work batch-type experiments were used to study the adsorption of the antibiotics doxycycline (DC), enrofloxacin (ENR), and sulfamethoxypyridazine (SMP) in cultivation soils, before and after the removal of soil organic matter. Organic matter removal by calcination resulted not only in C and N removal, but also in increased soil pH, exchangeable basic cations and surface area values. The results indicate a very different behavior depending on the type of antibiotic, showing the adsorption sequence DC > ENR > SMP. Specifically, DC adsorption was very high in untreated soil samples (with organic matter), and was still high (although decreased) after the removal of soil organic matter. Furthermore, the adsorption behavior of DC was clearly dependent on the pH of the medium. Regarding ENR, it also showed high adsorption, although to a lesser extent than DC. However, when soil organic matter was removed, ENR adsorption significantly decreased in all soil samples. As regards SMP, it was adsorbed to a much lesser extent, and the removal of soil organic matter caused an additional drastic decrease in adsorption, reaching negligible values in some samples. Desorption followed the reverse sequence of adsorption, specifically in the order DC < ENR < SMP. In the case of DC, desorption was negligible, both in samples with and without organic matter, while for ENR and SMP, desorption clearly increased for soil samples where organic matter was removed. These results may be of relevance as regards environmental quality and public health, especially to facilitate a correct use of soils and organic amendments in areas that receive the application of substances containing the investigated antibiotics.

Adsorption-desorption of doxycycline in agricultural soils: Batch and stirred-flow-chamber experiments.

With the aim of obtaining information about the environmental fate and dynamics of the antibiotic doxycycline (DC) when it reaches soil, adsorption and desorption processes were studied for this compound in 20 agricultural soils, by means of batch-type and stirred-flow-chamber experiments. The results indicate that the studied soils adsorbed high amounts of DC, with adsorption percentages >91% in all cases. In addition, adsorption results were satisfactorily modeled, with good fittings to the Langmuir and Freundlich equations, with the values for Langmuir's maximum adsorption capacity (qmax) varying between 14,692 and 26,141 µmol kg-1 (average 17,816), and between 1,906 and 13,120 Ln µmol1-n kg-1 (average 6,969) for the Freundlich affinity coefficient, which are very high. The soil variables most related to the adsorption of the antibiotic were linked to organic matter (specifically, soil organic carbon-SOC- and soil nitrogen -N- contents), and to the clay fraction, as well as to cation exchange capacity, being the soils with a greater content in these variables those that presented a greater adsorption. FTIR results shown that DC adsorption mechanisms were based on interactions such as hydrogen bonds and π-π interactions between the antibiotic and soils. Desorption was very low, reaching values between 1 and 2% in batch experiments, and between 5 and 15% in stirred flow chamber experiments, which indicates a strong hysteresis affecting adsorption and desorption processes. This fact can be considered positively, as these soils could retain DC very strongly, thus reducing risks to human and ecological health.

Association between vitamin D deficiency and common variants of Vitamin D binding protein gene among Mexican Mestizo and indigenous postmenopausal women.

PURPOSE: Vitamin D deficiency (VDD) and polymorphisms in the group-specific component (GC) gene are known to be associated in different populations. However, the effects of such genetic variants may vary across different populations. Thus, the objective of this study was to estimate the association between Vitamin D-Binding Protein (VDBP) haplotypes and VDD in mestizo postmenopausal women and Mexican Amerindian ethnic groups. METHODS: This was a cross-sectional study of 726 postmenopausal Mexican women from the Health Workers Cohort Study (HWCS) and 166 postmenopausal women from the Metabolic Analysis in an Indigenous Sample (MAIS) cohort in Mexico. GC polymorphisms (rs7045 and rs4588) were analyzed by TaqMan probes. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured by Chemiluminescent Microparticle Immuno Assay. RESULTS: The prevalence of VDD serum 25(OH)D < 20 ng/mL was 43.7% in mestizo women and 44.6% in indigenous women. In HWCS, the single nucleotide polymorphisms (SNPs) rs7041 and rs4588 were associated with VDD. In addition, women from the HWCS, carrying the haplotypes GC2/2 and GC1f/2 had higher odds of VDD (OR = 2.83, 95% CI 1.14, 7.02; and OR = 2.30, 95% CI 1.40, 3.78, respectively) compared to women with haplotype 1f/1 s. These associations were not statistically significant in the MAIS cohort. CONCLUSIONS: Our results show genetic association of the analyzed SNPs and related haplotypes, on the GC gene, with VDD in mestizo Mexican postmenopausal women. Moreover, a high prevalence of VDD with high genetic variability within the country was observed. Our results support the need for national policies for preventing VDD.

Estimation of adsorption/desorption Freundlich's affinity coefficients for oxytetracycline and chlortetracycline from soil properties: Experimental data and pedotransfer functions.

Tetracycline antibiotics spread in the environment constitute a real threat, causing risks that should be controlled. Retention/release of these compounds after interacting with soil components are the main process governing their entry into water bodies, plant uptake, and availability for soil microorganisms. In this work, batch-type experiments were performed to study adsorption/desorption of oxytetracycline (OTC) and chlortetracycline (CTC) in 63 crop soils. The Freundlich model satisfactory described adsorption curves, showing strong affinity of both antibiotics to soils, with adsorption coefficient (KF(ads)) values between 1015 and 9733 Ln µmol1-n kg-1 for OTC, and between 1099 and 11344 Ln µmol1-n kg-1 for CTC. Desorption percentages were always lower than 10%, indicating that adsorption is highly irreversible. Furthermore, the desorption coefficient (KF(des)) correlated positive and significantly with KF(ads), showing that those soils characterized by higher adsorption were also those showing less desorption. Soil organic carbon (SOC) was the soil characteristic that most explained the variance of KF, both for adsorption and desorption, which caused that soils with higher SOC scores showed higher adsorption and lower desorption for both antibiotics. Pedotransfer functions were developed for OTC and CTC, and resulted effective to satisfactory predict KF(ads) and KF(des) values. These equations would facilitate an easy identification of soils vulnerable to antibiotics pollution, which would allow to program appropriate management practices to decrease undesirable effects on the environment and on public health.

Influence of mussel shell, oak ash and pine bark on the adsorption and desorption of sulfonamides in agricultural soils.

Taking into account the high mobility and environmental risks due to sulfonamide antibiotics as emerging pollutants, batch-type experiments were performed to study adsorption/desorption of three sulfonamides (sulfadiazine -SDZ-, sulfamethazine -SMT- and sulfachloropyridazine -SCP-) in three agricultural soils. The study was carried out both for un-amended and amended soil samples, using different doses (0, 12, 24 and 48 Mg ha-1) of three different by-products (mussel shell, oak ash and pine bark). Adsorption on un-amended soils was rather low, with percentages between 11 and 45% for SDZ, 20-64% for SMT, and 19-65% for SCP. Both the Linear and Freundlich models fitted well to adsorption curves. In the case of un-amended soils, and regarding the Linear model, the values of the coefficient of distribution (Kd, expressed in L kg-1) were between 0.6 and 1.3 for SDZ, between 0.7 and 1.1 for SMT, and between 0.6 and 2.6 for SCP. As regards the Freundlich model, the values of the adsorption constant (KF, expressed in L1/n µmol1-1/n kg-1), were in the range 0.4-1.9 for SDZ, 0.9-2.9 for SMT, and 1.2-3.8 for SCP. Simultaneously, desorption percentages were high, reaching 13.7-47.7% for SDZ, 12.6-35.1% for SMT, and 13.7-34.3% for SCP, when the highest initial antibiotic concentration (50 µmol L-1) was added, thus indicating low retention and high mobility for these compounds in soils. Mussel shell and oak ash amendments did not increase retention of any of the three sulfonamides. However, the incorporation of pine bark resulted in an increase in the adsorption and decrease in desorption for all three antibiotics. Specifically, for soils amended with pine bark at 48 Mg ha-1, Kd values (expressed in L kg-1) were between 2.1 and 2.9 for SDZ, between 3.4 and 3.6 for SMT, and between 2.5 and 8.2 for SCP. Regarding KF (expressed in L1/n µmol1-1/n kg-1), its values ranged from 5.6 to 6.3 for SDZ, 6.2-8.8 for SMT, and 5.3-7.1 for SCP. These scores were clearly higher than those of un-amended soils, and pine bark amendment also resulted in lower desorption percentages, ranging 8.7-11.4% for SDZ, 4.0-10.7% for SMT, and 6.5-16.9% for SCP. This positive effect on the retention of sulfonamides due to pine bark can be attributed to its high organic carbon content (48.6%), as well as to its acidic pHw (4.0). Therefore, pine bark amendment can be considered an effective alternative to increase the retention of sulfonamides in soils, thus reducing their bioavailability and transport to other environmental compartments, and subsequent risks of negative impacts on human and environmental health.

Experimental data and model prediction of tetracycline adsorption and desorption in agricultural soils.

In this work, tetracycline (TC) adsorption and desorption were studied, and the soil properties that most influenced the process were identified. Batch experiments were carried out on 63 crop soil samples, which showed a wide range of values in their physicochemical characteristics. Adsorption curves fit well to the Freundlich equation, with KF values varying between 901 and 9202 Ln µmol1-n kg-1. Kd values ranged between 53 and 6899 L kg-1 for an initial concentration (Co) of 400 µM, whereas the adsorption capacity (qa) ranged from 8541 to 14,852 µmol kg-1. TC retention on soils was high, with adsorption values always higher than 58%, and desorption values lower than 9%. Bivariate correlations and multiple linear regressions were performed to identify those soil variables having a greater influence on TC adsorption and desorption. The results indicate that organic carbon, clay, exchangeable aluminum, available phosphorus, effective cation exchange capacity content, and pH are the main characteristics affecting TC adsorption and desorption. The models, developed by means of multiple linear regression, gave satisfactory and robust predictions for TC adsorption and desorption, using easily determinable soil characteristics as input.

Retention and transport of mecoprop on acid sandy-loam soils.

Interaction with soil components is one of the key processes governing the fate of agrochemicals in the environment. In this work, we studied the adsorption / desorption and transport of mecoprop (methylchlorophenoxypropionic acid or MCPP) in four acid sandy-loam soils with different organic matter contents. Kinetics of adsorption and adsorption/desorption at equilibrium were studied in batch experiments, whereas transport was studied in laboratory columns. Adsorption and desorption were found to be linear or nearly-linear. The kinetics of mecoprop adsorption were relatively fast in all cases (less than 24h). Adsorption and desorption were adequately described by the linear and Freundlich models, with KF values that ranged from 0.7 to 8.8Ln µmol1-nkg-1 and KD values from 0.3 to 3.6Lkg-1. The results of the transport experiments showed that the retention of mecoprop by soil was very low (less than 6.2%). The retention of mecoprop by the soils in all experiments increased with organic matter content. Overall, it was observed that mecoprop was weakly adsorbed by the soils, what would result in a high risk of leaching of this compound in the environment.

Degradation of sulfadiazine, sulfachloropyridazine and sulfamethazine in aqueous media.

Antibiotics discharged to the environment constitute a main concern for which different treatment alternatives are being studied, some of them based on antibiotics removal or inactivation using by-products with adsorbent capacity, or which can act as catalyst for photo-degradation. But a preliminary step is to determine the general characteristics and magnitude of the degradation process effectively acting on antibiotics. A specific case is that of sulfonamides (SAs), one of the antibiotic groups most widely used in veterinary medicine, and which are considered the most mobile antibiotics, causing that they are frequently detected in both surface- and ground-waters, facilitating their entry in the food chain and causing public health hazards. In this work we investigated abiotic and biotic degradation of three sulfonamides (sulfadiazine -SDZ-, sulfachloropyridazine -SCP-, and sulfamethazine -SMT-) in aqueous media. The results indicated that, in filtered milliQ water and under simulated sunlight, the degradation sequence was: SCP > SDZ ≈ SMT. Furthermore, the rate of degradation clearly increased with the raise of pH: at pH 4.0, half-lives were 1.2, 70.5 and 84.4 h for SCP, SDZ and SMT, respectively, while at pH 7.2 they were 2.3, 9.4 and 13.2 h for SCP, SMT and SDZ. The addition of a culture medium hardly caused any change in degradation rates as compared to experiments performed in milliQ water at the same pH value (7.2), suggesting that in this case sulfonamides degradation rate was not affected by the presence of some chemical elements and compounds, such as sodium, chloride and phosphate. However, the addition of bacterial suspensions extracted from a soil and from poultry manure increased the rate of degradation of these antibiotics. This increase in degradation cannot be attributed to biodegradation, since there was no degradation in the dark during the time of the experiment (72 h). This indicates that photo-degradation constitutes the main removal mechanism for SAs in aqueous media, a mechanism that in this case was favored by humic acids supplied with the extracts from soil and manure. The overall results could contribute to the understanding of the environmental fate of the three sulfonamides studied, aiding to program actions that could favor their inactivation, which is especially relevant since its dissemination can involve serious environmental and public health risks.

Chiral amplification of disodium cromoglycate chromonics induced by a codeine derivative.

Chromonic liquid crystals (CLC) are lyotropic phases formed by discotic mesogens in water. Simple chiral dopants such as amino acids have been reported to turn chromonic liquid crystals into their cholesteric counterparts. Here we report a chirality amplification effect in the nematic phase of a 9 wt% disodium cromoglycate (DSCG) lyotropic liquid crystal (LLC) upon doping with a water-soluble codeine derivative. The transition on cooling the isotropic to the nematic phase showed the presence of homochiral spindle-shaped droplets (tactoids). NMR DOSY experiments on a triple gradient probe revealed a small degree of diffusion anisotropy for the alkaloid embedded in the liquid crystal structure. These results in combination with XRD, CD and POM experiments agree with a supramolecular aggregation model based on simple columnar stacks.

A qualitative study on a decision aid for breast cancer screening: Views from women and health professionals.

This qualitative study evaluates a decision aid that includes the benefits and harms of breast cancer screening and analyses women's perception of the information received and healthcare professionals' perceptions of the convenience of providing it. Seven focus groups of women aged 40-69 years (n = 39) and two groups of healthcare professionals (n = 23) were conducted in Catalonia and the Canary Islands. The focus groups consisted of guided discussions regarding decision-making about breast cancer screening, and acceptability and feasibility of the decision aid. A content analysis was performed. Women positively value receiving information regarding the benefits and harms of breast cancer screening. Several women had difficulties understanding some concepts, especially those regarding overdiagnosis. Women preferred to share the decisions on screening with healthcare professionals. The professionals noted the lack of inclusion of some harms and benefits in the decision aid, and proposed improving the clarity of the statistical information. The information on overdiagnosis generates confusion among women and controversy among professionals. Faced with the new information presented by the decision aid, the majority of women prefer shared decision-making; however, its feasibility might be limited by a lack of knowledge and attitudes of rejection from healthcare professionals.

EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis.

In this article, the 2009 European League Against Rheumatism (EULAR) recommendations for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have been updated. The 2009 recommendations were on the management of primary small and medium vessel vasculitis. The 2015 update has been developed by an international task force representing EULAR, the European Renal Association and the European Vasculitis Society (EUVAS). The recommendations are based upon evidence from systematic literature reviews, as well as expert opinion where appropriate. The evidence presented was discussed and summarised by the experts in the course of a consensus-finding and voting process. Levels of evidence and grades of recommendations were derived and levels of agreement (strengths of recommendations) determined. In addition to the voting by the task force members, the relevance of the recommendations was assessed by an online voting survey among members of EUVAS. Fifteen recommendations were developed, covering general aspects, such as attaining remission and the need for shared decision making between clinicians and patients. More specific items relate to starting immunosuppressive therapy in combination with glucocorticoids to induce remission, followed by a period of remission maintenance; for remission induction in life-threatening or organ-threatening AAV, cyclophosphamide and rituximab are considered to have similar efficacy; plasma exchange which is recommended, where licensed, in the setting of rapidly progressive renal failure or severe diffuse pulmonary haemorrhage. These recommendations are intended for use by healthcare professionals, doctors in specialist training, medical students, pharmaceutical industries and drug regulatory organisations.

Expanding the Potential of Heteroaryl Vinyl Sulfones.

The easily available vinyl sulfone 3 showed great potential for new applications in several fields such as organic synthesis and bioconjugate formation. This was demonstrated by performing a systematic assessment of its reactivity in Michael, radical, and cycloaddition reactions. Heteroaryl vinyl sulfone 3 presented excellent output in terms of reactivity and selectivity, proving superior to phenyl vinyl sulfone 1 and with clear advantages over bis-sulfone 2. This behavior might be due to the conformational and orbital control exerted by the tetrazole unit according to DFT calculations. Moreover, some alternative transformations to the Julia-Kocienski olefination on the obtained products are also described.