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).
We have evaluated the spread of SARS-CoV-2 through Latin America and the Caribbean (LAC) region by means of a correlation between climate and air pollution indicators, namely, average temperature, ...minimum temperature, maximum temperature, rainfall, average relative humidity, wind speed, and air pollution indicators PM10, PM2.5, and NO2 with the COVID-19 daily new cases and deaths. The study focuses in the following LAC cities: Mexico City (Mexico), Santo Domingo (Dominican Republic), San Juan (Puerto Rico), Bogotá (Colombia), Guayaquil (Ecuador), Manaus (Brazil), Lima (Perú), Santiago (Chile), São Paulo (Brazil) and Buenos Aires (Argentina). The results show that average temperature, minimum temperature, and air quality were significantly associated with the spread of COVID-19 in LAC. Additionally, humidity, wind speed and rainfall showed a significant relationship with daily cases, total cases and mortality for various cities. Income inequality and poverty levels were also considered as a variable for qualitative analysis. Our findings suggest that and income inequality and poverty levels in the cities analyzed were related to the spread of COVID-19 positive and negative, respectively. These results might help decision-makers to design future strategies to tackle the spread of COVID-19 in LAC and around the world.
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•This study evaluates the impact of climate and air pollution on the spread of COVID-19 in Latin America and the Caribbean.•Low wind speeds might enhance airborne transmission, according to the correlation found in several cities.•COVID-19 daily new cases were found to be positively correlated with PM10, PM2.5 and NO2 in several studied cities.•The spread of COVID-19 in the region shows a correlation with socioeconomic indexes, like the Gini index and poverty rates.
With the rise of two-dimensional (2D) transition-metal dichalcogenide (TMD) semiconductors and their prospective use in commercial (opto)electronic applications, it has become key to develop ...scalable and reliable TMD synthesis methods with well-monitored and controlled levels of impurities. While metal–organic chemical vapor deposition (MOCVD) has emerged as the method of choice for large-scale TMD fabrication, carbon (C) incorporation arising during MOCVD growth of TMDs has been a persistent concernespecially in instances where organic chalcogen precursors are desired as a less hazardous alternative to more toxic chalcogen hydrides. However, the underlying mechanisms of such unintentional C incorporation and the effects on film growth and properties are still elusive. Here, we report on the role of C-containing side products of organosulfur precursor pyrolysis in MoS2 thin films grown from molybdenum hexacarbonyl Mo(CO)6 and diethyl sulfide (CH3CH2)2S (DES). By combining in situ gas-phase monitoring with ex situ microscopy and spectroscopy analyses, we systematically investigate the effect of temperature and Mo(CO)6/DES/H2 gas mixture ratios on film morphology, chemical composition, and stoichiometry. Aiming at high-quality TMD growth that typically requires elevated growth temperatures and high DES/Mo(CO)6 precursor ratios, we observed that temperatures above DES pyrolysis onset (≳600 °C) and excessive DES flow result in the formation of nanographitic carbon, competing with MoS2 growth. We found that by introducing H2 gas to the process, DES pyrolysis is significantly hindered, which reduces carbon incorporation. The C content in the MoS2 films is shown to quench the MoS2 photoluminescence and influence the trion-to-exciton ratio via charge transfer. This finding is fundamental for understanding process-induced C impurity doping in MOCVD-grown 2D semiconductors and might have important implications for the functionality and performance of (opto)electronic devices.
The aim of this work was to analyze the changes in the emissions from the transport sector during the COVID-19 lockdown in Colombia. We compared estimated emissions from road transportation of four ...groups of pollutants, namely, greenhouse gases (CO2, CH4, N2O), ozone precursor gases (CO, NMVOC, NOx), aerosols (BC, PM2.5, PM10), and acidifying gases (NH3, SO2), during the first half of 2020 with values obtained in the same period of 2018. The estimate of emissions from road transportation was determined using a standardized methodology consistent with the 2006 Intergovernmental Panel on Climate Change (IPCC) Guidelines for National Greenhouse Gas Inventories and the European Environment Agency/European Monitoring and Evaluation Program. We found a substantial reduction in GHG emissions for CH4, N2O, and CO2 by 17%, 21%, and 28%, respectively. The ozone precursors CO and NMVOC presented a decrease of 21% and 22%, respectively, while NOx emissions were reduced up to 15% for the study period. In addition, BC decreased 15%, and there was a reduction of 17% for both PM10 and PM2.5 emissions. Finally, acidifying gases presented negative variations of 19% for SO2 and 23% for NH3 emissions. Furthermore, these results were consistent with the Ozone Monitoring Instrument (OMI) satellite observations and measurements at air quality stations. Our results suggest that the largest decreases were due to the reduction in the burning of gasoline and diesel oil from the transport sector during the COVID-19 lockdown. These results can serve decision makers in adopting strategies to improve air quality related to the analyzed sector.
This work presents an analysis of fire events recorded in Isla Salamanca Natural Park and their impact on the air quality in the district of Barranquilla, with an emphasis on 2020 due to the increase ...in the number of ha burned by forest fires that year. The analysis was based on the data provided by the environmental authority for 2015–2020. The average number of ha burned in 2020 was 50% (events recorded since 2015), with a total area of fires corresponding to 256.9 ha, which is of concern considering the ecological importance of the park and its proximity to the district of Barranquilla, Colombia. The study evaluated the spatial–temporal distributions of forest fires and their possible direct effects on air quality. For 2020, it was found that the maximum hourly measurements of the Tres Ave Marias station for particulate matter less than 2.5 (135.013 µg/m3) corresponded to the recorded event that occurred in June 2020, whereas those of the Móvil station for PM10 (263.98 µg/m3) and PM2.5 (278.7 µg/m3) corresponded to the events of 28 June 2020, and 9 August 2020. These concentrations were higher than the standard values of the average maximum limits for 24 h established in the current Colombian regulations, and both events coincided with fire events reported by the environmental authorities, where a total of 249 ha of Isla Salamanca Natural Park were burned. These things considered, it was evident that the Policía station had the highest concentrations of pollutants on average.
This article investigates the snow albedo changes in Colombian tropical glaciers, namely, Sierra Nevada de Santa Marta (SNSM), Sierra Nevada del Cocuy (NSC), Nevado del Ruíz (NDR), Nevado Santa ...Isabel (NDS), Nevado del Tolima (NDT), and Nevado del Huila (NDH). They are associated with the possible mineral dust deposition from the Sahara Desert during the June and July months using snow albedo (SA), snow cover (SC), and land surface temperature (LST) from the Moderate Resolution Imaging Spectroradiometer (MODIS) aboard NASA’s Terra and Aqua satellites. And mineral dust (MD) from The Modern-Era Retrospective Analysis for Research and Applications, version 2 (MERRA-2), both of them during 2000–2020. Results show the largest snow albedo reductions were observed at 39.39%, 32.1%, and 30.58% in SNC, SNSM, and NDR, respectively. Meanwhile, a multiple correlation showed that the glaciers where MD contributed the most to SA behavior were 35.4%, 24%, and 21.4% in NDS, NDC, and NDR. Results also display an increasing trend of dust deposition on Colombian tropical glaciers between 2.81 × 10−3 µg·m−2·year−1 and 6.58 × 10−3 µg·m−2·year−1. The results may help recognize the influence of Saharan dust on reducing snow albedo in tropical glaciers in Colombia. The findings from this study also have the potential to be utilized as input for both regional and global climate models. This could enhance our comprehension of how tropical glaciers are impacted by climate change.
Fire is a process of disturbance of natural ecosystems that can be used for land management and soil preparation for agricultural purposes, but can also drastically affect biodiversity and the ...distribution and abundance of species by changing land use and altering the microclimate. The analysis of data on thermal anomalies has become a valuable tool for the study of places with low monitoring of the occurrence of fires. In this study, information from the MODIS sensor was used to analyze the spatio-temporal distribution of fires in the five natural regions of Colombia (Caribbean, Andean, Pacific, Orinoquia, and Amazon) in the period of 2000–2020. Nevertheless, MODIS fire hotspots present some difficulties in estimating the magnitude of fire activity, due the relations between active fires and burned areas, which are not constant in space and time. The method used in this work consisted to performance an inter-annual and intra-annual analysis of thermal anomalies data and identifying the incidence of temperature in the occurrence of fires. The fire density (defined as the number of fires per unit area) and the fire trends over the study period were also analyzed. Inter-annual fire peaks were recorded in 2004 (8.21%) and 2007 (8.04%), and three main fire hotspots were identified in the Orinoquia, Andean, and Caribbean regions. Moreover, 87% of fire peaks were observed in the dry season (December–March). On the other hand, the highest incidence of thermal anomalies occurred in the Orinoquia region (83409 ± 185 fires), and the highest incidence of fires per unit area was recorded in the Andean region (0.162 ± 0.086 fires-km2-year). Fire activities varied strongly according to region and year over the study period. Significant correlations were observed between temperature and fire density in the Andean (Rho = 0.7506), Pacific (Rho = 0.7364), and Caribbean (Rho = 0.5571) regions. Thus, temperature seem to be a driver of fire density in these regions.
Snow albedo is an important variable in the coupled atmosphere-earth system at the global level. Moreover, studying its behavior allows us to know the state of the cryosphere. The Sierra Nevada de ...Santa Marta (SNSM) is a glacier area and the northernmost tropical (10.82° N, 73.75° W) region in South America. It has a height of up to 5775 m.a.sl., which is the second highest mountain in the world near the marine coast. We analyzed variations in snow albedo related to snow cover, snowfall, temperature, light-absorbing impurities such as blank carbon (BC), organic carbon (OC) and dust, and El Niño—Southern Oscillation (ENSO) phenomenon through 20 years (2000–2020). We mainly use daily data from the Moderate Resolution Imaging Spectroradiometer (MODIS) onboard the Terra and Aqua NASA satellites. Results showed through correlations that snow albedo has decreased due to Land Surface Temperature (55%, p < 0.001), a positive phase of ENSO (42%, p < 0.001) and dust (37%, p < 0.01) in the SNSM. Additionally, a dust negative effect was more evident on the southern side (up to 49%, p < 0.001) of the SNSM. Backward trajectories by the NOAA HYSPLIT model suggest that dust sources would be soil erosion in the surrounding region. Results can help recognize the influence of ENSO and dust in the glacier decrease of the SNSM.
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