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This paper presents the Integrated Nowcasting through Comprehensive Analysis (INCA) system, which has been developed for use in mountainous terrain. Analysis and nowcasting fields include temperature, humidity, wind, precipitation amount, precipitation type, cloudiness, and global radiation. The analysis part of the system combines surface station data with remote sensing data in such a way that the observations at the station locations are reproduced, whereas the remote sensing data provide the spatial structure for the interpolation. The nowcasting part employs classical correlation-based motion vectors derived from previous consecutive analyses. In the case of precipitation the nowcast includes an intensity-dependent elevation effect. After 2–6 h of forecast time the nowcast is merged into an NWP forecast provided by a limited-area model, using a predefined temporal weighting function. Cross validation of the analysis and verification of the nowcast are performed. Analysis quality is high for temperature, but comparatively low for wind and precipitation, because of the limited representativeness of station data in mountainous terrain, which can be only partially compensated by the analysis algorithm. Significant added value of the system compared to the NWP forecast is found in the first few hours of the nowcast. At longer lead times the effects of the latest observations becomes small, but in the case of temperature the downscaling of the NWP forecast within the INCA system continues to provide some improvement compared to the direct NWP output.

The ability of radar–rain gauge merging algorithms to precisely analyse convective precipitation patterns is of high interest for many applications, e.g. hydrological modelling, thunderstorm warnings, and, as a reference, to spatially validate numerical weather prediction models. However, due to drawbacks of methods like cross-validation and due to the limited availability of reference data sets on high temporal and spatial scales, an adequate validation is usually hardly possible, especially on an operational basis. The present study evaluates the skill of very high-resolution and frequently updated precipitation analyses (rapid-INCA) by means of a very dense weather station network (WegenerNet), operated in a limited domain of the southeastern parts of Austria (Styria). Based on case studies and a longer-term validation over the convective season 2011, a general underestimation of the rapid-INCA precipitation amounts is shown by both continuous and categorical verification measures, although the temporal and spatial variability of the errors is – by convective nature – high. The contribution of the rain gauge measurements to the analysis skill is crucial. However, the capability of the analyses to precisely assess the convective precipitation distribution predominantly depends on the representativeness of the stations under the prevalent convective condition.

Systemic lupus erythematosus (SLE) is an autoimmune disease with wide clinical variability. Brazil has vast regional diversity, both from an ethnic and socio-cultural point of view. To map the clinical profile of SLE in Brazil and explore how this distribution is associated with regional disparities. This cross-sectional study (GSK Study 207353) evaluated 300 Brazilian patients ≥18 years old with SLE (American College of Rheumatology [ACR] criteria, 1997) who had been under SLE care for ≥1 year. Five SLE reference teaching facilities were selected, one in each of the following Brazilian regions: North (NO), Northeast (NE), Midwest (CO), Southeast (SE), and South (SU). Each region included 60 patients. Clinical and demographic characteristics, and patterns of care were measured through questionnaires completed by physicians or nurses. The SLE Disease Activity Index (SLEDAI) score described disease activity and the Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) described damage accrual. To assess the potential association between regional disparities and clinical outcomes, a hospitalisation profile was described. A bootstrapping approach of logistic regression was used to explore potential factors associated with hospitalisation. Overall, 92.3% of patients were female, with a mean (standard deviation; SD) age of 41.8 (12.7) years and a mean (SD) disease duration of 11.8 (7.9) years. Overall, 161 (53.7%) patients were of Latino origin; in the NO this proportion was 88%. White patients predominated in the SU (58.3%); and black patients in the SE (31.7%). The mean (SD) number of years of schooling was 11.3 (4.6), and was highest in the NO (14.2 [3.6]) and lowest in the SU (9.0 [4.0]; p<0.001). With regard to the distribution of the SLE clinical profile according to ACR criteria, arthritis was found in 221 patients and predominated in all regions (mean 73.7%), with a lower prevalence in the CO (40%; p<0.001; Figure 1A). The mean (SD) SLEDAI score was 4.33 (5.39) at the time of interview. The main contributing factors to disease activity, according to SLEDAI, were complement consumption (18%), arthritis (15.3%), and alopecia (15%). The SDI scale was scored for cataracts (15%), proteinuria (8.7%), and thrombosis (7.3%). Among the associated comorbidities, hypertension was predominant in the NO (35%; p=0.001). Smoking predominated in the SU (23%; p<0.001); obesity (27%; p=0.059) and dyslipidemia (35%; p=0.023), in the SE. Regarding patterns of care (Figure 1B), antimalarials were most frequently prescribed in the SE (88.3%) and the SU (91.7%). Corticosteroids prevailed in the NO (96.7%). The mean (SD) time between home and care facility was 4.5 (12.6) hours. Patients in the NO reported the longest transport time to reach the care facility (11.5 [25.4] hours; p<0.001). The hospitalisation rate during the study period was 21.3% across all regions, with no statistical difference between centres (p=0.651). Reasons for hospitalisation included disease activity (36 [12%]), infection (19 [6.3%]), surgery (10 [3.3%]), and management of clinical morbidities (6 [2.0%]). Hospitalisation was associated with ethnicity (p<0.016), occupational status (p<0.001), age (p=0.02), and the use of hydroxychloroquine (HCQ) or chloroquine (CQ; p<0.001). This nationwide study highlights ethnic, social, and patterns-of-care disparities among Brazilian patients with SLE. The modelling shows evidence that such disparities contribute to the divergent clinical spectrum observed in Brazil. GSK ANA, antinuclear antibody Medical writing assistance was provided by Helen Taylor, Fishawack Indicia Ltd., UK, part of Fishawack Health, and was funded by GSK. Mirhelen Abreu Grant/research support from: GSK, Amgen, Biogen, Libbs, Odirlei Monticielo Speakers bureau: GSK, AbbVie, UCB, Roche, Novartis, Consultant of: GSK, AbbVie, Janssen, Vander Fernandes Speakers bureau: Janssen, Novartis, Roche, AbbVie, Pfizer, Grant/research support from: Novartis, GSK, Pfizer, Alexandre Cristovão Maiorano: None declared, Fernando dos Santos Beserra: None declared, Flavia Lamarao Employee of: GSK, Nathalie David Shareholder of: GSK, Employee of: GSK, Bruna de Veras Employee of: GSK, Blanca Bica: None declared, Domingos Sávio Nunes de Lima Grant/research support from: GSK, Marta Maria das Chagas Medeiros: None declared [Display omitted]

Juvenile systemic sclerosis (jSSc) is a rare disease in childhood. To date, no composite response index exists to assess treatment effect in jSSc patients. ACR CRISS score (probability of improvement ranging from 0 to 1 based on mRSS, FVC%, PtGA, MDGA and HAQ-DI) and revised ACR CRISS (rCRISS, proportion of patients who improve in ≥ 3/5 ACR CRISS core items by a certain percentage, e.g. 30%, except 5% for FVC) were developed by experts in the field as outcome measures in adult patients with SSc. In addition, the Ranked Composite Important Difference (RCID) score was recently introduced as anchor to the ACR CRISS. We aimed to study the applicability and performance of the ACR CRISS, rCRISS and RCID in a prospectively followed cohort of patients with diffuse cutaneous jSSc. Data from the international jSSc inceptions cohort were used for this analysis. The ACR CRISS, rCRISS and RCID were calculated between baseline and 12-months follow-up according to the scoring algorithms. Missing values in the core items were estimated by multiple imputation by chained equations. Here we aimed to determine the value of the response measures to detect clinically change defined by the anchor questions about change (much better or little better versus almost the same, little worse or much worse) in patients overall health due to scleroderma since the last visit provided by the treating physicians and parents or patients (aged > 12 years). We included 95 jSSc patients with diffuse cutaneous subtype with available baseline and 12-months visit. Seventy-nine percent were female, the mean age at enrollment was 13.0 (3.8) and the mean disease duration was 3.1 (2.8) years. Among 95 patients, 57% were treated with steroids, 47% with methotrexate, 27% with MMF and 3% with a biological at baseline. ACR CRISS showed a ceiling effect (>.998) in 51% and a floor effect (<0.005) in 26% of patients. Patients who reported at least moderate improvement had a median ACR CRISS of 0.99 and in mean 2.6 (1.3) core items that improved by ≥20% from baseline to 12-months follow-up. The rCRISS 20/30/50 responses were 59%/49%/33% in patients who reported improvement (table 1) and 25%/25%/8% in patients with worsening. The RCID was approximately normal distributed (mean 20.7, SD 43.4). Mean (SD) RCID for patients who reported worsening was -10.5 (38.6) vs RCID of 20.7 (45.2) for patients who reported improvement. RCID scores for physician reported anchors of worsening or improvement were 6.5 (44.2) and 18 (45.4), respectively. The concordance between a positive RCID score and rCRISS 20/30 was moderate (rCRISS 20 and RCID, 43%, kappa=0.43; rCRISS 30 and RCID, 38%, kappa=0.36). Our data confirmed the presence of a ceiling and floor effect of ACR CRISS as shown in studies of adult SSc patients. The CRISS, rCRISS and RCID response distinguished between patients who rated their disease course since last visit as worsened or improved. Future studies should focus on the determination of specific pediatric weights for the CRISS and RCID components rather than extrapolation from adult SSc. In general, the RCID offers a meaningful tool in order to determine response to therapy in future clinical trials in jSSc patients. NIL. NIL. None Declared. Table 1ACR CRISS, rCRISS and RCID score by patients and physicians ratings about scleroderma disease courseWorsening/ no improvement reported by patients(n=12)Improvement reported by patients(n=49)P valueWorsening/ no improvement reported by physicians(n=14)Improvement reported by physicians(n=50)P valueMedian ACR CRISS score (IQR)0.0 (0 to 0.75)0.99 (0 to 1.0)0.0070.35 (0 to 0.99)0.99 (0 to 1.0)0.037rCRISS response 20%3(25%)29 (59%)0.0345 (36%)29 (58%)0.140rCRISS response 30%3 (25%)24 (49%)0.1342 (14%)27 (54%)0.008rCRISS response 50%1 (8%)16 (33%)0.0920 (0%)18 (36%)0.008Mean RCID score (SD)-10.5 (38.6)20.7 (45.2)0.0316.5 (44.2)18 (45.4)0.411CRISS = Composite Response Index in Systemic Sclerosis; RCID=Ranked Compsoite Important Difference; rCRISS = revised Composite Response Index in Systemic Sclerosis; SD = standard deviation

Background:Mental health was widely affected during the new coronavirus pandemic. In addition, some measures adopted by most countries in order to contain the virus spread, such as isolation and social distancing, leading to the interruption of routine activities, including partial or complete interruption of face-to-face classes may be associated with increased stress, depression and anxiety among undergraduate medical students (1). From March to September, 2020, the Brazilian Society of Rheumatology carried out the Mario Pinotti II Project (MPII), a prospective, multicenter, observational cohort study designed to monitor the COVID-19 in patients with rheumatic disease on hydroxychloroquine, using periodic telephone calls performed by undergraduate medical students (2).Objectives:To compare the mental health status of medical students who were participating from the MPII with theirs colleagues not involved in this project.Methods:A web-based survey via google forms platform was developed by a panel composed of undergraduate medical students, rheumatologists, medical school professors, and a psychology professor. It included details on demographic and life habits data and domains regarding depression, anxiety and stress, using the DASS-21 (Depression, Anxiety & Stress Scale), Brazilian version. Data collection occurred from July 20th to August 31st, 2020. Statistical analysis was performed using the SPSS version 20.0. Univariate and multivariate linear regression analysis were performed to verify associations with the DASS-21, defined as dependent variable. A p-value < 0.05 was deemed as significant. This study was approved by the Institutional Research Ethics Committee.Results:A total of 684 undergraduate medical students were included in this study, of whom 228 as MPII volunteers (VG) and 456 as control group (CG). Median age was 23 years (IQ 21-24) and the CG was older than the VG (p<0.03). Most of them were white (68.8%) and women (63%). There were no significant differences regarding comorbidities, ethnicity, smoking status, alcohol intake and physical activity. Older age, male gender, participation of MPII study, absence of a worsening in sleep pattern during the pandemic and a lower number of prior comorbidities were associated with lower DASS21 scores, suggesting a better mental health (Table 1).Conclusion:Several aspects may be involved with mental health, including increased emotional maturity, gender and sleep pattern. Although with marginal independent association, medical students with participation in the MPII study had better mental health than their student colleagues not engaged with this research. Our data pointed out that voluntary participation in a research project which foresees interaction by telephone contact with rheumatic patients, professors, rheumatologists, and colleagues is associated with better mental health.References:[1]Meo SA, Abukhalaf AA, Alomar AA, Sattar K, Klonoff DC. Covid-19 pandemic: Impact of quarantine on medical students’ mental wellbeing and learning behaviors. Pakistan J Med Sci 2020;36(COVID19-S4):S43–8.[2]Gomides A, Ferreira G, Kakehas A, Lacerda M, Marques C, Paiva E et al. Impact of chronic use of antimalarials on SARS-COV-2 infection in patients with immune-mediated rheumatic diseases: protocol design for a multicentric observational cohort in Brazil. JMIR Research Protocols, 2020.PreprintTable 1.Univariate and multivariate analysis of predictors associated to the DASS-21 in undergraduate medical students during the COVID-19 pandemicUnivariate analysisMultivariate analysisVariableB95%CIp-ValueB95%CIp-ValueAge-0.32-0.61 to -0.030.03-0.47-0.81 to -0.130.008Female gender4.883.021 to 6.76<0.001---Stable love relationship-2.49-4.35 to -0.640.008-2.5-4.4 to -0.590.01Number of previous comorbidities reported4.693.71 to 5.68<0.0014.823.73 to 5.92<0.001MP-II volunteering-2.81-4.74 to -0.860.005---Worsening in sleep pattern6.414.62 to 8.20<0.0015.013.07 to 6.96<0.001Disclosure of Interests:None declared

Background:The role of chronic use of hydroxychloroquine (HCQ) in rheumatic disease (RD) patients during the SARS-CoV-2 pandemic is still subject of discussion.Objectives:To compare the occurrence of COVID-19 and its outcomes between RD patients on HCQ use with individuals from the same household not taking the drug during community viral transmission in an observational prospective multicenter study in Brazil.Methods:Participants were enrolled and monitored through 24-week (From March 29th to Sep 30th, 2020) regularly scheduled phone calls performed by trained medical professionals. Epidemiological and demographic data, as well as RD disease activity status and current treatment data, specific information about COVID-19, hospitalization, need for intensive care, and death was recorded in both groups and stored in the Research Electronic Data Capture (REDCap) database. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. The statistical analysis was performed using IBM-SPSS v.20.0 software. Group comparisons were made using the Man-Whitney, Chi-Square and Fisher Exact Test, as well as multivariate regression models adjusted to confounders. Survival curves were performed using Kaplan-Meier analysis.Results:A total of 10,427 participants mean age (SD) of 44.04 (14.98) years were enrolled, including 6004 (57.6%) rheumatic disease patients, of whom 70.8% had systemic lupus erythematosus (SLE), 6.7% rheumatoid arthritis (RA), 4% primary Sjögren’s syndrome (pSS), 1.8% mixed connective tissue disease (DMTC), 1% systemic sclerosis (SSc) and others (15.9), including overlap syndromes. In total, 1,132 (10.8%) participants fulfilled criteria for COVID-19, being 6.7% RD patients and 4.1% controls (p=0.002). A recent influenza vaccination had a protective role (p<0.001). Moderate and severe COVID-19 included the need for hospitalization, intensive care, mechanical ventilation or death. Infection severity was not different between groups (p=0.391) (Table 1). After adjustments for multiple confounders, the main risk factors significantly associated with COVID-19 were higher education level (OR=1.29 95%CI 1.05-1.59), being healthcare professionals (OR=1.91; 95%CI 1.45-2.53), presence of two comorbidities (OR=1.31; 95%CI 1.01-1.66) and three or more comorbidities associated (OR=1.69; 95%CI 1.23-2.32). Interestingly, age >=65 years (OR=0.20; 95%CI 0.11-0.34) was negatively associated. Regarding RD, the risk factors associated with COVID-19 diagnosys were SLE (OR= 2.37; 95%CI 1.92-293), SSc (OR=2.25; 95%CI 1.05-4.83) and rituximab use (OR=1.92; 95%CI 1.13-3.26). In addition, age >=65 years (OR=5.47; 95%CI 1.7-19.4) and heart disease (OR=2.60; 95%CI 1.06-6.38) were associated with hospitalization. Seven female RD patients died, six with SLE and one with pSS, and the presence of two or more comorbidities were associated with higher mortality rate.Conclusion:Chronic HCQ use did not prevent COVID-19 in RD compared to their household cohabitants. Health care profession, presence of comorbidities LES, SSc and rituximab were identified as main risk factors for COVID-19 and aging and heart disease as higher risk for hospitalization. Our data suggest these outcomes could be considered to manage them in clinical practice.Table 1.Frequency and severity of COVID-19 in patients with rheumatic diseases on chronic use of hydroxychloroquine compared to their household controlsCOVID-19 outcomesTotal (%)GroupsPPatients (%)Controls (%)DiagnosisNo9256 (89.1)5300 (88.3)3956 (90.2)0.002Yes1132 (10.9)704 (11.7)428 (9.8)SeverityMild1059 (93.6)662 (94.0)397 (92.8)0.391Moderate52 (4.6)32 (4.5)20 (4.7)Severe21 (1.9)10 (1.4)11 (2.6)HCQ: hydroxychloroquine.Moderate and severe COVID-19 included the need for any of the following: hospitalization, intensive care, mechanical ventilation or death.Acknowledgements:To the Brazilian Society of Rheumatology for technical support and rapid nationwide mobilization.To all the 395 interviewers (medical students and physicians) who collaborated in the study and the participantsTo CNPq (Number 403442/2020-6)Disclosure of Interests:None declared

Neuropsychiatric disorders associated with systemic lupus erythematosus are very common. Treatment generally consists of glucocorticoids and immunosuppressive therapy; however, some cases are unresponsive. Electroconvulsive therapy (ECT) is a recognized treatment modality in psychiatry and is an option for refractory cases of neuropsychiatric lupus. This report describes three cases of neuropsychiatric lupus that improved with ECT after failure of antipsychotics and immunosuppressive therapy. All cases met DSM-5 criteria for catatonia (case 1: agitation, stereotypies, and grimacing; case 2: stupor, mutism, and grimacing; case 3: agitation, mutism, and stereotypies); therefore, ECT was indicated. This case series shows that ECT can be a therapeutic option in patients with neuropsychiatric lupus, especially when associated with catatonia and unresponsive to conventional treatment.

Ensemble prediction systems are becoming of more and more interest for various applications. Especially ensemble nowcasting systems are increasingly requested by different end users. In this study we introduce such an integrated probabilistic nowcasting system, En-INCA. In a case study we show the added value and increased skill of the new system and demonstrate the improved performance in comparison with a state-of-the-art LAM-EPS.

The INCA-CE (Integrated Nowcasting through Comprehensive Analysis – Central Europe) project aims at implementing a transnational weather information system as well as applications for different socio-economic sectors to reduce risks of major economic damage and loss of life caused by severe weather. Civil protection and also stakeholders from economic sectors are in a growing need of accurate and reliable short-term weather forecasts. Within INCA-CE, a state-of-the art nowcasting system (INCA) is implemented at weather services throughout the European Union's CE (Central Europe) Programme Area, providing analyses and short term forecasts to the aforementioned end-users. In a coherent approach, the INCA (Integrated Nowcasting through Comprehensive Analysis) system will be adapted for implementation and use in a number of partner countries. Within transregional working groups, the gap between short-term weather information and its downstream activities in hydrological disaster management, civil protection and road management will be bridged and best practice management and measure plans will be produced. A web-based platform for outreach to related socio-economic sectors will initiate and foster a dialogue between weather services and further stakeholders like tourism or the insurance sector, flood authorities for disaster management, and the construction industry for cost-efficient scheduling and planning. Furthermore, the project will produce a compact guideline for policy makers on how to combine structural development aspects with these new features. In the present paper, an outline of the project implementation, a short overview about the INCA system and two case studies on precipitation nowcasts will be given. Moreover, directions for further developments both within the INCA system and the INCA-CE project will be pointed out.

Background Takayasu’s arteritis (TA) is a chronic granulomatous vasculitis affecting the large and medium arteries and can result in end organ damage. The disease is rare and there are few reports about the clinical features in the pediatric population. Objectives To evaluate and to compare the clinical features of TA in Brazilian children and adolescents. Methods In this Brazilian multicenter retrospective study including 10 pediatric rheumatology centers we identified 71 children and adolescents with TA diagnosed before the age of 18 years according to the validated classification criteria for pediatric age1. Patients’ demographic, clinical, laboratory and angiographic data were collected. The angiographic type was classified according to the 1994 International Conference of Takayasu arteritis in Tokyo2. Patients were divided in 2 groups: children, younger than 10 years – group 1, and adolescents, older than or equal to 10 years – group 2 and their disease characteristics at initial presentation were compared. Results Thirty-six (50.7%) patients were in group 1 and 35 (49.3%) were in group 2. Twenty-one (58.3%) patients in group 1 and 30 (85.7%) patients in group 2 were girls (p=0.010). The mean onset age was 5.7 and 12.7 in groups 1 and 2 (p<0.001); the mean time to diagnosis was 1.8 and 0.7 in groups 1 and 2 (p= 0.001) and the mean follow-up time was 7.2 and 3.6 in groups 1 and 2 (p <0.001). The predominant clinical symptoms at onset were decreased pulses (85.9%), followed by arterial hypertension (84.5%), constitutional (77.5%) and neurological symptoms (70.4%), however without statistical differences between the two groups. The main laboratory finding was an increased erythrocyte sedimentation rate followed by leukocytosis. Anemia and thrombocytosis were significantly more frequent in group 1 (p = 0.031; p= 0.001). Angiographic data were similar in both groups. Conclusions Children under the age of 10 had more laboratory abnormalities, but similar clinical and angiographic features when compared to adolescents with TA. A delay in diagnosis is more common in younger patients and clinicians must be aware about this disease in this age group. References Ozen S, Pistorio A, Iusan SM, Bakkaloglu A, Herlin T, Brik R et al. EULAR/PRINTO/PRES criteria for Henoch-Schoenlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu’s arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis. 2010;69:798-806. Hata A, Noda M, Moriwaki R, Numano F. Angiographic findings of Takayasu arteritis: New classification. Int J Cardiol.1996;54(suppl):S155-S163. Disclosure of Interest: None Declared