Publications by authors named "Fernando Sales"

3 Publications

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Telehealth and the COVID-19 Pandemic: International Perspectives and a Health Systems Framework for Telehealth Implementation to Support Critical Response.

Yearb Med Inform 2021 Apr 21. Epub 2021 Apr 21.

Sri Sathya Sai Central Trust, Puttaparthi, India.

Objectives: Telehealth implementation is a complex systems-based endeavour. This paper compares telehealth responses to (COrona VIrus Disease 2019) COVID-19 across ten countries to identify lessons learned about the complexity of telehealth during critical response such as in response to a global pandemic. Our overall objective is to develop a health systems-based framework for telehealth implementation to support critical response.

Methods: We sought responses from the members of the International Medical Informatics Association (IMIA) Telehealth Working Group (WG) on their practices and perception of telehealth practices during the times of COVID-19 pandemic in their respective countries. We then analysed their responses to identify six emerging themes that we mapped to the World Health Organization (WHO) model of health systems.

Results: Our analysis identified six emergent themes. (1) Government, legal or regulatory aspects of telehealth; (2) Increase in telehealth capacity and delivery; (3) Regulated and unregulated telehealth; (4) Changes in the uptake and perception of telemedicine; (5) Public engagement in telehealth responses to COVID-19; and (6) Implications for training and education. We discuss these themes and then use them to develop a systems framework for telehealth support in critical response.

Conclusion: COVID-19 has introduced new challenges for telehealth support in times of critical response. Our themes and systems framework extend the WHO systems model and highlight that telemedicine usage in response to the COVID-19 pandemic is complex and multidimensional. Our systems-based framework provides guidance for telehealth implementation as part of health systems response to a global pandemic such as COVID-19.
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April 2021

West African monsoon decadal variability and surface-related forcings: Second West African Monsoon Modeling and Evaluation Project Experiment (WAMME II).

Clim Dyn 2016 Dec 13;47(11):3517-3545. Epub 2016 Jun 13.

Chinese Academy of Meteorological Sciences, Beijing, China.

The second West African Monsoon Modeling and Evaluation Project Experiment (WAMME II) is designed to improve understanding of the possible roles and feedbacks of sea surface temperature (SST), land use land cover change (LULCC), and aerosols forcings in the Sahel climate system at seasonal to decadal scales. The project's strategy is to apply prescribed observationally based anomaly forcing, i.e., "idealized but realistic" forcing, in simulations by climate models. The goal is to assess these forcings' effects in producing/amplifying seasonal and decadal climate variability in the Sahel between the 1950s and the 1980s, which is selected to characterize the great drought period of the last century. This is the first multi-model experiment specifically designed to simultaneously evaluate such relative contributions. The WAMME II models have consistently demonstrated that SST forcing is a major contributor to the 20 century Sahel drought. Under the influence of the maximum possible SST forcing, the ensemble mean of WAMME II models can produce up to 60% of the precipitation difference during the period. The present paper also addresses the role of SSTs in triggering and maintaining the Sahel drought. In this regard, the consensus of WAMME II models is that both Indian and Pacific Ocean SSTs greatly contributed to the drought, with the former producing an anomalous displacement of the Intertropical Convergence Zone (ITCZ) before the WAM onset, and the latter mainly contributes to the summer WAM drought. The WAMME II models also show that the impact of LULCC forcing on the Sahel climate system is weaker than that of SST forcing, but still of first order magnitude. According to the results, under LULCC forcing the ensemble mean of WAMME II models can produces about 40% of the precipitation difference between the 1980s and the 1950s. The role of land surface processes in responding to and amplifying the drought is also identified. The results suggest that catastrophic consequences are likely to occur in the regional Sahel climate when SST anomalies in individual ocean basins and in land conditions combine synergistically to favor drought.
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December 2016

Evaluation of plaque composition by intravascular ultrasound "virtual histology": the impact of dense calcium on the measurement of necrotic tissue.

EuroIntervention 2010 Aug;6(3):394-9

Heart Institute, University of São Paulo Medical School, Brazil.

Aims: We aimed to evaluate if the co-localisation of calcium and necrosis in intravascular ultrasound virtual histology (IVUS-VH) is due to artefact, and whether this effect can be mathematically estimated.

Methods And Results: We hypothesised that, in case calcium induces an artefactual coding of necrosis, any addition in calcium content would generate an artificial increment in the necrotic tissue. Stent struts were used to simulate the "added calcium". The change in the amount and in the spatial localisation of necrotic tissue was evaluated before and after stenting (n=17 coronary lesions) by means of a especially developed imaging software. The area of "calcium" increased from a median of 0.04 mm2 at baseline to 0.76 mm2 after stenting (p<0.01). In parallel the median necrotic content increased from 0.19 mm2 to 0.59 mm2 (p<0.01). The "added" calcium strongly predicted a proportional increase in necrosis-coded tissue in the areas surrounding the calcium-like spots (model R2=0.70; p<0.001).

Conclusions: Artificial addition of calcium-like elements to the atherosclerotic plaque led to an increase in necrotic tissue in virtual histology that is probably artefactual. The overestimation of necrotic tissue by calcium strictly followed a linear pattern, indicating that it may be amenable to mathematical correction.
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August 2010