Development of multilayer Hydroxyapatite - Ag/TiN-Ti coatings deposited by radio frequency magnetron sputtering with potential application in the biomedical field

"NOTICE: this is the author's version of a work that was accepted for publication in Surface and Coatings Technology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Surface and Coatings Technology, VOL 377, (2019) DOI 10.1016/j.surfcoat.2019.06.097"[EN] The use of composite coatings is emerging as a great alternative to conventional coatings, allowing the combination of different superficial properties that are widely desired in surgical implants, such as osteointegration and bactericidal character, and cannot be provided by one material alone. In the present investigation the effect of the incorporation of a TiN-Ti intermediate bilayer on the chemical composition, structure, morphology, roughness, residual stresses and adhesion of a multi-layer Hydroxyapatite (HA)-Ag coating deposited on Ti-6Al-4V by magnetron sputtering was evaluated. Additionally, the cytotoxicity of the developed system was evaluated by in vitro tests. According to the results obtained, a decrease in the Ca/P ratio from 1.85 to 1.74 was obtained through the deposition of an HA-Ag system on the intermediate bilayer, and the crystallinity of the developed coating was favored. The multi-layer structure was effectively observed by field emission scanning electron microscopy, where it was possible to identify each of the HA, Ag, TiN and Ti layers. Meanwhile, an increase of 7% in crystallite size, a decrease of 36% in residual stresses and an increase of 32% in adhesion were registered for this composite coating compared to the free intermediate bilayer system. Finally, biological evaluation allowed the non-cytotoxic character of the deposited coatings to be confirmed.We thank the University of Antioquia, the Centro de Investigation, Innovation y Desarrollo de materiales (CIDEMAT) group, the Departamento Administrativo de Ciencia, Tecnologia e Innovation (COLCIENCIAS) for financing the Project 15-1696, the scholarship program of Enlazamundos, PR and JLGR acknowledge financial support from the Spanish Ministry of Economy and Competitiveness (MINECO) through the project MAT2016-76039-C4-1-R (AEI/FEDER, UE) (including the FEDER financial support). CIBER-BBN is an initiative funded by the VI National R&D&I Plan 2008-2011, Iniciativa Ingenio 2010, Consolider Program. CIBER Actions are financed by the Institute de Salud Carlos III with assistance from the European Regional Development Fund.Lenis, J.; Bejarano, G.; Rico Tortosa, PM.; Gómez Ribelles, JL.; Bolívar, F. (2019). Development of multilayer Hydroxyapatite - Ag/TiN-Ti coatings deposited by radio frequency magnetron sputtering with potential application in the biomedical field. Surface and Coatings Technology. 377:1-9. https://doi.org/10.1016/j.surfcoat.2019.06.097S19377Melero, H., Fernández, J., & Guilemany Casadamon, J. M. (2011). Recubrimientos bioactivos: Hidroxiapatita y titania. Biomecánica, 19(1). doi:10.5821/sibb.v19i1.1814Ozeki, K., Yuhta, T., Fukui, Y., & Aoki, H. (2002). Phase composition of sputtered films from a hydroxyapatite target. Surface and Coatings Technology, 160(1), 54-61. doi:10.1016/s0257-8972(02)00363-8Nelea, V., Morosanu, C., Iliescu, M., & Mihailescu, I. N. (2003). 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Controlled clinical trial comparing the effectiveness of a mindfulness and self-compassion 4-session programme versus an 8-session programme to reduce work stress and burnout in family and community medicine physicians and nurses: MINDUUDD study protocol

Background: Health personnel are susceptible to high levels of work stress and burnout due to the psychological and emotional demands of their work, as well as to other aspects related to the organisation of that work. This paper describes the rationale and design of the MINDUUDD study, the aim of which is to evaluate the effectiveness of a mindfulness and self-compassion 4-session programme versus the standard 8-session programme to reduce work stress and burnout in Family and Community Medicine and Nursing tutors and residents. Methods: The MINDUDD study is a multicentre cluster randomised controlled trial with three parallel arms. Six Teaching Units will be randomised to one of the three study groups: 1) Experimental Group-8 (EG8); 2) Experimental Group-4 (EG4) Control group (CG). At least 132 subjects will participate (66 tutors/66 residents), 44 in the EG8, 44 in the EG4, and 44 in the CG. Interventions will be based on the Mindfulness-Based Stress Reduction (MBSR) program, including some self-compassion practices of the Mindful Self-Compassion (MSC) programme. The EG8 intervention will be implemented during 8 weekly face-to-face sessions of 2.5 h each, while the EG4 intervention will consist of 4 sessions of 2.5 h each. The participants will have to practice at home for 30 min/day in the EG8 and 15 min/day in the EG4. The Five Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale (SCS), Perceived Stress Questionnaire (PSQ), Maslach Burnout Inventory (MBI), Jefferson Scale of Physician Empathy (JSPE), and Goldberg Anxiety-Depression Scale (GADS) will be administered. Measurements will be taken at baseline, at the end of the programs, and at three months after completion. The effect of the interventions will be evaluated by bivariate and multivariate analyses (Multiple Linear Regression). Discussion: If the abbreviated mindfulness programme is at least as effective as the standard program, its incorporation into the curriculum and training plans will be easier and more appropriate. It will also be more easily applied and accepted by primary care professionals because of the reduced resources and means required for its implementation, and it may also extend beyond care settings to academic and teaching environments as well

Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo

Objetivo Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad. Material y métodos Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2.864 pacientes. Resultados Utilizando datos retrospectivos, 81 de los 314 médicos (25, 8% [IC del 95%, 21, 3 a 30, 9]) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28, 0% [IC del 95%, 23, 4 a 33, 2]) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0, 19, IC del 95%, 0, 13 a 0, 28) y presentar un asma persistente grave al inicio del estudio (OR 0, 20, IC del 95%, 0, 12 a 0, 34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1, 70, IC del 95%, 1, 40 a 2, 06). Conclusiones El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma. Objective: To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods: We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results: Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions: Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines