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

Direct fabrication and IV characterization of sub-surface conductive channels in diamond with MeV ion implantation

Abstract. In the present work we report about the investigation of the conduction mechanism of sp2 carbon micro-channels in single crystal diamond. The structures are fabricated with a technique which employs a MeV focused ion-beam to damage diamond in conjunction with variable thickness masks. This process changes significantly the structural properties of the target material, because the ion nuclear energy loss induces carbon conversion from sp3 to sp2 state mainly at the end of range of the ions (few micrometers). Furthermore, placing a mask with increasing thickness on the sample it is possible to modulate the channels depth at their endpoints, allowing their electrical connection with the surface. A single-crystal HPHT diamond sample was implanted with 1.8 MeV He+ ions at room temperature, the implantation fluence was set in the range 2.1 × 10 16 −6.3 × 10 17 ions cm−2 , determining the formation of micro-channels with a graded level of damage extending down to a depth of about 3 μm. After deposition of metallic contacts at the channels’ endpoints, the electrical characterization was performed measuring the I -V curves at variable temperatures in the 80 −690 K range. The Variable Range Hopping model was used to fit the experimental data in the ohmic regime, allowing the estimation of characteristic parameters such as the density of localized states at the Fermi level. A value of 5.5 × 10 17 states cm−3 eV−1 was obtained, in satisfactory agreement with values previously reported in literature. The power-law dependence between current and voltage is consistent with the space charge limited mechanism at moderate electric field

The Iberian Middle Jurassic carbonate-platform system: Synthesis of the palaeogeographic elements of its eastern margin (Spain)

During the Middle Jurassic, the domain of the Iberian and Catalan Coastal ranges of eastern Spain was occupied by a system of fault-controlled carbonate platforms that flanked the Iberian Massif to the East. This platform system marked the transition between the shelves of the Alpine Tethys and the Central Atlantic Ocean. The palaeogeographic reconstruction of the Iberian Middle Jurassic platform system is based on more than 199 surface sections and 37 wells. From southwest to northeast, eight main palaeogeographic elements with associated characteristic facies are recognized. These represent a system of horsts and grabens. In the southwest, the Internal Castilian Platform is characterized by the frequently dolomitized oolitic and restricted facies of the Yemeda Formation. To the northeast, the NW-trending open-marine carbonate environments of the External Castilian and Aragonese platforms were separated by the fault-controlled El Maestrazgo High that is characterized mainly by the dolomitized Rafales Formation. The External Castilian and Aragonese platforms consist from bottom to top of the microfilament mudstones to wackestones of the El Pedregal Formation, the bioclastic and oolitic grainstones to packstones of the Moscardon Formation, and the Domen˜o Formation, that reflects a return to an open-marine low-energy wackestone to mudstone facies, locally containing patches of oolitic grainstones. The highly subsiding Tortosa Platform, represented by the Sant Blai, Cardo and La Tossa formations, is bounded by the dolomitic facies deposited on the El Maestrazgo and the Tarragona highs, and by the Catalan Massif where no Middle Jurassic deposits have been recorded. The open-marine facies and condensed sections of the Beceite Strait separated the Aragonese and Tortosa platforms. A regional stratigraphical gap spanning the upper Callovian Lamberti Zone to the lower Oxfordian Cordatum Zone is evident. A system of northwest- and northeast-trending normal faults controlled thickness and facies distribution. Data from the Iberian carbonate-platform system indicate that expanded sections were not necessarily associated with open-marine environments. Condensed and expanded sections are developed in open and restricted-marine facies, even on such palaeogeographic highs as the El Maestrazgo High. Restricted and shallow-marine environments occasionally developed in parts of the External Castilian Platform