Determinants and Differences in Satisfaction with the Inhaler Among Patients with Asthma or COPD

Satisfaction with the inhaler is an important determinant of treatment adherence in patients with asthma and chronic obstructive pulmonary disease (COPD). However, few studies have compared these 2 groups to identify the factors associated with satisfaction with the inhaler. To assess and compare satisfaction with the inhaler in patients with asthma or COPD and to determine the variables associated with high inhaler satisfaction. A multicenter, cross-sectional study of 816 patients (406 with asthma and 410 with COPD) was conducted. Satisfaction was assessed with the Feeling of Satisfaction with Inhaler (FSI-10) questionnaire. All participants completed the Test of Adherence to Inhalers and either the Asthma Control Test (ACT) or the COPD Assessment Test (CAT). Overall, the asthma group was significantly more satisfied with the inhaler (mean [standard deviation] FSI-10 scores: 44.1 [6.5] vs 42.0 [7.7]; P <.001) and more satisfied on most (7 of 10; 70%) items. Patients with asthma were significantly more satisfied with the inhaler regardless of the adherence level or the type of nonadherence pattern. Younger age, good disease control (ACT ≥20 or CAT ≤10), previous inhaler training, and absence of unwitting nonadherence were all independently and significantly associated with high inhaler satisfaction. Age, disease control, and training in inhalation technique all play a more significant role than the specific diagnosis in explaining satisfaction with the device in patients with asthma and COPD. These findings underscore the need to provide better training and more active monitoring of the inhalation technique to improve patient satisfaction, treatment adherence, and clinical outcomes

The European Solar Telescope

The European Solar Telescope (EST) is a project aimed at studying the magnetic connectivity of the solar atmosphere, from the deep photosphere to the upper chromosphere. Its design combines the knowledge and expertise gathered by the European solar physics community during the construction and operation of state-of-the-art solar telescopes operating in visible and near-infrared wavelengths: the Swedish 1m Solar Telescope, the German Vacuum Tower Telescope and GREGOR, the French Télescope Héliographique pour l'Étude du Magnétisme et des Instabilités Solaires, and the Dutch Open Telescope. With its 4.2 m primary mirror and an open configuration, EST will become the most powerful European ground-based facility to study the Sun in the coming decades in the visible and near-infrared bands. EST uses the most innovative technological advances: the first adaptive secondary mirror ever used in a solar telescope, a complex multi-conjugate adaptive optics with deformable mirrors that form part of the optical design in a natural way, a polarimetrically compensated telescope design that eliminates the complex temporal variation and wavelength dependence of the telescope Mueller matrix, and an instrument suite containing several (etalon-based) tunable imaging spectropolarimeters and several integral field unit spectropolarimeters. This publication summarises some fundamental science questions that can be addressed with the telescope, together with a complete description of its major subsystems

Global Retinoblastoma Presentation and Analysis by National Income Level

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4) were female. Most patients (n = 3685 84.7%) were from low-and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 62.8%), followed by strabismus (n = 429 10.2%) and proptosis (n = 309 7.4%). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 95% CI, 12.94-24.80, and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 95% CI, 4.30-7.68). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs. © 2020 American Medical Association. All rights reserved

Promoción de la Educación del Carácter mediante el CAS del Bachillerato Internacional

Este artículo analiza el componente CAS (Creatividad, Actividad y Servicio) del Bachillerato Interna- cional, y su relación con la Educación del Carácter. El CAS promueve fortalezas del carácter planteadas en distintos programas de Educación del Carácter. No obstante, en la bibliografía existente no se han identificado de manera explícita estas relaciones entre CAS y carácter. Con el objetivo de hallar los tipos de Educación del Carácter que se trabajan en el CAS, este trabajo presenta una revisión sistemática de la literatura (SLR) siguiendo el método PRISMA. Se encontraron 99 trabajos, de los cuales finalmente se incluyeron 17 en el análisis, tras aplicar los criterios de inclusión y exclusión. Distintas tipologías de Educación del Carácter aparecen reflejadas en todos ellos. La Educación del Carácter se encuentra inmersa en el programa CAS de diversos modos, tales como Educación en habilidades para la vida, Aprendizaje-servicio o Educación moral, entre otros. Por tanto, existe una dificultad en la literatura para definir carácter y Educación del Carácter, dado que es un concepto elástico y controvertido o, como algunos autores apuntan, un concepto paraguas.This article analyzes the CAS component (Creativity, Activity and Service) of the International Baccalaureate, and its relationship with Character Education. The CAS promotes character strengths raised in different Character Education programs. However, these relationships between CAS and character have not been explicitly identified in the existing literature. In order to find the types of Character Education that are worked on in the CAS, this work presents a systematic review of the literature (SLR) following the PRISMA method. 99 works were found, of which 17 were finally included in the analysis, after applying the inclusion and exclusion criteria. Different typologies of Character Education are reflected in all of them. Character Education is immersed in the CAS program in various ways, such as Life Skills Education, Service-Learning or Moral Education, among others. Therefore, there is a difficulty in the literature to define character and Character Education, since it is an elastic and controversial concept or, as some authors point out, an umbrella concept

Promoción de la Educación del Carácter mediante el CAS del Bachillerato Internacional

Este artículo analiza el componente CAS (Creatividad, Actividad y Servicio) del Bachillerato Interna- cional, y su relación con la Educación del Carácter. El CAS promueve fortalezas del carácter planteadas en distintos programas de Educación del Carácter. No obstante, en la bibliografía existente no se han identificado de manera explícita estas relaciones entre CAS y carácter. Con el objetivo de hallar los tipos de Educación del Carácter que se trabajan en el CAS, este trabajo presenta una revisión sistemática de la literatura (SLR) siguiendo el método PRISMA. Se encontraron 99 trabajos, de los cuales finalmente se incluyeron 17 en el análisis, tras aplicar los criterios de inclusión y exclusión. Distintas tipologías de Educación del Carácter aparecen reflejadas en todos ellos. La Educación del Carácter se encuentra inmersa en el programa CAS de diversos modos, tales como Educación en habilidades para la vida, Aprendizaje-servicio o Educación moral, entre otros. Por tanto, existe una dificultad en la literatura para definir carácter y Educación del Carácter, dado que es un concepto elástico y controvertido o, como algunos autores apuntan, un concepto paraguas.This article analyzes the CAS component (Creativity, Activity and Service) of the International Baccalaureate, and its relationship with Character Education. The CAS promotes character strengths raised in different Character Education programs. However, these relationships between CAS and character have not been explicitly identified in the existing literature. In order to find the types of Character Education that are worked on in the CAS, this work presents a systematic review of the literature (SLR) following the PRISMA method. 99 works were found, of which 17 were finally included in the analysis, after applying the inclusion and exclusion criteria. Different typologies of Character Education are reflected in all of them. Character Education is immersed in the CAS program in various ways, such as Life Skills Education, Service-Learning or Moral Education, among others. Therefore, there is a difficulty in the literature to define character and Character Education, since it is an elastic and controversial concept or, as some authors point out, an umbrella concept

Promoción de la Educación del Carácter mediante el CAS del Bachillerato Internacional

Este artículo analiza el componente CAS (Creatividad, Actividad y Servicio) del Bachillerato Interna- cional, y su relación con la Educación del Carácter. El CAS promueve fortalezas del carácter planteadas en distintos programas de Educación del Carácter. No obstante, en la bibliografía existente no se han identificado de manera explícita estas relaciones entre CAS y carácter. Con el objetivo de hallar los tipos de Educación del Carácter que se trabajan en el CAS, este trabajo presenta una revisión sistemática de la literatura (SLR) siguiendo el método PRISMA. Se encontraron 99 trabajos, de los cuales finalmente se incluyeron 17 en el análisis, tras aplicar los criterios de inclusión y exclusión. Distintas tipologías de Educación del Carácter aparecen reflejadas en todos ellos. La Educación del Carácter se encuentra inmersa en el programa CAS de diversos modos, tales como Educación en habilidades para la vida, Aprendizaje-servicio o Educación moral, entre otros. Por tanto, existe una dificultad en la literatura para definir carácter y Educación del Carácter, dado que es un concepto elástico y controvertido o, como algunos autores apuntan, un concepto paraguas.This article analyzes the CAS component (Creativity, Activity and Service) of the International Baccalaureate, and its relationship with Character Education. The CAS promotes character strengths raised in different Character Education programs. However, these relationships between CAS and character have not been explicitly identified in the existing literature. In order to find the types of Character Education that are worked on in the CAS, this work presents a systematic review of the literature (SLR) following the PRISMA method. 99 works were found, of which 17 were finally included in the analysis, after applying the inclusion and exclusion criteria. Different typologies of Character Education are reflected in all of them. Character Education is immersed in the CAS program in various ways, such as Life Skills Education, Service-Learning or Moral Education, among others. Therefore, there is a difficulty in the literature to define character and Character Education, since it is an elastic and controversial concept or, as some authors point out, an umbrella concept

Endocrine disruptor activity in waters from turbot aquaculture

International audienc

Endocrine disruptor activity in waters from turbot aquaculture

International audienc

Characterisation of bioactive compounds in infant formulas using immobilised recombinant estrogen receptor-alpha affinity columns.

In this study, the use of recombinant estrogen receptor alpha (ER alpha)-based affinity columns was reported, for the isolation and the identification of estrogenic substances present in complex matrices, focusing on bioactive compounds present in foodstuff. The capability of affinity columns to trap high, but also low-affinity radio-labelled ligands (17 beta-estradiol, genistein and bisphenol A) was demonstrated. Three pooled samples of infant formulas (milk-based, hypoallergenic and soy-based formulas for infants aged 0-4 months) from a EU market basket were prepared by the CASCADE Network of Excellence. After determining the estrogenic activity of these food samples, human recombinant ER alpha ligand binding domain (LBD) based affinity columns combined with suitable analytical methods (high resolution LC-MS/MS) were used to identify the bioactive compounds present in the soy-based formula extract, namely phytoestrogens (genistein and daidzein) involved in the agonistic activity measured. Incubations of genistein with liver microsomes were carried out and the extracts analysed following the same protocol, demonstrating that hER alpha affinity columns can also be used for trapping active metabolites. This approach combining bioluminescent cell lines with this useful tool based on hER alpha-LBD affinity columns thus allowed the purification and the concentration of both known and unknown estrogenic ligands prior to investigation of their structure using LC-MS