Analysis of the Adherence and Safety of Second Oral Glucose-Lowering Therapy in Routine Practice From the Mediterranean Area : A Retrospective Cohort Study

Altres ajuts: AstraZeneca/ESR-16-12628Altres ajuts: Applied Research Collaboration East Midlands (ARC EM)Altres ajuts: National Institute for Health Research (NIHR)Altres ajuts: Imperial Biomedical Research Centre (NIHR)The aims of our study was compare adherence measured by the medical possession ratio (MPR), time until discontinuation and describe adverse events after adding a DPP-4i, SGLT-2i, or sulfonylureas (SU) to metformin in a primary care population with insufficient glycemic control. We used routinely-collected health data from the SIDIAP database. The included subjects were matched by propensity score. The follow-up period was up to 24 months or premature discontinuation. The primary outcomes were the percentage of subjects with good adherence, treatment discontinuation and adverse events among treatment groups. The proportion of patients with good adherence (MPR> 0.8) after the addition of DPP-4i, SGLT-2i or SU was 53.6%, 68.7%, and 43.0%, respectively. SGLT-2i users were 1.7 times more likely to achieve good adherence compared with DPP-4i users (odds ratio [OR]:1.72, 98% confidence interval [CI]:1.51, 1.96), and 2.8 times more likely compared with SU users (OR: 0.35, 98% CI: 0.07, 0.29). The discontinuation hazard ratios were 1.43 (98%CI: 1.26; 1.62) and 1.60 (98%CI: 1.42; 1.81) times higher among SGLT-2i and SU users than DPP-4i users during the follow-up period. No differences were observed for adverse events among the treatment groups. In conclusion, in our real-world setting, the combination of SGLT-2i with metformin was associated with better adherence. The mean time until discontinuation was longer in the SGLT-2i group in comparison with the DPP-4i or SU groups

Los estudiantes de medicina españoles y la medicina de familia. Datos de las 2 fases de una encuesta estatal

Objetivo Explorar percepciones y expectativas de estudiantes de los cursos 1.°, 3.° y 5.° de las facultades de medicina sobre medicina de familia y comunitaria (MFyC) y atención primaria (AP). Diseño Estudio observacional con administración de un cuestionario en 2 cortes transversales con un intervalo de 2 años. Emplazamiento Facultades de medicina españolas. Participantes Estudiantes de los cursos 1.°, 3.° y 5.° de 22 facultades (1.a fase) y 15 en la segunda. Mediciones principales Cuestionario autocumplimentado administrado durante el primer trimestre de los cursos 2009-2010 y 2011-2012. Consta de 70 ítems en 3 bloques: percepciones sobre MFyC (19 ítems), formación en MFyC (26 ítems), expectativas y preferencias (25 ítems), más 13 ítems específicos para alumnos de 3.° y 5.°. La mayoría se respondían según una escala Likert (de 1 a 6). Resultados En la 1.a fase se obtuvieron 5.299 cuestionarios y 3.869 en la segunda. Los estudiantes perciben la MFyC y AP como un ámbito esencial del sistema sanitario y de ejercicio profesional pero con escaso atractivo científico-técnico. El 87% consideran necesaria y obligatoria la formación en MFyC y que debería iniciarse en el 3.er curso. Prefieren las especialidades médicas hospitalarias (88-89%) seguidas de las quirúrgicas y la pediatría. La MFyC es preferida por el 37-39%. Al iniciar la carrera solamente entre el 24 y el 28% de los estudiantes tienen una decisión clara sobre la especialidad que van a escoger. Conclusiones La MFyC y la AP son ámbitos esenciales y han de formar parte de los currículum pero tienen una baja consideración científica. Objective: To examine the perceptions and expectations about Family Practice (FP) and Primary Care (PC) in 1st, 3rd and 5th year students in medical schools. Design: An observational study in two cross sections with intervals of two years. Location: Spanish Medical Schools. Participants: 1st, 3rd and 5th year students of 22 schools (1st phase) and 15 (second phase). Primary measurements: Self-report questionnaires completed during the first quarter of the 2009-2010 and 2011-2012 academic years. It had 70 items in three blocks: perceptions of FP (19 items), training in FP (26 items), expectations and preferences (25 items), plus 13 specific items for 3rd and 5th year students. Most of the items were answered in a 6 point Likert scale. Results: A total of 5299 responses in phase I, and 3869 in phase II were received. Students perceive FP and PC as essential areas of the health system and professional practice, but with little scientific and technical appeal. The large majortiy, 87%, consider training in FP necessary and compulsory, and it should start in third year. They prefer hospital medical specialities (88-89%), followed by surgical and paediatrics. FP is preferred by the 37-39%. Only between 24% and 28% of students have a clear preference for a specialty when they start medical studies. Conclusions: FP and PC are key areas and should be part of the curriculum, but are perceived to be of low scientific appeal

Modifiable risk factors associated with prediabetes in men and women: A cross-sectional analysis of the cohort study in primary health care on the evolution of patients with prediabetes

Background: Prediabetes is a high-risk state for diabetes development, but little is known about the factors associated with this state. The aim of the study was to identify modifiable risk factors associated with the presence of prediabetes in men and women. Methods: Cohort Study in Primary Health Care on the Evolution of Patients with Prediabetes (PREDAPS-Study) is a prospective study on a cohort of 1184 subjects with prediabetes and another cohort of 838 subjects without glucose metabolism disorders. It is being conducted by 125 general practitioners in Spain. Data for this analysis were collected during the baseline stage in 2012. The modifiable risk factors included were: smoking habit, alcohol consumption, low physical activity, inadequate diet, hypertension, dyslipidemia, and obesity. To assess independent association between each factor and prediabetes, odds ratios (ORs) were estimated using logistic regression models. Results: Abdominal obesity, low plasma levels of high-density lipoprotein cholesterol (HDL-cholesterol), and hypertension were independently associated with the presence of prediabetes in both men and women. After adjusting for all factors, the respective ORs (95% Confidence Intervals) were 1.98 (1.41-2.79), 1.88 (1.23-2.88) and 1.86 (1.39-2.51) for men, and 1.89 (1.36-2.62), 1.58 (1.12-2.23) and 1.44 (1.07-1.92) for women. Also, general obesity was a risk factor in both sexes but did not reach statistical significance among men, after adjusting for all factors. Risky alcohol consumption was a risk factor for prediabetes in men, OR 1.49 (1.00-2.24). Conclusions: Obesity, low HDL-cholesterol levels, and hypertension were modifiable risk factors independently related to the presence of prediabetes in both sexes. The magnitudes of the associations were stronger for men than women. Abdominal obesity in both men and women displayed the strongest association with prediabetes. The findings suggest that there are some differences between men and women, which should be taken into account when implementing specific recommendations to prevent or delay the onset of diabetes in adult population

The Robotic Multiobject Focal Plane System of the Dark Energy Spectroscopic Instrument (DESI)

A system of 5020 robotic fiber positioners was installed in 2019 on the Mayall Telescope, at Kitt Peak National Observatory. The robots automatically retarget their optical fibers every 10-20 minutes, each to a precision of several microns, with a reconfiguration time of fewer than 2 minutes. Over the next 5 yr, they will enable the newly constructed Dark Energy Spectroscopic Instrument (DESI) to measure the spectra of 35 million galaxies and quasars. DESI will produce the largest 3D map of the universe to date and measure the expansion history of the cosmos. In addition to the 5020 robotic positioners and optical fibers, DESI’s Focal Plane System includes six guide cameras, four wave front cameras, 123 fiducial point sources, and a metrology camera mounted at the primary mirror. The system also includes associated structural, thermal, and electrical systems. In all, it contains over 675,000 individual parts. We discuss the design, construction, quality control, and integration of all these components. We include a summary of the key requirements, the review and acceptance process, on-sky validations of requirements, and lessons learned for future multiobject, fiber-fed spectrographs

The Early Data Release of the Dark Energy Spectroscopic Instrument

\ua9 2024. The Author(s). Published by the American Astronomical Society. The Dark Energy Spectroscopic Instrument (DESI) completed its 5 month Survey Validation in 2021 May. Spectra of stellar and extragalactic targets from Survey Validation constitute the first major data sample from the DESI survey. This paper describes the public release of those spectra, the catalogs of derived properties, and the intermediate data products. In total, the public release includes good-quality spectral information from 466,447 objects targeted as part of the Milky Way Survey, 428,758 as part of the Bright Galaxy Survey, 227,318 as part of the Luminous Red Galaxy sample, 437,664 as part of the Emission Line Galaxy sample, and 76,079 as part of the Quasar sample. In addition, the release includes spectral information from 137,148 objects that expand the scope beyond the primary samples as part of a series of secondary programs. Here, we describe the spectral data, data quality, data products, Large-Scale Structure science catalogs, access to the data, and references that provide relevant background to using these spectra

Validation of the Scientific Program for the Dark Energy Spectroscopic Instrument

The Dark Energy Spectroscopic Instrument (DESI) was designed to conduct a survey covering 14,000 deg$^2$ over five years to constrain the cosmic expansion history through precise measurements of Baryon Acoustic Oscillations (BAO). The scientific program for DESI was evaluated during a five month Survey Validation (SV) campaign before beginning full operations. This program produced deep spectra of tens of thousands of objects from each of the stellar (MWS), bright galaxy (BGS), luminous red galaxy (LRG), emission line galaxy (ELG), and quasar target classes. These SV spectra were used to optimize redshift distributions, characterize exposure times, determine calibration procedures, and assess observational overheads for the five-year program. In this paper, we present the final target selection algorithms, redshift distributions, and projected cosmology constraints resulting from those studies. We also present a `One-Percent survey' conducted at the conclusion of Survey Validation covering 140 deg$^2$ using the final target selection algorithms with exposures of a depth typical of the main survey. The Survey Validation indicates that DESI will be able to complete the full 14,000 deg$^2$ program with spectroscopically-confirmed targets from the MWS, BGS, LRG, ELG, and quasar programs with total sample sizes of 7.2, 13.8, 7.46, 15.7, and 2.87 million, respectively. These samples will allow exploration of the Milky Way halo, clustering on all scales, and BAO measurements with a statistical precision of 0.28% over the redshift interval $z<1.1$, 0.39% over the redshift interval $1.1<z<1.9$, and 0.46% over the redshift interval $1.9<z<3.5$.Comment: 42 pages, 18 figures, accepted by A

Southern African Large Telescope Spectroscopy of BL Lacs for the CTA project

In the last two decades, very-high-energy gamma-ray astronomy has reached maturity: over 200 sources have been detected, both Galactic and extragalactic, by ground-based experiments. At present, Active Galactic Nuclei (AGN) make up about 40% of the more than 200 sources detected at very high energies with ground-based telescopes, the majority of which are blazars, i.e. their jets are closely aligned with the line of sight to Earth and three quarters of which are classified as high-frequency peaked BL Lac objects. One challenge to studies of the cosmological evolution of BL Lacs is the difficulty of obtaining redshifts from their nearly featureless, continuum-dominated spectra. It is expected that a significant fraction of the AGN to be detected with the future Cherenkov Telescope Array (CTA) observatory will have no spectroscopic redshifts, compromising the reliability of BL Lac population studies, particularly of their cosmic evolution. We started an effort in 2019 to measure the redshifts of a large fraction of the AGN that are likely to be detected with CTA, using the Southern African Large Telescope (SALT). In this contribution, we present two results from an on-going SALT program focused on the determination of BL Lac object redshifts that will be relevant for the CTA observatory

Unique nanostructural features in Fe, Mn-doped YBCO thin films

An attempt to grow a thin epitaxial composite film of YBa2Cu3O7-δ (YBCO) with spinel MnFe2O4 (MFO) nanoparticles on a LAO substrate using the CSD approach resulted in a decomposition of the spinel and various doping modes of YBCO with the Fe and Mn cations. These nanostructural effects lead to a lowering of Tc and a slight Jc increase in field. Using a combination of advanced transmission electron microscopy (TEM) techniques such as atomic resolution high-angle annular dark field scanning transmission electron microscopy, energy dispersive X-ray spectroscopy and electron energy-loss spectroscopy we have been able to decipher and characterize the effects of the Fe and Mn doping on the film architecture. The YBaCuFeO5 anion-deficient double perovskite phase was detected in the form of 3D inclusions as well as epitaxially grown lamellas within the YBCO matrix. These nano-inclusions play a positive role as pinning centers responsible for the Jc/Jsf (H) dependency smoothening at high magnetic fields in the YBCO-MFO films with respect to the pristine YBCO films.The authors gratefully acknowledge Prof. Dr. A. Abakumov and Dr. J. Gazquez for discussions and corrections. Part of this work was performed within the framework of the EUROTAPES project (FP7-NMP.2011.2.2-1 Grant no. 280432), funded by the European Union. ICMAB research was financed by the Ministry of Economy and Competitiveness, and FEDER funds under the projects MAT2011-28874-C02-01, MAT2014-51778-C2-1-R, ENE2014-56109-C3-3-R and Consolider Nanoselect CSD2007-00041, and by Generalitat de Catalunya (2009 SGR 770, 2015 SGR 753 and Xarmae). ICMAB acknowledges support from Severo Ochoa Program (MINECO, Grant SEV-2015-0496).Peer reviewe