COPD patient profiles in primary care. Referral criteria.

COPD is a disease with a high prevalence that diminishes the quality of life of many patients. Despite this, there are still high rates of under-diagnosis in Spain, partly due to a lack of recognition of the pathology by patients. In this context, the role played by primary care teams becomes fundamental, as they are one of the first lines of entry into the health system. In this paper we explain the different COPD profiles that may be present, and update the tools for diagnosis and treatment, which, together with an attitude of active suspicion of the disease, can help in the correct management of patients, whether they are undiagnosed or have subsequent complications.

Auditoría de la dispensación de antibióticos en la farmacia comunitaria (proyecto ‘Happy Patient’) / Audit of antibiotic dispensing in the community pharmacy ('Happy Patient' project)

Resumen: La dispensación y la prescripción de antibióticos no se adecúa a los estándares científicos en muchos de los países en la Unión Europea, entre los que se encuentra España, resultando una amenaza para la salud de la población. Para hacer frente al crecimiento de las resistencias antimicrobianas surgió el proyecto “Happy Patient” bajo el auspicio de la Comisión Europea. Objetivos: conocer las características de la dispensación de antibióticos en farmacias comunitarias españolas. Comparar la variabilidad entre las diferentes farmacias comunitarias españolas. Material y métodos: se utilizó el método “Audit Project Odense®” para conocer cómo eran las dispensaciones de antibióticos en las farmacias comunitarias, pidiendo a los farmacéuticos participantes registrar durante 5 días consecutivos entre los meses de febrero y abril de 2022, las actuaciones llevadas a cabo durante la dispensación de antibióticos por vía oral para uso humano y para el tratamiento de infecciones agudas. Resultados: se entrevistaron a 573 usuarios (59,9 % mujeres) de todas las edades. Los usuarios conocían en un 83,6 % para qué había sido prescrito el antibiótico siendo el más demandado la amoxicilina seguido de la amoxicilina con ácido clavulánico. En un 15 % de las dispensaciones (n=86) se realizaron los tres controles de seguridad: interacciones, contraindicaciones y alergias. El dispensador contactó muy raramente con el prescriptor (4 veces), pero cuando lo hizo, éste cambió la prescripción. En el 62,3 % de los casos se ofreció información sobre la duración del tratamiento y la amoxicilina con y sin ácido clavulánico fue el antibiótico dispensado en el que en más ocasiones se advirtió de los efectos secundarios. En un 24,6 % de las dispensaciones no se ofreció ninguna información personalizada del medicamento. En el 81,7 % el farmacéutico estuvo de acuerdo con el tratamiento prescrito (AU)

Evaluation of the degradation of the graphene-polypropylene composites of masks in harsh working conditions.

The recent COVID-19 outbreak has led health authorities to recommend at least the use of surgical masks, most preferably respirators (FFP2 or KN95), to prevent the spread of the virus. Non-woven fabrics have been chosen as the best option to manufacture the face masks, due to their filtration efficiency, low cost, and versatility. Modifying the mask filters with graphene has been of great interest due to its potential use as antibacterial and virucidal properties. Indeed, some companies have commercialized face masks in which graphene is coated and/or embedded. However, the Canadian sanitary authorities advised against using the Shandong Shengquan New Materials Co. graphene masks because of the possibility of pulmonary damage produced by graphene inhalation. Thus, we have analyzed the stability of the graphene filter of these masks and compared it with two other commercially available graphene mask filters, evaluating the morphological and spectroscopical change of the fibers, as well as the particles released during the endurance tests. Our work introduces the necessary tools and methodology to evaluate the potential degradation of face masks under extreme working conditions. These methods complement the present standard tests ensuring the security of the new filters based on composites or nanomaterials.

Conocimiento del farmacéutico comunitario sobre el asma y el control del paciente asmático / Community pharmacist's knowledge of asthma and asthma patient management

Introducción: el asma es una patología que afecta a casi 3 millones de españoles. A día de hoy existen datos preocupantes en cuanto a la patología asmática, con un infradiagnóstico del 50 % y un mal control del paciente asmático de un 60-70 %. Además, varios estudios muestran que el propio paciente no tiene una percepción real de su enfermedad o hace un mal uso de su tratamiento; hecho del que no escapan los propios profesionales sanitarios que atienden a estos pacientes.Objetivo: evaluar los conocimientos de los farmacéuticos comunitarios sobre la patología asmática y su tratamiento además de explorar posibles opciones de mejora a través de una formación adecuada y actualizada y de acciones coordinadas con atención primaria.Resultados: se obtuvieron un total de 566 respuestas. De ellas, los porcentajes de respuestas acertadas según la temática fueron: prevalencia 51.59 %, diagnóstico 59.01 %, evolución 80,57 %, mortalidad 20,67 %, etiología 40,46 %, control 30,45 % y tratamiento 48,35 %. Además, queda patente la disponibilidad para llevar a cabo tareas en las que cooperar con los médicos de atención primaria y acciones que podrían implementarse en la farmacia comunitaria sin grandes dificultades.Conclusiones: el estudio refleja la falta de formación de los farmacéuticos comunitarios en las áreas de prevalencia, diagnóstico, mortalidad, etiología, control y tratamiento del asma; haciéndose imprescindible un estudio riguroso de la falta de conocimientos antes de emprender intervenciones educativas y formativas. Las propuestas de mejora más valoradas han sido comunicación directa con el médico, medidas higiénico-dietéticas y la integración de la farmacia comunitaria en el sistema de salud. (AU)

Steroids and mortality in non-critically ill COVID-19 patients: a propensity score-weighted study in a Chilean cohort.

OBJECTIVES: The aim of this study was to evaluate the impact on 30-day mortality of early use of corticosteroids in COVID-19 patients with supplementary oxygen requirements and without invasive mechanical ventilation at the initiation of therapy. METHODS: All patients hospitalized with COVID-19 between April 15 and July 15, 2020, and requiring supplementary oxygen, were prospectively included in a database. Patients who died or required intubation within the first 48 hours were excluded. Patients who received corticosteroids within the first 5 days of hospitalization and at least 24 hours prior to intubation were allocated to the 'early corticosteroids' group. To compare both populations and adjust for non-random treatment assignment bias, a weight-adjusted propensity score model was used. RESULTS: In total, 571 patients met the inclusion criteria, 520 had sufficient information for the analysis. Of these, 233 received early corticosteroids and 287 did not. Analysis showed a reduction of 8.5% (p = 0.038) in 30-day mortality in the early corticosteroid group. The reduction in mortality was not significant when patients with corticosteroid initiation between day 5 and day 8 of hospitalization were included. CONCLUSION: Early corticosteroid use reduced mortality in patients with pneumonia due to COVID-19, who required supplementary oxygen but not initial invasive mechanical ventilation.

Motives driving gaze and walking decisions.

To navigate complex environments, people must decide how to direct gaze to acquire relevant information and decide where, when, and how to move the body. Recent work supports the idea that gaze may be directed to reduce task-relevant environmental uncertainty and to ensure movement accuracy based on the cost (or effort) to move the body and maintain balance. During walking, these two factors may compete for gaze allocation and explain how we make decisions about where to step. Using a forced-choice walking paradigm, where we manipulated the visual uncertainty (simulating uncertain terrain characteristics) and motor cost associated with specific step-target choices, we examined the motives driving gaze and step decisions. We characterized each individual's distinct gaze behavior based on their sensitivity to changes in visual uncertainty, which predicted step-choice behavior when foot-placement accuracy was important to the task. We show that individuals who tended to look at both target choices as visual uncertainty increased prioritized stepping onto the more certain location after looking at it longer, even at the expense of increased motor cost. In contrast, individuals who tended to look at only one of the target choices as visual uncertainty increased preferred to step on the target that minimized motor cost. Overall, we demonstrate that how a person explores the environment with their eyes dictates where they step. These gaze and step decisions may relate to the value a person assigns to information gain, being certain of their actions, and conserving energy.

A bioinspired metal-organic approach to cross-linked functional 3D nanofibrous hydro- and aero-gels with effective mixture separation of nucleobases by molecular recognition.

The direct reaction between Cu(CH3COO)2 and uracil-1-acetic acid in water gives rise to the formation of a hydrogel consisting of entangled nanometric ribbons of a crystalline antiferromagnetic 1D Cu(ii) coordination polymer (CP) decorated with biocompatible uracil nucleobases. This hydrogel is the precursor for the preparation of a meso/macroporous ultralight aerogel that shows a remarkable Young's modulus. As a proof-of-concept of the molecular recognition capability of the terminal uracil moieties anchored at Cu(ii) CP chains, this material has been tested as the selective stationary phase for the separation of nucleobase derivatives in HPLC columns.

Covalent organic framework nanosheets: preparation, properties and applications.

Covalent organic frameworks (COFs) are crystalline and porous materials with bi- or three-dimensional structures built up by connecting their molecular precursors by dynamic covalent bonds. Using bottom-up or top-down strategies, bi-dimensional COFs can be obtained as single- or few-layer materials, thus enlarging the family of 2D-materials based on graphene. The main advantage of 2D-materials based on COFs is the fact that they can be chemically designed, thus allowing the formation of á la carte materials with well-designed functionalities including their size and features of their pores. The aim of this perspective review is to illustrate in a rational way the current state-of-the-art in the field of COF nanosheet formation using the two general approaches of material nano-structuring. This article reviews a selected collection of samples that illustrates the essential concepts, strategies of preparation following the two general approaches, bottom-up and top-down, and a selection of COF nanolayers showing seminal properties and potential material applications. Finally, we provide some perspectives of this novel research field.

Age-related changes in gaze sampling strategies during obstacle navigation.

BACKGROUND: Appropriate coordination of gaze behavior and body motion is essential for navigating cluttered environments. This is often complicated by having to contend with a concurrent secondary task, like engaging in a conversation or looking for relevant landmarks. However, there is little evidence of how aging and multitasking affects how gaze is deployed during obstacle navigation to guide our movements. RESEARCH QUESTION: How do gaze patterns differ between young and older adults when navigating around a series of obstacles under dual-task conditions? METHODS: 17 young adults and 17 older adults navigated around vertically-oriented obstacles in isolation (i.e., single-task condition) and while engaging in a concurrent backward-counting or visual search task (i.e., dual-task conditions). In the visual search condition, participants had to identify the location of an object (i.e., a black shape on a tile) along the perimeter of the pathway, simulating a landmark. We quantified the spatial-temporal pattern of gaze to obstacles relative to body position, as well as the frequency and duration of gaze fixations to obstacles, route-planning features, and landmarks. RESULTS: We found that older adults transferred gaze away from obstacles earlier and contacted obstacles more frequently than young adults. However, the proportion of fixation number and duration to obstacles did not differ between groups in any condition. In addition, older adults had to allocate gaze to landmarks to a greater extent in the visual search condition-at the expense of fixating route-planning areas-to maintain similar search performance in the dual-task condition compared to the single-task condition. SIGNIFICANCE: Older adults use different gaze strategies and have greater difficulty under dual-tasking conditions than young adults when navigating around a series of obstacles. We suggest that deficits in visual working memory and/or divided attention may explain these results.

Motor cost affects the decision of when to shift gaze for guiding movement.

Frequent gait modifications are often required to navigate our world. These can involve long or wide steps or changes in direction. People generally prefer to minimize the motor cost (or effort) of a movement, although with changes in gait this is not always possible. The decision of when and where to shift gaze is critical for controlling motor actions, since vision informs the brain about the available choices for movement-in this case, where to step. Here we asked how motor cost influences the allocation of gaze. To address this, we had participants walk and step to the center of sequential targets on the ground. We manipulated the motor cost associated with controlling foot placement by varying the location of one target in the lateral direction on a trial-to-trial basis within environments with different numbers of targets. Costlier steps caused a switch from a gaze strategy of planning future steps to one favoring visual feedback of the current foot placement when participants had to negotiate another target immediately after. Specifically, costlier steps delayed gaze shifts away from the manipulated target. We show that this relates to the cost of moving the leg and redirecting the body's center of mass from target to target. Overall, our results suggest that temporal gaze decisions are affected by motor costs associated with step-to-step demands of the environment. Moreover, they provide insight into what affects the coordination between the eyes and feet for the control of stable and accurate foot placement while walking. NEW & NOTEWORTHY Changes in gait allow us to navigate our world. For instance, one may step long or wide to avoid a spilled drink. The brain can direct gaze to gather relevant information for making these types of motor decisions; however, the factors affecting gaze allocation in natural behaviors are poorly understood. We show how the motor cost associated with a step influences the decision of when to redirect gaze to ensure accurate foot placement while walking.

Measurement of the interaction between mucin and oenological tannins by Surface Plasmon Resonance (SPR); relationship with astringency.

The interaction between stomach porcine mucin and 3 oenological tannins (extract of ellagitannins from oak, extract of gallotannins from gall nuts and extract of proanthocyanidins from grape seeds) was measured by Surface Plasmon Resonance (SPR). These tannins were analysed and their astringency was determined using the Astringency Index method and by tasting. The interaction constants were determined using a Biacore SPR device (1:1 Langmuir binding model). The results indicate that the ellagitannins are more astringent than gallotannins and those, in turn, are more astringent than seed proanthocyanidins if the richness of the commercial extracts is considered. The astringency index of these tannins had high correlation and regression coefficients with their kinetic and thermodynamic dissociation constants. This data support a hypothesis that astringency depends not only on the thermodynamic tendency to form the complex between tannins and salivary proteins but also probably on the time required to dissociate the complex.

Adaptive Gaze Strategies to Reduce Environmental Uncertainty During a Sequential Visuomotor Behaviour.

People must decide where, when, and for how long to allocate gaze to perform different motor behaviours. However, the factors guiding gaze during these ongoing, natural behaviours are poorly understood. Gaze shifts help acquire information, suggesting that people should direct gaze to locations where environmental details most relevant to the task are uncertain. To explore this, human subjects stepped on a series of targets as they walked. We used different levels of target uncertainty, and through instruction, altered the importance of (or subjective value assigned to) foot-placement accuracy. Gaze time on targets increased with greater target uncertainty when precise foot placement was more important, and these longer gaze times associated with reduced foot-placement error. Gaze times as well as the gaze shifts to and from targets relative to stepping differed depending on the target's position in the sequence and uncertainty level. Overall, we show that gaze is allocated to reduce uncertainty about target locations, and this depends on the value of this information gain for successful task performance. Furthermore, we show that the spatial-temporal pattern of gaze to resolve uncertainty changes with the evolution of the motor behaviour, indicating a flexible strategy to plan and control movement.

Multistimuli Response Micro- and Nanolayers of a Coordination Polymer Based on Cu2 I2 Chains Linked by 2-Aminopyrazine.

A nonporous laminar coordination polymer of formula [Cu2 I2 (2-aminopyrazine)]n is prepared by direct reaction between CuI and 2-aminopyrazine, two industrially available building blocks. The fine tuning of the reaction conditions allows obtaining [Cu2 I2 (2-aminopyrazine)]n in micrometric and nanometric sizes with same structure and composition. Interestingly, both materials show similar reversible thermo- and pressure-luminescent response as well as reversible electrical response to volatile organic solvents such as acetic acid. X-ray diffraction studies under different conditions, temperatures and pressures, in combination with theoretical calculations allow rationalizing the physical properties of this compound and its changes under physical stimuli. Thus, the emission dramatically increases when lowering the temperature, while an enhancement of the pressure produces a decrease in the emission intensity. These observations emerge as a direct consequence of the high structural flexibility of the Cu2 I2 chains which undergo a contraction in CuCu distances as far as temperature decreases or pressure increases. However, the strong structural changes observed under high pressure lead to an unexpected effect that produces a less effective CuCu orbital overlapping that justifies the decrease in the intensity emission. This work shows the high potential of materials based on Cu2 I2 chains for new applications.

Homogeneous Diffusion Solid Model as a Realistic Approach to Describe Adsorption onto Materials with Different Geometries.

In this work, the adsorption kinetics of p-nitrophenol (PNP) onto several commercial activated carbons (ACs) with different textural and geometrical characteristics was studied. For this aim, a homogeneous diffusion solid model (HDSM) was used, which does take the adsorbent shape into account. The HDSM was solved by means of the finite element method (FEM) using the commercial software COMSOL. The different kinetic patterns observed in the experiments carried out can be described by the developed model, which shows that the sharp drop of adsorption rate observed in some samples is caused by the formation of a concentration wave. The model allows one to visualize the changes in concentration taking place in both liquid and solid phases, which enables us to link the kinetic behaviour with the main features of the carbon samples.

MasterChem: cooking 2D-polymers.

2D-polymers are still dominated by graphene and closely related materials such as boron nitride, transition metal sulphides and oxides. However, the rational combination of molecules with suitable design is already showing the high potential of chemistry in this new research field. The aim of this feature article is to illustrate, and provide some perspectives, the current state-of-the-art in the field of synthetic 2D-polymers showing different alternatives to prepare this novel type of polymers based on the rational use of chemistry. This review comprises a brief revision of the essential concepts, the strategies of preparation following the two general approaches, bottom-up and top-down, and a revision of the promising seminal properties showed by some of these nanomaterials.

Halo and Pseudohalo Cu(I)-Pyridinato Double Chains with Tunable Physical Properties.

The properties recently reported on the Cu(I)-iodide pyrimidine nonporous 1D-coordination polymer [CuI(ANP)]n (ANP = 2-amino-5-nitropyridine) showing reversible physically and chemically driven electrical response have prompted us to carry a comparative study with the series of [CuX(ANP)]n (X = Cl (1), X = Br (2), X = CN (4), and X = SCN (5)) in order to understand the potential influence of the halide and pseudohalide bridging ligands on the physical properties and their electrical response to vapors of these materials. The structural characterization of the series shows a common feature, the presence of -X-Cu(ANP)-X- (X = Cl, Br, I, SCN) double chain structure. Complex [Cu(ANP)(CN)]n (4) presents a helical single chain. Additionally, the chains show supramolecular interlinked interactions via hydrogen bonding giving rise to the formation of extended networks. Their luminescent and electrical properties have been studied. The results obtained have been correlated with structural changes. Furthermore, the experimental and theoretical results have been compared using the density functional theory (DFT). The electrical response of the materials has been evaluated in the presence of vapors of diethyl ether, dimethyl methylphosphonate (DMMP), CH2Cl2, HAcO, MeOH, and EtOH, to build up simple prototype devices for gas detectors. Selectivity toward gases consisting of molecules with H-bonding donor or acceptor groups is clearly observed. This selective molecular recognition is likely due to the 2-amino-5-nitropyridine terminal ligand.