Energy transfer in N-component nanosystems enhanced by pulse-driven vibronic many-body entanglement.

The processing of energy by transfer and redistribution, plays a key role in the evolution of dynamical systems. At the ultrasmall and ultrafast scale of nanosystems, quantum coherence could in principle also play a role and has been reported in many pulse-driven nanosystems (e.g. quantum dots and even the microscopic Light-Harvesting Complex II (LHC-II) aggregate). Typical theoretical analyses cannot easily be scaled to describe these general N-component nanosystems; they do not treat the pulse dynamically; and they approximate memory effects. Here our aim is to shed light on what new physics might arise beyond these approximations. We adopt a purposely minimal model such that the time-dependence of the pulse is included explicitly in the Hamiltonian. This simple model generates complex dynamics: specifically, pulses of intermediate duration generate highly entangled vibronic (i.e. electronic-vibrational) states that spread multiple excitons - and hence energy - maximally within the system. Subsequent pulses can then act on such entangled states to efficiently channel subsequent energy capture. The underlying pulse-generated vibronic entanglement increases in strength and robustness as N increases.

GEMA 5.3. Spanish Guideline on the Management of Asthma.

The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).

La Guía Española para el Manejo del Asma, mejor conocida por su acrónimo en español, GEMA, está a nuestra disposición desde hace más de veinte años. Veintiuna sociedades científicas o grupos relacionados, tanto de España como de otros países, han participado en la preparación y desarrollo de la edición actualizada de GEMA que, de hecho, se ha posicionado en la actualidad a nivel mundial como la guía de referencia sobre asma en lengua española.Su objetivo es prevenir y mejorar la situación clínica de las personas con asma, aumentando el conocimiento de los profesionales sanitarios involucrados en su cuidado. Su propósito es convertir la evidencia científica en recomendaciones prácticas sencillas y fáciles de seguir. Por lo tanto, no se trata de una monografía que reúna todo el conocimiento científico sobre la enfermedad, sino más bien de un documento conciso con lo esencial, diseñado para ser aplicado rápidamente en la práctica clínica de rutina. Las recomendaciones son necesariamente multidisciplinares, están desarrolladas para ser útiles y una herramienta indispensable para médicos de diferentes especialidades, así como para profesionales de enfermería y farmacia.Seguramente, los aspectos más destacados de la guía son las recomendaciones para: establecer el diagnóstico del asma utilizando un algoritmo secuencial basado en pruebas diagnósticas objetivas; el seguimiento de los pacientes, preferentemente basado en la estrategia de lograr y mantener el control de la enfermedad; el tratamiento según el nivel de gravedad del asma utilizando seis escalones, desde la menor hasta la mayor necesidad de medicamentos, y el algoritmo de tratamiento basado en fenotipos para la indicación de biológicos en pacientes con asma grave no controlada. A esto se suma ahora una novedad para su fácil uso y seguimiento a través de una aplicación informática basada en la inteligencia artificial conversacional de tipo chatbot (ia-GEMA).

[Referral Criteria for Asthma: An Updated Consensus]. / Criterios de derivación en asma: Actualización documento de consenso.

Asthma is one of the most prevalent chronic diseases in Spain. In 2019, the Spanish Society of Allergology and Clinical Immunology (SEAIC), the Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of General and Family Physicians (SEMG) and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) drafted a document laying down the criteria for referral and action guidelines in the diagnosis, control and monitoring of the asthmatic patient to facilitate ongoing care and improved attention in every setting. The new circumstances derived from the Covid-19 pandemic have demanded that some of the recommendations of the previous edition be updated and adapted to the new healthcare situation.

Full Counting Statistics of Topological Defects after Crossing a Phase Transition.

We consider the number distribution of topological defects resulting from the finite-time crossing of a continuous phase transition and identify signatures of universality beyond the mean value, predicted by the Kibble-Zurek mechanism. Statistics of defects follows a binomial distribution with N Bernouilli trials associated with the probability of forming a topological defect at the locations where multiple domains merge. All cumulants of the distribution are predicted to exhibit a common universal power-law scaling with the quench time in which the transition is crossed. Knowledge of the distribution is used to discuss the onset of adiabatic dynamics and bound rare events associated with large deviations.

Discrepancias en la clasificación de los glucocorticoides inhalados entre GEMA y GINA / Discrepancies Between GEMA and GINA in the Classification of Inhaled Corticosteroids

No disponible

La guía española del manejo del asma (GEMA 4.0) está obsoleta en lo que a vacunación antineumocócica se refiere. Respuesta de los autores / Obsolete anti-pneumococcal vaccination recommendations in the spanish guidelines for the management of asthma (GEMA 4.0): the authors reply

No disponible

Valoración externa de las recomendaciones de la GEMA2009 por un panel multiprofesional de expertos en asma / External Assessment of the GEMA2009 Recommendations by a Multidisciplinary Expert Panel on Asthma

ObjetivosValorar el grado de acuerdo de un panel de expertos en asma de diferentes especialidades con las recomendaciones que propone la Guía Española para el Manejo del Asma (GEMA) 2009.Material y métodosEl estudio se efectuó en 4 fases: 1) constitución del comité científico formado por los 9 coordinadores de GEMA2009, para la selección de las recomendaciones de la Guía que conforman el cuestionario Delphi del estudio (56 ítems); 2) selección de un panel estatal multicéntrico con 74 expertos en asma de todas las especialidades implicadas en la Guía (neumólogos, alergólogos, médicos de familia, otorrinolaringólogos, y especialistas de pediatría); 3) encuesta Delphi en 2 rondas (con valoración personal de cada ítem mediante escala Likert de 5 puntos), por correo electrónico, con informe a panelistas de resultados intermedios; y 4) análisis y discusión de resultados por el comité científico del proyecto.ResultadosSe apreció un consenso de criterio en 49 de las 56 cuestiones analizadas ya en la primera ronda. Tras la interacción del panel, se lograron consensuar 53 ítems de la encuesta, en el sentido favorable al acuerdo del panel con las recomendaciones GEMA. En una de las cuestiones no consensuadas, sobre indicación de inmunoterapia en asma alérgica, se apreció una significativa disparidad de opinión entre especialidades. En otra, sobre las medidas de control ambiental en alergia a ácaros, se apreció una manifiesta oposición del panel (55%), y en la última, sobre la necesidad de cambiar de trabajo en pacientes con síndrome reactivo de disfunción de la vía aérea, se observó una ausencia significativa de criterio establecido en buena parte de los encuestados (40% expresan «ni de acuerdo, ni en desacuerdo»)(AU)

ConclusionesLa valoración externa por expertos en asma de diferentes especialidades constata un elevado nivel de acuerdo profesional con las recomendaciones formuladas en GEMA2009 (93%). Probablemente el desacuerdo evidenciado en 3 de las recomendaciones reflejan la escasez de evidencias, o su gran variabilidad, para establecer recomendaciones consistentes. Estas cuestiones podrían representar áreas susceptibles de un mayor esfuerzo investigador futuro(AU)

ObjectivesTo assess the level of agreement on the GEMA 2009 clinical recommendations by a Spanish expert panel on asthma.Materials and methodsThe study was divided into four stages: 1) establishment of a 9 member scientific committee (GEMA authors) for selection of GEMA recommendations to use in the survey; 2) formation of a panel of 74 professionals with expertise in this field (pulmonologists, allergists, family doctors, ear, nose and throat and paediatric specialists); 3) Delphi survey in two rounds, sent by mail, with intermediate processing of opinions and a report to the panel members; and 4) analysis and discussion of results for the Scientific Committee.ResultsSeventy four participants completed the two rounds of survey. During the first round, a consensus was reached in 49 out of 56 questions analysed. Following discussion by the panel, the consensus was increased to a total of 53 items in the survey. With respect to the remaining questions, Insufficient consensus was obtained on the rest of the questions, due to differing views between sub-specialists, or lack of criteria by most of the experts.ConclusionsThe external analysis by asthma experts from different specialities showed a high level of professional agreement with the GEMA 2009 recommendations in Spain (96.5%). The disagreement shown in three recommendations reflect the lack of a high level evidence. These issues represent areas of interest for future research(AU)

[External assessment of the GEMA2009 recommendations by a multidisciplinary expert panel on asthma]. / Valoración externa de las recomendaciones de la GEMA2009 por un panel multiprofesional de expertos en asma.

OBJECTIVES: To assess the level of agreement on the GEMA 2009 clinical recommendations by a Spanish expert panel on asthma. MATERIALS AND METHODS: The study was divided into four stages: 1) establishment of a 9 member scientific committee (GEMA authors) for selection of GEMA recommendations to use in the survey; 2) formation of a panel of 74 professionals with expertise in this field (pulmonologists, allergists, family doctors, ear, nose and throat and paediatric specialists); 3) Delphi survey in two rounds, sent by mail, with intermediate processing of opinions and a report to the panel members; and 4) analysis and discussion of results for the Scientific Committee. RESULTS: Seventy four participants completed the two rounds of survey. During the first round, a consensus was reached in 49 out of 56 questions analysed. Following discussion by the panel, the consensus was increased to a total of 53 items in the survey. With respect to the remaining questions, Insufficient consensus was obtained on the rest of the questions, due to differing views between sub-specialists, or lack of criteria by most of the experts. CONCLUSIONS: The external analysis by asthma experts from different specialities showed a high level of professional agreement with the GEMA 2009 recommendations in Spain (96.5%). The disagreement shown in three recommendations reflect the lack of a high level evidence. These issues represent areas of interest for future research.