Relationship between Corneal Morphogeometrical Properties and Biomechanical Parameters Derived from Dynamic Bidirectional Air Applanation Measurement Procedure in Keratoconus

The morphogeometric analysis of the corneal structure has become a clinically relevant diagnostic procedure in keratoconus (KC) as well as the in vivo evaluation of the corneal biomechanical properties. However, the relationship between these two types of metrics is still not well understood. The current study investigated the relationship of corneal morphogeometry and volume with two biomechanical parameters: corneal hysteresis (CH) and corneal resistance factor (CRF), both provided by an Ocular Response Analyzer (Reichert). It included 109 eyes from 109 patients (aged between 18 and 69 years) with a diagnosis of keratoconus (KC) who underwent a complete eye examination including a comprehensive corneal topographic analysis with the Sirius system (CSO). With the topographic information obtained, a morphogeometric and volumetric analysis was performed, defining different variables of clinical use. CH and CRF were found to be correlated with these variables, but this correlation was highly influenced by corneal thickness. This suggests that the mechanical properties of KC cornea contribute only in a partial and limited manner to these biomechanical parameters, being mostly influenced by morphogeometry under normal intraocular pressure levels. This would explain the limitation of CH and CRF as diagnostic tools for the detection of incipient cases of KC.This publication was carried out in the framework of the Thematic Network for Co-Operative Research in Health (RETICS) reference number RD12/0034/0007 and RD16/0008/0012, financed by the Carlos III Health Institute—General Subdirection of Networks and Cooperative Investigation Centers (R&D&I National Plan 2008–2011) and the European Regional Development Fund (FEDER). The author David P. Piñero has been supported by the Ministry of Economy, Industry, and Competitiveness of Spain within the program Ramón y Cajal, RYC-2016-20471

First order transition and phase separation in pyrochlores with colossal-magnetoresistance

Tl$_{2}$Mn$_{2}$O$_{7}$ pyrochlores present colossal magnetoresistance (CMR) around the long range ferromagnetic ordering temperature (T$_{C}$). The character of this magnetic phase transition has been determined to be first order, by purely magnetic methods, in contrast to the second order character previously reported by Zhao et al. (Phys. Rev. Lett. 83, 219 (1999)). The highest CMR effect, as in Tl$_{1.8}$Cd$_{0.2}$Mn$_{2}$O$_{7}$, corresponds to a stronger first order character. This character implies a second type of magnetic interaction, besides the direct superexchange between the Mn$^{4+}$ ions, as well as a phase coexistence. A model is proposed, with a complete Hamiltonian (including superexchange and an indirect interaction), which reproduce the observed phenomenology.Comment: 6 pages. Figures include

Disorder induced phase segregation in La2/3Ca1/3MnO3 manganites

Neutron powder diffraction experiments on La2/3Ca1/3MnO3 over a broad temperature range above and below the metal-insulator transition have been analyzed beyond the Rietveld average approach by use of Reverse Monte Carlo modelling. This approach allows the calculation of atomic pair distribution functions and spin correlation functions constrained to describe the observed Bragg and diffuse nuclear and magnetic scattering. The results evidence phase separation within a paramagnetic matrix into ferro and antiferromagnetic domains correlated to anistropic lattice distortions in the vicinity of the metal-insulator transition.Comment: 3 pages, 4 figures. Submitted to Phys. Rev. Lett. Figure 1 replace

Phase Competition in Ln0.5a0.5mno3 Perovskites

Single crystals of the systems Pr0.5(Ca1-xSrx)0.5MnO3, (Pr1-yYy)0.5(Ca1-xSrx)0.5MnO3, and Sm0.5Sr0.5MnO3 were grown to provide a series of samples with fixed ratio Mn(III)/Mn(IV)=1 having geometric tolerance factors that span the transition from localized to itinerant electronic behavior of the MnO3 array. A unique ferromagnetic phase appears at the critical tolerance factor tc= 0.975 that separates charge ordering and localized-electron behavior for t<tc from itinerant or molecular-orbital behavior for t>tc. This ferromagnetic phase, which has to be distinguished from the ferromagnetic metallic phase stabilized at tolerance factors t>tc, separates two distinguishable Type-CE antiferromagnetic phases that are metamagnetic. Measurements of the transport properties under hydrostatic pressure were carried out on a compositions t a little below tc in order to compare the effects of chemical vs. hydrostatic pressure on the phases that compete with one another near t=tc.Comment: 10 pages. To be publised in Phys. Rev.

Si ocurrió un evento adverso piense en decir “lo siento”

Fundamento. La información al paciente víctima de un evento adverso (EA) presenta ciertas particularidades en función del marco legal del país en el que se produzca, especialmente en lo referido al ofrecimiento de una disculpa. En el presente trabajo se pretende establecer los límites y las condiciones que debemos considerar a la hora de trasladar una disculpa al paciente que ha sufrido un EA. Método. Conferencia de consenso entre 26 profesionales de distintas comunidades autónomas, instituciones y perfiles profesionales con experiencia acreditada en la gestión de sistemas de Seguridad del Paciente y Derecho Penal de diferentes ámbitos laborales (sanidad, aseguradoras, inspección, académico). Resultados. El paciente, tras un EA además de ser informado, debiera recibir una disculpa expresada en términos neutros (manifestación empática y de pesar por lo sucedido), sin que el informante se identifique a sí mismo como responsable del daño, culpabilice a terceros, ni ofrezca una compensación en nombre de la compañía aseguradora. El profesional que se siente más directamente involucrado en el incidente es normalmente el menos indicado para informar y disculparse. El informante debe ajustarse al tipo y gravedad del EA. La normativa y condiciones del seguro de responsabilidad aconsejan no ofrecer información concreta sobre la magnitud de la compensación. Conclusiones. La disculpa debe medirse en función del marco normativo que rige en cada país. En nuestro caso procede una respuesta de empatía hacia el paciente, manifestando pesar por lo sucedido (decir lo siento) que puede facilitar la relación con el paciente, reducir su desconfianza y el número de litigios. Background. Disclosing information to a patient who is a victim of an adverse event (AE) presents some particularities depending on the legal framework in the country where the AE occurred. The aim of this study is to identify the limits and conditions when apologizing to a patient who has suffered an AE. Methods. A consensus conference involving 26 professionals from different autonomous communities, institutions, and profiles (health, insurance, inspection, academic) with accredited experience in patient safety management systems and criminal law. Results. Open disclosure should include an apology expressed in neutral terms (showing empathy and regret for what has happened) without the informant being identified as responsible for the damage, blaming third parties, or offering compensation on behalf of the insurance company. The professional who feels most directly involved in the incident is usually the least likely to report it and apologise. The informant profile must conform to the type and severity of the AE. The rules and conditions of liability insurance advise against providing specific information on the amount of compensation. Conclusions. The apology should be offered in terms of the regulatory framework in force in each country. In Spain, an appropriate response of empathy for the patient is warranted, expressing regret for what happened (apologising), which can facilitate the relationship with the patient, mitigate their mistrust, and reduce the number of disputes

Evaluación de la maduración oseo-dentaria y erupción dentaria en pacientes con hipotiroidismo congénito

Se describen como uno de los aspectos odontológicos más significativos del hipotiroidismo congénito (HC)retraso en la formación corono-radicular y en la erupción de los dientes permanentes. Objetivo: evaluar si el diagnóstico y el tratamiento temprano de HC, permiten un proceso normal de crecimiento y desarrollo óseo, dentario, oclusal y funcional. Método: estudio descriptivo, observacional, transversal e inferencial en niños de ambos sexos (n36) con HC. Se conformaron dos grupos de acuerdo al momento de inicio del tratamiento con levotiroxina: G1: antes del primer mes de vida (n24). G2: entre 30 días y un año de edad (n12). En ambos grupos se efectuó evaluación clínico-endocrinológica, clínico-odontológica y radiográfica para establecer la edad ósea y dentaria. Para el análisis estadístico se utilizaron pruebas no paramétricas Resultados.La secuencia eruptiva de los dientes permanentes fue normal en el 100% en G2 y en 83,33%de G1. El 58,82% de G1 y el 55,55% de G2 presentaron oclusión normal. Se observó oligodoncia en el 9,52% de G1 y el 8,33% de G2. Por otra parte, solo G1 presentó 16,66% de dientes supernumerarios En cuanto al análisis funcional, en ambos grupos 25% de los niños tuvieron respiración bucal, 66,66% respiración nasal y el 8,33% mixta; la deglución fue funcional en el 25% y disfuncional en el 75% de la muestra.En ambos grupos en las mujeres la edad ósea está más adelantada en relación a la cronológica y la dentaria que en el grupo de varones. Mientras que en ellos lo fue la edad dentaria En los varones de ambos grupos existe una tendencia ascendente considerando la edad ósea, cronológica y dentaria. En las mujeres, los valores menores correspondieron a la edad cronológica, seguida por la edad dentaria y ósea. Conclusión: el tratamiento temprano con terapia sustitutiva con levotiroxina en niños con HC, favorece el desarrollo normal de las estructuras oseodentarias, con características similares a las encontradas en niños sanos.Fil: Martínez, María Cecilia. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes; Argentina.Fil: Damiani, Patricia María. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra integral niños y adolescentes "A"; Argentina.Fil: Tolcachir, Betina R. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes B. Argentina.Fil: Evjanian de Giménez, GIadys. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes Área Odontopediatría; Argentina.Fil: Varela de Villalba, Teresa Beatriz. Escuela de Posgrado. Facultad de Odontología. Universidad Nacional de Córdoba; Argentina.Fil: Villalba, Silvina Beatriz. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra integral niños y adolescentes "A"; Argentina.Fil: Rubial, María Cristina. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Ortodoncía A; Argentina.Fil: Rugani, Marta Leonor. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra integral niños y adolescentes A; Argentina.Fil: Giménez, Enrique Daniel. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Diagnóstico por Imágenes A; Argentina.Fil: Mira, M. Servicio de Endocrinología del Hospital de Niños de la Santísima Trinidad; Argentina.Fil: Martín, S. Servicio de Endocrinología del Hospital de Niños de la Santísima Trinidad; Argentina.Fil: Lescano de Ferrer, Alfonsina. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes Área Odontopediatría; Argentina.Otras Ciencias de la Salu

Interventions in health organisations to reduce the impact of adverse events in second and third victims

Background Adverse events (AE) are also the cause of suffering in health professionals involved. This study was designed to identify and analyse organization-level strategies adopted in both primary care and hospitals in Spain to address the impact of serious AE on second and third victims. Methods A cross-sectional study was conducted in healthcare organizations assessing: safety culture; health organization crisis management plans for serious AE; actions planned to ensure transparency in communication with patients (and relatives) who experience an AE; support for second victims; and protective measures to safeguard the institution’s reputation (the third victim). Results A total of 406 managers and patient safety coordinators replied to the survey. Deficient provision of support for second victims was acknowledged by 71 and 61 % of the participants from hospitals and primary care respectively; these respondents reported there was no support protocol for second victims in place in their organizations. Regarding third victim initiatives, 35 % of hospital and 43 % of primary care professionals indicated no crisis management plan for serious AE existed in their organization, and in the case of primary care, there was no crisis committee in 34 % of cases. The degree of implementation of second and third victim support interventions was perceived to be greater in hospitals (mean 14.1, SD 3.5) than in primary care (mean 11.8, SD 3.1) (p?<?0.001). Conclusions Many Spanish health organizations do not have a second and third victim support or a crisis management plan in place to respond to serious AEs

The aftermath of adverse events in spanish primary care and hospital health professionals

Background Adverse events (AEs) cause harm in patients and disturbance for the professionals involved in the event (second victims). This study assessed the impact of AEs in primary care (PC) and hospitals in Spain on second victims. Methods A cross-sectional study was conducted. We carried out a survey based on a random sample of doctors and nurses from PC and hospital settings in Spain. A total of 1087 health professionals responded, 610 from PC and 477 from hospitals. Results A total of 430 health professionals (39.6%) had informed a patient of an error. Reporting to patients was carried out by those with the strongest safety culture (Odds Ratio –OR- 1.1, 95% Confidence Interval –CI- 1.0-1.2), nurses (OR 1.9, 95% CI 1.5-2.3), those under 50 years of age (OR 0.7, 95% CI 0.6-0.9) and primary care staff (OR 0.6, 95% CI 0.5-0.9). A total of 381 (62.5%, 95% CI 59-66%) and 346 (72.5%, IC95% 69-77%) primary care and hospital health professionals, respectively, reported having gone through the second-victim experience, either directly or through a colleague, in the previous 5 years. The emotional responses were: feelings of guilt (521, 58.8%), anxiety (426, 49.6%), re-living the event (360, 42.2%), tiredness (341, 39.4%), insomnia (317, 38.0%) and persistent feelings of insecurity (284, 32.8%). In doctors, the most common responses were: feelings of guilt (OR 0.7 IC95% 0.6-0.8), re-living the event (OR 0.7, IC95% o.6-0.8), and anxiety (OR 0.8, IC95% 0.6-0.9), while nurses showed greater solidarity in terms of supporting the second victim, in both PC (p?=?0.019) and hospital (p?=?0.019) settings. Conclusions Adverse events cause guilt, anxiety, and loss of confidence in health professionals. Most are involved in such events as second victims at least once in their careers. They rarely receive any training or education on coping strategies for this phenomenon