Errores de medicación en niños que acuden a los servicios de urgencias pediátricas

Errores de medicación; Servicios de urgencias; PediatríaMedication errors; Emergency departments; PediatricsErrors de medicació; Servei d'urgències; PediatriaObjectives: Medication safety represents an important challenge in children. There are limited studies on medication errors in pediatric patients visiting emergency departments. To help bridge this gap, we characterized the medication errors detected in these patients, determining their severity, the stages of the medication process in which they occurred, the drugs involved, and the types and causes associated with the errors. Methods: We conducted a multicenter prospective observational study in the pediatric emergency departments of 8 Spanish public hospitals over a 4-month period. Medication errors detected by emergency pediatricians in patients between 0 and 16 years of age were evaluated by a clinical pharmacist and a pediatrician. Each medication error was analyzed according to the updated Spanish Taxonomy of Medication Errors. Results: In 99,797 visits to pediatric emergency departments, 218 (0.2%) medication errors were detected, of which 74 (33.9%) resulted in harm (adverse drug events). Preschoolers were the age group with the most medication errors (126/218). Errors originated mainly in the prescribing stage (66.1%), and also by self-medication (16.5%) and due to wrong administration of the medication by family members (15.6%). Dosing errors (51.4%) and wrong/improper drugs (46.8%) were the most frequent error types. Anti-infective drugs (63.5%) were the most common drugs implicated in medication errors with harm. Underlying causes associated with a higher proportion of medication errors were "medication knowledge deficit" (63.8%), "deviation from procedures/guidelines" (48.6%) and "lack of patient information" (30.3%). Conclusions: Medication errors presented by children attending emergency departments arise from prescriptions, self-medicationand administration, and lead to patient harm in one third of cases. Developing effective interventions based on the types of errors and the underlying causes identified will improve patient safety.Objetivos La seguridad de medicamentos en pediatría supone un verdadero reto. Se dispone de escasos estudios que hayan analizado los errores de medicación en los pacientes pediátricos que acuden a los servicios de urgencias. El objetivo de este estudio ha sido caracterizar los errores detectados en estos pacientes, determinando su severidad, los procesos afectados, los medicamentos implicados, y los tipos de errores y causas asociados. Métodos Estudio multicéntrico observacional prospectivo realizado en los servicios de urgencias de 8 hospitales públicos españoles durante 4 meses. Los errores de medicación detectados por los pediatras de urgencias en pacientes entre 0 y 16 años fueron evaluados por un farmacéutico y un pediatra. Los errores de medicación fueron analizados utilizando la Taxonomía Española de Errores de Medicación actualizada. Resultados En 99.797 visitas a urgencias se detectaron 218 (0,2%) errores de medicación, de los cuales 74 (33,9%) causaron daños (eventos adversos por medicamentos). Los preescolares fueron el grupo poblacional con mayor número de errores de medicación (126/218). Los errores se originaron mayoritariamente en la prescripción (66,1%), por automedicación (16,5%) y por administración equivocada por parte de familiares (15,6%). Los tipos de errores más frecuentes fueron “dosis incorrectas” (51,4%) y “medicamento inapropiado” (46,8%). Los antiinfecciosos (63,5%) fueron los fármacos más comúnmente implicados en los errores con daño. Las causas subyacentes asociadas a una mayor proporción de errores de medicación fueron: “falta de conocimiento del medicamento” (63,8%), “falta de seguimiento de los procedimientos” (48,6%) y “falta de información del paciente” (30,3%). Conclusiones Los errores de medicación en la población pediátrica que acude a urgencias se producen en la prescripción, por automedicación y en la administración, provocando daños a los pacientes en un tercio de las ocasiones. Desarrollar prácticas seguras basadas en los tipos de errores detectados y sus causas subyacentes, mejorará la seguridad de los pacientes.This study has been carried out with the support of a grant provided by the Spanish Society of Hospital Pharmacists for the period 2015–2016

Thermal diffusion segregation in granular binary mixtures described by the Enskog equation

Diffusion induced by a thermal gradient in a granular binary mixture is analyzed in the context of the (inelastic) Enskog equation. Although the Enskog equation neglects velocity correlations among particles which are about to collide, it retains spatial correlations arising from volume exclusion effects and thus it is expected to apply to moderate densities. In the steady state with gradients only along a given direction, a segregation criterion is obtained from the thermal diffusion factor $\Lambda$ measuring the amount of segregation parallel to the thermal gradient. As expected, the sign of the factor $\Lambda$ provides a criterion for the transition between the Brazil-nut effect (BNE) and the reverse Brazil-nut effect (RBNE) by varying the parameters of the mixture (masses, sizes, concentration, solid volume fraction, and coefficients of restitution). The form of the phase diagrams for the BNE/RBNE transition is illustrated in detail for several systems, with special emphasis on the significant role played by the inelasticity of collisions. In particular, an effect already found in dilute gases (segregation in a binary mixture of identical masses and sizes {\em but} different coefficients of restitution) is extended to dense systems. A comparison with recent computer simulation results shows a good qualitative agreement at the level of the thermal diffusion factor. The present analysis generalizes to arbitrary concentration previous theoretical results derived in the tracer limit case.Comment: 7 figures, 1 table. To appear in New J. Phys., special issue on "Granular Segregation

A mid-term astrometric and photometric study of Trans-Neptunian Object (90482) Orcus

From CCD observations of a fixed and large star field that contained the binary TNO Orcus, we have been able to derive high-precision relative astrometry and photometry of the Orcus system with respect to background stars. The RA residuals of an orbital fit to the astrometric data revealed a periodicity of 9.7+-0.3 days, which is what one would expect to be induced by the known Orcus companion. The residuals are also correlated with the theoretical positions of the satellite with regard to the primary. We therefore have revealed the presence of Orcus' satellite in our astrometric measurements. The photocenter motion is much larger than the motion of Orcus around the barycenter, and we show here that detecting some binaries through a carefully devised astrometric technique might be feasible with telescopes of moderate size. We also analyzed the system's mid-term photometry to determine whether the rotation could be tidally locked to the satellite's orbital period. We found that a photometric variability of 9.7+-0.3 days is clear in our data, and is nearly coincident with the orbital period of the satellite. We believe this variability might be induced by the satellite's rotation. There is also a slight hint for an additional small variability in the 10 hr range that was already reported in the literature. This short-term variability would indicate that the primary is not tidally locked and therefore the system would not have reached a double synchronous state. Implications for the basic physical properties of the primary and its satellite are discussed. From angular momentum considerations we suspect that the Orcus satellite might have formed from a rotational fission. This requires that the mass of the satellite would be around 0.09 times that of the primary, close to the value that one derives by using an albedo of 0.12 for the satellite and assuming equal densities for both objects.Comment: in Press at A&

Segregation by thermal diffusion of an intruder in a moderately dense granular fluid

A solution of the inelastic Enskog equation that goes beyond the weak dissipation limit and applies for moderate densities is used to determine the thermal diffusion factor of an intruder immersed in a dense granular gas under gravity. This factor provides a segregation criterion that shows the transition between the Brazil-nut effect (BNE) and the reverse Brazil-nut effect (RBNE) by varying the parameters of the system (masses, sizes, density and coefficients of restitution). The form of the phase-diagrams for the BNE/RBNE transition depends sensitively on the value of gravity relative to the thermal gradient, so that it is possible to switch between both states for given values of the parameters of the system. Two specific limits are considered with detail: (i) absence of gravity, and (ii) homogeneous temperature. In the latter case, after some approximations, our results are consistent with previous theoretical results derived from the Enskog equation. Our results also indicate that the influence of dissipation on thermal diffusion is more important in the absence of gravity than in the opposite limit. The present analysis extends previous theoretical results derived in the dilute limit case [V. Garz\'o, Europhys. Lett. {\bf 75}, 521 (2006)] and is consistent with the findings of some recent experimental results.Comment: 10 figure

Little change in the sizes of the most massive galaxies since z = 1

Recent reports suggest that elliptical galaxies have increased their size dramatically over the last ~8 Gyr. This result points to a major re-think of the processes dominating the latetime evolution of galaxies. In this paper we present the first estimates for the scale sizes of brightest cluster galaxies (BCGs) in the redshift range 0.8 < z < 1.3 from an analysis of deep Hubble Space Telescope imaging, comparing to a well matched local sample taken from the Local Cluster Substructure Survey at z ~ 0.2. For a small sample of 5 high redshift BCGs we measure half-light radii ranging from 14 - 53 kpc using de Vaucuoleurs profile fits, with an average determined from stacking of 32.1 \pm 2.5 kpc compared to a value 43.2 \pm 1.0 kpc for the low redshift comparison sample. This implies that the scale sizes of BCGs at z = 1 are ~ 30% smaller than at z = 0.25. Analyses comparing either Sersic or Petrosian radii also indicate little or no evolution between the two samples. The detection of only modest evolution at most out to z = 1 argues against BCGs having undergone the large increase in size reported for massive galaxies since z = 2 and in fact the scale-size evolution of BCGs appears closer to that reported for radio galaxies over a similar epoch. We conclude that this lack of size evolution, particularly when coupled with recent results on the lack of BCG stellar mass evolution, demonstrates that major merging is not an important process in the late time evolution of these systems. The homogeneity and maturity of BCGs at z = 1 continues to challenge galaxy evolution models.Comment: Accepted for publication in MNRA

TNOs are Cool: A survey of the trans-Neptunian region V. Physical characterization of 18 Plutinos using Herschel PACS observations

We present Herschel PACS photometry of 18 Plutinos and determine sizes and albedos for these objects using thermal modeling. We analyze our results for correlations, draw conclusions on the Plutino size distribution, and compare to earlier results. Flux densities are derived from PACS mini scan-maps using specialized data reduction and photometry methods. In order to improve the quality of our results, we combine our PACS data with existing Spitzer MIPS data where possible, and refine existing absolute magnitudes for the targets. The physical characterization of our sample is done using a thermal model. Uncertainties of the physical parameters are derived using customized Monte Carlo methods. The correlation analysis is performed using a bootstrap Spearman rank analysis. We find the sizes of our Plutinos to range from 150 to 730 km and geometric albedos to vary between 0.04 and 0.28. The average albedo of the sample is 0.08 \pm 0.03, which is comparable to the mean albedo of Centaurs, Jupiter Family comets and other Trans-Neptunian Objects. We were able to calibrate the Plutino size scale for the first time and find the cumulative Plutino size distribution to be best fit using a cumulative power law with q = 2 at sizes ranging from 120-400 km and q = 3 at larger sizes. We revise the bulk density of 1999 TC36 and find a density of 0.64 (+0.15/-0.11) g cm-3. On the basis of a modified Spearman rank analysis technique our Plutino sample appears to be biased with respect to object size but unbiased with respect to albedo. Furthermore, we find biases based on geometrical aspects and color in our sample. There is qualitative evidence that icy Plutinos have higher albedos than the average of the sample.Comment: 18 pages, 8 figures, 8 tables, accepted for publication in A&

Cluster galaxies in XMMU J2235-2557: galaxy population properties in most massive environments at z~1.4

We present a multi-wavelength study of galaxy populations in the core of the massive, X-ray luminous cluster XMMU J2235 at z=1.39, based on VLT and HST optical and near-infrared photometry. Luminosity functions in the z, H, and Ks bands show a faint-end slope consistent with being flat, and a characteristic magnitude M* close to passive evolution predictions of M* of local massive clusters, with a formation redshift z>2. The color-magnitude and color-mass diagrams show evidence of a tight red sequence of massive galaxies, with overall old stellar populations, generally early-type morphology, typically showing early-type spectral features and rest-frame far-UV emission consistent with very low star formation rates (SFR<0.2Msun/yr). Star forming spectroscopic members, with SFRs of up to ~100Msun/yr, are all located at clustercentric distances >~250kpc, with the central cluster region already appearing effectively quenched. Massive galaxies in the core of this cluster appear to be in an advanced evolutionary stage in terms of both star formation and mass assembly. The high-mass end of the galaxy stellar mass function is essentially already in place, and the stellar mass fraction estimated within r500 (~1%, Kroupa IMF) is already similar to that of local massive clusters. On the other hand, morphological analysis of the massive red sequence galaxies suggests that they are smaller than similarly massive local early-types. While possibly affected by systematics and biases, this result might imply that, in spite of the overall early assembly of these sources, their evolution is not complete, and processes like minor (and likely dry) merging might still shape their structural properties to resemble those of their local counterparts, without substantially affecting their stellar mass or host stellar populations.[abridged]Comment: 14 pages, 9 figures, accepted for publication in Astronomy & Astrophysic

Global methylome scores correlate with histological subtypes of colorectal carcinoma and show different associations with common clinical and molecular features

Background. The typical methylation patterns associated with cancer are hypermethylation at gene promoters and global genome hypomethylation. Aberrant CpG island hypermethylation at promoter regions and global genome hypomethylation have not been associated with histological colorectal carcinomas (CRC) subsets. Using Illumina’s 450 k Infinium Human Methylation beadchip, the methylome of 82 CRCs were analyzed, comprising different histological subtypes: 40 serrated adenocarcinomas (SAC), 32 conventional carcinomas (CC) and 10 CRCs showing histological and molecular features of microsatellite instability (hmMSI‐H), and, additionally, 35 normal adjacent mucosae. Scores reflecting the overall methylation at 250 bp, 1 kb and 2 kb from the transcription starting site (TSS) were studied. Results. SAC has an intermediate methylation pattern between CC and hmMSI‐H for the three genome locations. In addition, the shift from promoter hypermethylation to genomic hypomethylation occurs at a small sequence between 250 bp and 1 Kb from the gene TSS, and an asymmetric distribution of methylation was observed between both sides of the CpG islands (N vs. S shores). Conclusion. These findings show that different histological subtypes of CRC have a particular global methylation pattern depending on sequence distance to TSS and highlight the so far underestimated importance of CpGs aberrantly hypomethylated in the clinical phenotype of CRCs.This work was supported by two grants from Instituto de Salud Carlos III, Ministerio de Sanidad, Spain and FEDER funds (refs: PI12-1232, PI18-0144) and another from the European Union’s Horizon 2020 research and innovation program (ref. 848098

Globular cluster systems in fossil groups: NGC6482, NGC1132 and ESO306-017

We study the globular cluster (GC) systems in three representative fossil group galaxies: the nearest (NGC6482), the prototype (NGC1132) and the most massive known to date (ESO306-017). This is the first systematic study of GC systems in fossil groups. Using data obtained with the Hubble Space Telescope Advanced Camera for Surveys in the F475W and F850LP filters, we determine the GC color and magnitude distributions, surface number density profiles, and specific frequencies. In all three systems, the GC color distribution is bimodal, the GCs are spatially more extended than the starlight, and the red population is more concentrated than the blue. The specific frequencies seem to scale with the optical luminosities of the central galaxy and span a range similar to that of the normal bright elliptical galaxies in rich environments. We also analyze the galaxy surface brightness distributions to look for deviations from the best-fit S\'ersic profiles; we find evidence of recent dynamical interaction in all three fossil group galaxies. Using X-ray data from the literature, we find that luminosity and metallicity appear to correlate with the number of GCs and their mean color, respectively. Interestingly, although NGC6482 has the lowest mass and luminosity in our sample, its GC system has the reddest mean color, and the surrounding X-ray gas has the highest metallicity.Comment: 16 pages, 13 figures. Accepted for publication in A&

Thorough Characterization of ETHQB3.5, a QTL Involved in Melon Fruit Climacteric Behavior and Aroma Volatile Composition

The effect of the QTL involved in climacteric ripening ETHQB3.5 on the fruit VOC composition was studied using a set of Near-Isogenic Lines (NILs) containing overlapping introgressions from the Korean accession PI 16375 on the chromosome 3 in the climacteric ‘Piel de Sapo’ (PS) genetic background. ETHQB3.5 was mapped in an interval of 1.24 Mb that contained a NAC transcription factor. NIL fruits also showed differences in VOC composition belonging to acetate esters, non-acetate esters, and sulfur-derived families. Cosegregation of VOC composition (23 out of 48 total QTLs were mapped) and climacteric ripening was observed, suggesting a pleiotropic effect of ETHQB3.5. On the other hand, other VOCs (mainly alkanes, aldehydes, and ketones) showed a pattern of variation independent of ETHQB3.5 effects, indicating the presence of other genes controlling non-climacteric ripening VOCs. Network correlation analysis and hierarchical clustering found groups of highly correlated compounds and confirmed the involvement of the climacteric differences in compound classes and VOC differences. The modification of melon VOCs may be achieved with or without interfering with its physiological behavior, but it is likely that high relative concentrations of some type of ethylene-dependent esters could be achieved in climacteric cultivars.Publishe