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1.
Mol Biol Evol ; 39(2)2022 02 03.
Artículo en Inglés | MEDLINE | ID: mdl-35134226

RESUMEN

Environmental changes threaten insect pollinators, creating risks for agriculture and ecosystem stability. Despite their importance, we know little about how wild insects respond to environmental pressures. To understand the genomic bases of adaptation in an ecologically important pollinator, we analyzed genomes of Bombus terrestris bumblebees collected across Great Britain. We reveal extensive genetic diversity within this population, and strong signatures of recent adaptation throughout the genome affecting key processes including neurobiology and wing development. We also discover unusual features of the genome, including a region containing 53 genes that lacks genetic diversity in many bee species, and a horizontal gene transfer from a Wolbachia bacteria. Overall, the genetic diversity we observe and how it is distributed throughout the genome and the population should support the resilience of this important pollinator species to ongoing and future selective pressures. Applying our approach to more species should help understand how they can differ in their adaptive potential, and to develop conservation strategies for those most at risk.


Asunto(s)
Ecosistema , Genómica , Animales , Abejas/genética
2.
J Anim Ecol ; 92(2): 297-309, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-35978494

RESUMEN

Determining when animal populations have experienced stress in the past is fundamental to understanding how risk factors drive contemporary and future species' responses to environmental change. For insects, quantifying stress and associating it with environmental factors has been challenging due to a paucity of time-series data and because detectable population-level responses can show varying lag effects. One solution is to leverage historic entomological specimens to detect morphological proxies of stress experienced at the time stressors emerged, allowing us to more accurately determine population responses. Here we studied specimens of four bumblebee species, an invaluable group of insect pollinators, from five museums collected across Britain over the 20th century. We calculated the degree of fluctuating asymmetry (FA; random deviations from bilateral symmetry) between the right and left forewings as a potential proxy of developmental stress. We: (a) investigated whether baseline FA levels vary between species, and how this compares between the first and second half of the century; (b) determined the extent of FA change over the century in the four bumblebee species, and whether this followed a linear or nonlinear trend; (c) tested which annual climatic conditions correlated with increased FA in bumblebees. Species differed in their baseline FA, with FA being higher in the two species that have recently expanded their ranges in Britain. Overall, FA significantly increased over the century but followed a nonlinear trend, with the increase starting c. 1925. We found relatively warm and wet years were associated with higher FA. Collectively our findings show that FA in bumblebees increased over the 20th century and under weather conditions that will likely increase in frequency with climate change. By plotting FA trends and quantifying the contribution of annual climate conditions on past populations, we provide an important step towards improving our understanding of how environmental factors could impact future populations of wild beneficial insects.


Asunto(s)
Cambio Climático , Museos , Animales , Abejas
3.
Oecologia ; 202(3): 535-547, 2023 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-37428254

RESUMEN

Annual social insects are an integral functional group of organisms, particularly in temperate environments. An emblematic part of their annual cycle is the social phase, during which the colony-founding queen rears workers that later assist her in rearing sexual progeny (gynes and drones). In many annual social insects, such as species of bees, wasps, and other groups, developing larvae are provisioned gradually as they develop (progressive provisioning) leading to multiple larval generations being reared simultaneously. We present a model for how the queen in such cases should optimize her egg-laying rate throughout the social phase depending on number-size trade-offs, colony age-structure, and energy balance. Complementing previous theory on optimal allocation between workers vs. sexuals in annual social insects and on temporal egg-laying patterns in solitary insects, we elucidate how resource competition among overlapping larval generations can influence optimal egg-laying strategies. With model parameters informed by knowledge of a common bumblebee species, the optimal egg-laying schedule consists of two temporally separated early broods followed by a more continuous rearing phase, matching empirical observations. However, eggs should initially be laid continuously at a gradually increasing rate when resources are scarce or mortality risks high and in cases where larvae are fully supplied with resources at the egg-laying stage (mass-provisioning). These factors, alongside sexual:worker body size ratios, further determine the overall trend in egg-laying rates over the colony cycle. Our analysis provides an inroad to study and mechanistically understand variation in colony development strategies within and across species of annual social insects.


Asunto(s)
Conducta Social , Avispas , Femenino , Abejas , Animales , Reproducción , Insectos , Oviposición , Larva
4.
Ecol Lett ; 25(1): 3-16, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34713543

RESUMEN

Foraging by consumers acts as a biotic filtering mechanism for biodiversity at the trophic level of resources. Variation in foraging behaviour has cascading effects on abundance, diversity, and functional trait composition of the community of resource species. Here we propose diversity at giving-up density (DivGUD), i.e. when foragers quit exploiting a patch, as a novel concept and simple measure quantifying cascading effects at multiple spatial scales. In experimental landscapes with an assemblage of plant seeds, patch residency of wild rodents decreased local α-DivGUD (via elevated mortality of species with large seeds) and regional γ-DivGUD, while dissimilarity among patches in a landscape (ß-DivGUD) increased. By linking theories of adaptive foraging behaviour with community ecology, DivGUD allows to investigate cascading indirect predation effects, e.g. the ecology-of-fear framework, feedbacks between functional trait composition of resource species and consumer communities, and effects of inter-individual differences among foragers on the biodiversity of resource communities.


Asunto(s)
Biodiversidad , Conducta Predatoria , Animales , Ecosistema
5.
BMC Med Inform Decis Mak ; 22(1): 55, 2022 03 02.
Artículo en Inglés | MEDLINE | ID: mdl-35236345

RESUMEN

BACKGROUND: Overcrowding is a serious problem that impacts the ability to provide optimal level of care in a timely manner. High patient volume is known to increase the boarding time at the emergency department (ED), as well as at post-anesthesia care unit (PACU). Furthermore, the same high volume increases inpatient bed transfer times, which causes delays in elective surgeries, increases the probability of near misses, patient safety incidents, and adverse events. OBJECTIVE: The purpose of this study is to develop a Machine Learning (ML) based strategy to predict weekly forecasts of the inpatient bed demand in order to assist the resource planning for the ED and PACU, resulting in a more efficient utilization. METHODS: The data utilized included all adult inpatient encounters at Geisinger Medical Center (GMC) for the last 5 years. The variables considered were class of inpatient encounter, observation, or surgical overnight recovery (SORU) at the time of their discharge. The ML based strategy is built using the K-means clustering method and the Support Vector Machine Regression technique (K-SVR). RESULTS: The performance obtained by the K-SVR strategy in the retrospective cohort amounts to a mean absolute percentage error (MAPE) that ranges between 0.49 and 4.10% based on the test period. Additionally, results present a reduced variability, which translates into more stable forecasting results. CONCLUSIONS: The results from this study demonstrate the capacity of ML techniques to forecast inpatient bed demand, particularly using K-SVR. It is expected that the implementation of this model in the workflow of bed capacity management will create efficiencies, which will translate in a more reliable, inexpensive and timely care for patients.


Asunto(s)
Servicio de Urgencia en Hospital , Pacientes Internos , Adulto , Predicción , Humanos , Aprendizaje Automático , Estudios Retrospectivos
6.
Proc Biol Sci ; 287(1922): 20192442, 2020 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-32126960

RESUMEN

For social bees, an understudied step in evaluating pesticide risk is how contaminated food entering colonies affects residing offspring development and maturation. For instance, neurotoxic insecticide compounds in food could affect central nervous system development predisposing individuals to become poorer task performers later-in-life. Studying bumblebee colonies provisioned with neonicotinoid spiked nectar substitute, we measured brain volume and learning behaviour of 3 or 12-day old adults that had experienced in-hive exposure during brood and/or early-stage adult development. Micro-computed tomography scanning and segmentation of multiple brain neuropils showed exposure during either of the developmental stages caused reduced mushroom body calycal growth relative to unexposed workers. Associated with this was a lower probability of responding to a sucrose reward and lower learning performance in an olfactory conditioning test. While calycal volume of control workers positively correlated with learning score, this relationship was absent for exposed workers indicating neuropil functional impairment. Comparison of 3- and 12-day adults exposed during brood development showed a similar degree of reduced calycal volume and impaired behaviour highlighting lasting and irrecoverable effects from exposure despite no adult exposure. Our findings help explain how the onset of pesticide exposure to whole colonies can lead to lag-effects on growth and resultant dysfunction.


Asunto(s)
Abejas/fisiología , Conducta Animal/efectos de los fármacos , Insecticidas/toxicidad , Animales , Encéfalo , Conducta Alimentaria , Imidazoles/toxicidad , Aprendizaje/efectos de los fármacos , Neonicotinoides , Nitrocompuestos/toxicidad , Plaguicidas/toxicidad , Néctar de las Plantas , Recompensa , Microtomografía por Rayos X
7.
Mol Ecol ; 28(8): 1964-1974, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30843300

RESUMEN

Social bees are important insect pollinators of wildflowers and agricultural crops, making their reported declines a global concern. A major factor implicated in these declines is the widespread use of neonicotinoid pesticides. Indeed, recent research has demonstrated that exposure to low doses of these neurotoxic pesticides impairs bee behaviours important for colony function and survival. However, our understanding of the molecular-genetic pathways that lead to such effects is limited, as is our knowledge of how effects may differ between colony members. To understand what genes and pathways are affected by exposure of bumblebee workers and queens to neonicotinoid pesticides, we implemented a transcriptome-wide gene expression study. We chronically exposed Bombus terrestriscolonies to either clothianidin or imidacloprid at field-realistic concentrations while controlling for factors including colony social environment and worker age. We reveal that genes involved in important biological processes including mitochondrial function are differentially expressed in response to neonicotinoid exposure. Additionally, clothianidin exposure had stronger effects on gene expression amplitude and alternative splicing than imidacloprid. Finally, exposure affected workers more strongly than queens. Our work demonstrates how RNA-Seq transcriptome profiling can provide detailed novel insight on the mechanisms mediating pesticide toxicity to a key insect pollinator.


Asunto(s)
Abejas/genética , Conducta Animal/efectos de los fármacos , Neonicotinoides/efectos adversos , Plaguicidas/efectos adversos , Animales , Abejas/efectos de los fármacos , Conducta Animal/fisiología , Productos Agrícolas , Regulación de la Expresión Génica/efectos de los fármacos , Polinización/efectos de los fármacos , Polinización/genética
8.
Int Rev Psychiatry ; 31(7-8): 598-602, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31592689

RESUMEN

Medical students' wellbeing and mental health are of extreme importance. Studies from around the world have shown that the rates of burnout appear to be high. It is also well recognized that individuals with mental illnesses frequently avoid seeking help for fear of stigma, affecting their careers and being rejected or treated differently by their peers, or due to the perception that they will be deemed unfit for practice or rejected from their preferred specialty. Students who are open about their mental health conditions are often ostracized by their own peers and dismissed or even mistreated by teachers who consider mental 'toughness' to be a requirement for success in the medical arena. The impact of socioeconomic conditions cannot be under-estimated. We carried out a survey of mental health and wellbeing of medical students in the National University of Asuncion. A sample of 180 students across different years showed that 21% had sought help and 4% had been diagnosed with a mental condition before entering medical school; 3% had been previously diagnosed with Attention Deficit Hyperactivity Disorder or Autism Spectrum Disorders; 14% currently consult with a health professional specifically about their mental health; and 8% reported currently taking medication for their mental health. The most common medication was Escitalopram at 21%, followed by Sertraline with 11%. Various sources of stress were identified, all of which were noted to be concerning four specific domains: financial difficulties, familial issues, housing issues, and difficulties surrounding studies. Of these students, 20% were CAGE positive and 9.4% reported using substances to feel better. These findings indicate that medical students need better support to ensure that they function better. They require in-depth exploration of the potential causes of their illnesses.


Asunto(s)
Estado de Salud , Trastornos Mentales/tratamiento farmacológico , Salud Mental/estadística & datos numéricos , Estigma Social , Estudiantes de Medicina/estadística & datos numéricos , Agotamiento Profesional/psicología , Educación Médica , Femenino , Humanos , Masculino , Paraguay , Estrés Psicológico/psicología , Estudiantes de Medicina/psicología , Encuestas y Cuestionarios
9.
Proc Biol Sci ; 285(1885)2018 08 29.
Artículo en Inglés | MEDLINE | ID: mdl-30158303

RESUMEN

Social bees represent an important group of pollinating insects that can be exposed to potentially harmful pesticides when foraging on treated or contaminated flowering plants. To investigate if such exposure is detrimental to bees, many studies have exclusively fed individuals with pesticide-spiked food, informing us about the hazard but not necessarily the risk of exposure. While such studies are important to establish the physiological and behavioural effects on individuals, they do not consider the possibility that the risk of exposure may change over time. For example, many pesticide assays exclude potential behavioural adaptations to novel toxins, such as rejection of harmful compounds by choosing to feed on an uncontaminated food source, thus behaviourally lowering the risk of exposure. In this paper, we conducted an experiment over 10 days in which bumblebees could forage on an array of sucrose feeders containing 0, 2 and 11 parts per billion of the neonicotinoid pesticide thiamethoxam. This more closely mimics pesticide exposure in the wild by allowing foraging bees to (i) experience a field realistic range of pesticide concentrations across a chronic exposure period, (ii) have repeated interactions with the pesticide in their environment, and (iii) retain the social cues associated with foraging by using whole colonies. We found that the proportion of visits to pesticide-laced feeders increased over time, resulting in greater consumption of pesticide-laced sucrose relative to untreated sucrose. After changing the spatial position of each feeder, foragers continued to preferentially visit the pesticide-laced feeders which indicates that workers can detect thiamethoxam and alter their behaviour to continue feeding on it. The increasing preference for consuming the neonicotinoid-treated food therefore increases the risk of exposure for the colony during prolonged pesticide exposure. Our results highlight the need to incorporate attractiveness of pesticides to foraging bees (and potentially other insect pollinators) in addition to simply considering the proportion of pesticide-contaminated floral resources within the foraging landscape.


Asunto(s)
Conducta Alimentaria/efectos de los fármacos , Insecticidas/análisis , Tiametoxam/análisis , Animales , Abejas , Dieta , Relación Dosis-Respuesta a Droga , Preferencias Alimentarias/efectos de los fármacos , Factores de Tiempo
10.
J Asthma ; 53(10): 1018-25, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27437609

RESUMEN

OBJECTIVES: An increased asthma prevalence was found in cleaners. Many of them work in precarious employment conditions, potentially leading to stress, a known risk factor for asthma. We aimed to analyze whether asthma in cleaners might partly be explained by psychosocial working conditions. METHODS: The study population of this cross-sectional study included 199 cleaners employed at regional public health services in Puno Province (Peru). They were compared to 79 unexposed workers from Lima, Peru (response 83%). Both groups answered the short version of the European Working Condition Survey and a modified version of the European Community Respiratory Health screening questionnaire. After multiple imputation, the association between psychosocial working conditions and asthma (wheeze without cold or use of asthma medication) was assessed. RESULTS: The 12-months prevalence of asthma was 22% among cleaners versus 5% among unexposed workers (pChi(2) = .001). Cleaners were more likely than unexposed workers to work with temporary or sub-contracts, have a high employment insecurity, high strain working conditions and low social support (all pChi(2) < .05). Twenty-six percent vs. 10% reported a high bullying score; 39% vs. 8% had experienced violence at work (both pChi(2) < .001). High bullying score (adjusted Odds Ratio 5.6; 95% Confidence Interval 1.5-21.4) and violence (2.4; 1.1-5.4) were the main predictors of asthma. Taking these factors into account, being a cleaner was not statistically significantly associated with the outcome (3.5; 0.9-13.8). CONCLUSIONS: Poor psychosocial working conditions of cleaners may partly explain the high prevalence of asthma. The underlying mechanism might be a stress-induced inflammatory immune response.


Asunto(s)
Asma/epidemiología , Acoso Escolar , Tareas del Hogar/estadística & datos numéricos , Violencia Laboral , Femenino , Humanos , Satisfacción en el Trabajo , Masculino , Oportunidad Relativa , Perú/epidemiología , Estrés Psicológico , Lugar de Trabajo , Adulto Joven
11.
BMC Med Inform Decis Mak ; 15: 81, 2015 Oct 12.
Artículo en Inglés | MEDLINE | ID: mdl-26459258

RESUMEN

BACKGROUND: Important barriers for widespread use of health information exchange (HIE) are usability and interface issues. However, most HIEs are implemented without performing a needs assessment with the end users, healthcare providers. We performed a user needs assessment for the process of obtaining clinical information from other health care organizations about a hospitalized patient and identified the types of information most valued for medical decision-making. METHODS: Quantitative and qualitative analysis were used to evaluate the process to obtain and use outside clinical information (OI) using semi-structured interviews (16 internists), direct observation (750 h), and operational data from the electronic medical records (30,461 hospitalizations) of an internal medicine department in a public, teaching hospital in Tampa, Florida. RESULTS: 13.7 % of hospitalizations generate at least one request for OI. On average, the process comprised 13 steps, 6 decisions points, and 4 different participants. Physicians estimate that the average time to receive OI is 18 h. Physicians perceived that OI received is not useful 33-66 % of the time because information received is irrelevant or not timely. Technical barriers to OI use included poor accessibility and ineffective information visualization. Common problems with the process were receiving extraneous notes and the need to re-request the information. Drivers for OI use were to trend lab or imaging abnormalities, understand medical history of critically ill or hospital-to-hospital transferred patients, and assess previous echocardiograms and bacterial cultures. About 85 % of the physicians believe HIE would have a positive effect on improving healthcare delivery. CONCLUSIONS: Although hospitalists are challenged by a complex process to obtain OI, they recognize the value of specific information for enhancing medical decision-making. HIE systems are likely to have increased utilization and effectiveness if specific patient-level clinical information is delivered at the right time to the right users.


Asunto(s)
Toma de Decisiones Clínicas , Intercambio de Información en Salud , Personal de Salud , Aplicaciones de la Informática Médica , Evaluación de Necesidades , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad
12.
EFSA J ; 21(5): e07989, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-37179655

RESUMEN

The European Commission asked EFSA to revise the risk assessment for honey bees, bumble bees and solitary bees. This guidance document describes how to perform risk assessment for bees from plant protection products, in accordance with Regulation (EU) 1107/2009. It is a review of EFSA's existing guidance document, which was published in 2013. The guidance document outlines a tiered approach for exposure estimation in different scenarios and tiers. It includes hazard characterisation and provides risk assessment methodology covering dietary and contact exposure. The document also provides recommendations for higher tier studies, risk from metabolites and plant protection products as mixture.

13.
Materials (Basel) ; 15(13)2022 Jun 21.
Artículo en Inglés | MEDLINE | ID: mdl-35806510

RESUMEN

The development of an optimal low-calcium alkali-activated binder for high-temperature stability based on ferronickel slag, silica fume, potassium hydroxide, and potassium silicate was investigated based on Mixture Design of Experiment (Mixture DOE). Mass loss, shrinkage/expansion, and compressive and flexural strengths before and after exposure to a high thermal load (900 °C for two hours) were selected as performance markers. Chemical activator minimization was considered in the selection of the optimal mix to reduce CO2 emissions. Unheated 42-day compressive strength was found to be as high as 99.6 MPa whereas the 42-day residual compressive strength after exposure to the high temperature reached 35 MPa (results pertaining to different mixes). Similarly, the maximum unheated 42-day flexural strength achieved was 8.8 MPa, and the maximum residual flexural strength after extreme temperature exposure was 2.5 MPa. The binder showed comparable properties to other alkali-activated ones already studied and a superior thermal performance when compared to Ordinary Portland Cement. A quantitative X-ray diffraction analysis was performed on selected hardened mixes, and fayalite was found to be an important component in the optimal formulation. A life-cycle analysis was performed to study the CO2 savings, which corresponded to 55% for economic allocation.

14.
Open Res Eur ; 2: 79, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-37645348

RESUMEN

The need for repair and maintenance has become dominant in the European construction sector. This, combined with the urge to decrease CO 2 emissions, has resulted in the development of lower carbon footprint repair solutions such as textile reinforced mortars (TRM) based on alkali-activated materials (AAM). Life cycle studies indicate that AAM CO 2 savings, when compared to Portland cement, range from 80% to 30%. Furthermore, in this study, recycled aggregates were considered with the aim to promote a circular economy mindset. AAM mortars formulation based on fly ash, ladle furnace slag and metakaolin were tested for compressive and flexural strength. Three out of all formulations were chosen for an analysis on the potential of these mortars to be used for TRM applications. Tensile and shear bond tests, combined with a concrete substrate, were executed as indicators of the TRM effectiveness. Scanning electron microscopy and chemical analysis based on energy dispersive X-ray spectroscopy were used to interpret the results and reveal the reasons behind the different level of performance of these composites. Results indicated that TRM based on high calcium fly ash are unsuitable for structural strengthening applications due to low bond between matrix and/or substrate and fibers. Metakaolin-based TRM showed good performance both in terms of tensile strength and bond capacity, which suggests potential as a repair mortar.

15.
Front Insect Sci ; 1: 741349, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-38468876

RESUMEN

Agricultural intensification has drastically altered foraging landscapes for bees, with large-scale crop monocultures associated with floral diversity loss. Research on bumblebees and honeybees has shown individuals feeding on pollen from a low richness of floral sources can experience negative impacts on health and longevity relative to higher pollen source richness of similar protein concentrations. Florally rich landscapes are thus generally assumed to better support social bees. Yet, little is known about whether the effects of reduced pollen source richness can be mitigated by feeding on pollen with higher crude protein concentration, and importantly how variation in diet affects whole colony growth, rearing decisions and sexual production. Studying queen-right bumblebee (Bombus terrestris) colonies, we monitored colony development under a polyfloral pollen diet or a monofloral pollen diet with 1.5-1.8 times higher crude protein concentration. Over 6 weeks, we found monofloral colonies performed better for all measures, with no apparent long-term effects on colony mass or worker production, and a higher number of pupae in monofloral colonies at the end of the experiment. Unexpectedly, polyfloral colonies showed higher mortality, and little evidence of any strategy to counteract the effects of reduced protein; with fewer and lower mass workers being reared, and males showing a similar trend. Our findings (i) provide well-needed daily growth dynamics of queenright colonies under varied diets, and (ii) support the view that pollen protein content in the foraging landscape rather than floral species richness per se is likely a key driver of colony health and success.

16.
Proc Biol Sci ; 276(1677): 4423-31, 2009 Dec 22.
Artículo en Inglés | MEDLINE | ID: mdl-19793758

RESUMEN

Identifying species exhibiting variation in social organization is an important step towards explaining the genetic and environmental factors underlying social evolution. In most studied populations of the ant Leptothorax acervorum, reproduction is shared among queens in multiple queen colonies (polygyny). By contrast, reports from other populations, but based on weaker evidence, suggest a single queen may monopolize all reproduction in multiple queen colonies (functional monogyny). Here we identify a marked polymorphism in social organization in this species, by conclusively showing that functional monogyny is exhibited in a Spanish population, showing that the social organization is stable and not purely a consequence of daughter queens overwintering, that daughter queen re-adoption is frequent and queen turnover is low. Importantly, we show that polygynous and functionally monogynous populations are not genetically distinct from one another based on mtDNA and nDNA. This suggests a recent evolutionary divergence between social phenotypes. Finally, when functionally monogynous and polygynous colonies were kept under identical laboratory conditions, social organization did not change, suggesting a genetic basis for the polymorphism. We discuss the implications of these findings to the study of reproductive skew.


Asunto(s)
Hormigas/fisiología , Evolución Biológica , Jerarquia Social , Conducta Sexual Animal/fisiología , Conducta Social , Animales , Hormigas/genética , Análisis por Conglomerados , Femenino , Genotipo , Repeticiones de Microsatélite/genética , Ovario/citología , Filogenia , Reacción en Cadena de la Polimerasa , España
17.
J Healthc Qual ; 40(3): 129-138, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-28857931

RESUMEN

A diverse universe of statistical models in the literature aim to help hospitals understand the risk factors of their preventable readmissions. However, these models are usually not necessarily applicable in other contexts, fail to achieve good discriminatory power, or cannot be compared with other models. We built and compared predictive models based on machine learning algorithms for 30-day preventable hospital readmissions of Medicare patients. This work used the same inclusion/exclusion criteria for diseases used by the Centers for Medicare and Medicaid Services. In addition, risk stratification techniques were implemented to study covariate behavior on each risk strata. The new models resulted in improved performance measured by the area under the receiver operating characteristic curve. Finally, factors such as higher length of stay, disease severity index, being discharged to a hospital, and primary language other than English were associated with increased risk to be readmitted within 30 days. In the future, better predictive models for 30-day preventable hospital readmissions can point to the development of systems that identify patients at high risk and lead to the implementation of interventions (e.g., discharge planning and follow-up) to those patients, providing consistent improvement in the quality and efficiency of the healthcare system.


Asunto(s)
Algoritmos , Centers for Medicare and Medicaid Services, U.S./estadística & datos numéricos , Aprendizaje Automático , Alta del Paciente/estadística & datos numéricos , Alta del Paciente/tendencias , Readmisión del Paciente/estadística & datos numéricos , Readmisión del Paciente/tendencias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos , Adulto Joven
18.
FEMS Microbiol Ecol ; 93(5)2017 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-28379446

RESUMEN

Microbial ecology provides insights into the ecological and evolutionary dynamics of microbial communities underpinning every ecosystem on Earth. Microbial communities can now be investigated in unprecedented detail, although there is still a wealth of open questions to be tackled. Here we identify 50 research questions of fundamental importance to the science or application of microbial ecology, with the intention of summarising the field and bringing focus to new research avenues. Questions are categorised into seven themes: host-microbiome interactions; health and infectious diseases; human health and food security; microbial ecology in a changing world; environmental processes; functional diversity; and evolutionary processes. Many questions recognise that microbes provide an extraordinary array of functional diversity that can be harnessed to solve real-world problems. Our limited knowledge of spatial and temporal variation in microbial diversity and function is also reflected, as is the need to integrate micro- and macro-ecological concepts, and knowledge derived from studies with humans and other diverse organisms. Although not exhaustive, the questions presented are intended to stimulate discussion and provide focus for researchers, funders and policy makers, informing the future research agenda in microbial ecology.


Asunto(s)
Bacterias/crecimiento & desarrollo , Evolución Biológica , Enfermedades Transmisibles , Ecosistema , Inocuidad de los Alimentos , Microbiota , Ecología , Humanos
19.
Artículo en Español | LILACS-Express | LILACS | ID: biblio-1506962

RESUMEN

El Trastorno Negativista Desafiante será diagnosticado en un niño que presenta un comportamiento disruptivo para su edad y cultura, caracterizado por un patrón persistente de mal humor o irritabilidad, que discute o presenta comportamientos desafiantes y/o vengativos por lo menos durante los últimos 6 meses. Este trastorno no sólo afecta al niño, sino que es un problema de salud pública, que alcanza a la familia, a los maestros y a los pares. Cuando no se atiende adecuadamente, el trastorno negativista desafiante puede evolucionar a un problema de conducta mayor como el trastorno disocial o a la generación de una personalidad antisocial. Con el fin de ayudar a pediatras y a psiquiatras infantiles en el reconocimiento y manejo de estos "niños problemáticos", este artículo de revisión tiene el objetivo de presentar una puesta al día del concepto, etiopatogenia, clínica, diagnóstico y modalidades terapéuticas para este desafiante grupo de pacientes.


Oppositional Defiant Disorder is diagnosed in a child who exhibits a disruptive behavior for their age and culture, characterized by a persistent pattern of an angry mood or irritability, and who presents oppositional and / or vindictive behavior for at least the last 6 months. This disorder not only affects the child, but is a public health problem that affects the child's family, teachers and peers. When not addressed properly, oppositional defiant disorder can evolve into a significant behavioral problem, such as conduct disorder or antisocial personality disorder. In order to help pediatricians and child psychiatrists in the recognition and management of these "problematic children", this review article aims to present an update of the definition, pathogenesis, clinical presentation, diagnosis and therapeutic modalities for this challenging group of patients.

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