RESUMEN
BACKGROUND: Emergency department (ED) crowding is a global burden. Interventions to reduce ED utilization have been widely discussed in the literature, but previous reviews have mainly focused on specific interventions or patient groups within the EDs. The purpose of this scoping review was to identify, summarize, and categorize the various types of non-ED-based interventions designed to reduce unnecessary visits to EDs. METHODS: This scoping review followed the JBI Manual for Evidence Synthesis and the PRISMA-SCR checklist. A comprehensive structured literature search was performed in the databases MEDLINE and Embase from 2008 to March 2024. The inclusion criteria covered studies reporting on interventions outside the ED that aimed to reduce ED visits. Two reviewers independently screened the records and categorized the included articles by intervention type, location, and population. RESULTS: Among the 15,324 screened records, we included 210 studies, comprising 183 intervention studies and 27 systematic reviews. In the primary studies, care coordination/case management or other care programs were the most commonly examined out of 15 different intervention categories. The majority of interventions took place in clinics or medical centers, in patients' homes, followed by hospitals and primary care settings - and targeted patients with specific medical conditions. CONCLUSION: A large number of studies have been published investigating interventions to mitigate the influx of patients to EDs. Many of these targeted patients with specific medical conditions, frequent users and high-risk patients. Further research is needed to address other high prevalent groups in the ED - including older adults and mental health patients (who are ill but may not need the ED). There is also room for further research on new interventions to reduce ED utilization in low-acuity patients and in the general patient population.
Asunto(s)
Aglomeración , Servicio de Urgencia en Hospital , Humanos , Servicio de Urgencia en Hospital/estadística & datos numéricosRESUMEN
The copepod Calanus finmarchicus is a key component of northern Atlantic food webs, linking energy-transfer from phytoplankton to higher trophic levels. We examined the effect of different ocean acidification (OA) scenarios (i.e., ambient, 1080, 2080, and 3080 µatm CO2) over two subsequent generations under limited food availability. Determination of metabolic and feeding rates, and estimations of the scope for growth, suggests that negative effects observed on vital rates (ontogenetic development, somatic growth, fecundity) may be a consequence of energy budget constraints due to higher maintenance costs under high pCO2-environments. A significant delay in development rate among the parental generation animals exposed to 2080 µatm CO2, but not in the following F1 generation under the same conditions, suggests that C. finmarchicus may have adaptive potential to withstand the direct long-term effects of even the more pessimistic future OA scenarios but underlines the importance of transgenerational experiments. The results also indicate that in a more acidic ocean, increased energy expenditure through rising respiration could lower the energy transfer to higher trophic levels and thus hamper the productivity of the northern Atlantic ecosystem.
Asunto(s)
Dióxido de Carbono/química , Copépodos , Agua de Mar/química , Animales , Copépodos/crecimiento & desarrollo , Copépodos/metabolismo , Ingestión de Alimentos , Ecosistema , Cadena Alimentaria , Concentración de Iones de Hidrógeno , Océanos y Mares , Fitoplancton/metabolismoRESUMEN
Suppression subtractive hybridization (SSH) cDNA library construction and characterization was used to identify differentially regulated transcripts from oil exposure in liver of male Atlantic herring (Clupea harengus) fed a diet containing 900 mg crude oil/kg for 2 mo. In total, 439 expressed sequence tags (EST) were sequenced, 223 from the forward subtracted library (enriched for genes putatively upregulated by oil exposure) and 216 from the reverse subtracted library (enriched for genes putatively downregulated by oil exposure). Follow-up reverse-transcription (RT) quantitative polymerase chain reaction (qPCR) analyses of gene transcription were conducted on additional herring exposed to food containing 9 (low), 90 (medium), and 900 (high) mg crude oil/kg feed for 2 mo. Chronic exposure of Atlantic herring to an oil-contaminated diet mediated upregulation of transcripts encoding antifreeze proteins, proteins in the classical complement pathway (innate immunity), and iron-metabolism proteins. Gene ontology (GO) analysis showed that "cellular response to stress," "regulation to biological quality," "response to abiotic stimuli," and "temperature homeostasis" were the most affected go at the biological processes level, and "carbohydrate binding," "water binding," and "ion binding" at the molecular function level. Of the genes examined with RT-qPCR, CYP1A, antifreeze protein, retinol binding protein 1, deleted in malignant brain tumor 1, and ovary-specific C1q-like factor demonstrated a significant upregulation. Myeloid protein 1, microfibrillar-associated protein 4, WAP65, and pentraxin were downregulated in liver of fish from the high exposure group. In conclusion, this study suggests that 2 mo of oil exposure affected genes encoding proteins involved in temperature homeostasis and possible membrane stability in addition to immune-responsive proteins in Atlantic herring.
Asunto(s)
Copépodos , Proteínas de Peces/genética , Peces/genética , Petróleo/toxicidad , Contaminantes Químicos del Agua/toxicidad , Animales , Dieta/estadística & datos numéricos , Relación Dosis-Respuesta a Droga , Monitoreo del Ambiente , Femenino , Proteínas de Peces/metabolismo , Peces/metabolismo , Expresión Génica/efectos de los fármacos , Biblioteca de Genes , Hígado/metabolismo , Masculino , Contaminantes Químicos del Agua/administración & dosificaciónRESUMEN
BACKGROUND: Blockchain can be described as an immutable ledger, logging data entries in a decentralized manner. This new technology has been suggested to disrupt a wide range of data-driven domains, including the health domain. OBJECTIVE: The purpose of this study was to systematically review, assess and synthesize peer-reviewed publications utilizing/proposing to utilize blockchain to improve processes and services in healthcare, health sciences and health education. METHOD: A structured literature search on the topic was conducted in October 2018 relevant bibliographic databases. RESULT: 39 publications fulfilled the inclusion criteria. The result indicates that Electronic Health Records and Personal Health Records are the most targeted areas using blockchain technology. Access control, interoperability, provenance and data integrity are all issues that are meant to be improved by blockchain technology in this field. Ethereum and Hyperledger fabric seem to be the most used platforms/frameworks in this domain. CONCLUSION: This study shows that the endeavors of using blockchain technology in the health domain are increasing exponentially. There are areas within the health domain that potentially could be highly impacted by blockchain technology.
Asunto(s)
Cadena de Bloques/normas , Atención a la Salud/normas , Registros Electrónicos de Salud/normas , Intercambio de Información en Salud/normas , Registros de Salud Personal , Mejoramiento de la Calidad , HumanosRESUMEN
BACKGROUND: Obsessive-compulsive disorder (OCD) is a chronic mental health disorder characterized by recurring obsessions and compulsions affecting 1-3% of children and adolescents. Current treatment options are limited by accessibility, availability, and quality of care. New technologies provide opportunities to address at least some of these challenges. This paper aims to investigate the acceptability, feasibility, and efficacy of traditional cognitive behavioral therapy with Internet cognitive behavioral therapy (iCBT) for pediatric OCD according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. METHOD: We searched EMBASE, Medline, PsycINFO, CENTRAL, LILACS, CINAHL, and Scopus. Results include articles from 1987 to March 2018. Main inclusion criteria were patients aged 4-18, primary diagnosis of OCD, and iCBT. RESULTS: Of the 2323 unique articles identified during the initial search, six studies with a total of 96 participants met our inclusion criteria: three randomized controlled trials, one single-case multiple-baseline design, one open-label trial, and one case series. Four studies reported a significant decrease in OCD severity on the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) following iCBT, one study reported significant decrease in CY-BOCS scores for iCBT relative to waitlist, and the case series reported (some) symptom reduction in all participants. Six studies reported high rates of feasibility, and five studies reported good acceptability of iCBT. CONCLUSION: At present, evidence regarding acceptability, feasibility, and efficacy of iCBT for pediatric OCD is limited. Results are promising but need to be confirmed and refined in further research. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD4201808587.
Asunto(s)
Terapia Cognitivo-Conductual/métodos , Internet , Trastorno Obsesivo Compulsivo/terapia , Adolescente , Niño , Preescolar , Estudios de Factibilidad , Humanos , Aceptación de la Atención de SaludRESUMEN
Some species of macromycetes (mushrooms) consistently are found to contain high concentrations of toxic metals such as cadmium (Cd) and mercury (Hg), and consumption of wild-growing mushrooms is acknowledged as a significant source for Cd and Hg in humans. Yet little is known about the speciation of Cd and Hg in mushroom tissues. Here we present the first evidence of peptides of the phytochelatin family being responsible for binding a large fraction of Cd in caps of the macromycete Boletus edulis exposed to excess metals. Concentrations of Cd, Zn, Cu and Hg, as well as cytosolic Cd-binding capacity (CCBC), glutathione (GSH) and free proline (Pro) were quantified in fruiting bodies of B. edulis differentially exposed to a wide range of metals. Metal distribution among cytosolic compounds were investigated by size exclusion chromatography (SEC), followed by metal determinations with atomic absorption chromatography (AAS) and HR-ICP-MS. Cd-binding compounds in SEC elutates were investigated further by high performance liquid chromatography-mass spectrometry (HPLC-MS). CCBC was >90 times higher in the exposed group relative to the reference group (Mann-Whitney's P < 0.001), whereas concentrations of free Pro were almost identical for the two groups. For the whole study selection, CCBC correlated positively with metal exposure (Spearman's P < 0.001 for all four metals), suggesting dose-dependent induction of Cd-binding compounds by exposure to these metals, possibly as a defense mechanism. The presence of phytochelatins (PCs), a family of cystein-rich oligopeptides, was confirmed in Cd-containing SEC fractions by HPLC-MS. The appearance of more complex PCs was coupled to declining concentrations of GSH. To our knowledge this is the first report demonstrating the presence of PCs in a macromycete.
Asunto(s)
Agaricales/química , Agaricales/efectos de los fármacos , Glutatión/biosíntesis , Glutatión/aislamiento & purificación , Metales/metabolismo , Cromatografía en Gel , Cromatografía Líquida de Alta Presión , Glutatión/análisis , Espectrometría de Masas , Fitoquelatinas , Prolina/análisis , Unión Proteica , Espectrofotometría AtómicaRESUMEN
The antifreeze proteins (AFPs) are a family of proteins characterised by their ability to inhibit the growth of ice. These proteins have evolved as a protection against lethal freezing in freeze avoiding species. Metal stress has been shown to reduce the cold hardening in invertebrates, but no study has investigated how this type of stress affects the production of AFPs. This study demonstrates that exposure to cadmium (Cd), copper (Cu) and zinc (Zn) reduces the normal developmental increase in AFP levels in Tenebrio molitor larvae reared under summer conditions. Exposure to winter conditions, however stimulated the production of AFPs in the metal exposed larvae, and raised the concentrations of AFPs to normal winter levels. The reduced level of AFPs in metal-stressed animals acclimated to summer conditions seems to arise from alterations in the normal gene expression of AFPs. The results indicate that metal exposure may cause freeze avoiding insects to become more susceptible to lethal freezing, as they enter the winter with lowered levels of AFPs. Such an effect cannot be revealed by ordinary toxicological tests, but may nevertheless be of considerable ecological importance.
Asunto(s)
Proteínas Anticongelantes/metabolismo , Metales Pesados/farmacología , Tenebrio/metabolismo , Aclimatación/efectos de los fármacos , Animales , Peso Corporal/efectos de los fármacos , Frío , Regulación de la Expresión Génica , Hemolinfa/metabolismo , Proteínas de Insectos/metabolismo , Larva/metabolismo , Concentración Osmolar , Estaciones del Año , Tenebrio/efectos de los fármacosRESUMEN
With the advent of next generation sequencing, new avenues have opened to study genomics in wild populations of non-model species. Here, we describe a successful approach to a genome-wide medium density Single Nucleotide Polymorphism (SNP) panel in a non-model species, the house sparrow (Passer domesticus), through the development of a 10 K Illumina iSelect HD BeadChip. Genomic DNA and cDNA derived from six individuals were sequenced on a 454 GS FLX system and generated a total of 1.2 million sequences, in which SNPs were detected. As no reference genome exists for the house sparrow, we used the zebra finch (Taeniopygia guttata) reference genome to determine the most likely position of each SNP. The 10 000 SNPs on the SNP-chip were selected to be distributed evenly across 31 chromosomes, giving on average one SNP per 100 000 bp. The SNP-chip was screened across 1968 individual house sparrows from four island populations. Of the original 10 000 SNPs, 7413 were found to be variable, and 99% of these SNPs were successfully called in at least 93% of all individuals. We used the SNP-chip to demonstrate the ability of such genome-wide marker data to detect population sub-division, and compared these results to similar analyses using microsatellites. The SNP-chip will be used to map Quantitative Trait Loci (QTL) for fitness-related phenotypic traits in natural populations.
Asunto(s)
Genética de Población/métodos , Genoma/genética , Análisis de Secuencia por Matrices de Oligonucleótidos/métodos , Polimorfismo de Nucleótido Simple/genética , Sitios de Carácter Cuantitativo/genética , Gorriones/genética , Animales , Secuencia de Bases , ADN Complementario/genética , Repeticiones de Microsatélite/genética , Datos de Secuencia Molecular , Noruega , Análisis de Secuencia de ADN , Especificidad de la EspecieRESUMEN
Carbon dioxide (CO(2)) acts as a weak acid in water and the increasing level of CO(2) in the atmosphere leads to ocean acidification. In addition, possible leakage from sub-seabed storage of anthropogenic CO(2) may pose a threat to the marine environment. (1)H NMR spectroscopy was applied to extracts of hemolymph, gills and leg muscle from shore crabs (Carcinus maenas) to examine the metabolic response to elevated levels of CO(2). Crabs were exposed to different levels of CO(2)-acidified seawater with pH(NBS) 7.4, 6.6 and 6.3 (pCO(2)~2600, 16,000 and 30,000 µatm, respectively) for two weeks (level-dependent exposure). In addition, the metabolic response was followed for up to 4 weeks of exposure to seawater pH(NBS) 6.9 (pCO(2)~7600 µatm). Partial least squares regression analysis of data showed an increased differentiation between metabolic fingerprints of controls and exposed groups for all sample types with increasing CO(2) levels. Difference between controls and animals subjected to time-dependent exposure appeared after 4 weeks in the hemolymph and gills, and after 48 h of exposure in the leg muscle. Changes in metabolic profiles were mainly due to a reduced level of important intracellular osmolytes such as amino acids (glycine, proline), while the level of other metabolites varied between the different sample types. The results are similar to what is observed in animals exposed to hypo-osmotic stress and may suggest disturbances in intracellular iso-osmotic regulation. The results may also reflect increased catabolism of amino acids to supply the body fluids with proton-buffering ammonia (NH(3)). Alternatively, the findings may reflect an exhaustive effect of CO(2) exposure.