ABSTRACT
Objective: The primary objective of this study is to describe associations between emergency department (ED)-to-skilled nursing facility (SNF) transition and ED length-of-stay (LOS). The secondary objective is to explore how social determinants of health (SDOH) influence ED-to-SNF transition visit parameters. In 2020, The Centers for Medicare & Medicaid Services issued the "COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers" eliminating the requirement of a 3-day qualifying hospital stay before SNF placement. The waiver allowed ED patients to be transitioned directly to an SNF from the ED. Methods: We conducted a descriptive retrospective case-control study of adult patients who sought care in the University of North Carolina Hospitals (UNCH) ED between March 1, 2020, and March 1, 2022, lived in a non-SNF residence before their ED visit, and were transitioned directly to an SNF from the ED (n 1 = 27), compared with a group seen in the ED and admitted to hospital for SNF placement (n 2 = 54). Results: The ED-to-SNF group experienced a significantly longer ED LOS compared to the ED-to-Inpatient-to-SNF group: 72.8 hours (95% confidence interval [CI], 59.2-86.4) compared to 14.5 hours (95% CI, 12.1-16.9). We found no significant differences in SDOH between the ED-to-SNF group and the ED-to-Inpatient-to-SNF group. Conclusion: Patients who transition from the ED to an SNF experience long ED stays that may adversely affect health and well-being. Transitioning directly from the ED to an SNF may contribute to ED boarding and overcrowding.
ABSTRACT
The recently discovered COMM domain-containing (COMMD) protein family has ten members (COMMD1-10). A COMMD protein contains a carboxyl-terminal COMM (copper metabolism gene MURR1) domain which provides an interface for protein-protein interactions. However, no COMMD4 gene has been identified in amphioxus. In this study, we report the identification and characterization of a COMMD4 gene from the amphioxus (designated as AmphiCOMMD4). First, we cloned the full length of AmphiCOMMD4 gene and found that the deduced amino acid sequence of AmphiCOMMD4 has 55.5-82.5% similarity and 38.8-64.0% identity to those from other species. Second, the genomic structure analysis of AmphiCOMMD4 gene showed that COMMD4 underwent intron loss in amphioxus. Third, we found that the AmphiCOMMD4 was ubiquitously and differentially expressed in five investigated tissues (muscles, gills, intestine, hepatic cecum and gonad). Finally, we found that the expression level of AmphiCOMMD4 gene was induced by LPS stimulation. In conclusion, our study elaborates the COMMD4 in amphioxus and provides an insight into the innate immunity and the evolution of the COMMD family.
