Non-pharmacological interventions for delirium in the pediatric population: a systematic review with narrative synthesis.

BACKGROUND: Delirium is a serious complication experienced by hospitalized children. Therefore, preventive management strategies are recommended for these patients. However, comprehensive analyses of delirium interventions in children remain insufficient. Specifically, this systematic review aimed to summarize non-pharmacological interventions for pediatric delirium, addressing the urgent need for a comprehensive understanding of effective strategies. We also explored frequently measured outcome variables to contribute evidence for future research on delirium outcomes in children. METHODS: This systematic review searched articles from PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medica databases. The eligibility criteria were formed under the population, intervention, comparator, outcome, and study design framework. Studies were included if they involved (1) children aged under 18 years receiving hospital care, (2) non-pharmacological delirium interventions, (3) comparators involving no intervention or pharmacological delirium interventions, and (4) outcomes measuring the effectiveness of non-pharmacological delirium interventions. Only peer-reviewed articles published in English were included. RESULTS: Overall, 16 studies were analyzed; of them, 9 assessed non-pharmacological interventions for emergence delirium and 7 assessed interventions for pediatric delirium. The intervention types were grouped as follows: educational (n = 5), multicomponent (n = 6), and technology-assisted (n = 5). Along with pediatric and emergence delirium, the most frequently measured outcome variables were pain, patient anxiety, parental anxiety, pediatric intensive care unit length of stay, agitation, analgesic consumption, and postoperative maladaptive behavior. CONCLUSIONS: Non-pharmacological interventions for children are effective treatments without associated complications. However, determining the most effective non-pharmacological delirium intervention for hospitalized children based on current data remains challenging.

Patterns of medical care utilization according to environmental factors in asthma and chronic obstructive pulmonary disease patients.

BACKGROUND/AIMS: Weather and air pollution are associated with the exacerbation of respiratory diseases. We investigated patterns of medical care use according to meteorological factors and air pollution in patients with asthma or chronic obstructive pulmonary disease (COPD). METHODS: We analyzed the medical care utilization patterns of patients with asthma or COPD registered in the Korea Health Insurance Review and Assessment database for the period 2007 to 2013. The patterns were divided into hospitalization and emergency department (ED) use. RESULTS: The medical care use of patients with asthma or COPD increased when the mean temperature and relative humidity were lower, and the temperature difference and atmospheric pressure were greater. Medical care use increased with the concentrations of particulate matter and ozone. Among age groups, sensitivity to pollutants was greatest in patients aged ≥ 65 years. The effect of being elderly was greater for asthma than for COPD, with a higher hospitalization rate. ED utilization affected by environmental factors was significantly greater for females and hospitalization was significantly more common for males. CONCLUSION: Meteorological factors and air pollutants were shown to contribute to increased medical care utilization by patients with asthma and COPD, particularly elderly patients. The overall effect was greater for COPD, but the effect in elderly patients was greater for asthma. In addition, the patterns of change in medical care use due to environmental factors differed according to sex.

Relationship between reactive oxygen species and water-soluble organic compounds: Time-resolved benzene carboxylic acids measurement in the coastal area during the KORUS-AQ campaign.

This study investigated the relationship between water-soluble organic compounds of ambient particulate matter (PM) and cellular redox activity collected from May 28 to June 20 of 2016 at the west coastal site in the Republic of Korea during the KORea-US Air Quality (KORUS-AQ) campaign. Automatic four-hour integrated samples operated at a flow rate of 92 L per minute for the analysis of organic carbon (OC), water-soluble organic carbon (WSOC), elemental carbon (EC), water-soluble ions (WSIs), and benzene carboxylic acids (BCAs) were collected on a 47 mm quartz fiber filter. The influence of atmospheric transport processes was assessed by the Weather Research and Forecasting (WRF) model. OC, EC, WSOC, and BCA were determined by SUNET carbon analyzer, total organic carbon (TOC) analyzer, and liquid chromatography-mass spectrometry mass spectrometry (LC-MSMS), respectively. Twenty-four-hour integrated samples were collected for reactive oxygen species (ROS) analysis using a fluorogenic cell-based method to investigate the main chemical classes of toxicity. The results illustrate that WSOC and specific water-soluble species are associated with the oxidative potential of particulate matter. Pairwise correlation scatterplots between the daily-averaged WSOC and ROS (r2 of 0.81), and 135-BCA and ROS (r2 of 0.84), indicate that secondary organic aerosol production was highly associated with ROS activity. In addition, X-ray spectral analysis together with secondary electron images (SEIs) of PM2.5 particles collected during high ROS concentration events clearly indicate that water-soluble organic aerosols are major contributors to PM2.5 mass. This study provides insight into the components of particulate matter that are drivers of the oxidative potential of atmospheric particulate matter and potential tracers for this activity.

Repression of FLOWERING LOCUS T chromatin by functionally redundant histone H3 lysine 4 demethylases in Arabidopsis.

FLOWERING LOCUS T (FT) plays a key role as a mobile floral induction signal that initiates the floral transition. Therefore, precise control of FT expression is critical for the reproductive success of flowering plants. Coexistence of bivalent histone H3 lysine 27 trimethylation (H3K27me3) and H3K4me3 marks at the FT locus and the role of H3K27me3 as a strong FT repression mechanism in Arabidopsis have been reported. However, the role of an active mark, H3K4me3, in FT regulation has not been addressed, nor have the components affecting this mark been identified. Mutations in Arabidopsis thaliana Jumonji4 (AtJmj4) and EARLY FLOWERING6 (ELF6), two Arabidopsis genes encoding Jumonji (Jmj) family proteins, caused FT-dependent, additive early flowering correlated with increased expression of FT mRNA and increased H3K4me3 levels within FT chromatin. Purified recombinant AtJmj4 protein possesses specific demethylase activity for mono-, di-, and trimethylated H3K4. Tagged AtJmj4 and ELF6 proteins associate directly with the FT transcription initiation region, a region where the H3K4me3 levels were increased most significantly in the mutants. Thus, our study demonstrates the roles of AtJmj4 and ELF6 as H3K4 demethylases directly repressing FT chromatin and preventing precocious flowering in Arabidopsis.