Post-hospital care pathway for individuals with hip fracture: what is the optimal setting and rehabilitation intensity? An observational study.

PURPOSE: Health systems are using ever-increasing resources on treating hip fractures. Optimal post-hospital care needs to be defined to design an effective care pathway. The aim of the present study was to describe the post-hospital care pathway of individuals with hip fracture and to assess its association with the degree of recovery of independence achieved four months after surgery. MATERIALS AND METHODS: A prognostic multicentric cohort study was conducted. All patients aged 65 years and over who were admitted with a diagnosis of fragility hip fracture were enrolled. After the hospital discharge, the patients were followed either at an inpatient rehabilitation facility with an intensive or extensive regimen, a nursing home, a long-term care facility or at home. Among the various care pathways, the intensity of rehabilitation differed according to its duration, frequency of sessions, and activities proposed. Primary outcome was the patient's degree of independence achieved four months after surgery, as measured with Activities of Daily Living scale. Several covariates were collected to test the correlation between the different post-hospital care pathways and the recovery of independence. RESULTS: A total of 923 patients completed the follow-up. A post- hospital rehabilitation pathway was indicated for 88.2% of the patients. The extensive rehabilitation pathway, indicated for 36.7% of the patients, was the most common. The intensive rehabilitation pathway gave better results in terms of independence at four-month follow up, leading to a median ADL score of 1.4 (95% CI 1.0-2.0). The other care pathways did not show significant difference between each other. CONCLUSIONS: High-intensity rehabilitation was associated to better results in terms of recovering of Activities of Daily Living.IMPLICATIONS FOR REHABILITATIONPost-hospital care pathways that include an intensive rehabilitation treatment should be improved/supported to make them available to a larger number of hip fracture patients.Patient selection criteria for post-hospital rehabilitation pathways should be standardized to optimize available healthcare resources.A cost-effectiveness analysis should be performed to analyze the economic sustainability of each post-hospital care pathway.

Yolk proteolysis and aquaporin-1o play essential roles to regulate fish oocyte hydration during meiosis resumption.

In marine fish, meiosis resumption is associated with a remarkable hydration of the oocyte, which contributes to the survival and dispersal of eggs and early embryos in the ocean. The accumulation of ions and the increase in free amino acids generated from the cleavage of yolk proteins (YPs) provide the osmotic mechanism for water influx into the oocyte, in which is involved the recently identified, fish specific aquaporin-1o (AQP1o). However, the timing when these processes occur during oocyte maturation, and the regulatory pathways involved, remain unknown. Here, we show that gilthead sea bream AQP1o (SaAQP1o) is synthesized at early vitellogenesis and transported towards the oocyte cortex throughout oocyte growth. During oocyte maturation, shortly after germinal vesicle breakdown and before complete hydrolysis of YPs and maximum K(+) accumulation is reached, SaAQP1o is further translocated into the oocyte plasma membrane. Inhibitors of yolk proteolysis and SaAQP1o water permeability reduce sea bream oocyte hydration that normally accompanies meiotic maturation in vitro by 80% and 20%, respectively. Thus, yolk hydrolysis appears to play a major role to create the osmotic driving force, while SaAQP1o possibly facilitates water influx into the oocyte. These results provide further evidence for the role of AQP1o mediating water uptake into fish oocytes, and support a novel model of fish oocyte hydration, whereby the accumulation of osmotic effectors and AQP1o intracellular trafficking are two highly regulated mechanisms.

Cathepsin B-mediated yolk protein degradation during killifish oocyte maturation is blocked by an H+-ATPase inhibitor: effects on the hydration mechanism.

In teleost oocytes, yolk proteins (YPs) derived from the yolk precursors vitellogenins are partially cleaved into free amino acids and small peptides during meiotic maturation before ovulation. This process increases the osmotic pressure of the oocyte that drives its hydration, which is essential for the production of buoyant eggs by marine teleosts (pelagophil species). However, this mechanism also occurs in marine species that produce benthic eggs (benthophil), such as the killifish (Fundulus heteroclitus), in which oocyte hydration is driven by K+. Both in pelagophil and benthophil teleosts, the enzymatic machinery underlying the maturation-associated proteolysis of YPs is poorly understood. In this study, lysosomal cysteine proteinases potentially involved in YP processing, cathepsins L, B, and F (CatL, CatB, and CatF, respectively), were immunolocalized in acidic yolk globules of vitellogenic oocytes from the killifish. During oocyte maturation in vitro induced with the maturation-inducing steroid (MIS), CatF disappeared from yolk organelles and CatL became inactivated, whereas CatB proenzyme was processed into active enzyme. Consequently, CatB enzyme activity and hydrolysis of major YPs were enhanced. Follicle-enclosed oocytes incubated with the MIS in the presence of bafilomycin A1, a specific inhibitor of vacuolar-type H+-ATPase, underwent maturation in vitro, but acidification of yolk globules, activation of CatB, and proteolysis of YPs were prevented. In addition, MIS plus bafilomycin A1-treated oocytes accumulated less K+ than those stimulated with MIS alone; hence, oocyte hydration was reduced. These results suggest that CatB is the major protease involved in yolk processing during the maturation of killifish oocytes, whose activation requires acidic conditions maintained by a vacuolar-type H+-ATPase. Also, the data indicate a link between ion translocation and YP proteolysis, suggesting that both events may be equally important physiological mechanisms for oocyte hydration in benthophil teleosts.

Servicios de provisión de agua potable y desagues cloacales. Regulación y control

A partir de las disposiciones contenidas en la normativa vigente, aplicable a la Concesión de los Servicios de Provisión de Agua Potable y Desagues Cloacales y teniendo en cuenta la necesidad de aplicar adecuados mecanismos de regulación y control, se analizan los derechos y obligaciones de los principales actores del servicio concesionado, la distribución de las facultades de control correspondientes al ejercicio del Poder de Policía y se formula una propuesta para la organización y funcionamiento del Ente Regulador, que se estima adecuada para la protección del usuario como objetivo fundamental

Servicios de provisión de agua potable y desag³es cloacales: regulación y control

Analiza la normativa vigente aplicable a la concesión de los servicios de provisión de agua potable y desag³es cloacales, teniendo en cuenta la necesidad de aplicar adecuados mecanismos de regulación y control. Señala los derechos y obligaciones de los principales actores del servicio, la distribución de las facultades del control y formula una propuesta para la organización y funcionamiento del ente regulador