Nutrition and Isolation in a Rural US Population over 80 Years Old: A Descriptive Analysis of a Vulnerable Population.

Factors allowing rural, community-dwelling 80+ year-olds to thrive remain unexplored. Isolation can impact this vulnerable population. In this study, patients were prospectively surveyed for age, gender, cohabitation (self, spouse, family) and location (suburban, rural, and isolated). Mini-nutritional assessment short form (MNA-SF) and BMI were obtained. A p < 0.05 represented statistical significance. Patients (n = 167) were mostly female (120; 71.9%) with an average overweight BMI (26.5) and low-normal MNA-SF scores (11.8). Most live alone (49.7%), followed by spousal (31.7%) and family (18.6%) cohabitation. Over 80% are rural (71) or rural-isolated (67), and of these, 83% had normal nutrition. Self-habitation correlated with lower MNA-SF scores (p = 0.02). Normal BMIs correlated with family cohabitation (OR = 0.90 [CI: 0.82-0.99]) and nourished MNA-SF scores with spousal cohabitation (OR = 1.69; CI: 1.15-2.47) rather than living alone. Self-habitation increases vulnerability to obesity and malnutrition. Interventions should aim to maintain independence while improving the effects of habitation on nutrition.

Targeted care coordination towards patients with a history of multiple readmissions effectively reduces readmissions.

BACKGROUND: To decrease hospital readmission rates, clinical practices create a transition of care (TOC) process to assess patients and coordinate care postdischarge. As current evidence suggests lack of universal benefit, this study's objectives are to determine what patient and process factors associate with hospital readmissions, as well as construct a model to decrease 30-day readmissions. METHODS: Three months of retrospective discharged patient data (n = 123) were analysed for readmission influences including: patient-specific comorbidities, admission-specific diagnoses, and TOC components. A structured intervention of weekly contact, the Care Coordination Cocoon (CCC), was created for multiply readmitted patients (MRPs), defined as ≥2 readmissions. Three months of postintervention data (n = 141) were analysed. Overall readmission rates and patient- and process-specific characteristics were analysed for associations with hospital readmission. RESULTS: Standard TOC lacked significance. Patient-specific comorbidities of cancer (odds ratio [OR] 6.27; 95% confidence interval [CI] 1.73-22.75) and coronary artery disease (OR 6.71; 95% CI 1.84-24.46), and admission-specific diagnoses within pulmonary system admissions (OR 7.20; 95% CI 1.96-26.41) were associated with readmissions. Post-CCC data demonstrated a 48-h call (OR 0.21; 95% CI 0.09-0.50), answered calls (OR 0.16; CI 0.07-0.38), 14-day scheduled visit (OR 0.20; 95% CI 0.07-0.54), and visit arrival (OR 0.39; 95% CI 0.17-0.91) independently associated with decreased readmission rate. Patient-specific (hypertension-OR 3.65; CI 1.03-12.87) and admission-specific (nephrologic system-OR 3.22; CI 1.02-10.14) factors associated with readmissions which differed from the initial analysis. CONCLUSIONS: Targeting a practice's MRPs with CCC resources improves the association of TOC components with readmissions and rates decreased. This is a more efficient use of TOC resources.

Products from pyrolysis of gas-phase propionaldehyde.

A hyperthermal nozzle was utilized to study the thermal decomposition of propionaldehyde, CH3CH2CHO, over a temperature range of 1073-1600 K. Products were identified with two detection methods: matrix-isolation Fourier transform infrared spectroscopy and photoionization mass spectrometry. Evidence was observed for four reactions during the breakdown of propionaldehyde: α-C-C bond scission yielding CH3CH2, CO, and H, an elimination reaction forming methylketene and H2, an isomerization pathway leading to propyne via the elimination of H2O, and a ß-C-C bond scission channel forming methyl radical and (•)CH2CHO. The products identified during this experiment were CO, HCO, CH3CH2, CH3CH═C═O, H2O, CH3C≡CH, CH3, H2C═C═O, CH2CH2, CH3CH═CH2, HC≡CH, CH2CCH, H2CO, C4H2, C4H4, and CH3CHO. The first eight products result from primary or bimolecular reactions involving propionaldehyde while the remaining products occur from reactions including the initial pyrolysis products. While the pyrolysis of propionaldehyde involves reactions similar to those observed for acetaldehyde and butyraldehyde in recent studies, there are a few unique products observed which highlight the need for further study of the pyrolysis mechanism.