Drug-coated balloons versus conventional percutaneous transluminal angioplasty for treatment-naïve dysfunctional arteriovenous fistulas.: A 10-year single center retrospective study.

OBJECTIVES: To compare the primary patency and restenosis rates in treatment naieve dialysis arteriovenous fistulas (AVFs) after drug-coated balloons (DCB) versus plain balloon angioplasty (PTA). METHODS: This retrospective study included 157 patients who underwent AVF angioplasty for treatment-native AVF stenosis between January 2012 to 2022. The fistulas were Brachiocephalic (75%), Brachiobasilic (17%), and radiocephalic (8%). The index intervention was with either DCB or percutaneous transluminal angioplasty (PTA) with subsequent follow up. Patients with central venous stenosis, thrombosed fistula, fistula stents, AV graft or surgical intervention after the index procedure were excluded. RESULTS: Arteriovenous fistula angioplasty was done in 28 patients using DCB and in 129 patients using PTA. A total of 108 patients presented with a single stenosis, 42 with 2 stenoses, and 7 with 3 stenoses. The location of these stenoses was in the venous outflow (57%), the juxta anastomotic segment (31%), and cephalic arch (12%). The median time to re-intervention for the PTA was 216 days compared to 304 days for the DCB (p=0.079). Primary patency at 6 months was 60.4% for PTA and 75% for DCB (p=0.141) CONCLUSION: Although DCB angioplasty of treatmentnaïve dysfunctional AVF tends to improve the time to intervention and 6-month primary patency compared to PTA, this difference did not reach statistical significance.

Sustainable microalgal biomass as a potential functional food and its applications in food industry: a comprehensive review.

Microalgae (MA) are the most abundant seaweeds with high nutritional properties. They are accepted as potential biocatalysts for the bioremediation of wastewater. They are widely used in food, feed, and biofuel industries and can potentially be food for future generations. MA-based purification of wastewater technology could be a universal alternative solution for the recovery of resources from wastewater for low-cost biomass feedstock for industry. They provide a wide range of functional components, viz. omega-3 fatty acids, along with a plenteous number of pigments such as ß-carotene, astaxanthin, lutein, phycocyanin, and chlorophyll, which are used extensively as food additives and nutraceuticals. Further, proteins, lipids, vitamins, and carbohydrates are described as nutritional characteristics in MA. They are investigated as single-cell protein, thickening/stabilizing agents, and pigment sources in the food industry. The review emphasizes the production and extraction of nutritional and functional components of algal biomass and the role of microalgal polysaccharides in digestion and nutritional absorption in the gastrointestinal tract. Further, the use of MA in the food industry was also investigated along with their potential therapeutic applications.

Development, characterization and use of rosemary essential oil loaded water-chestnut starch based nanoemulsion coatings for enhancing post-harvest quality of apples var. Golden delicious.

The study aimed at evaluating the influence of water-chestnut starch-based coatings loaded with rosemary essential oil (REO) at concentrations of 0.10%, 0.25% and 0.50% (w/v) on postharvest cold storage stability of apple var. Golden delicious for 120 days. Average droplet diameter of nanoemulsions was in range of 315-450 nm and it increased with increase in the REO concentration. Minimum weight loss was observed in fruits treated with coating material containing 0.50% REO. Samples coated with starch+0.50% REO exhibited highest firmness value of 68.22 ± 1.02 N under controlled atmosphere storage (CAS). Anthocyanins, ascorbic acid, total phenolic content and antioxidant activity were retained in all samples coated with formulated emulsion. Antifungal assay against Pencillium expansum indicated that 0.50% REO had maximum antifungal activity. Increase in REO concentration from 0.10 to 0.50% in starch coating formulations resulted in reduced lesion diameter in coated samples under both the storage conditions. Lesion diameter (LD) was found highest in control (39.40 ± 0.20 mm) under ambient conditions. Coated fruit samples showed a significant (p≤0.05) reduction in LD under both the ambient and CAS conditions however, more pronounced effect was reported under CAS. Fruits coated with edible coatings enriched with different REO concentrations under CAS exhibited significantly (p≤0.05) lower chilling injury index (ST+0.50%REO < ST+0.25%REO<0.10%REO) compared to control.

Physicochemical, thermal, pasting, morphological, functional and bioactive binding characteristics of starches of different oat varieties of North-Western Himalayas.

Starches were isolated from five oat varieties (SFO-1, SFO-3, Sabzar, SKO-20 and SKO-96) grown in North-Western Himalayas of India. Moisture content of the varieties ranged from 9.25 ± 0.09 to 13.21 ± 0.11 %, indicating their shelf-stability. Results suggested >90 % purity of starches as was evident from values of ash, proteins, and lipids. Amylose content results showed that all starches fall within category of intermediate-amylose starches. Lambdamax, blue value and OD620/550 were found significantly (p ≤ 0.05) higher in SKO-20. Sabzar exhibited higher starch hydrolysis percentage of 85.16 % whereas, lowest was observed in SKO-20 (78.12 %). Degree of syneresis was higher in SKO-20 however, its freeze-thaw stability was lesser. Wide peak in FTIR spectra at 3320 cm-1 confirms nature of starches. SKO-20 exhibited significantly higher onset gelatinization temperature (65.19 ± 1.06 °C) and enthalpy (15.78 ± 0.15 J/g) whereas, Sabzar exhibited lowest enthalpy. Pasting characteristics indicated lowest and highest final viscosity in SKO-20 (341.30 ± 2.11 mPas) and SKO-96 (1470 ± 4.56 mPas), respectively. SEM results indicated irregular and polygonal shape of starches with size <10 µm. SKO-20 exhibited lowest disintegration time of 2.08 ± 0.01 min and Sabzar showed highest (3.31 ± 0.07 min). SKO-20 released more curcumin (71.28 %) whereas, Sabzar released less. This suggests that SKO-20 could be used as better excipient for delivery of curcumin at target site.

A comprehensive review on functional beverages from cereal grains-characterization of nutraceutical potential, processing technologies and product types.

Due to growing consumer interest in fitness and wellbeing, foods and beverages with therapeutic and functional qualities are in higher demand. In addition to being significant staple crops and major providers of nutrition and energy, cereals are rich in bioactive phytochemicals with health benefits. Cereal grains offer a lot of promise for processing into functional beverages since these include a wide variety of bioactive phytochemicals such as phenolic compounds, carotenoids, dietary fibres, phytosterols, tocols, gamma-oryzanol, and phytic acid. Despite the fact that a wide variety of beverages made from cereal grains are produced globally, they have received very little technological and scientific attention. The beverages confer replacements for milk made from cereal grains, roasted cereal grain teas and fermented non-alcoholic cereal grain drinks. This review emphasizes on the three primary kinds of functional beverages made from cereal grains. Further, the potential applications and directions for the future related to these beverages are discussed with elaborated processing methods, health benefits and product attributes. Cereal grain-based beverages may represent a promising new class of healthy functional beverages in our daily lives as the food industry gets more diverse.

Exploring modified rice flour and supplementation approach to enhance resistant starch content: Visco thermal and structural characterization.

Supplementation of rice flour with Apple Pomace Powder (APP) and Synthetic Vinegar (SV) was investigated to reduce the glycemic potential of ready-to-eat snacks using extrusion cooking. The aim of the study was to compare the increase in resistant starch and decrease in glycemic index of modified rice flour based extrudates after supplementing the Modified rice flour with synthetic vinegar and apple pomace. The effects of independent variables-SV (3-6.5 %) and APP (2-23 %) were evaluated on resistant starch, predicted glycemic index, glycemic load, L*, a*, b*, ΔE and overall acceptability of supplemented extrudates. Design expert predicted 6 % SV and 10 % APP as desirable conditions for enhancement of resistant starch and reduction of glycemic index. Resistant Starch (RS) of supplemented extrudates increased by 88 % while as pGI and GL was decreased by 12 % and 66 % respectively as compared to un-supplemented extrudates. L* value increased from 39.11 to 46.78, a* value increased from 11.85 to 22.55, b* value increased from 10.10 to 26.22 and Δ E increased from 7.24 to 17.93 respectively in supplemented extrudates. The results suggested that apple pomace and vinegar can act in synergy to reduce the in-vitro digestibility of rice based snacks, while maintaining the sensory acceptance of the developed product. The significant (p < 0.001) decrease in the glycemic index was achieved as the supplementation level increased. The increase in RS correlates with the decrease in glycemic index and glycemic load.

Effect of roasting and frying treatments on aflatoxins and capsaicinoids content and nutritional profile of green chilies (Capsicum annum L.).

This study was conducted to assess the effect of two thermal treatments, viz. roasting and pan frying (deep frying), on nutritional profile, aflatoxin, and capsaicin content in green chilies. Green chilies were subjected to roasting and frying to reduce the aflatoxin contamination, besides retaining their pungency and nutritional profile. Reversed-phase HPLC was employed to determine the levels of aflatoxins B1, B2, G1, and G2 in thermally treated and control samples. The proximate compositions of roasted and fried chili samples were significantly (p ≤ .05) different from raw chili (control), except ash content. Vitamin A levels decreased significantly (p ≤ .05) during roasting and were undetected in fried chili samples. Likewise, vitamin C was undetected in both roasted and fried chili samples. Significantly decreasing (p ≤ .05) trends were noticed in capsaicinoids viz. capsaicin and dihydrocapsaicin contents including Scoville Heat Units (SHU) during roasting and frying. However, retention of capsaicinoids was higher in roasted chilies (730.00 ± 4.90 mg/kg) than fried samples (502.56 ± 5.10 mg/kg). The levels of all the four major aflatoxins (AFs)- AFB1, AFB2, AFG1, and AFG2 recorded in control were much higher than the limits prescribed by the European Union for spices. Both thermal treatments (roasting and frying) employed proved to be effective in reducing aflatoxins like AFB2, AFG1, and AFG2 in chilies to below the prescribed limits, while as the level of AFB1 was reduced below the limits by only the frying method. This study therefore indicated the substantial impact of frying on aflatoxins.

Nutritional and bioactive components of rice-chickpea based snacks as affected by severe and mild extrusion cooking.

BACKGROUND: Severe extrusion cooking (SEC) has been extensively explored for product development and has been compared with mild extrusion cooking (MEC). Different blends of chickpea-rice flour for extrusion can be used to achieve a balance between nutritive value and valued product characteristics. This study was therefore designed to optimize the severe and mild extrusion conditions for rice-chickpea flour blends to cater for increasing consumer demand for snacks with the aim of comparing the effects of severe and mild extrusion cooking (MEC) on nutritional quality. RESULTS: The results revealed a significantly (P < 0.05) higher percentage reduction in sucrose during severe extrusion (46.85%) compared to mild extrusion (7.88%). Likewise, the percentage increase in maltose, glucose, and fructose was significantly (P < 0.05) higher during SEC than during mild extrusion. Total phenolic content increased by 13.96% during mild extrusion, whereas, during severe extrusion it decreased by 15%. Total flavonoid content and total antioxidant activity decreased by 11.11% and 15.63%, respectively, during severe extrusion whereas, total flavonoid content and total antioxidant activity increased by 13.17% and 24.29%, respectively, during MEC. The loss in condensed tannin content was significantly (P < 0.05) higher (33.82%) during SEC than with MEC (12.05%). With regard to amino acids, the maximum loss was observed in methionine (53.38%) followed by lysine (40.63%) during SEC. However, the mineral content was found to increase during SEC. CONCLUSION: This study revealed that MEC is superior to SEC in terms of minimizing deleterious effects on overall nutritional value of ready-to-eat snacks. © 2022 Society of Chemical Industry.

Phytoremediation of heavy metals in soil and water: An eco-friendly, sustainable and multidisciplinary approach.

Rapid industrialization, increased waste production and surge in agricultural activities, mining, contaminated irrigation water and industrial effluents contribute to the contamination of water resources due to heavy metal (HM) accumulation. Humans employ HM-contaminated resources to produce food, which eventually accumulates in the food chain. Decontamination of these valuable resources, as well as avoidance of additional contamination has long been needed to avoid detrimental health impacts. Phytoremediation is a realistic and promising strategy for heavy metal removal from polluted areas, based on the employment of hyper-accumulator plant species that are extremely tolerant to HMs present in the environment/soil. Green plants are used to remove, decompose, or detoxify hazardous metals in this technique. For soil decontamination, five types of phytoremediation methods have been used viz. phytostabilization, phytodegradation, rhizofiltration, phytoextraction and phytovolatilization. Traditional phytoremediation methods, on the other hand, have significant limits in terms of large-scale application, thus biotechnological efforts to modify plants for HM phytoremediation ways are being explored to improve the efficacy of plants as HM decontamination candidates. It is relatively a new technology that is widely regarded as economic, efficient and unique besides being environment friendly. New metal hyperaccumulators with high efficiency are being explored and employed for their use in phytoremediation and phytomining. Therefore, this review comprehensively discusses different strategies and biotechnological approaches for the removal of various HM containments from the environment, with emphasis on the advancements and implications of phytoremediation, along with their applications in cleaning up various toxic pollutants. Moreover, sources, effects of HMs and factors affecting phytoremediation of HMs metals have also been discussed.

Sustainable nanotechnology based wastewater treatment strategies: achievements, challenges and future perspectives.

Nanotechnology is being an emerging science for wastewater treatment requires more research emphasis and depth knowledge. For wastewater treatment, different forms of nanomaterials are used based on the type of contaminants and treatment efficiency desired. With the development in the field of nanomaterials, novel and emerging nanomaterials are coming into existence. The nanomaterials used for wastewater treatment can be carbon, single-walled carbon nanotubes, multiple walled carbon nanotubes, covalent organic frameworks, metal and metal oxide- based nanoparticles. Graphene based nanoparticles, their oxides (GO) and reduced graphene oxide (rGO) find tremendous applicability to be used in wastewater treatment purposes. Due to the introduction of graphene oxide nanoparticles in the adsorbent materials, their adsorption capacities have get enhanced and such materials have also improved the mechanical stability of the adsorbent. Ferric oxide shows greater adsorption capacities for organic pollutants. Furthermore, magnetic nano-powder confers a low adsorption capacity for phenols. Pyrrolidone reduced graphene oxide (PVP-RGO) nanoparticles have been used as adsorbents for the elimination of inorganic target contaminant copper, with great adsorption (1698 mg/g). The present study comprehensively reviews nanotechnology as a wastewater treatment strategy besides enlightening its safety issues and efficiency. The novelty of this article is that it highlights the overview of recent applications of various types of nanomaterials and research works releated to it. Such an approach will be helpful to get insights into technological advances, applications and future challenges of nanotechnology implementation for wastewater treatment.

Effect of oxalic acid and salicylic acid treatments on the post-harvest life of temperate grown apricot varieties (Prunus armeniaca) during controlled atmosphere storage.

This study aimed at investigating the influence of different postharvest treatments with oxalic acid (OA) and salicylic acid (SA) on quality attributes and postharvest shelf life of temperate grown apricot varieties stored under controlled atmosphere (CA) storage conditions. After each treatment was given, the samples were stored in CA store maintained at a temperature of 0 °C, 90 ± 5% relative humidity, 5% oxygen and 15% carbon dioxide for 30 days. Results indicated that both OA and SA treatments significantly (p ≤ 0.05) retained total soluble solids, titratable acidity, color profile, ascorbic acid content and total phenolic content of apricot varieties and had a positive effect on antioxidant activity and texture of samples compared to control. However, carotenoid content was found to be higher in control. Both the treatments reduced chilling injury index, weight loss and decay percentage of samples. Moreover, it was found that SA treatment was the most effective treatment in maintaining visual color of apricots while OA maintained fruit firmness and effectively decreased the decay percentage and chilling injury index of apricot varieties. In conclusion, it was found that both OA and SA have the potential to extend storage life of apricots and maintain quality attributes of the crop during CA storage.

Nano-engineered materials for sensing food pollutants: Technological advancements and safety issues.

Food spoilage and safety are key concerns of the modern food sector. Among them, several types of polluting agents are the prime grounds of food deterioration. In this context, nanotechnology-based measures are setting new frontiers to strengthen food applications. Herein, we summarize the nanotechnological dimension of the food industry for both processing and packaging applications. Active bioseparation, smart delivery, nanoencapsulation, nutraceuticals, and nanosensors for biological detection are a few emerging topics of nanobiotechnology in the food sector. The development of functional foods is another milestone set by food nanotechnology by building the link between humans and diet. However, the establishment of optimal intake, product formulations, and delivery matrices, the discovery of beneficial compounds are a few of the key challenges that need to be addressed. Nanotechnology provides effective solutions for the aforementioned problem giving various novel nanomaterials and methodologies. Various nanodelivery systems have been designed, e.g., cochleate, liposomes, multiple emulsions, and polysaccharide-protein coacervates. However, their real applications in food sciences are very limited. This review also provides the status and outlook of nanotechnological systems for future food applications.

Influence of Anticaking Agents and Storage Conditions on Quality Characteristics of Spray Dried Apricot Powder: Shelf Life Prediction Studies Using Guggenheim-Anderson-de Boer (GAB) Model.

Apricot powder was developed through spray drying using gum arabic as an encapsulating material at a concentration of 19%. Inlet air temperature, feed total soluble solids (TSS), feed flow rate, and atomization speed were 190 °C, 23.0 °C, 300.05 mL/h, and 17,433 rpm, respectively. This study was therefore conducted to investigate the influence of anticaking agents (tricalcium phosphate and silicon dioxide) and storage conditions (ambient and accelerated) on physicochemical, micrometric, and thermal characteristics of spray-dried apricot powder (SDAP) packaged in aluminum laminates. Both tricalcium phosphate (TCP) and silicon dioxide (SiO2) improved the shelf life and quality of SDAP, with TCP being more effective, since a lower increase in water activity (aw), moisture content, degree of caking, hygroscopicity, and rehydration time was observed in TCP-treated samples followed by SiO2-treated samples than the control. Furthermore, flowability, glass transition temperature (Tg), and sticky-point temperature (Ts) of SDAP tended to decrease in a significant manner (p < 0.05) under both storage conditions. However, the rate of decrease was higher during accelerated storage. The water activity of treated samples under ambient conditions did not exceed 0.60 and had a total plate count within the permissible range of 40,000 CFU/g, indicating shelf stability of the powder. The predicted shelf life of powder obtained from the Guggenheim−Anderson−de Boer (GAB) model and experimental values were very similar, with TCP-treated samples having a predicted shelf life of 157 days and 77 days under ambient and accelerated storage conditions, respectively. However, the respective experimental shelf life under the same conditions was 150 and 75 days, respectively. Similarly, the predicted shelf life of SiO2-treated samples under ambient and accelerated storage was 137 and 39 days, respectively, whereas the experimental values were 148 and 47 days, respectively. In conclusion, TCP proved more effective than SiO2 at preserving shelf life by preventing moisture ingress.

Paclitaxel-Coated Balloons Compared to Plain Balloon Angioplasty in the Management of Dysfunctional Arteriovenous Fistulae: A Single-Center Randomized Clinical Trial.

The study aimed to compare paclitaxel-coated balloons (PCB) to percutaneous transluminal plain balloon angioplasty (PTA) in the management of dysfunctional arteriovenous fistulae. This single institution randomized controlled trial was approved by the institutional and local review boards and is registered in the ClinicalTrials.gov website. The study was initially designed to recruit a total of 92 patients. However, recruitment was terminated after the release of the meta-analysis that raised concerns about the potential increased risk of death associated with PCB. A total of 23 patients with nonthrombosed dysfunctional fistulae (mean age 67 years, 12 females) were recruited (PCB = 12) from October 2017 to September 2018. The fistulae were radiocephalic (n = 5), brachiocephalic (n = 12), brachiobasilic (n = 6), and seven immature fistulae. After a 2-min predilatation of the target lesions, patients were randomized to receive an additional 2-min of angioplasty with either a plain balloon or PCB (Lutonix). The primary endpoint was fistula patency at 12 months. The secondary endpoints included technical and clinical success, time-to-reintervention, survival at 12 months, and complications. The primary endpoint of fistula patency at 12 months was met in three patients treated with PCB and two patients treated with PTA. The all-cause mortality at one year was 8% (n = 2), both were in the PTA group. Treatment failed in restoring adequate fistula function in four patients [2 PCB with immature arteriovenous fistula (AVF) and two PTA with mature AVF]. Three patients were lost to follow-up (1 PCB, 2 PTA). Of the remaining patients (6 PCB and 4 PTA), there was no significant difference in the median time-to-reintervention between the two groups (148 vs. 174 days). Two minor complications were recorded which did not require any additional treatment. Although this trial was terminated prematurely, there appears to be no significant difference between PCB and PTA in maintaining fistula patency and reducing the time-to-reintervention. No mortality was recorded in the PCB group during the study period.

Impact of COVID-related lockdowns on environmental and climate change scenarios.

The outbreak of COVID-19 pandemic has emerged as a major challenge from human health perspective. The alarming exponential increase in the transmission and fatality rates related to this disease has brought the world to a halt so as to cope up with its stern consequences. This has led to the imposition of lockdown across the globe to prevent the further spread of this disease. This lock down brought about drastic impacts at social and economic fronts. However, it also posed some positive impacts on environment as well particularly in the context of air quality due to reduction in concentrations of particulate matter (PM), NO2 and CO across the major cities of the globe as indicated by several research organizations. In China, Italy, France and Spain, there were about 20-30% reduction in NO2 emission while in USA 30% reduction in NO2 emission were observed. Compared to previous year, there was 11.4% improvement in the air quality in China. Drastic reductions in NO (-77.3%), NO2 (-54.3%) and CO (-64.8%) (negative sign indicating a decline) concentrations were observed in Brazil during partial lockdown compared to the five year monthly mean. In India there were about -51.84, -53.11, -17.97, -52.68, -30.35, 0.78 and -12.33% reduction in the concentration of PM10, PM2.5, SO2, NO2, CO, O3 and NH3 respectively. This article highlights the impact of lockdown on the environment and also discusses the pre and post lockdown air pollution scenario across major cities of the world. Several aspect of environment such as air, water, noise pollution and waste management during, pre and post lockdown scenario were studied and evaluated comprehensively. This research would therefore serve as a guide to environmentalist, administrators and frontline warriors for fighting our the way to beat this deadly disease and minimize its long term implications on health and environment.

Diagnostic accuracy of high resolution MR imaging in local staging of bladder tumors.

OBJECTIVE: To determine the diagnostic accuracy of high-resolution MR imaging done at 1.5T in distinguishing bladder-restricted tumor from non-bladder-restricted tumor and compare the mean short axis dimension of metastatic pelvic lymph nodes with benign pelvic lymph nodes. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, from March 2008 to July 2011. METHODOLOGY: Patients with bladder cancer were enrolled. Based on pathologic T-staging following radical cystectomy, patients were assigned to one of two groups. Patients with stage T1 and T2 disease were assigned to the bladder-restricted tumor (BRT) group and those with stage T3 and T4 disease to the non-bladder-restricted tumor (NBRT). High-resolution unenhanced MR imaging done prior to cystectomy was reviewed retrospectively (1.5 T MRI unit; GE Healthcare). Results from MR imaging-based categorization were compared with pathology reports to fulfill the objective. Mean short-axis diameter of largest visible lymph nodes in patients with nodal metastasis was compared with mean short-axis diameter of largest visible lymph nodes in patients with benign lymph nodes. RESULTS: The accuracy of MRI in differentiating distinguishing bladder-restricted tumor from non-bladder-restricted tumor was 67.72%. The mean short axis diameter of metastatic lymph nodes was greater than that of non-metastatic lymph nodes, i.e., 7.4 mm and 5.4 mm respectively. CONCLUSION: Conventional high resolution 1.5T MRI does not appear to offer advantage over imaging done at low field strength scanners.

Indicators of recurrent hospitalization for pneumonia in the elderly.

OBJECTIVES: To identify modifiable risk factors of late unplanned readmissions for elderly with community-acquired pneumonia. DESIGN: A case-control study. SETTING: Three university-affiliated tertiary-care hospitals. PARTICIPANTS: Two hundred four case-control pairs. Case patients referred to all patients readmitted with pneumonia 30 days to 1 year after discharge. Control subjects were matched for age, admission date, and residence before admission. MEASUREMENTS: Baseline sociodemographic information, clinical data, activity of daily living (ADLs) information, and Charlson Comorbidity Index score were obtained. The Pneumonia Severity Index was calculated with swallowing dysfunction and pattern and extent of radiographic abnormalities, antimicrobial coverage, and total duration recorded. RESULTS: Median time to readmission was 123 days (interquartile range=65-238 days). Readmission was not associated with increased severity or length of hospital stay. In a Cox proportional hazards regression model, swallowing dysfunction (hazard ratio (HR)=2.15, 95% confidence interval (CI)=1.46-2.97), current smoking (HR=2.04, 95% CI=1.48-2.82), use of tranquilizers (HR=1.5, 95% CI=1.02-2.22), and lower ADL scores (HR=1.06, 95% CI=1.02-1.10) were independently associated with readmission for pneumonia. The receipt of angiotensin-converting enzyme inhibitors (HR=0.46, 95% CI=0.27-0.78) and prior pneumococcal vaccination (HR=0.59, 95% CI=0.42-0.82) had a protective effect. CONCLUSION: Although there are limited effective measures to improve functional status, preventive strategies that include smoking cessation and pneumococcal vaccination should be actively pursued. Routine evaluation of swallowing dysfunction and use of pharmacological agents to improve the cough reflex deserve further evaluation in multicenter controlled trials.