Depressive Symptoms and Malnutrition are Associated with Other Geriatric Syndromes and Increase Risk for 30-Day Readmission in Hospitalized Older Adults: A Prospective Cohort Study

Background: Readmission in older adults is typically complex with multiple contributing factors. We aim to examine how two prevalent and potentially modifiable geriatric conditions – depressive symptoms and malnutrition – relate to other geriatric syndromes and 30-day readmission in hospitalized older adults. Methods: Consecutive admissions of patients >65 years to a general medical department were recruited over 15 months. Patients were screened for depression, malnutrition, delirium, cognitive impairment, and frailty at admission. Medical records were reviewed for intermediary events including poor oral intake and functional decline during hospitalization. Unplanned readmission within 30-days of discharge was tracked through the hospital’s electronic health records and follow-up telephone interviews. We use directed acyclic graphs (DAGs) to depict the relationship of depressive symptoms and malnutrition with geriatric syndromes that constitute covariates of interest and 30-day readmission outcome. Multiple logistic regression was performed for the independent associations of depressive symptoms and malnutrition with 30-day readmission, adjusting for variables based on DAG-identified minimal adjustment set. Results: We recruited 1619 consecutive admissions, with mean age 76.4 (7.9) years and 51.3% females. 30-day readmission occurred in 331 (22.0%) patients. Depressive symptoms (OR 1.55, 95% CI 1.15-2.07), malnutrition (OR 1.59, 95% CI 1.14-2.23), higher comorbidity burden, hospitalization in the one-year preceding index admission, frailty, delirium, as well as functional decline and poor oral intake during the index admission, were more commonly observed among patients who were readmitted within 30 days of discharge (P<0.05). Patients with active depressive symptoms were significantly more likely to be frail (OR=1.62, 95% CI 1.22-2.16), had poor oral intake (OR=1.35, 95% CI 1.02-1.79) and functional decline during admission (OR=1.58, 95% CI 1.11-2.23). Malnutrition at admission was significantly associated with frailty, delirium, cognitive impairment and poor oral intake during hospitalization (P<0.05). In minimal adjustment set identified by DAG, depressive symptoms (OR=1.38, 95% CI 1.02-1.86) remained significantly associated with 30-day readmission. The association of malnutrition with 30-day readmission was attenuated after adjusting for age, ethnicity and depressive symptoms in the minimal adjustment set (OR=1.40, 95% CI 0.99-1.98, P=0.06). Conclusion: The observed causal associations support screening and targeted interventions for depressive symptoms and malnutrition during admission and in the post-acute period.

Group and Crowd Scenes

Chapter 17 provides approaches and blocking templates for shooting a large group in a cinematic way. Films often show families at the dinner table, business meetings, speeches, performances, crowds, and other gatherings. These scenes must present clear geography so that viewers can get their bearings and keep them as a scene’s story is told. In spite of the many people involved there is often little action: this makes it more important to add visual interest to the storytelling by using interesting angles, camera movement, wipes, foreground, and other techniques. Certain templates of camera coverage can be applied with minimal adjustment to a variety of scenarios. This chapter describes and illustrates blocking and shooting options that can provide the basis of good visual storytelling and continuity editing for scenes involving groups or crowds.

Early topping: an alternative to standard topping increases yield in cannabis production

In commercial settings, cannabis is generally propagated through cuttings, a process referred in the industry as cloning. Some producers perform either topping or fimming to trigger the production of axillary shoots, which will enhance the number of flowers per plants and thus increase the yield of the cannabis plants. Topping or fimming is generally performed after the cuttings have been transferred to rooting media for two weeks. We have tested a new method to increase the shoot number per plant. The modification of the standard topping method consist of performing the topping on mother plants, prior to taking the cuttings for cloning, and the cuttings are taken one week after the topping is performed. The resulting plantlets develop axillary shoots much faster and the time of production from cuttings to harvesting is decreased by 7-10 days. The method proposed herein requires minimal adjustment to the existing workflow and the plants produce as much as when standard topping is performed. Moreover, this method cuts backs on the production time and nearly two weeks are saved compared to the standard topping procedure since the plantlets do not need to recover after topping. Application of this new procedure results in faster production time and ultimately enhanced productivity.

Longitudinal Evaluation of Radiopacity of Resin Composites: Influence of Photoactivation and Accelerated Photoaging

SUMMARY This study aimed to assess longitudinally the radiopacity of resin composites under the influence of photoactivation and photoaging processes. Ten specimens (1 mm thick and 4 mm in diameter) of three different microhybrid resin composites, Filtek Z250 XT (R1), TPH 3 Spectrum (R2), and Opallis (R3), were prepared for this study. For longitudinal assessment of radiopacity, radiographic images were obtained five times. The first time (T1), the specimens were not photoactivated; the second time (T2), the specimens were photoactivated; and the next three times, photoaging was carried out, with images obtained at 24 hours (T3), 48 hours (T4), and 72 hours (T5) after this process. The photoaging was conducted using LED light (700 lumens, 9 W, 6400 k) under controlled environmental conditions at 37°C (±1°C) and 65% (±5%) relative humidity. The digital system DIGORA Optime was used. The digital images were measured using the histogram function, and then the pixel intensity values were converted into mmAl (the standard unit of radiopacity) using a linear regression function, with minimal adjustment of R2 ≥ 0.9. Data in mmAl were statistically analyzed using an analysis of variance (α=0.05). R2 resin composite showed higher values of radiopacity, R1 resin composite showed intermediate values, and R3 resin composite showed lower values. Only at T1 did the higher radiopacity of R2 composite differ significantly from other groups (p = 0.0000). After application of treatments (photoactivation and photoaging), all radiopacity values were similar (p-values to T2=0.0507, T3=0.0536, T4=0.0502, T5=0.0501) due to consecutive increase of radiopacity of R1 and R3 composites from T2. Photoactivation and photoaging processes influenced the radiopacity, but changes occurring in the degree of radiopacity were dependent on the composition and chemical characteristics of each composite used.

A Fully Conserved Minimal Adjustment Scheme with (T, S) Coherency for Stabilization of Hydrographic Profiles

A new, fully conserved minimal adjustment scheme with temperature and salinity (T, S) coherency is presented for eliminating false static instability generated from analyzing and assimilating stable ocean (T, S) profiles data, that is, from generalized averaging over purely observed data (data analysis) or over modeled/observed data (data assimilation). This approach consists of a variational method with (a) fully (heat, salt, and potential energy) conserved conditions, (b) minimal adjustment, and (c) (T, S) coherency. Comparison with three existing schemes (minimal adjustment, conserved minimal adjustment, and convective adjustment) using observational profiles and a simple one-dimensional ocean mixed layer model shows the superiority of this new scheme.