Characteristics of undernourished older medical patients and the identification of predictors for undernutrition status

<p>Abstract</p> <p>Background</p> <p>Undernutrition among older people is a continuing source of concern, particularly among acutely hospitalized patients. The purpose of the current study is to compare malnourished elderly patients with those at nutritional risk and identify factors contributing to the variability between the groups.</p> <p>Methods</p> <p>The study was carried out at the Soroka University Medical Center in the south of Israel. From September 2003 through December 2004, all patients 65 years-of-age or older admitted to any of the internal medicine departments, were screened within 72 hours of admission to determine nutritional status using the short version of the Mini Nutritional Assessment (MNA-SF). Patients at nutritional risk were entered the study and were divided into malnourished or 'at risk' based on the full version of the MNA. Data regarding medical, nutritional, functional, and emotional status were obtained by trained interviewers.</p> <p>Results</p> <p>Two hundred fifty-nine elderly patients, 43.6% men, participated in the study; 18.5% were identified as malnourished and 81.5% were at risk for malnutrition according to the MNA. The malnourished group was less educated, had a higher depression score and lower cognitive and physical functioning. Higher prevalence of chewing problems, nausea, and vomiting was detected among malnourished patients. There was no difference between the groups in health status indicators except for subjective health evaluation which was poorer among the malnourished group. Lower dietary score indicating lower intake of vegetables fruits and fluid, poor appetite and difficulties in eating distinguished between malnourished and at-risk populations with the highest sensitivity and specificity as compare with the anthropometric, global, and self-assessment of nutritional status parts of the MNA. In a multivariate analysis, lower cognitive function, education <12 years and chewing problems were all risk factors for malnutrition.</p> <p>Conclusion</p> <p>Our study indicates that low food consumption as well as poor appetite and chewing problems are associated with the development of malnutrition. Given the critical importance of nutritional status in the hospitalized elderly, further intervention trials are required to determine the best intervention strategies to overcome these problems.</p

The impact of quality management systems on construction performance in the North West of England

As the total construction output in the North West of England (NWE) is forecast to rise by an average of 2.5% over the next five years. It is imperative for organizations in the region to improve their overall construction performance, particularly if they are to hit the targets presented by UK Government in the construction 2025 report. Despite the known benefits of quality management systems (QMS) its implementation in relation to construction performance is very limited, particularly in the UK. Therefore, the purpose of this paper is to examine whether QMS can affect construction performance in the NWE. A pragmatic mixed method approach of sequential explanatory strategy was adopted to conduct this research. This initially involved a quantitative approach of questionnaire surveys to gain opinions and views of a representative sample of industry professionals based in the NWE. The quantitative results were analyzed to discover relationships in the data and further formulate the questions for the qualitative interviews. Three interviews with leading industry professionals were then conducted and the data was analyzed using a thematic approach. The themes identified in the interviews were then cross-referenced with the data discovered in the questionnaire survey and literature review. The findings provide a clear indication that the implementation of a QMS has a positive effect on construction performance in the NWE. Immediate improvements in efficiency of a construction organization when implementing a QMS were discovered, including greater managerial control and the recording and reduction in defects. Long term effects of changing company attitude by setting out company requirements and responsibilities through highlighting the significance of quality, and furthermore encouraging a culture of co-operation and teamwork, were also proven to increase construction performance as time progresses. To further enhance this research the focus could be on the whole of the UK. However, a greater amount of time would be required to gain the required representative sample. Furthermore, although the questionnaire survey was distributed equally within the selected sample, a greater number of respondents working for contractors responded. Therefore, the respondents of the questionnaire survey were not equal in terms of organization (client, contractor, sub-contractor, project manager). According to the best knowledge of the authors and through searching many sources, there are no specific studies examining QMS and their effect on construction performance in the UK and particularly in the NWE. Therefore, it is believed the study is the first of its kind. The study discovered many findings that can be considered as a contribution to practice and theory. Moreover, it can be considered as a fundamental base for future studies in this research area. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group

Jet energy measurement with the ATLAS detector in proton-proton collisions at root s=7 TeV

The jet energy scale and its systematic uncertainty are determined for jets measured with the ATLAS detector at the LHC in proton-proton collision data at a centre-of-mass energy of √s = 7TeV corresponding to an integrated luminosity of 38 pb-1. Jets are reconstructed with the anti-kt algorithm with distance parameters R=0. 4 or R=0. 6. Jet energy and angle corrections are determined from Monte Carlo simulations to calibrate jets with transverse momenta pT≥20 GeV and pseudorapidities {pipe}η{pipe}<4. 5. The jet energy systematic uncertainty is estimated using the single isolated hadron response measured in situ and in test-beams, exploiting the transverse momentum balance between central and forward jets in events with dijet topologies and studying systematic variations in Monte Carlo simulations. The jet energy uncertainty is less than 2. 5 % in the central calorimeter region ({pipe}η{pipe}<0. 8) for jets with 60≤pT<800 GeV, and is maximally 14 % for pT<30 GeV in the most forward region 3. 2≤{pipe}η{pipe}<4. 5. The jet energy is validated for jet transverse momenta up to 1 TeV to the level of a few percent using several in situ techniques by comparing a well-known reference such as the recoiling photon pT, the sum of the transverse momenta of tracks associated to the jet, or a system of low-pT jets recoiling against a high-pT jet. More sophisticated jet calibration schemes are presented based on calorimeter cell energy density weighting or hadronic properties of jets, aiming for an improved jet energy resolution and a reduced flavour dependence of the jet response. The systematic uncertainty of the jet energy determined from a combination of in situ techniques is consistent with the one derived from single hadron response measurements over a wide kinematic range. The nominal corrections and uncertainties are derived for isolated jets in an inclusive sample of high-pT jets. Special cases such as event topologies with close-by jets, or selections of samples with an enhanced content of jets originating from light quarks, heavy quarks or gluons are also discussed and the corresponding uncertainties are determined. © 2013 CERN for the benefit of the ATLAS collaboration