Nutritional Risk, Health Outcomes, and Hospital Costs Among Chinese Immobile Older Inpatients: A National Study

Purpose: Evidence of the impact of nutritional risk on health outcomes and hospital costs among Chinese older inpatients is limited. Relatively few studies have investigated the association between clinical and cost outcomes and nutritional risk in immobile older inpatients, particularly those with neoplasms, injury, digestive, cardiac, and respiratory conditions. Methods: This China-wide prospective observational cohort study comprised 5,386 immobile older inpatients hospitalized at 25 hospitals. All patients were screened for nutritional risk using the Nutrition Risk Screening (NRS 2002). A descriptive analysis of baseline variables was followed by multivariate analysis (Cox proportional hazards models and generalized linear model) to compare the health and economic outcomes, namely, mortality, length of hospital stay (LoS), and hospital costs associated with a positive NRS 2002 result. Results: The prevalence of a positive NRS 2002 result was 65.3% (n = 3,517). The prevalence of “at-risk” patients (NRS 2002 scores of 3+) was highest in patients with cardiac conditions (31.5%) and lowest in patients with diseases of the respiratory system (6.9%). Controlling for sex, age, education, type of insurance, smoking status, the main diagnosed disease, and Charlson comorbidity index (CCI), the multivariate analysis showed that the NRS 2002 score = 3 [hazard ratio (HR): 1.376, 95% CI: 1.031–1.836] were associated with approximately a 1.5-fold higher likelihood of death. NRS 2002 scores = 4 (HR: 1.982, 95% CI: 1.491–2.633) and NRS scores ≥ 5 (HR: 1.982, 95% CI: 1.498–2.622) were associated with a 2-fold higher likelihood of death, compared with NRS 2002 scores <3. An NRS 2002 score of 3 (percentage change: 16.4, 95% CI: 9.6–23.6), score of 4 (32.4, 95% CI: 24–41.4), and scores of ≥ 5 (36.8, 95% CI 28.3–45.8) were associated with a significantly (16.4, 32.4, and 36.8%, respectively) higher likelihood of increased LoS compared with an NRS 2002 scores <3. The NRS 2002 score = 3 group (17.8, 95% CI: 8.6–27.7) was associated with a 17.8%, the NRS 2002 score = 4 group (31.1, 95% CI: 19.8–43.5) a 31.1%, and the NRS 2002 score ≥ 5 group (44.3, 95% CI: 32.3–57.4) a 44.3%, higher likelihood of increased hospital costs compared with a NRS 2002 scores <3 group. Specifically, the most notable mortality-specific comorbidity and LoS-specific comorbidity was injury, while the most notable cost-specific comorbidity was diseases of the digestive system. Conclusions: This study demonstrated the high burden of undernutrition at the time of hospital admission on the health and hospital cost outcomes for older immobile inpatients. These findings underscore the need for nutritional risk screening in all Chinese hospitalized patients, and improved diagnosis, treatment, and nutritional support to improve immobile patient outcomes and to reduce healthcare costs

Hospitalization Costs of COVID-19 Cases and Their Associated Factors in Guangdong, China: A Cross-Sectional Study

Background: The ongoing COVID-19 pandemic has brought significant challenges to health system and consumed a lot of health resources. However, evidence on the hospitalization costs and their associated factors in COVID-19 cases is scarce.Objectives: To describe the total and components of hospitalization costs of COVID-19 cases, and investigate the associated factors of costs.Methods: We included 876 confirmed COVID-19 cases admitted to 33 designated hospitals from January 15th to April 27th, 2020 in Guangdong, China, and collected their demographic and clinical information. A multiple linear regression model was performed to estimate the associations of hospitalization costs with potential associated factors.Results: The median of total hospitalization costs of COVID-19 cases was $2,869.4 (IQR:$3,916.8). We found higher total costs in male (% difference: 29.7, 95% CI: 15.5, 45.6) than in female cases, in older cases than in younger ones, in severe cases (% difference: 344.8, 95% CI: 222.5, 513.6) than in mild ones, in cases with clinical aggravation than those without, in cases with clinical symptoms (% difference: 47.7, 95% CI: 26.2, 72.9) than those without, and in cases with comorbidities (% difference: 21.1%, 21.1, 95% CI: 4.4, 40.6) than those without. We also found lower non-pharmacologic therapy costs in cases treated with traditional Chinese medicine (TCM) therapy (% difference: −47.4, 95% CI: −64.5 to −22.0) than cases without.Conclusion: The hospitalization costs of COVID-19 cases in Guangdong were comparable to the national level. Factors associated with higher hospitalization costs included sex, older age, clinical severity and aggravation, clinical symptoms and comorbidities at admission. TCM therapy was found to be associated with lower costs for some non-pharmacologic therapies

Planar heterojunction organic photovoltaic cells based on tetramethyl substituted copper(II) phthalocyanine treated with thermal annealing

© 2014 IOP Publishing Ltd. The fabrication of planar heterojunction (PHJ) organic photovoltaic (OPV) cells using tetramethyl substituted copper(II) phthalocyanine (CuMePc) as an electron donor and C60as an acceptor is described. The impact of post-fabrication thermal annealing upon the performance of these cells has been examined. Atomic force microscopy (AFM) images and UV-visible absorption spectra of CuMePc thin films revealed crystallization of CuMePc induced by thermal annealing at 190°C. The crystallized CuMePc films accounted for improved hole mobility, broadened absorption spectrum, and increased donor/acceptor interface in the as-fabricated cells after thermal annealing. AFM images also revealed that the surface of MoO3film was smooth and close-packed after thermal annealing, which efficiently blocked the leakage current in the annealed cells, leading to dramatic improvement of performance for the PHJ cells using CuMePc as the electron donor and MoO3or V2O5as the anode buffer layer. The power conversion efficiency of the thermal-annealed PHJ cell with a configuration of ITO/MoO3/CuMePc/C60/Bathocuproine/Al was higher than that of the bulk heterojunction (BHJ) cell fabricated by co-depositing CuMePc and C60. It was mainly because the isolated clusters of CuMePc and/or C60molecules formed during the fabrication of the BHJ cell was avoided in the PHJ cell.Link_to_subscribed_fulltex

A Comprehensive Evaluation of the Community Environment Adaptability for Elderly People Based on the Improved TOPSIS

As the main way of providing care for elderly people, home-based old-age care puts forward higher requirements for the environmental adaptability of the community. Five communities in Wuhu were selected for a comprehensive assessment of environmental suitability. In order to ensure a comprehensive and accurate assessment of the environmental adaptability of the community, we used the analytic hierarchy process (AHP) to calculate the weight of each indicator and the technique for order preference by similarity to ideal solution (TOPSIS) method to evaluate the adaptability of community, as well as further analyses using a two-dimensional data space map. The results show that the Weixing community is the most suitable for the elderly and outdoor activities of the community

Evaluation of leaf wax delta D and soil brGDGTs as tools for paleoaltimetry on the southeastern Tibetan Plateau

The orogenic history of the Tibetan Plateau (TP) and surrounding mountain ranges continues to be a major source of disagreement among geologists, particularly concerning the uplift models for the Cenozoic evolution of the TP and estimates for when the highest and largest plateau on Earth reached its current elevation. Quantitative reconstructions of past elevation from geologic samples are necessary to document the uplift history of TP and examine the interactions between tectonic-relief and climate over geological time-scales. Several studies establishing lipid biomarker-based paleoaltimetry based on leaf wax delta D values and brGDGTs have been reported in recent years for the TP and surrounding regions, but have yet to be synthesized into a regional framework for paleoelevation determination and uncertainty analysis. Here we report new leaf wax delta D and brGDGTs data developed from surface soil samples along an elevation transect spanning similar to 1250-3900 m.a.s.l in the Hengduan Mountains on the southeastern edge of the TP. We find that the abundance-weighted mean leaf wax delta D (n-C-27, n-C-29 and n-C-31) values (delta D-wa(s)) lapse rates determined for the Hengduan Mountains and for five other nearby study locations are statistically indistinguishable, and can be combined to provide a regional delta D(was )lapse rate of -1.97 +/- 0.04 parts per thousand (1 sigma)/100 m for use in regional paleoelevation studies across the southeastern TP. We also find a strong correlation (R-2 = 0.71) between brGDGTs and elevation-dependent mean annual air temperature, which contributes to a number of studies in the region that support the use of fossil brGDGTs as a paleoelevation proxy. Our results reveal that delta D(was )and brGDGTs for the Hengduan Mountains provide similar empirical uncertainty in paleoelevation reconstruction, with standard errors of elevation estimation (SE) of +/- 483 m (+/- 1 sigma) and +/- 394 m (+/- 1 sigma), respectively. We propose a paleoaltimetric approach that combines delta D-wa(s) and brGDGT data, in order to derive paleoelevation estimates with lower uncertainties. In the Hengduan Mountains data set, the approach yields a SE (+/- 286 m; +/- 1 sigma) that is 27-40% lower than when delta D-wa(s) values and brGDGTs are applied separately

Length of Stay, Hospital Costs and Mortality Associated With Comorbidity According to the Charlson Comorbidity Index in Immobile Patients After Ischemic Stroke in China: A National Study.

In this study, we examined the length of stay (LoS)-predictive comorbidities, hospital costs-predictive comorbidities, and mortality-predictive comorbidities in immobile ischemic stroke (IS) patients; second, we used the Charlson Comorbidity Index (CCI) to assess the association between comorbidity and the LoS and hospitalization costs of stroke; third, we assessed the magnitude of excess IS mortality related to comorbidities. Between November 2015 and July 2017, 5114 patients hospitalized for IS in 25 general hospitals from six provinces in eastern, western, and central China were evaluated. LoS was the period from the date of admission to the date of discharge or date of death. Costs were collected from the hospital information system (HIS) after the enrolled patients were discharged or died in hospital. The HIS belongs to the hospital's financial system, which records all the expenses of the patient during the hospital stay. Cause of death was recorded in the HIS for 90 days after admission regardless of whether death occurred before or after discharge. Using the CCI, a comorbidity index was categorized as zero, one, two, and three or more CCI diseases. A generalized linear model with a gamma distribution and a log link was used to assess the association of LoS and hospital costs with the comorbidity index. Kaplan-Meier survival curves was used to examine overall survival rates. We found that 55.2% of IS patients had a comorbidity. Prevalence of peripheral vascular disease (21.7%) and diabetes without end-organ damage (18.8%) were the major comorbidities. A high CCI=3+ score was an effective predictor of a high risk of longer LoS and death compared with a low CCI score; and CCI=2 score and CCI=3+ score were efficient predictors of a high risk of elevated hospital costs. Specifically, the most notable LoS-specific comorbidities, and cost-specific comorbidities was dementia, while the most notable mortality-specific comorbidities was moderate or severe renal disease. CCI has significant predictive value for clinical outcomes in IS. Due to population aging, the CCI should be used to identify, monitor and manage chronic comorbidities among immobile IS populations

In-situ electrospun aligned and maize-like AgNPs/PVA@Ag nanofibers for surface-enhanced Raman scattering on arbitrary surface

An efficient electrospun aligned surface enhanced Raman scattering (SERS) and maize-like substrate of polyvinyl alcohol (PVA) composite and Ag colloid nanofibers decorated with thermal evaporated Ag nanoparticles (AgNPs) has been developed by taking advantage of electrostatic interactions. The synergistic effects of the evaporated AgNPs (niblets) and the Ag colloid in PVA (corncob) could arouse strong electromagnetic field between the lateral and vertical nanogaps which has been demonstrated by experiment and finite-different time-domain (FDTD) simulation. In this experiment, the aligned nanofibers possesses an excellent sensitivity by detection of crystal violet (CV) and malachite green (MG) molecule at low concentration. Moreover, the proposed flexible SERS sensor was measured with outstanding uniformity and reproducibility. We also carried out in-situ electrospinning on a curved surface to detect the mixture of Sudan I, CV and MG molecule, which demonstrates that flexible SERS sensor, has enormous potential in accurate and in-situ detection on the complex geometric structure

Risk factors for 3-month mortality in bedridden patients with hospital-acquired pneumonia: A multicentre prospective study.

BackgroundMortality among patients with hospital-acquired pneumonia (HAP) is quite high; however, information on risk factors for short-term mortality in this population remains limited. The aim of the current study was to identify the risk factors for mortality in bedridden patients with HAP during a 3-month observation period.MethodsA secondary data analysis was conducted. In total, 1141 HAP cases from 25 hospitals were included in the analysis. Univariate and multilevel regression analyses were performed to identify the risk factors for mortality.ResultsDuring the 3-month observation period, there were 189 deaths among bedridden patients with HAP. The mortality rate in this study was 16.56%. Multilevel regression analysis showed that ventilator-associated pneumonia (OR = 2.034, 95%CI: 1.256, 3.296, p = 0.004), pressure injuries (OR = 2.202, 95%CI: 1.258, 3.852, p = 0.006), number of comorbidities (OR = 1.076, 95%CI: 1.016,1.140, p = 0.013) and adjusted Charlson Comorbidity Index score (OR = 1.210, 95%CI: 1.090, 1.343, pConclusionsThe identification of risk factors associated with mortality is an important step towards individualizing care plans. Our findings may help healthcare workers select high-risk patients for specific interventions. Further study is needed to explore whether appropriate interventions against modifiable risk factors, such as reduced immobility complications or ventilator-associated pneumonia, could improve the prognoses