Mini Nutritional Assessment as a useful method to predict the development of pressure ulcer among elderly inpatients

Abstract: OBJECTIVES: Malnutrition is a major risk factor of pressure ulcers (PU). However, the best method of nutritional assessment to prevent PU is still unclear. This study was designed to determine the usefulness of Mini Nutritional Assessment (MNA) and plasma amino acid analysis to predict the formation of PU among inpatients. DESIGN: This was a prospective, observational cohort study with a mean observation period of 62.2±86.4 days. SETTING: Intermediate and acute care wards of a hospital in rural Japan. PARTICIPANTS: The 422 patients analyzed had an average age of 85.0±7.6 years. MEASUREMENTS: MNA, Subjective Global Assessment (SGA), Braden Scale (PU prognostic score), pressure ulcer formation, and biochemical analysis including plasma amino acid concentrations. RESULTS: PU developed in 7.1% of the patients. A MNA score of less than 8 was more sensitive than a rating of moderate or severe malnourishment on the SGA combined with a Braden Scale score of <15 in predicting future PU. Area under the receiver operating characteristic curve (AUC) of MNA was superior to that of the Braden Scale. Braden Scale nutrition subscore had the lowest AUC among the six Braden Scale subscores. The PU group showed significantly lower plasma arginine concentrations than the No PU group. CONCLUSION: MNA was able to predict the development of PU. A MNA of <8 performed better than the SGA, Braden Scale, and plasma arginine levels in predicting PU development. Although lower plasma arginine concentration at time of admission was associated with PU development, the area under the ROC curve was not significant. The findings from this prospective study support the use of nutritional assessment among inpatients in order to predict PU risk and target appropriate interventions

On the superficiality of Welsh agreement

A notable feature of Welsh is a number of agreement phenomena, all of which only occur with pronouns. Finite verbs agree with a following pronominal subject, prepositions agree with a following pronominal complement, and a particle which introduces non-finite clauses agrees with a following pronominal subject. Similarly, nouns have a preceding clitic agreeing with a following pronominal possessor, non-finite verbs have a preceding clitic agreeing with a following pronominal object, and what looks like the non-finite form of bod "be", which introduces certain subordinate clauses, has a preceding clitic agreeing with a following pronominal subject. There seems to be a single phenomenon here. Approaches that involve an abstract level face problems and there is no evidence that the phenomenon involves an abstract level. It seems quite plausible to suggest that superficial linear order is crucial, and this idea can be implemented in a straightforward way within linearization-based Head-driven Phrase Structure Grammar (HPSG). The properties of agreement also entail that unexpressed noun phrases of various kinds must be represented in the superficial constituent structure and not just at some abstract level, contrary to the view of some frameworks. © 2009 Springer Science+Business Media B.V