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We used Veterans Health Administration (VHA) national administrative data files to identify a cohort (fiscal years 2005-2014) of veterans with spinal cord injuries and disorders (SCID) to determine risk factors for and consequences of lower extremity fracture nonunions. Odds ratios (OR) for fracture nonunion were computed using multivariable-adjusted logistic regression models. We identified three risk factors for nonunion: (i) older age (OR = 2.29; 95% confidence interval [CI] 1.21-4.33), (ii) longer duration of SCID (OR = 1.02; 95% CI 1.00-1.04), and (iii) fracture site (distal femur), with OR (comparison distal femur) including distal tibia/fibula (OR = 0.14; 95% CI 0.09-0.24), proximal tibia/fibula (OR = 0.19; 95% CI 0.09-0.38), proximal femur (OR = 0.10; 95% CI 0.04-0.21), and hip (OR = 0.13; 95% CI 0.07-0.26). Nonunions resulted in multiple complications, with upwards of 1/3 developing a pressure injury, 13% osteomyelitis, and almost 25% requiring a subsequent amputation. Our data have identified a high-risk population for fracture nonunion of older veterans with a long duration of SCID who sustain a distal femur fracture. In view of the serious complications of these nonunions, targeted interventions in these high-risk individuals who have any signs of delayed union should be considered. © 2021 The Authors.

The topic of emotion and decision making is an old one. Classic Western philosophical perspectives generally considered emotion a contaminating influence on cognition, one that needed to be suppressed, ignored, or ideally brought in line with reason. Recent psychological research shows that, contrary to such pessimistic perspectives, emotion plays a largely functional and adaptive role in regulating cognition and decision making. We first outline how affect regulates cognition using the affect-as-information account as a guiding framework. We next discuss foundational research on the role of emotion in regulating cognition and decision making consistent with this account. Finally, we end with a discussion of new research developments and open research questions. Keywords: emotion; decision making; cognition; judgment; mood

Despite the abundance of evidence demonstrating a dedicated link between positive and negative affect and specific ways of thinking, not all findings are consistent with this view. New research suggests that the relationship between affect and thinking can be altered and often reversed, by varying the mental context in which affect is experienced. The affect-as-cognitive-feedback account can explain a wide range of phenomena, including both prior findings and this more recent research, and generate new predictions. According to this account, affective reactions confer value on accessible information processing strategies (e.g., global vs. local processing) and other mental content that happens to be accessible at the time. This view underscores that the relationship between affect and cognition is not fixed but instead is highly malleable. We present evidence that supports this account, along with new findings that suggest a malleable influence of specific affective states on cognition.