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Aim: Heart failure (HF) outcomes are disproportionately worse in patients discharged to skilled nursing facilities (SNF) as opposed to home. We hypothesized that dementia and delirium were key factors influencing these differences. Our aim was to explore the associations of dementia and delirium with risk of hospital readmission and mortality in HF patients discharged to SNF., Methods and Results: The study population included Veterans hospitalized for a primary diagnosis of HF and discharged to SNFs between 2010 and 2015. Pre-existing dementia was identified based on International Classification of Diseases-9 codes. Delirium was determined using the Minimum Data Set 3.0 Confusion Assessment Method algorithm. Proportional hazard regression analyses were used to model outcomes and were adjusted for covariates of interest. Patients (n = 21 655) were older (77.0 ± 10.5 years) and predominantly male (96.9%). Four groups were created according to presence (+) or absence (-) of dementia and delirium. Relative to the dementia-/delirium- group, the dementia-/delirium+ group was associated with increased 30 day mortality [adjusted hazard ratio (HR) = 2.2, 95% confidence interval (CI) = 1.7, 3.0] and 365 day mortality (adjusted HR = 1.5, 95% CI = 1.3, 1.7). Readmission was highest in the dementia-/delirium+ group after 30 days (HR = 1.2, 95% CI = 1.0, 1.5). In the group with dementia (delirium-/dementia+), 30 day mortality (12.8%; HR = 0.7, 95% CI = 0.7, 0.8) and readmissions (5.3%; HR = 1.0, 95% CI = 0.8, 1.1) were not different relative to the reference group., Conclusions: Delirium, independent of pre-existing dementia, confers increased risk of hospital readmission and mortality in HF patients discharged to SNFs. Managing HF after hospitalization is a complex cognitive task and an increased focus on mental status in the acute care setting prior to discharge is needed to improve HF management and transitional care, mitigate adverse outcomes, and reduce healthcare costs., (© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Used effectively, stereoscopic three-dimensional (3D) technologies can engage students with complex disciplinary content as they are presented with informative representations of abstract concepts. In addition, preliminary evidence suggests that stereoscopy may enhance learning and retention in some educational settings. Biological concepts particularly benefit from this type of presentation since complex spatially oriented structures frequently define function within these systems. Viewing biological phenomena in 3D as they are in real life allows the user to relate these spatial relationships and easily grasp concepts making the key connection between structure and function. In addition, viewing these concepts interactively in 3D and in a manner that leads to increased engagement for young prospective scientists can further increase the impact. We conducted two studies evaluating the use of this technology as an instructional tool to teach high school students complex biological concepts. The first study tested the use of stereoscopic materials for teaching brain function and human anatomy to four classes. The second study evaluated stereoscopic images to support the learning of cell structure and DNA in four different high school classes. Most important, students who used stereoscopic 3D had significantly higher test scores than those who did not. In addition, students reported enjoying 3D presentations, and it was among their top choices for learning about these complex concepts. In summary, our evidence adds further support for the benefits of 3D images to students' learning of science concepts., (Copyright © 2015 The American Physiological Society.)

Background: Obese victims of blunt force trauma have poor outcomes, often related to an increased incidence of missed injuries. Our purpose was to determine whether patients with an increased body mass index (BMI) who sustain blunt trauma in motor vehicle collisions (MVCs) have an increased risk of diaphragmatic injury, an injury often associated with diagnostic delay., Methods: The National Automotive Sampling System was used to identify front seat occupants involved in MVCs from 1995 to 2001. BMI was determined for all subjects, and diaphragmatic injury was the outcome of interest. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to quantify the association between occupant BMI and DI., Results: When analyzed as an independent risk factor, for all collision types, a BMI >/= 25 was not significantly associated with diaphragmatic injury (RR, 1.25; 95% CI, 0.71-2.20). However, when considering only near-side MVCs, a significant twofold increased risk was observed (RR, 2.03; 95% CI, 1.39-2.96), whereas no association for occupants involved in frontal collisions was observed (RR, 1.05; 95% CI, 0.30-3.74)., Conclusion: An elevated BMI appears to be associated with an increased risk of diaphragmatic injury in patients involved in near-side MVCs. This association provides insight as to the cause of diaphragmatic injury and may aid clinicians in detecting these often occult injuries.

Most studies of alcohol consumption patterns and alcohol-related problems among college students have failed to include a diagnostic measure based on Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria. Applying the DSM-IV standards would facilitate an analysis of the prevalence of alcohol-use disorders and individual symptoms of those disorders. A structured diagnostic interview based on DSM-IV criteria (the alcohol section of the Substance Abuse Module) and several alcohol screening instruments were administered to 306 undergraduate students at an urban commuter campus. The prevalence of current and lifetime alcohol-use disorders, individual symptoms of those disorders, and other alcohol-related problems are reported, as well as data regarding alcohol consumption patterns and binge drinking. The data are analyzed in terms of demographic variables, including sex, ethnicity, year in school, age, and marital status of those in the sample.

The Office of Pollution Prevention and Toxics (OPPT), United States Environmental Protection Agency (USEPA) routinely uses structure-activity relationships (SAR) for the aquatic hazard assessment of new chemicals submitted under Section 5 of the Toxic Substances Control Act (TSCA). With 15 years of experience and the general acceptance of toxicity predictions based on SARs, OPPT has expanded the use and application of the methodology to include existing chemicals used in printing, dry cleaning, and paint stripping. SAR analysis has also been used in the hazard evaluation of the U.S. and EU/OECD high production volume (HPV) chemicals. This paper describes the assumptions, limitations, and methodology for the use of SARs to evaluate large sets of discrete organic chemicals.

As testing is not required, ecotoxicity or fate data are available for approximately 5% of the approximately 2,300 new chemicals/year (26,000 + total) submitted to the US-EPA. The EPA's Office of Pollution Prevention and Toxics (OPPT) regulatory program was forced to develop and rely upon QSARs to estimate the ecotoxicity and fate of most of the new chemicals evaluated for hazard and risk assessment. QSAR methods routinely result in ecotoxicity estimations of acute and chronic toxicity to fish, aquatic invertebrates, and algae, and in fate estimations of physical/chemical properties, degradation, and bioconcentration. The EPA's Toxic Substances Control Act (TSCA) Inventory of existing chemicals currently lists over 72,000 chemicals. Most existing chemicals also appear to have little or no ecotoxicity or fate data available and the OPPT new chemical QSAR methods now provide predictions and cross-checks of test data for the regulation of existing chemicals. Examples include the Toxics Release Inventory (TRI), the Design for the Environment (DfE), and the OECD/SIDS/HPV Programs. QSAR screening of the TSCA Inventory has prioritized thousands of existing chemicals for possible regulatory testing of: 1) persistent bioaccumulative chemicals, and 2) the high ecotoxicity of specific discrete organic chemicals.

Recently, four biochemical mechanisms have been implicated in the pathogenesis of certain late complications of diabetes mellitus. All of these mechanisms (altered polyol pathway activity, disrupted myo-inositol metabolism, increased vascular permeability, and increased nonenzymatic glycosylation of proteins) are activated by exposure of tissues to hyperglycemia. There is evidence to suggest that the development of retinopathy, nephropathy, and neuropathy is directly related to the level of glycemia in patients with diabetes mellitus. Whether strict glycemic control will prevent or reverse diabetic complications is the subject of the Diabetes Control and Complications Trial. Until the results of that study are reported, and until euglycemia can be achieved in all diabetic patients, the search will continue for other pharmacologic agents that might prevent the development of complications. Therapies that are currently under investigation include administration of aldose reductase inhibitors and supplementation of dietary myo-inositol. It is too early to conclude whether such therapies will prove useful in the prevention or reversal of diabetic complications.