Improving Heart Failure Education Prior to Discharge: An Emmi Implementation Project

Background: Heart failure is one of the leading causes of hospitalizations and increased health care costs in the United States. Many patients are readmitted within 30 days of discharge, resulting in increased costs. Purpose of Capstone Project: The purpose of this capstone project was to improve heart failure education for patients admitted with heart failure to Mercy Medical Center by utilizing Emmi educational videos in order to decrease the risk of hospital readmissions, improve quality of life, and decrease costs. Methods: The project focused on educating nurses about the importance of utilizing the video. It was asked of the nurses that each patient admitted with a diagnosis of heart failure have the opportunity to watch the educational video prior to discharge. The number of patients with heart failure that were given the opportunity to watch the Emmi educational video was collected. The evaluation of this project was a comparison of the number of Emmi educational videos utilized before the implementation of the Capstone Project to the numbers of videos utilized after the implementation. Results: When comparing the ordering of the Emmi videos after implementation to before the implementation, there was a noticeable increase in Emmi usage. This included the ordering for all categories of the heart failure Emmi and the general heart failure Emmi. Unfortunately, ordering the Emmi did not mean that the video was utilized. Recommendations: It was recommend that the utilization of Emmi videos be continued. Nurses need continued encouragement to utilize the video and not just order it. It was also recommended that APRNs and PAs focus on ordering and implementing the Emmi videos. Lastly, making Emmi utilization a function of case managers, cardiac rehab nurses, and discharge nurses was recommended

Trajectories of Happiness Following Acquired Disability

Current deficits in the rehabilitation psychology literature involving longitudinal studies investigating positive outcomes following acquired disabilities have deserved research attention. In the current study, data on happiness as an enduring mood tone, as measured by the Life Satisfaction Index (LSI) was collected from 1271 individuals (“insiders”) having incurred either a traumatic brain injury (TBI), spinal cord injury (SCI), severe burn, or intra-articular fracture (IAF) or from someone who felt close enough to speak on their behalf (“outsiders”). Data on happiness, functional independence as measured by the Functional Independence Measure (FIM), and other variables of interest were collected at 12 months, 24 months, 48 months, and 60 months after being medically discharged. Hierarchical Linear Modeling (HLM) analyses showed that trajectories of happiness remained stable across participants and did not change significantly over five years post-discharge regardless of injury type, FIM, or insider/outsider status. Happiness was significantly predicted by FIM, injury type, and whether the respondent was an insider or outsider. Those who were more impaired and less functionally independent were less happy. Those with a TBI were consistently less happy than those with an IAF or SCI and outsiders reported greater happiness on behalf of the insider than did the insiders themselves. This study shows that there is stability in happiness levels that can be sustained at least five years post-discharge and that there are discrepancies between insider and outsider reports of subjective happiness. Proxy reports can be used as valuable and valid secondary sources of information but should not be used as substitutes for first hand reports unless absolutely necessary

An Experimental Study Investigating the Type of Data Visualizations Used in Infographics on Participant Recall and Information Recognition

The concept of agricultural sustainability, specifically sustainable beef production, is not well established, and much misinformation frames this conversation. One way agricultural communicators can educate the public on this controversial topic is through infographics. Scholars have suggested recall, or the mental process of retrieving information from the past, as a technique to understand what someone has comprehended when exposed to new information. The Limited Capacity Model of Motivated Mediated Message Processing (LC4MP) provides insight into human information processing and recall, and it guided this study’s development. The purpose of this study was to determine the effect various types of data visualizations used in infographics about agricultural topics have on college students’ knowledge and ability to recall attributes from the data visualizations. An experimental study was conducted where participants viewed one of three infographics with embedded data visualizations and answered questions to understand their recall of information, design elements, and information recognition. The results show pictographs were significantly more effective in participant information recognition and the free and cued recall of design; however, it was not significant for free and cued recall of information. These findings add to the agricultural communication literature as they show how the type of data visualization can impact how viewers encode, store, and retrieve information. The researchers suggest agricultural communicators implement pictographs more frequently in infographic communications strategy. Additionally, agricultural communicators must begin to train students on the use of data visualization techniques in classroom settings

Comparing the Safety and Efficacy of a Rapid High-Sensitivity Cardiac Troponin I Protocol Between Hospital-Based and Free-Standing Emergency Departments

Study Objectives: Current high sensitivity cardiac troponin I (hs-cTnI) research has been conducted almost exclusively in hospital-based emergency department (HBED) settings and the translation of these protocols into free-standing emergency departments (FSED) has yet to be explored. This study compared the safety and efficacy of applying a rapid-rule out protocol using hs-cTnI for exclusion of acute myocardial infarction (AMI) in HBEDs and FSEDs. Methods: This was a secondary analysis of a randomized trial of patients evaluated for possible AMI in 9 emergency departments (ED) from July 2020 through March 2021. The trial arms included a new 0/1-hour rapid protocol using hs-cTnI versus standard care, which used a 0/3-hour protocol without reporting hs-cTnI values below the 99th percentile. The primary outcome was safe ED discharge, defined as discharge with no death or AMI within 30-days. Analysis included a mixed-effect model adjusting for demographic variables. Results: There was a statistically significant difference in safe discharges from FSEDs when comparing the standard care arm (86.2%) to the rapid rule-out protocol (95.1%). There was a statistically significant reduction in FSED length of stay with application of a rapid rule-out protocol at 3.43 hours vs. 3.97 hours using standard care. The percentage of patients who ruled-out with their initial hs-cTnI (\u3c4 ng/L) at FSEDs (74%) was also significantly larger when compared to HBEDs (54%). Conclusion: Implementation of a hs-cTnI rapid 0/1-hour protocol to evaluate for AMI in FSEDs is feasible and had greater impact on safe ED discharge and length of stay compared to HBEDs

Cohesin-based chromatin interactions enable regulated gene expression within pre-existing architectural compartments

Chromosome conformation capture approaches have shown that interphase chromatin is partitioned into spatially segregated Mb-sized compartments and sub-Mb-sized topological domains. This compartmentalization is thought to facilitate the matching of genes and regulatory elements, but its precise function and mechanistic basis remain unknown. Cohesin controls chromosome topology to enable DNA repair and chromosome segregation in cycling cells. In addition, cohesin associates with active enhancers and promoters and with CTCF to form long-range interactions important for gene regulation. Although these findings suggest an important role for cohesin in genome organization, this role has not been assessed on a global scale. Unexpectedly, we find that architectural compartments are maintained in non-cycling mouse thymocytes after genetic depletion of cohesin in vivo. Cohesin was however required for specific long-range interactions within compartments where cohesin-regulated genes reside. Cohesin depletion diminished interactions between cohesin-bound sites, while alternative interactions between chromatin features associated with transcriptional activation and repression became more prominent, with corresponding changes in gene expression. Our findings indicate that cohesin-mediated long-range interactions facilitate discrete gene expression states within pre-existing chromosomal compartments

Delivery of Dark Material to Vesta via Carbonaceous Chondritic Impacts

NASA's Dawn spacecraft observations of asteroid (4) Vesta reveal a surface with the highest albedo and color variation of any asteroid we have observed so far. Terrains rich in low albedo dark material (DM) have been identified using Dawn Framing Camera (FC) 0.75 {\mu}m filter images in several geologic settings: associated with impact craters (in the ejecta blanket material and/or on the crater walls and rims); as flow-like deposits or rays commonly associated with topographic highs; and as dark spots (likely secondary impacts) nearby impact craters. This DM could be a relic of ancient volcanic activity or exogenic in origin. We report that the majority of the spectra of DM are similar to carbonaceous chondrite meteorites mixed with materials indigenous to Vesta. Using high-resolution seven color images we compared DM color properties (albedo, band depth) with laboratory measurements of possible analog materials. Band depth and albedo of DM are identical to those of carbonaceous chondrite xenolith-rich howardite Mt. Pratt (PRA) 04401. Laboratory mixtures of Murchison CM2 carbonaceous chondrite and basaltic eucrite Millbillillie also show band depth and albedo affinity to DM. Modeling of carbonaceous chondrite abundance in DM (1-6 vol%) is consistent with howardite meteorites. We find no evidence for large-scale volcanism (exposed dikes/pyroclastic falls) as the source of DM. Our modeling efforts using impact crater scaling laws and numerical models of ejecta reaccretion suggest the delivery and emplacement of this DM on Vesta during the formation of the ~400 km Veneneia basin by a low-velocity (<2 km/sec) carbonaceous impactor. This discovery is important because it strengthens the long-held idea that primitive bodies are the source of carbon and probably volatiles in the early Solar System.Comment: Icarus (Accepted) Pages: 58 Figures: 15 Tables:

Is rapid acute coronary syndrome evaluation with high-sensitivity cardiac troponin less costly? An economic evaluation

ObjectiveProtocols to evaluate for myocardial infarction (MI) using high-sensitivity cardiac troponin (hs-cTn) have the potential to drive costs upward due to the added sensitivity. We performed an economic evaluation of an accelerated protocol (AP) to evaluate for MI using hs-cTn to identify changes in costs of treatment and length of stay compared with conventional testing.MethodsWe performed a planned secondary economic analysis of a large, cluster randomized trial across nine emergency departments (EDs) from July 2020 to April 2021. Patients were included if they were 18 years or older with clinical suspicion for MI. In the AP, patients could be discharged without further testing at 0 h if they had a hs-cTnI &lt; 4 ng/L and at 1 h if the initial value were 4 ng/L and the 1-h value ≤7 ng/L. Patients in the standard of care (SC) protocol used conventional cTn testing at 0 and 3 h. The primary outcome was the total cost of treatment, and the secondary outcome was ED length of stay.ResultsAmong 32,450 included patients, an AP had no significant differences in cost (+$89, CI: −$714, $893 hospital cost, +$362, CI: −$414,$1138 health system cost) or ED length of stay (+46, CI: −28, 120 min) compared with the SC protocol. In lower acuity, free-standing EDs, patients under the AP experienced shorter length of stay (−37 min, CI: −62, 12 min) and reduced health system cost (−$112, CI: −$250, $25).ConclusionOverall, the implementation of AP using hs-cTn does not result in higher costs

Longer lifespan in male mice treated with a weakly estrogenic agonist, an antioxidant, an α-glucosidase inhibitor or a Nrf2-inducer

The National Institute on Aging Interventions Testing Program (ITP) evaluates agents hypothesized to increase healthy lifespan in genetically heterogeneous mice. Each compound is tested in parallel at three sites, and all results are published. We report the effects of lifelong treatment of mice with four agents not previously tested: Protandim, fish oil, ursodeoxycholic acid (UDCA) and metformin – the latter with and without rapamycin, and two drugs previously examined: 17-α-estradiol and nordihydroguaiaretic acid (NDGA), at doses greater and less than used previously. 17-α-estradiol at a threefold higher dose robustly extended both median and maximal lifespan, but still only in males. The male-specific extension of median lifespan by NDGA was replicated at the original dose, and using doses threefold lower and higher. The effects of NDGA were dose dependent and male specific but without an effect on maximal lifespan. Protandim, a mixture of botanical extracts that activate Nrf2, extended median lifespan in males only. Metformin alone, at a dose of 0.1% in the diet, did not significantly extend lifespan. Metformin (0.1%) combined with rapamycin (14 ppm) robustly extended lifespan, suggestive of an added benefit, based on historical comparison with earlier studies of rapamycin given alone. The α-glucosidase inhibitor, acarbose, at a concentration previously tested (1000 ppm), significantly increased median longevity in males and 90th percentile lifespan in both sexes, even when treatment was started at 16 months. Neither fish oil nor UDCA extended lifespan. These results underscore the reproducibility of ITP longevity studies and illustrate the importance of identifying optimal doses in lifespan studies