Inferior vena cava diameter and risk of acute decompensated heart failure rehospitalisations.

OBJECTIVES: Inferior vena cava (IVC) diameter may be a surrogate for volume status in acute decompensated heart failure (ADHF). The utility of IVC diameter measurement is under studied. The aim of this study was to assess the relationship between IVC diameter, clinical variables and ADHF rehospitalisations. METHODS: Retrospective chart review of 200 patients admitted for ADHF from 2018 to 2019 with transthoracic echocardiogram during index hospitalisation. Charts were assessed for ADHF rehospitalisation within 1 year. RESULTS: The median age was 64, 30.5% were female, and average left ventricular ejection fraction was 41%±20%. IVC diameter correlated to pulmonary arterial (PA) pressure (R=0.347, p<0.001) and body surface area (BSA) (R=0.424 p<0.001). IVC diameter corrected for BSA correlated to PA pressure (R=0.287, p<0.001) and log N-terminal B-type natriuretic peptide (NT-proBNP) (R=0.247, p≤0.01). Patients rehospitalised within 1 year had significantly greater mean IVC diameter compared with those not rehospitalised (p<0.001) while there was no difference in mean net weight lost during index hospitalisation or mean log NT-proBNP. Patients with IVC diameter greater than 2.07 cm had significantly increased ADHF rehospitalisation (85.6% vs 49.3%, log rank p<0.001) with HR 2.44 (95% CI 1.85 to 3.23, p<0.001). In multivariable Cox regression only IVC diameter (p<0.001), presence of tricuspid regurgitation (p=0.02) and NYHA class III/IV (p<0.001) independently predicted ADHF rehospitalisation within 1 year. CONCLUSIONS: IVC diameter is predictive of rehospitalisation in patients with ADHF and may identify patients in need of greater monitoring and diuresis.

TAZ Is a Negative Regulator of PPARγ Activity in Adipocytes and TAZ Deletion Improves Insulin Sensitivity and Glucose Tolerance.

Insulin resistance is a major factor in obesity-linked type 2 diabetes. PPARγ is a master regulator of adipogenesis, and small molecule agonists, termed thiazolidinediones, are potent therapeutic insulin sensitizers. Here, we studied the role of transcriptional co-activator with PDZ-binding motif (TAZ) as a transcriptional co-repressor of PPARγ. We found that adipocyte-specific TAZ knockout (TAZ AKO) mice demonstrate a constitutively active PPARγ state. Obese TAZ AKO mice show improved glucose tolerance and insulin sensitivity compared to littermate controls. PPARγ response genes are upregulated in adipose tissue from TAZ AKO mice and adipose tissue inflammation was also decreased. In vitro and in vivo mechanistic studies revealed that the TAZ-PPARγ interaction is partially dependent on ERK-mediated Ser112 PPARγ phosphorylation. As adipocyte PPARγ Ser112 phosphorylation is increased in obesity, repression of PPARγ activity by TAZ could contribute to insulin resistance. These results identify TAZ as a new factor in the development of obesity-induced insulin resistance.

Flax and wattle seed powders enhance volume and softness of gluten-free bread.

Gluten-free bread is generally associated with several quality defects such as reduced volume, dry texture and poor mouthfeel. Flaxseed gum has been shown to increase viscosity of bread dough. The aim of this study was to evaluate the effect of 1% (total base) addition of seed powders from flax ( Linum usitatissimum) and four acacia cultivars ( Acacia dealbata, A. decurrens, A. terminalis and A. verniciflua) on pasting properties, texture and volume of gluten-free bread. The incorporation of all seed powders reduced crumb hardness by 30-65% and increased specific loaf volume by 50%. Water absorption capacity and emulsifying ability contributed to these textural improvements and were attributed to water-soluble carbohydrates and insoluble fibre, while no foaming ability was detected. Darker crumb was observed upon flax addition, while dark particles were visible upon acacia addition. Scanning electron microscopy depicted absence of holes in the pore surface and viscoelastic starch-protein network in the seed powder containing bread.

Nutrition Education for the Health-care Provider Improves Patient Outcomes.

Nutrition education is globally lacking in medical training, despite the fact that dietary habits are a crucial component of physician self-care, disease prevention, and treatment. Research has shown that a physician's health status directly affects the quality of their preventative health counseling and patient outcomes, yet on average less than 20 hours over 4 years of medical education is spent teaching nutrition. This leaves providers with a gap in knowledge regarding this critical component of health. In a recent study, only 14% of resident physicians reported being adequately trained to provide nutritional counseling. Educating health-care professionals on how to eat well provides an opportunity to improve physician and patient well-being.

Immigrant Arab adolescents in ethnic enclaves: physical and phenomenological contexts of identity negotiation.

Ecologically embedded social identity theories were used to examine the risk and protective factors associated with the identity negotiation and adjustment of recent immigrant Arab (IA) adolescents to the United States residing in ethnic enclaves. Yemeni, Lebanese, and Iraqi 8th-graders (n = 45) from 4 ethnic enclave schools participated in focus-group interviews. In-depth analyses of interviews revealed that living in an ethnic enclave enhanced IA adolescents' feelings of belonging to the community. However, the new immigrant status coupled with country of origin determined the permeability of intergroup boundaries with well-established Arab and Arab American peers. Their identity negotiations and social identity salience (national, religious, and pan-Arab) were informed by transitional experiences from home to host country and the prevailing political and cultural tensions between the two, recognition of national hierarchy within the Arab community, perceptions of discrimination by the larger society, changed educational aspirations consequent to immigration, and current physical (school and community) and phenomenological contexts. Findings suggest that current theoretical perspectives should be extended to incorporate phenomenological representations of past spaces and places not currently occupied to understand adolescents' multifaceted identity.

Relationship between School Administrators' Reports of Parental Involvement in School and Students' Substance Use: A National Study.

This study examines the relationship between student substance use and school-level parental involvement as reported by administrators. Questionnaires were administered to school administrators and 111,652 students in 1,011 U.S. schools. Hierarchical logistic regression analyses conducted on 1998-2003 data from students and administrators indicate significantly lower prevalence of alcohol use among 8th graders in schools where administrators reported high parental involvement. Overall, administrators' reports of high parental involvement were unrelated to prevalence of substance use among 10th graders, and were associated with higher prevalence of alcohol use among 12th-graders. Implications and limitations are discussed, along with suggestions for future research.

Alcohol, tobacco, and other drug use prevention programs in U.S. schools: a descriptive summary.

This report identifies the prevalence of state, local, and commercially developed substance abuse prevention programs in middle and high schools from 2001 to 2007, using survey data from nationally representative samples of 1,206 schools. Based on school administrators' reports, schools and school districts offer students an average of 1.62 prevention programs during their school years from elementary through high school. Bivariate and multivariate regression analyses were conducted with school demographic characteristics public versus private, size, population density, region of the country, school race/ethnic composition, and socioeconomic status of the student body (SES) as predictors of total number of programs that students received and of the relative use of local, state, and commercial programs. Schools in the West had significantly fewer prevention programs than those in other regions of the country. Students in predominantly White and in higher SES schools received significantly more prevention programs than students in majority African American, majority Hispanic, or in lower SES affluent schools. The most frequently reported programs that students received were locally developed. D.A.R.E. was the most widely adopted prevention program. Findings from this study suggest that schools often develop their own curriculum to suit their students' needs, and students are exposed to multiple prevention programs through their school years, making it difficult to examine the effectiveness of any single program in preventing and reducing substance use among students.

How substance use differs among American secondary schools.

The purpose of this study was to examine (1) the extent to which student drug use and related measures vary among American secondary schools, and (2) how substance use varies among schools by certain school characteristics. Data come from the Monitoring the Future project's annual surveys of nationally representative samples of 8th-, 10th-, and 12th-grade students from 1991 to 2002. The results show that the preponderance of variance in drug use and related variables lies within schools; only a relatively small amount of variance is between schools. Although the variance lies primarily within schools, there remain important school-to-school differences in the extent to which students are exposed to drug use. The analyses of school characteristics show that schools do indeed differ in drug use by their students, particularly by school type, socioeconomic status, and race/ethnicity. Eighth and 10th grade (but not 12th grade) students in public schools are more likely to be cigarette smokers than students in private schools. Students in public middle schools are at higher risk for use of alcohol and marijuana; however, among 12th graders, students in Catholic schools are at higher risk. School size is generally unrelated to substance use, with few exceptions. For the most part, there is a negative association between school socioeconomic status and student substance use among 8th graders; but by 12th grade, the association tends to be positive or not significant. Racial/ethnic composition is significantly associated with student substance use, with majority African American schools typically showing the lowest rates of use at all grades.

School tobacco control policies related to students' smoking and attitudes toward smoking: national survey results, 1999-2000.

The belief that schools can play a powerful role in preventing tobacco use among adolescents has led to the implementation of various tobacco-related policies and practices. This study examines the association between school policies regarding monitoring student behavior, severity of action taken for infraction of policies, and tobacco use by staff, and student smoking behavior and attitudes. Data on students' smoking behavior and attitudes were obtained from the 1999 and 2000 Monitoring the Future surveys of nationally representative samples of 8th-, 10th-, and 12th-grade students. Data on school policies and practices were obtained from administrators in those same schools. Hierarchical analyses using HLM5 were conducted. Strictness of monitoring was significantly negatively associated with daily cigarette use by middle school students. Permitting staff to smoke was significantly positively associated with students' daily cigarette use and negatively with their disapproval of cigarette use. Policy implications are discussed.

Effects of school-level norms on student substance use.

This study examines the relationship between school norms of substance use disapproval (disapproval by the student body) and students' use of cigarettes, alcohol, and marijuana. Data came from nationally representative samples of 8th (N = 16,051), 10th (N = 13,251), and 12th (N = 8,797) grade students, attending 150, 140, and 142 schools, respectively. These students participated in the Monitoring the Future Project in 1999. Measures of school norms of disapproval of substance use were obtained by aggregating students' personal disapproval of daily cigarette use, heavy drinking, and marijuana use within each school. Analysis using logistic nonlinear hierarchical models indicated that in general, school-level disapproval lowered the probability of students' use of these substances, controlling for their own disapproval and for student and school demographic characteristics. The beneficial effect of school-level disapproval of cigarette and marijuana use on 8th-grade students' probability of daily cigarette use and marijuana use was significantly higher than it was for the 12th-grade students. The effect of school-level disapproval of heavy drinking on the probability of students' drinking was not significantly different across the three grades. Further, a school environment of disapproval was also found to create a protective environment for those students in the 8th and 10th grades who were themselves not disapproving of daily cigarette use. These results argue for prevention programs that include creation of an overarching environment of disapproval of substance use in schools.