Hospital readmissions related to chronic heart failure (CHF) are costly, widespread, and often avoidable. Patient education that includes diagnosis, causes, medications, diet, exercise, and exacerbation warning signs has been shown to reduce the number of CHF readmissions. The purpose of this study was to use risk stratification to identify CHF patients at high risk for 30-day readmission. Once a high-risk CHF patient was identified, nursing interventions would be triggered to reduce readmissions and close the gaps in the continuum of care following acute care admission. Transitions of care theory was used as the framework for this project. The methodology had a quality improvement focus. The patient population consisted of high-risk CHF patients (n = 25) with NYHA classification of II-IV using the risk identification tool. Patients were identified using the tool, were followed for 30 days, and received nursing interventions to reduce the possibility of readmission. Only one of the identified patients was readmitted within 30 days for a diagnosis unrelated to CHF, resulting in no readmissions within this sub group. This study suggests that risk stratification can identify and direct resources to CHF patients, decreasing their likelihood for readmission. Nurse leaders can use standardized tools such as the risk identification tool, thereby reducing readmissions along with associated costs for readmissions.

We document how sampling from a conditional Student's t distribution is implemented in stochvol. Moreover, a simple example using EUR/CHF exchange rates illustrates how to use the augmented sampler. We conclude with results and implications. (author's abstract)

Class of 2013 Abstract / Specific Aims: To examine the relationship between hospital readmission rates and responses to a medication adherence questionnaire (Morisky) in patients with congestive heart failure (CHF). Methods: The Morisky questionnaire, assessing medication adherence, was administered to all CHF patients admitted from September 15, 2012 to March 7, 2013. Information collected from the electronic medical record (EMR) for all patients with complete Morisky questionnaires included: age, sex, ethnicity, insurance, height, weight, marital status, tobacco use, alcohol use, number of home medications, all-cause and CHF admission in the previous 365 days from when the questionnaire was administered as well as the following events/disease states: myocardial infarction, hypertension, atrial fibrillation, stroke, diabetes mellitus, peripheral vascular disease, chronic obstructive pulmonary disease, congestive heart disease and chronic kidney disease. Main Results: Of the 120 patients enrolled, 52% scored 1-5 on the Morisky questionnaire indicating some problem with medication adherence while 48% scored 0 (no problems). There was no correlation between the Morisky score and age (95% CI: -3.3-5.7), number of medications (95% CI: -0.26, 2.85), or number of comorbidities (95% CI: -1.02,0.03). The Morisky questionnaire was not predictive of all cause readmissions (95% CI: 0.35, 2.01) p = 0.691). For CHF readmissions the Morisky score was not significant (95% CI: 0.6, 4.11, p=0.358) but the confidence interval suggests a trend. Conclusion: There is no correlation between Morisky scores, age, comorbidities, and medication number. Readmission rates were not predicted by Morisky scores; with more participants a trend may be detected for CHF readmissions.

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No description available.

A insuficiência valvar crônica de mitral (IVCM) é a principal cardiopatia de cães, correspondendo a 75-85% dos casos de cardiopatias. É causada pela degeneração mixomatosa da valva mitral (endocardiose de mitral) sendo, então, uma doença degenerativa adquirida e que pode ocasionar a insuficiência cardíaca congestiva (ICC). Pode acometer qualquer raça de cão, mas é mais frequentemente observada nas raças de pequeno porte, dentre as quais, Poodle miniatura, Spitz Alemão, Dachshund, Yorkshire Terrier, Chihuahua e Cavalier King Charles Spaniel. Na endocardiose de mitral, o volume sanguíneo regurgitado causa sobrecarga do lado esquerdo do coração, devido ao aumento das pressões atrial e ventricular esquerdas, seguida de dilatação e hipertrofia dessas cavidades cardíacas. A elevação da pressão ventricular esquerda pode causar hipertensão pulmonar, congestão e, em estágios avançados, edema pulmonar. A doença pode evoluir assintomática, enquanto que naqueles casos que evoluem para insuficiência cardíaca congestiva (ICC) os sintomas mais usuais são: tosse, intolerância ao exercício, dispneia e síncope. Em 2009 o colégio americano de medicina interna veterinária (American College of Veterinary Internal Medicine -ACVIM) elaborou diretrizes para o tratamento da IVCM, tendo por base a classificação funcional adaptada do American College of Cardiology. Neste trabalho foram utilizados os fármacos anlodipino e pimobendana em associação a outros usualmente indicados no tratamento da ICC em cães, segundo consenso de 2009, indicados no tratamento da ICC em cães. Dois grupos (A e B) de cães, cada um constituído por 10 pacientes com IVCM em estágio C, foram tratados com furosemida e maleato de enalapril, sendo que os animais do grupo A receberão pimobendana e os do grupo B, anlodipino. Os animais foram avaliados em diferentes momentos (T0, T30, T60) observando-se as alterações nos exames ecodopplercardiográfico e eletrocardiográfico, bem como de pressão arterial sistólica / Chronic mitral valve regurgitation is the most frequent heart disease of dogs, accounting for 75-85 % of cases of heart diseases. It is caused by myxomatous mitral valve degeneration (mitral endocardiosis), therefore, an acquired degenerative disease that can lead to congestive heart failure (CHF). It affects any breed of dog, but is most often seen in small-sized breeds, like Miniature Poodle, German Spitz, Dachshund, Yorkshire Terrier, Chihuahua, and Cavalier King Charles Spaniel. In mitral endocardiosis, regurgitated blood volume causes overload on the left side of the heart due to increased left atrial and ventricular pressures, followed by dilation and hypertrophy of these heart chambers. The increase in left ventricular pressure can cause pulmonary hypertension, congestion and, in advanced stages, pulmonary edema. The disease can be asymptomatic, but in those cases that progress to congestive heart failure (CHF), the most common symptoms are coughing, exercise intolerance, dyspnea and syncope. In 2009 the American College of Veterinary Internal Medicine (ACVIM) has developed guidelines for the treatment of IVCM, based on the adapted functional classification of the American College of Cardiology. In this paper, amlodipine and pimobendan were used in combination with other commonly used drugs indicated in the treatment of CHF in dogs. Two groups (A and B) of dogs were used, each one consisted by 10 patients in stage C. Both received furosemide and enalapril maleate and animals of group A, additionally, received pimobendan and those of group B, amlodipine. All animals were evaluated at three different times (T0, T30, T60) observing changes in echodopplercardiographic and electrocardiographic examinations, as well as systolic blood pressure

Cette thèse décrit les études théoriques de deux catégories de phénomènes physiques: les transitions de phase et l'hydrodynamique physique. Dans la première catégorie se rangent plusieurs phénomènes ayant lieu dans des solides et dans des fluides. Les solides considérés sont des cristaux non-stoechiométriques supraconducteurs à haute température critique qui présentent des structures périodiques à période longue. Pour les fluides, on s'intéresse surtout à la cinétique des transitions de phase: il s'agit de la séparation de phase dans des mélanges binaires liquides, de l'ébullition et enfin de la condensation naturelle (rosée ou buée). La deuxième catégorie inclut la modélisation du mouvement de la ligne triple de contact liquide-gaz-solide le long d'un substrat hétérogène ainsi que l'analyse de l'instabilité d'une couche liquide placée dans le champ électrique.

A insuficiência valvar crônica de mitral (IVCM) é a principal cardiopatia de cães, correspondendo a 75-85% dos casos de cardiopatias. É causada pela degeneração mixomatosa da valva mitral (endocardiose de mitral) sendo, então, uma doença degenerativa adquirida e que pode ocasionar a insuficiência cardíaca congestiva (ICC). Pode acometer qualquer raça de cão, mas é mais frequentemente observada nas raças de pequeno porte, dentre as quais, Poodle miniatura, Spitz Alemão, Dachshund, Yorkshire Terrier, Chihuahua e Cavalier King Charles Spaniel. Na endocardiose de mitral, o volume sanguíneo regurgitado causa sobrecarga do lado esquerdo do coração, devido ao aumento das pressões atrial e ventricular esquerdas, seguida de dilatação e hipertrofia dessas cavidades cardíacas. A elevação da pressão ventricular esquerda pode causar hipertensão pulmonar, congestão e, em estágios avançados, edema pulmonar. A doença pode evoluir assintomática, enquanto que naqueles casos que evoluem para insuficiência cardíaca congestiva (ICC) os sintomas mais usuais são: tosse, intolerância ao exercício, dispneia e síncope. Em 2009 o colégio americano de medicina interna veterinária (American College of Veterinary Internal Medicine -ACVIM) elaborou diretrizes para o tratamento da IVCM, tendo por base a classificação funcional adaptada do American College of Cardiology. Neste trabalho foram utilizados os fármacos anlodipino e pimobendana em associação a outros usualmente indicados no tratamento da ICC em cães, segundo consenso de 2009, indicados no tratamento da ICC em cães. Dois grupos (A e B) de cães, cada um constituído por 10 pacientes com IVCM em estágio C, foram tratados com furosemida e maleato de enalapril, sendo que os animais do grupo A receberão pimobendana e os do grupo B, anlodipino. Os animais foram avaliados em diferentes momentos (T0, T30, T60) observando-se as alterações nos exames ecodopplercardiográfico e eletrocardiográfico, bem como de pressão arterial sistólica / Chronic mitral valve regurgitation is the most frequent heart disease of dogs, accounting for 75-85 % of cases of heart diseases. It is caused by myxomatous mitral valve degeneration (mitral endocardiosis), therefore, an acquired degenerative disease that can lead to congestive heart failure (CHF). It affects any breed of dog, but is most often seen in small-sized breeds, like Miniature Poodle, German Spitz, Dachshund, Yorkshire Terrier, Chihuahua, and Cavalier King Charles Spaniel. In mitral endocardiosis, regurgitated blood volume causes overload on the left side of the heart due to increased left atrial and ventricular pressures, followed by dilation and hypertrophy of these heart chambers. The increase in left ventricular pressure can cause pulmonary hypertension, congestion and, in advanced stages, pulmonary edema. The disease can be asymptomatic, but in those cases that progress to congestive heart failure (CHF), the most common symptoms are coughing, exercise intolerance, dyspnea and syncope. In 2009 the American College of Veterinary Internal Medicine (ACVIM) has developed guidelines for the treatment of IVCM, based on the adapted functional classification of the American College of Cardiology. In this paper, amlodipine and pimobendan were used in combination with other commonly used drugs indicated in the treatment of CHF in dogs. Two groups (A and B) of dogs were used, each one consisted by 10 patients in stage C. Both received furosemide and enalapril maleate and animals of group A, additionally, received pimobendan and those of group B, amlodipine. All animals were evaluated at three different times (T0, T30, T60) observing changes in echodopplercardiographic and electrocardiographic examinations, as well as systolic blood pressure

Cette thèse a pour objet l'étude expérimentale de la dynamique d'une bulle de vapeur créée en conditions d'ébullition nucléée dans un milieu sous-refroidi. La section d'essai est chauffée localement par focalisation d'un faisceau laser : les flux thermiques considérés varient entre 1e4 et 1.5e6 W/m2 et la température de l'eau varie entre 100 et 88°C.Trois régimes d'ébullition ont été observés. En conditions de saturation ou de faible sous-refroidissement et avec un faible flux thermique on observe un régime d'ébullition nucléée développée. Pour des sous-refroidissements supérieurs et des flux thermiques pas très élevés on observe un régime d'équilibre entre la masse de liquide évaporée à la base de la bulle et la quantité de vapeur condensée sur sa surface supérieure. Le troisième régime observé correspond à des flux thermiques élevés : sa caractéristique principale est la formation d'une poche de vapeur sur la surface chauffée qui reste attachée à la surface après la phase détachement de la bulle.La phase de condensation commence après le détachement de la bulle. Le rayon de détachement des bulles varie entre 1 et 2.5 mm. La mesure des propriétés des bulles a permis de les caractériser en termes de nombres adimensionnels. L'acquisition d'images à haute fréquence a permis d'observer la propagation d'ondes capillaires à la surface des bulles. Deux effets principaux de la propagation d'ondes capillaires sur la vitesse de condensation de la bulle ont été observés : l'augmentation de la surface d'échange entre les phases liquide et vapeur et la diminution de la vitesse de translation de la bulle, qui serait soumise à une trainée supérieure à cause de sa déformation. / The object of this thesis is an experimental study of vapor bubble dynamics in sub-cooled nucleate boiling. The test section is locally heated by focusing a laser beam: heat fluxes from 1e4 to 1.5e6 W/m2 and water temperature between 100 and 88°C have been considered. Three boiling regimes have been observed. Under saturated conditions and with low heat fluxes a developed nucleate boiling regime has been observed. Under higher sub-cooling and still with low heat fluxes an equilibrium regime has been observed in which the liquid flowrate evaporating at the bubble base is compensated by the vapor condensing flowrate at bubble top. A third regime have been observed at high heat fluxes for all water conditions: it is characterized by the formation of a large dry spot on the heated surface that keeps the nucleation site dry after bubble detachment. The condensation phase starts after bubble detachment. Bubble equivalent radius at detachment varies between 1 and 2.5 mm. Bubble properties have been measured and non-dimensional groups have been used to characterize bubble dynamics. Capillary waves have been observed on the bubble surface thanks to high-speed images acquisition. Two main phenomena have been proposed to explain capillary waves effects on bubble condensation: increasing of the phases interface area and decreasing of vapor bubble translation velocity, because of the increased drag force on the deformed bubble.