Early Home Visits by a Registered Nurse Care Manager with Heart Failure Patients

Strategies focused on 30 days in the life of a patient with heart failure will have limited impact on the burden that heart failure will have nationally or individually. The broader landscape of readmission risk underscores the need for a more comprehensive approach to heart failure management. Care management with a registered nurse demonstrated efficiently coordinate care. Home visits address the peaks of risk in the post-discharge transition and palliative phase while providing longitudinal support. The purpose of this study is to substantiate that early home visits and telephone followup with a registered nurse after discharge from the hospital will decrease the readmission rates of heart failure patients. The interventions used were face-to-face encounters, follow up telephone phone calls, a quality of life self-report tool and a medication reconciliation tool. This study utilized a secondary analysis of data collected with a state-funded grant to decrease readmissions of heart failure patients at a local 700-bed, not-for-profit hospital. The participants were identified based on their lack of insurance or being underinsured with Medicaid. A newly dedicated heart failure unit with 10 dedicated beds was opened in 2011. A team of case managers, nurses, and physicians responsible for referring the patients who met certain guidelines were referred to the care manager. If the patient met the insurance criteria and was NYHF Class III or IV, the patient would then be eligible for a care manager and pharmacist to assist with the transition home. Study results concluded that there were definite advantages to both these services in decreasing readmissions

Destruction of Refractory Carbon in Protoplanetary Disks

The Earth and other rocky bodies in the inner solar system contain significantly less carbon than the primordial materials that seeded their formation. These carbon-poor objects include the parent bodies of primitive meteorites, suggesting that at least one process responsible for solid-phase carbon depletion was active prior to the early stages of planet formation. Potential mechanisms include the erosion of carbonaceous materials by photons or atomic oxygen in the surface layers of the protoplanetary disk. Under photochemically generated favorable conditions, these reactions can deplete the near-surface abundance of carbon grains and polycyclic aromatic hydrocarbons by several orders of magnitude on short timescales relative to the lifetime of the disk out to radii of ~20-100+ au from the central star depending on the form of refractory carbon present. Due to the reliance of destruction mechanisms on a high influx of photons, the extent of refractory carbon depletion is quite sensitive to the disk's internal radiation field. Dust transport within the disk is required to affect the composition of the midplane. In our current model of a passive, constant-alpha disk, where alpha = 0.01, carbon grains can be turbulently lofted into the destructive surface layers and depleted out to radii of ~3-10 au for 0.1-1 um grains. Smaller grains can be cleared out of the planet-forming region completely. Destruction may be more effective in an actively accreting disk or when considering individual grain trajectories in non-idealized disks.Comment: 15 pages, 9 figures, Accepted for publication in Ap

Unlocking CO Depletion in Protoplanetary Disks II. Primordial C/H Predictions Inside the CO Snowline

CO is thought to be the main reservoir of volatile carbon in protoplanetary disks, and thus the primary initial source of carbon in the atmospheres of forming giant planets. However, recent observations of protoplanetary disks point towards low volatile carbon abundances in many systems, including at radii interior to the CO snowline. One potential explanation is that gas phase carbon is chemically reprocessed into less volatile species, which are frozen on dust grain surfaces as ice. This mechanism has the potential to change the primordial C/H ratio in the gas. However, current observations primarily probe the upper layers of the disk. It is not clear if the low volatile carbon abundances extend to the midplane, where planets form. We have run a grid of 198 chemical models, exploring how the chemical reprocessing of CO depends on disk mass, dust grain size distribution, temperature, cosmic ray and X-ray ionization rate, and initial water abundance. Building on our previous work focusing on the warm molecular layer, here we analyze the results for our grid of models in the disk midplane at 12 au. We find that either an ISM level cosmic ray ionization rate or the presence of UV photons due to a low dust surface density are needed to chemically reduce the midplane CO gas abundance by at least an order of magnitude within 1 Myr. In the majority of our models CO does not undergo substantial reprocessing by in situ chemistry and there is little change in the gas phase C/H and C/O ratios over the lifetime of the typical disk. However, in the small sub-set of disks where the disk midplane is subject to a source of ionization or photolysis, the gas phase C/O ratio increases by up to nearly 9 orders of magnitude due to conversion of CO into volatile hydrocarbons.Comment: Accepted for publication in ApJ, 15 pages, 10 figures, 3 table

Perceptions and Reflections of a Professional Pianist: A Case Report on Learning Human Anatomy through Cadaveric Dissection

Anatomical knowledge of the human body is a prerequisite for effortless and expressive movement for musicians.  A 35-year-old professional pianist, with no prior experience in the medical field, voluntarily completed a cadaveric dissection module of the upper extremity and spine.  The pianist was able to explore the intricate connections between human anatomy and the performance of piano music, gaining knowledge to enhance music quality and to manage and prevent injuries.  This case describes the pianist’s perceptions and reflections and highlights the potential value of anatomical education for individuals in non-medical fields.  This is, to our knowledge, the first documented case of a musician learning anatomy through cadaveric dissection

Herschel observations of EXtra-Ordinary Sources: Analysis of the HIFI 1.2 THz Wide Spectral Survey Toward Orion KL II. Chemical Implications

We present chemical implications arising from spectral models fit to the Herschel/HIFI spectral survey toward the Orion Kleinmann-Low nebula (Orion KL). We focus our discussion on the eight complex organics detected within the HIFI survey utilizing a novel technique to identify those molecules emitting in the hottest gas. In particular, we find the complex nitrogen bearing species CH$_{3}$CN, C$_{2}$H$_{3}$CN, C$_{2}$H$_{5}$CN, and NH$_{2}$CHO systematically trace hotter gas than the oxygen bearing organics CH$_{3}$OH, C$_{2}$H$_{5}$OH, CH$_{3}$OCH$_{3}$, and CH$_{3}$OCHO, which do not contain nitrogen. If these complex species form predominantly on grain surfaces, this may indicate N-bearing organics are more difficult to remove from grain surfaces than O-bearing species. Another possibility is that hot (T$_{\rm kin}$$\sim$300 K) gas phase chemistry naturally produces higher complex cyanide abundances while suppressing the formation of O-bearing complex organics. We compare our derived rotation temperatures and molecular abundances to chemical models, which include gas-phase and grain surface pathways. Abundances for a majority of the detected complex organics can be reproduced over timescales $\gtrsim$ 10$^{5}$ years, with several species being under predicted by less than 3$\sigma$. Derived rotation temperatures for most organics, furthermore, agree reasonably well with the predicted temperatures at peak abundance. We also find that sulfur bearing molecules which also contain oxygen (i.e. SO, SO$_{2}$, and OCS) tend to probe the hottest gas toward Orion KL indicating the formation pathways for these species are most efficient at high temperatures.Comment: 31 pages, 6 figures, 1 Table, accepted to the Astrophysical Journa

EFFECTS OF KAATSU TRAINING ON UPPER EXTREMITY SIZE AND STRENGTH

poster abstractConventional resistance training involves lifting heavy loads (~70% max-imal strength), which can be poorly tolerated or contraindicated in many clinical populations. KAATSU training is a novel training mode from Japan that combines muscle blood flow restriction with low load lifting (~20% max-imal strength). The purpose of this study was to investigate the effects of a KAATSU training program on upper extremity size and strength. Forty healthy subjects ages 18 to 30 were divided into exercise (EX) or control (CON) groups. Subjects reported to the laboratory three times per week for eight weeks. The EX group performed 3 sets of 15 repetitions of unilateral bicep curls and triceps extensions lifting loads equivalent to 20% of their predetermined maximal strength while wearing a pneumatic cuff to restrict blood flow on one arm (CUFF) and nothing on the other (NCUFF). The CON group did not perform any exercises but wore the cuff on one arm for a time comparable to the EX group. CUFF and NCUFF arms were randomly as-signed. Strength, girth, skin folds and tomography scans were taken pre-, during, and post-eight weeks. In the EX group, bicep curl (17.4% +4.1% and 18.7% +4.9%) and triceps extension (15.8% +3.4% and 10.7% +2.7%) strength increased significantly over the 8-week period for both the CUFF and NCUFF arms, respectively. No significant differences in strength occurred between the CUFF and NCUFF arms within the group. No strength changes were noted in the CON group for the CUFF and NCUFF arms. Arm girth and muscle cross-sectional area (mCSA) increased significantly in the EX subjects compared to the CON subjects, however no significant differ-ences were found when within group comparisons were made between the CUFF and NCUFF arms. This study indicates that KAATSU training can in-crease muscle strength and mCSA

KAATSU TRAINING: PERCEPTIONS AND COMPLIANCE TO AN UPPER ARM EXERCISE PROGRAM

poster abstractKAATSU training is a novel Japanese training mode involving low load (~20% maximal strength) weightlifting combined with blood flow restriction to the muscles. Little is known about the sensations experienced during KAATSU training and whether clients will tolerate it. The purpose of this study was to assess perceived sensations, exertion rates, and compliance to an upper arm KAATSU training program. Forty healthy subjects ages 18 to 30 were divided into exercise (EX) or control (CON) groups. Subjects report-ed to the laboratory three times per week for eight weeks. The EX group performed 3 sets of 15 repetitions of unilateral bicep curls and triceps exten-sions lifting loads equivalent to 20% of their predetermined maximal strength while wearing a pneumatic cuff on one arm (CUFF) and nothing on the other (NCUFF). The CON group did not perform any exercises but wore the cuff on one arm for a time comparable to the EX group. CUFF and NCUFF arms were randomly assigned. Sensations (burning, aching, pressure, pins & needles) and perceived exertion were assessed using visual analog scales that included emotions and verbal cues. Compliance (percentage of subjects completing the pre- and post-testing) and adherence (percentage of ses-sions completed) were tracked to provide an indication of training tolerance. Compliance was 85.4% and 97% for the EX and CON groups, respectively. EX subjects completed 85.4% of their workouts while controls attended 90.4% of their sessions. The prominent sensation reported in the CUFF arm was pressure (moderate; 3.2 +0.6) followed by aching (weak; 1.7 +0.4). Ratings of perceived exertion were higher for the CUFF (3.2 +1.0, 5.1 +1.8, and 7.0 +2.5) versus NCUFF (1.5 +0.3, 2.4 +0.3, and 3.3 +0.4) arm for sets 1, 2, and 3, respectively. KAATSU training is well tolerated by those performing it and a viable alternative to conventional resistance exercise