Knowledge of disease prevalence

and participation in clin

Knowledge of disease prevalence

and participation in clinical trials provides an understanding of recruitment and retention patterns of patients in these trials.”
“Background: Quality of life (QOL) of patients receiving home parenteral nutrition (HPN) may be impacted by device technology. Historically, our HPN patients used pole-mounted pumps which can hinder activities find more and affect QOL. Methods: Patients receiving HPN with a pole-mounted pump completed Short Form 36 (SF-36 (R)) and pump-specific questionnaires. Patients were then enrolled in a 2-month prospective crossover open study. Patients were randomized to use a pole-mounted pump or a portable pump. After 1 month, each arm crossed over. Measurements were repeated at 4 and 8 weeks. Results: Participants included 5 males, 15 females; age 52.8 +/- 3.3 (mean +/- SEM) years; 50% had short

bowel syndrome; received HPN for 83.3 +/- 15.9 months; infused HPN over 11.2 +/- 0.3 hours/day; 4.3 +/- 0.4 days/week. Portable pump users scored 53.75 +/- 5.64, 61.25 +/- 6.14, and 40.31 +/- 4.94 in SF-36v2 physical, social, and health vitality, respectively, while the stationary pump users scored 45.50 +/- 4.82, 55.00 +/- 5.97, and 35.31 +/- 4.63, respectively (NS). They reported ease of movement between rooms (4.11 +/- 0.21 vs 1.44 +/- 0.20; Z-VAD-FMK cell line P = .001); when traveling (5.00 +/- 0.00 vs 3.00 +/- 0.45; P < .02) (1 = very difficult, 5 = very easy); 5.0% were sleep disturbed with the portable compared to 42.1% with pole-mounted pump (P < .04). Overall, patients

were significantly happier with the portable vs pole-mounted pump (4.53 +/- 0.19 vs 2.68 +/- 0.22; P < .001) (1 = very unhappy, 5 = very happy). Conclusion: Our HPN selleck screening library patients reported improved happiness and satisfaction regarding ease of use and function with a portable vs pole-mounted pump”
“Campylobacter species belong to the most important foodborne bacteria which cause gastroenteritis in humans in both developed and developing countries. With increasing reporting rates, the public awareness towards Campylobacter infections is growing continuously. This strengthens the necessity to establish intervention measures for prevention and control of thermophilic Campylobacter spp. along the food chain, as in particular poultry and poultry meat represent a major source of human infections. An interdisciplinary One Health approach and a combined effort of all stakeholders are necessary to ultimately reduce the burden of campylobacteriosis cases in humans. Numerous studies point out, however, that at present a complete elimination of Campylobacter in the food chain is not feasible. The present aim should therefore be to establish control measures and intervention strategies to minimize the occurrence of Campylobacter spp. in livestock (e.g.

We all know that sufficient drainage is very important for the tr

We all know that sufficient drainage is very important for the treatment of chronic rhinosinusitis (CRS). Chronic maxillary sinusitis (CMS) is the high incidence of CRS. The aim of this study was to investigate the efficacy of quadrupedal head position in patients with CMS.\n\nMethods: One hundred six patients diagnosed with CMS were enrolled. Patients were randomized to quadrupedal head position group and non-quadrupedal head position group for 6 weeks of treatment. Treatment outcomes were measured using 1) Lund-Mackay scoring system of pre-and post-treatment

computer tomography (CT); and 2) Sinonasal Quality-of-Life (QoL) Survey completed at baseline and 6 weeks of therapy.\n\nResults: There were statistically significant differences in QoL scores and CT scores IPI-145 cost between quadrupedal head position group and non-quadrupedal head position group. The quadrupedal head position group had much more improvements in QoL scores and CT scores than that of non-quadrupedal head position group. One patient in the quadrupedal head position group required functional endoscopic sinus surgery (ESS) due to persistent symptoms, and nine patients in non-quadrupedal head position group needed ESS. There were less patients that required ESS in the quadrupedal head position

group than in the non-quadrupedal head position group.\n\nConclusions: The improvements of QoL scores and CT scores were significantly better in the quadrupedal head position group than that in the non-quadrupedal head position Selleckchem APR-246 group. Quadrupedal head position can be valuable adjuvant therapy for patients with CMS. (C)

2013 Elsevier Inc. All rights reserved.”
“Objectives: We assessed the likelihood of arytenoid dislocation during intubation through the application of controlled force.\n\nMethods: Six cadaveric human larynges were mounted in an apparatus for simulating forcible collision with the arytenoid complexes. An endotracheal tube tip probe (ETTP) was Used to push one arytenoid complex, and a non-slip probe (NSP) was tested on the other. Increasing pressure was applied until the find protocol probes either slipped or reached 5 kg of force. Dissection was then performed to assess the integrity of the cricoarytenoid ligament. The forces obtained by pushing an endotracheal tube against an electronic balance were measured to estimate the maximal possible intubating force.\n\nResults: None of the ETTP or NSP trials disrupted the cricoarytenoid joint ligaments, and the joint never appeared to be dislocated. The mean maximal forces were 1.8 kg for the ETTP (after which, slippage consistently occurred) and 4.7 kg for the NSP. The mean maximal forces from an endotracheal tube pushed against a scale were 1.5 kg (without stylet) and 4.6 kg (with stylet).

The kinetic studies of adsorption

for lead and cadmium io

The kinetic studies of adsorption

for lead and cadmium ions were found to obey a pseudo-second-order model and the adsorption of both ions was found to fit the Langmuir isotherm. The grafted fishbone was effectively used as a sorbent for the removal of Pb2+ and Cd2+ ions from aqueous solution. (C) 2013 Elsevier B.V. All rights reserved.”
“The grape has been classified as a non-climacteric fruit with a relatively low physiological activity. However, some studies report that transient increase PXD101 Epigenetics inhibitor of endogenous ethylene production occurs just before verasion. Major problems after harvest include stem browning, berry shattering, wilting of berry, and gray mold caused by Botrytis cinerea. The grape is stored at -1 to 0 degrees C with 90 to 95% RH. Constant low temperature and high RH are important to control water loss and decay. find more Preharvest applications

of chitosan, abscisic acid, ethephon, or ethanol improve grape quality (skin color, decay, and weight loss) and shelf-life. Chitosan, UV irradiation, eugenol or thymol, sulfur dioxide, and chlorine dioxide gas are treated on grape after harvest in order to extend shelf-life and preserve quality. Controlled atmosphere or modified atmosphere packaging can be used as supplemental treatments to extend postharvest-life. 2-5% O(2) + 1-3% CO(2) is currently recommended for table grapes. SO(2) is used for decay control. 10-15% CO(2) in air can be used to control gray mold. Optimum range of temperature, relative humidity, and atmospheric composition depends on the cultivar.”
“In the present study, to enhance the tensile and fracture toughnesses of epoxy/clay composites without compromising the strength, a modifying copolymer in-situ synthesized for clay modification during epoxy curing was incorporated to form an interpenetrating network (IPN) structure within epoxy network, leading to a double IPN structure. The IPN structure click here formed between

the clay and the modifying copolymer via ionic interaction was reversible and flexible, and expected to dissipate energy more efficiently than those involving covalent bonding or other physical interactions in polymer intercalated composites. The advantage of this double IPN structure lies in itself, which is that the two IPNs are topological interlocking within each other to make the matrix strong and tough. And our results showed that a balanced improvement in both strength and toughness of the epoxy/clay nanocomposite could be obtained by this design. (C) 2014 Elsevier Ltd. All rights reserved.”
“Microbial communities have the potential to control the biogeochemical fate of some radionuclides in contaminated land scenarios or in the vicinity of a geological repository for radioactive waste. However, there have been few studies of ionizing radiation effects on microbial communities in sediment systems.

Chelating intracellular Ca2+ or abrogating CaMKK-beta function by

Chelating intracellular Ca2+ or abrogating CaMKK-beta function by gene silencing or chemical inhibition prevented the CO(2)-induced

AMPK activation in AECs. Activation of AMPK or overexpression of constitutively active AMPK was sufficient to activate PKC-zeta and promote Na,K-ATPase endocytosis. Inhibition or downregulation of AMPK via adenoviral delivery of dominant-negative AMPK-alpha(1) prevented CO(2)-induced Na,K-ATPase endocytosis. The hypercapnia effects were independent of intracellular ROS. Exposure of rats to hypercapnia for up to 7 days caused a sustained decrease in AFR. Pretreatment with a beta-adrenergic agonist, isoproterenol, or a cAMP analog check details ameliorated the hypercapnia-induced impairment of AFR. Accordingly, we provide evidence that elevated CO(2) levels are sensed by AECs and that AMPK mediates CO(2)-induced Na,K-ATPase endocytosis and alveolar epithelial dysfunction, which can be prevented with beta-adrenergic agonists and cAMP.”
“Background: In adults, heart rate recovery is a predictor of mortality, while in adolescents it is associated

with cardio-metabolic risk factors. The aim of this study was to examine the relationship between body composition measures and heart rate recovery (HRR) after step test in Malaysian secondary Dibutyryl-cAMP mouse school students.\n\nMethods: In the Malaysian Health and Adolescents Longitudinal Research Team (MyHEART) study, 1071 healthy secondary school students, aged 13 years old, participated in the step test. Parameters for body composition measures were body mass index z-score, body fat percentage, waist circumference, and waist height ratio. The step test was

conducted by using a modified Harvard step test. Heart rate recovery of 1 minute (HRR1min) and heart rate recovery of 2 minutes (HRR2min) were calculated learn more by the difference between the peak pulse rate during exercise and the resting pulse rate at 1 and 2 minutes, respectively. Analysis was done separately based on gender. Pearson correlation analysis was used to determine the association between the HRR parameters with body composition measures, while multiple regression analysis was used to determine which body composition measures was the strongest predictor for HRR.\n\nResults: For both gender groups, all body composition measures were inversely correlated with HRR1min. In girls, all body composition measures were inversely correlated with HRR2min, while in boys all body composition measures, except BMI z-score, were associated with HRR2min. In multiple regression, only waist circumference was inversely associated with HRR2min (p=0.024) in boys, while in girls it was body fat percentage for HRR2min (p=0.008).\n\nConclusion: There was an inverse association between body composition measurements and HRR among apparently healthy adolescents. Therefore, it is important to identify cardio-metabolic risk factors in adolescent as an early prevention of consequent adulthood morbidity.

Key Messages: Many of the key principles of treatment for spinal

Key Messages: Many of the key principles of treatment for spinal injuries were developed at the end of the 19th century and during the First World War but units closed down and the knowledge gained was forgotten. With the advent of the Second World War, German refugees, many of whom had worked in the field of neurology (including Ludwig Guttmann), came to the United Kingdom armed with

a thorough training in neurology and rehabilitation and applied these principles to the treatment of spinal injuries for the benefit of the country which gave them refuge. (C) 2014 S. Karger AG, Basel”
“Chemical investigation of the glandular trichome exudate from Geranium carolinianum L. (Geraniaceae) led to the characterization of unique disaccharide derivatives, n-octyl 4-O-isobutyryl-alpha-L-rhamnopyranosyl-(1 -> 2)-6-O-isobutyryl-beta-D-glucopyranoside (1), n-octyl 4-O-isobutyryl-alpha-L-rhamnopyranosyl-(1 see more -> 2)-6-O-(2-methylbutyryl)-beta-D-glucopyranoside (2) and n-octyl

4-O-(2-methylbutyryl)-alpha-L-rhamnopyranosyl-(1 -> 2)-6-O-isobutyryl-beta-D-glucopyranoside (3), named earoliniasides A-C, AC220 nmr respectively. These structures were determined by spectral means. n-Alkyl glycoside derivatives have been isolated from the glandular trichome exudates for the first time. This rare type of secondary metabolites could be applicable to chemotaxonomic perspective because they are found in glandular trichome exudates of plants belonging to the genus Geranium, according to our studies.”
“Background: The prevalence of type 2 diabetes (T2D) has dramatically increased in Europe, and the age-at-diagnosis has become younger. Action is needed now to develop targeted prevention management program for T2D). The DE-PLAN (“Diabetes in Europe – Prevention using Lifestyle, Physical Activity and Nutritional intervention”) project, led by the University of Helsinki is currently addressing this major public health concern in Europe.\n\nMethods: The DE-PLAN project aims at developing learn more and testing models of efficient identification and intervention of individuals at high risk of type 2

diabetes in the community. It conducts a lifestyle modification intervention in people at high risk for T2D. Furthermore, it tests the feasibility and cost-effectiveness of the translation of the current research evidence about preventive intervention program into clinical settings within existing health care systems in 17 European countries.\n\nResults: This 3-year project spanning has commenced mid-2005. By now, 25 institutions from 17 countries are involved.\n\nConclusion: The development of efficient screening strategies for type 2 diabetes risk as well as the development of core intervention strategies for the primary prevention of type 2 diabetes should significantly enhance the ability of health care professionals to respond swiftly to the drastic increase of T2D and its burden to the society.

“We investigated mechanisms

of reproductive isolat

“We investigated mechanisms

of reproductive isolation in livebearing fishes (genus Poecilia) inhabiting sulfidic and nonsulfidic habitats in three replicate river drainages. Although sulfide spring fish convergently evolved divergent phenotypes, it was unclear if mechanisms Tariquidar supplier of reproductive isolation also evolved convergently. Using microsatellites, we found strongly reduced gene flow between adjacent populations from different habitat types, suggesting that local adaptation to sulfidic habitats repeatedly caused the emergence of reproductive isolation. Reciprocal translocation experiments indicate strong selection against immigrants into sulfidic waters, but also variation among drainages in the strength of selection against immigrants into nonsulfidic AZD2171 solubility dmso waters. Mate choice experiments revealed the evolution of assortative mating preferences in females from nonsulfidic

but not from sulfidic habitats. The inferred strength of sexual selection against immigrants (RIs) was negatively correlated with the strength of natural selection (RIm), a pattern that could be attributed to reinforcement, whereby natural selection strengthens behavioral isolation due to reduced hybrid fitness. Overall, reproductive isolation and genetic differentiation appear to be replicated and direct consequences of local adaptation to sulfide spring environments, but the relative contributions of different mechanisms of reproductive isolation vary across these evolutionarily independent replicates, highlighting both convergent and nonconvergent evolutionary trajectories of populations in each drainage.”
“Lipoproteins, especially high-density lipoproteins (HDL), very low-density lipoproteins (VLDL) and small, dense low-density lipoprotein (sdLDL), are believed to play an important role in the development of atherosclerosis.

In this work, a simple, selective and sensitive method for the simultaneous monitoring of these lipoproteins in human serum using microchip capillary electrophoresis was developed. Gold nanoparticles were used as an additive to the running buffer to obtain the absolute separation of the lipoproteins. Under optimised conditions, the linear ranges of large buoyant selleck chemicals llc low-density lipoproteins, sdLDL, VLDL and HDL were 10-800, 10-800, 40-1,000 and 20-800 mu g L(-1), and their limits of detection were 5, 5, 15 and 8 mu g L(-1), respectively. The intraassay and interassay relative standard deviation of lipoprotein peak areas were in the range of 3.8-7.4%. For practical application, variations in the serum lipoprotein of coronary heart disease patients were monitored by microchip-based CE. The results showed that the method was applicable for routine clinical use and allowed the rapid detection of different lipoprotein classes as well as their subclasses, thus greatly improving the analysis of atherosclerotic risk factors.

Most students (95%, 113/119) reported copying from their own prev

Most students (95%, 113/119) reported copying from their own previous notes, and 22% (26/119) reported copying from residents. Only 10% (12/119)

indicated that copying from other providers is acceptable, whereas 83% (98/118) believe copying from their own notes is acceptable. Most students use templates and auto-inserted data; 43% (51/120) reported documenting while signed in under an attending’s name. Greater use of documentation efficiency tools is associated with plans to enter a procedural specialty and with lack of awareness of the medical school copy-paste policy. Conclusions: Students frequently use a range of efficiency tools to document in the electronic health record, most commonly copying their own notes. Although the vast majority of students believe it is unacceptable to copy-paste

from other providers, most have observed clinical supervisors doing so.”
“The declining effectiveness of antibiotics Rabusertib order imposes potentially large health and economic burdens on societies. Quantifying the economic outcomes of antibiotic resistance Epigenetics inhibitor effectively can help policy-makers and healthcare professionals to set priorities, but determining the actual effect of antibiotic resistance on clinical outcomes is a necessary first step. In this article, we review and discuss the contributions and limitations of studies that estimate the disease burden attributable to antibiotic resistance and studies that estimate the economic burden of resistance. We also consider other factors that are important in a comprehensive approach to evaluating the economic burden of antibiotic resistance.”
“The aim of this systematic review

is to summarize and critically evaluate the evidence for or against the effectiveness of restraining devices on eye injury in motor vehicle collisions (MVCs). In a PubMed PD-1/PD-L1 inhibitor search, the search terms “eye injury and seatbelt,” “eye injury and car belt,” “eye injury and airbag,” and “eye injury and restraining” were used. Among the 30 potentially relevant articles, 5 articles met our inclusion criteria. The odds ratio (OR) and 95% confidence intervals (CIs) from each study were abstracted. The statistical analysis was performed with Review Manager (The Nordic Cochrane Centre). Three studies were subgrouped, and a meta-analysis of these data suggested no significant effects of an airbag on increasing eye injury in MVCs (n = 10,123,954; OR, 1.10; 95% CI, 0.77-1.56). Two studies were subgrouped, and a meta-analysis of these data suggested that there are beneficial effects of seat belts on decreasing eye injury in MVCs (n = 43,057,271; OR, 0.50; 95% CI, 0.50-0.51). Seat belts were effective to decrease eye injuries in MVCs. However, airbags had no significant effect on an increase to eye injuries. When using airbags, seat belts should be used together.

These effects are antagonized by the expression of shRNAs specifi

These effects are antagonized by the expression of shRNAs specific for Foxa2 but enhanced by shRNA for HDAC7. Collectively, these findings indicate that loss of differentiation potential of expanded VM-derived NPCs is attributed to a decrease in Foxa2 expression and suggest that activation of the endogenous Foxa2 gene by epigenetic regulation might be an approach to enhance the generation of DA neurons.”
“Lung lobectomy after contralateral pneumonectomy is a challenging procedure associated with high morbidity and mortality. To date, only limited evidence has been available, and adequate indication or surgical approach remain unclear.

We herein report a successful Napabucasin case of thoracoscopic lobectomy in a single-lung patient. A 63-year-old man, who had a history of left pneumonectomy for lung cancer, was found to have an abnormal opacity in the right middle zone at a health checkup 13 years after the previous operation. This nodule was later diagnosed as squamous cell cancer (cT2N0M0, stage 1B) and surgical resection was considered.

Thoracoscopic middle lobectomy with D1 lymph node dissection was performed for this patient under selective ventilation of the right upper and lower lobes. Postoperative course was uneventful buy Vorinostat and he was discharged on postoperative day 7, requiring no oxygen. The patient is doing well with no evidence of recurrence for 5 years. Given the lower invasiveness, thoracoscopic lobectomy under the selective ventilation of residual

lobes could be an option after contralateral pneumonectomy in selected patients. (C) 2015 by The Society of Thoracic Surgeons”
“Background: To compare the prevalence of impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM) in lean and overweight/obese women with polycystic ovary syndrome (PCOS), with the data from a normal population sample. Methods: PCOS-affected women fulfilling ESHRE diagnostic criteria underwent an oral glucose CX-6258 tolerance test. Prevalence of IGT and T2DM in control sample of white healthy females was extracted from the published data from NHANES II. Results: In 225 women with PCOS, IGT was present in 6/104 (5.8%) lean and in 15/121 (12.4%) overweight/obese women. T2DM was present in 1/104 (1.0%) lean and in 3/121 (2.5%) overweight/obese PCOS women. In a sample of 643 women from NHANES II, the crude rate of IGT was 5.9%. IGT was significantly more common only in the overweight/obese PCOS subgroup as compared to the NHANES II cohort (chi(2) = 5.99, p < 0.01). Conclusions: IGT was found significantly more frequently only in overweight/obese PCOS subjects in comparison with healthy controls. Copyright (C) 2009 S. Karger AG, Basel”
“Ultraviolet (UV) vision is widespread in a variety of animals, playing important roles in behaviours such as foraging and reproduction.

3 %) than in subjects with lower levels (38 9 %, p smaller than <

3 %) than in subjects with lower levels (38.9 %, p smaller than NVP-LDE225 0.04). Results of the study support the involvement of the systemic low-grade inflammation in the pathomechanisms of autism and its possible association with GI symptoms.”
“During healing following tooth extraction, inflammation and the immune response within the extraction socket are related to bone resorption. Objective: We sought to identify how the alloplastic material used for socket preservation affects the immune responses and osteoclastic activity within extraction sockets. Material and Methods: Using a porcine model, we extracted teeth and grafted biphasic calcium phosphate into the extraction sockets. We

then performed a peptide analysis with samples of gingival tissue from adjacent to the sockets and compared the extraction only (EO) and extraction with socket preservation (SP) groups. We also used real-time polymerase chain reaction (PCR) to evaluate the expression level of immunoglobulins, chemokines and other factors related to osteoclastogenesis. Differences between the groups were analyzed for statistical significance using paired t tests. Results: Levels of IgM, IgG and IGL expression were higher in the EO group than in the SP group 1 week post-extraction, as were the levels of CCL3, CCL5, CXCL2, IFN-gamma and TNF-alpha expression (p smaller than 0.05). In addition,

receptor activator of nuclear factor kappa-B ligand (RANKL) was also significantly check details upregulated in the EO group (p smaller than 0.05), as were IL-1 beta, IL-6 and IL-8 (p smaller than 0.05). Conclusions: These results suggest that the beneficial effect of socket preservation can be explained by suppression of immune responses and inflammation.”
“Human leg muscles are often activated

inhomogeneously, e.g. in standing. This may also occur in complex tasks like walking. Thus, bipolar surface electromyography (sEMG) may not accurately represent whole muscle activity. This study used 64-electrode high-density sEMG (HD-sEMG) to examine spatial variability of lateral gastrocnemius (LG) muscle activity during the stance phase of walking, maximal voluntary contractions (MVCs) and maximal M-waves, and determined the effects of different normalization approaches on spatial and inter-participant variability. Plantar flexion MVC, maximal electrically elicited PD-1/PD-L1 Inhibitor 3 M-waves and walking at self-selected speed were recorded in eight healthy males aged 24-34. sEMG signals were assessed in four ways: unnormalized, and normalized to MVC, M-wave or peak sEMG during the stance phase of walking. During walking, LG activity varied spatially, and was largest in the distal and lateral regions. Spatial variability fluctuated throughout the stance phase. Normalizing walking EMG signals to the peak value during stance reduced spatial variability within LG on average by 70%, and inter-participant variability by 67%.

Totally 18 mutant

Totally 18 mutant selleck strains were demonstrated by testing of 1,234 colonies and then used in citric acid production studies. Chemical mutagenesis was found as more effective in enhancing citric acid production than UV-induced mutagenesis. Maximum citric acid concentration (50.1 g/L) and yield obtained by the chemical mutant Y. lipolytica K-168 exceeded that of the initial strain by 57%. Growth and citric acid production of this strain was further

examined in natural fermentation media containing carrot juice or celery byproducts. Maximum citric acid concentration reached to 62.6 g/L in diluted carrot juice medium supplemented with glucose. It was determined that enriched carrot juice may serve as a good nutrient source and could

be used for citric acid production by K-168 strain.”
“Background: Asymptomatic or clinically mild hyponatremia commonly occurs in the setting of heart failure, especially among elderly and severely decompensated, fluid-overloaded patients, and is associated with increased morbidity and mortality. Successful detection and treatment of hyponatremia by cardiovascular and advanced practice nurses caring for patients with heart failure are part of multidisciplinary team care. Nurses should be able to detect signs and symptoms of hyponatremia and, even when patients are asymptomatic, initiate Anlotinib appropriate treatment promptly to prevent complications. Purpose: In this review, the epidemiology and JNJ-26481585 mw pathophysiology of hyponatremia in heart failure, and signs and symptoms are described. In patients with heart failure, challenges involved in determining the type of hyponatremia (hypervolemic, hypovolemic, or euvolemic) and in correctly managing hyponatremia to prevent serious complications are presented. Conventional treatment options and their limitations are reviewed, and the vasopressin-receptor antagonist tolvaptan, an emerging oral therapy option, is introduced

and discussed. Conclusions: Hyponatremia is a marker of morbidity and mortality in patients with heart failure. Nurses working collaboratively with other healthcare providers must be able to recognize the condition and understand treatment options, including potential adverse effects of current and emerging therapies. One emerging therapy-tolvaptan-can be used in hypervolemic and euvolemic hyponatremic patients with heart failure to correct serum sodium level without negatively affecting renal function. Clinical Implications: Improved nurse understanding of hyponatremia in patients with heart failure may promote nurse-initiated or nurse-facilitated detection and management, which could decrease mortality and morbidity.