Some investigators have identified volume overload admissions using discharge diagnosis codes in conjunction with dialysis procedure codes. For example, the claims- based definition used by Arneson et al. included fluid- related discharge diagnosis codes and also required the presence of a dialysis procedure code billed on the day of admission or the following day . Inclusion of disease- specific procedure codes often increases definition spe- cificity . As anticipated, when we added dialysis procedure codes to diagnosis code-based definitions, we observed gains in specificity paired with reductions in sen- sitivity. However, the overall impact on validity estimates was minimal. This finding may, in part, be attributable to a hospital’s tendency to adhere to a patient’s outpatient hemodialysis schedule. Based solely on schedule, regard- less of clinical presentation, greater than a third of all pa- tients would be expected to receive dialysis within 24 to 36 h of admission. Furthermore, Medicare billing rules may impact the accuracy of claims-based definitions relying on dialysis procedure codes. Hospitals cannot bill dialysis CPT codes for treatments provided without the physical presence of the attending physician during the dialysis session . In administrative data, this billing rule may lead to underestimation of dialysis procedures in academic environments where trainees supervise emer- gent overnight or weekend dialysis without in-hospital attending presence and in community hospitals where re- mote nephrology coverage is common. Thus, to maximize definition stability across clinical practice environments and to avoid outcome misclassification related to billing rules, it may be prudent to omit dialysis procedure CPT codes from claims-based definitions for volume overload hospital admissions.
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HF induced by chronic volume overload has been stu- died less, despite such overload due to valve insuffi- ciency being relatively common among HF patients . Volume overload due to a surgically created aorto-caval fistula (ACF) in rats is a well defined model of chronic HF [6-8], which mimics the gradual transition of asymp- tomatic cardiac hypertrophy into symptomatic HF. The creation of an ACF leads to increased cardiac output and eccentric ventricular hypertrophy that remains asymptomatic for 8-10 weeks. Because most of cardiac output is shunted into the inferior vena cava, the effec- tive cardiac output is reduced. leading to renal hypoper- fusion , neurohumoral activation, and sodium/water retention . Elevated cardiac filling pressures further contribute to cardiac overload [9-11]. By these mechan- isms, HF gradually develops .
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increase in the hazard ratio of death by 1.64. If IDCR de- creases to below 0.05 mg/dL/h, the odds ratio of dying in two months is 38 and the median survival in our study was only 32 days. While we believe that excessive vol- ume retention is the major factor driving low IDCR values, we do not exclude, and presume that there may be, a contribution of decreased creatinine production in certain high-risk patients . Either way, our study data have confirmed our mathematically-derived hy- potheses that IDCR varies with body fluid volume, can help exclude or indicate possible volume overload, and has excellent prognostic value in identifying hemodialysis patients at high risk of death.
regurgitation eventually leads to contractile dysfunction. However, it is unknown whether or not correction of the volume overload can lead to recovery of contractility. In this study we tested the hypothesis that depressed contractile function due to volume overload in mitral regurgitation could return toward normal after mitral valve replacement. Using a canine model of mitral regurgitation which is known to produce contractile dysfunction, we
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increased turnover of norepinephrine is clearly associated with excessive sympathetic stimulation but in animal models and humans with heart failure secondary to mechanical overload there is evidence for depression of neuronal uptake. Because norepinephrine is both released and taken up by sympathetic fibers it is impossible to assess norepinephrine kinetics in an intact heart without separating these two functions. A technique for doing so has recently been developed in normal dogs and we therefore acquired similar data in humans with heart failure secondary to chronic pressure and volume overload. The technique involves the combination of transient norepinephrine tracer coronary sinus
This study has several limitations. First, the onset and severity of clinical history and comorbidities including a history of volume overload is unknown. The history of volume overload was determined before dialysis in- duction. We did not use a bioimpedance method that could evaluate the presence of volume overload object- ively and strictly. We defined volume overload using the clinically convenient indicators of physical findings and chest X-rays. Compared to a previous study using the bioimpedance method, the severity of volume over- load defined in our study may be severely biased. Sec- ond, echocardiography only measured left ventricular ejection fraction; left ventricular hypertrophy and left ventricular mass were not measured. In addition, as the timing of echocardiography includes the phase of dialy- sis induction, the ejection fraction may have been modified by asymptomatic heart failure developed just before the dialysis initiation. Third, there are several potential selection biases in the present study. We did not consider the patients who died during hospitalization at the initiation of dialysis or those who died before reaching ESRD. A lead-time bias may also exist because there were no definite criteria for starting maintenance dialysis. The timing of dialysis initiation was determined according to the subjective judgment of the attending physician. In patients with a high risk of death dialysis can be initiated earlier. This, may pro- vide a positive lead-time bias for late referral patients and may attenuate the association between late referral and time-to-death. Fourth, some potentially important residual confounders were not measured, including lon- gitudinal data about the quality of dialysis which may be more important and relevant to the outcome.
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The clinical course of patients with chronic aortic regurgi- tation is tightly linked to volume overload and the process of cardiac remodeling. Asymptomatic patients with aortic valve regurgitation develop systolic dysfunction at a rate of < 6% per year. Asymptomatic patients with LV dys- function develop symptoms at a rate of > 25% per year, with an annual mortality > 10%. No medical interven- tions are known to ameliorate the severity of valve dys- function, although the hemodynamic impact of aortic valve regurgitation may be mitigated with vasodila- tors[16,17]. Aortic valve replacement surgery is recom- mended for patients with impending left ventricular dysfunction or heart failure.
Thus, the mechanism by which tolvaptan protects renal function from decline in CKD remains speculative. One explanation might be associated with the fact that tolvaptan allows the patients to have greater fluid intake, as patients in the T group would have required more fluid than those in the C group to maintain normal extracellular fluid volume. Table 2 Changes in biochemical markers at baseline and 1 year after the start of study in control group
myocardial hypertrophy in response to aortic insufficiency in young adult (9 mo) and old (18 or 22 mo) Fischer rats. Before, immediately after, and at 2 and 4 wk after creating aortic insufficiency, LV and aortic pressures were measured using a catheterization technique. 4 wk after surgery, we measured aortic flow, and estimated the LV passive pressure-volume relationship and the degree of LV hypertrophy after killing. Immediately after the surgical creation of aortic insufficiency, both young and old rats showed similar elevation of LV end- diastolic pressure (from 4.8 +/- 0.6 to 12.0 +/- 1.5 mmHg in the young rats, P less than 0.01; from 4.9 +/- 0.4 to 11.0 +/- 0.7 mmHg in the old rats, P less than 0.01). In the young rats LV, end-diastolic pressure decreased to 8.0 +/- 1.0 and to 8.5 +/- 0.9 mmHg at 2 and 4 wk (P less than 0.05). In contrast, LV end-diastolic pressure at 2 (16.9 +/- 3.1 mmHg) and 4 wk (16.1 +/- 2.7 mmHg) in the old rats was even higher, compared with the values measured immediately after aortic insufficiency. At 4 wk, LV end-diastolic meridional wall stress (calculated from the in vivo […]
There are certain limitations in this study. First, wall stress measurement is reliable when there is an equal wall thickness with symmetrical structure. Obviously, with the creation of small MI, there is an asymmetry of LV myocardium in both structure and consistency (myo- cardium vs. scar tissue). However, the scar tissue is small and restricted to the LV apex (approximately 14% of en- tire LV myocardium ). In fact, most of LV wall was thickened after induction of this small experimental MI. Nevertheless, we acknowledge that this is our major limitation. Secondly, there is an individual variability in response to dobutamine stimulation even in sham mice. Although the average sham mice (n = 5) showed only a modest increase in HR, PS-WS, and IWS during dobutamine stimulation, one mouse presented in Figure 1 showed a notable increase in HR and PS-WS in response to dobutamine. Nevertheless, even with increased HR and PS-WS, the calculated IWS remained relatively un- changed in the sham-operated mice. Lastly, the reliability of IWS index is based upon the stipulation that ED-WS is significantly low compared with the systolic wall stress. Thus, IWS index may not be accurate in obvious volume overload cases and/or dilated hearts with LV dysfunction where ED-WS is significantly higher than that in normal condition. Of note, ED-WS in human is higher than that in mice in relation to PS-WS, probably around 15 to 20% of PS-WS .
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Abstract: Transfusion-associated circulatory overload (TACO) is acute pulmonary edema associated with left atrial hypertension or volume overload occurring within 6 hours following a blood transfusion. Recognized by physicians as a common complication of blood transfusion, its incidence has been difficult to measure because active surveillance is required to counteract underreporting; active surveillance indicates overall incidence rates as high as 1% per trans- fused patient. Recent clinical and translational research has focused on the development of electronic alert systems to measure TACO incidence and provide alerts to physicians regarding patients at high risk. Translational research regarding the utility of biomarkers such as brain natriuretic protein (BNP) or N-terminal pro-BNP (NT-proBNP) as diagnostic tools for TACO has been only moderately successful, but the search for other biomarkers continues. Prevention strategies can be developed based upon evidence derived from both observational studies and might include: using documented risk factors to highlight patients at risk, preferably using real-time analysis of electronic medical records; implementation of modified transfusion strate- gies to minimize the volume and infusion rate of blood products; consideration of prophylactic diuretic therapy; and heightened diagnostic awareness combined with rapid implementation of treatment. Randomized clinical trials will be required to test such strategies before they are widely implemented. Finally, the occurrence of TACO ought to be considered as a potentially avoidable medical complication that could be used to benchmark transfusion and critical care practice across hospitals.
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Conclusion: The diagnosis of transfusion-related acute lung injury relies on excluding other causes of acute pulmonary edema following transfusion, such as sepsis, volume overload, and cardiogenic pulmonary edema. All plasma containing blood products have been implicated in transfusion- related acute lung injury, with the majority being linked to whole blood, packed red blood cells, platelets, and fresh-frozen plasma. The pathogenesis of transfusion-related acute lung injury may be explained by a "two-hit" hypothesis, involving priming of the inflammatory machinery and then activation of this primed mechanism. Treatment is supportive, with prognosis being substantially better than for most other causes of acute lung injury.
Patients with End-Stage Renal Disease (ESRD) are at high risk of death as a result of the cardiovascular disease (CVD), which cannot be explained by the conventional risk factors only. Haemodialysis patients frequently have elevated serum concentrations of the cardiac troponins T, speciﬁ c markers of myocardial injury. Plasma levels of brain natriuretic peptide (BNP) are elevated in ﬂ uid volume overload and heart failure, and decreased during dialysis. Currently, LV hypertrophy and LV dysfunction are considered the strongest predictors of cardiovascular mortality in dialysis population, and the synthesis of cardiac natri- uretic peptides is high in the presence of alterations in the left ventricular (LV) mass and function. Th e aim of this study was to investigate the factors associated with the increased serum levels of BNP and CTN in haemodialysis patients, and their impact on cardiovascular morbidity.
significant association with PH. It is of note that there is a correlation statistically significant between ECF/TBW and left atrium diameter (r = 0.33; p < 0.01) (data not shown). Thus, we hypothesize that volume overload can be important in the physiopathogenesis of PH observed in hemodialysis patients. Corroborating this idea, there are studies that demonstrate higher cardiac output and lower hemoglobin level in PH hemodialysis patients [17- 19]. In addition, a recent study by Agarwal  showed that left atrial diameter is strongly associated with PH in hemodialysis patients, fact that might reflect chronic volume overload. It is noteworthy that our results also suggest that if right cardiac catheterization had been car- ried out it possibly would reveal a post-capillary PH which is known as an important risk factor for poor out- come of patients with left heart disease .
The major effect of information overload syndrome includes the loss of productive time which may have been used on some other work if the mind of the student is not deviated. Information overload syndrome also reduces mental capacity of the university students. Information overload syndrome significantly affects the quality of thinking time because of deviated mind. The thinking about the productive things is deviated and the thinking time increases. Information overload syndrome not only deviates the mind but also affects the communication process. Information overload syndrome adversely affects the work planning. University students require more time to plan their work because of deviated minds. All these things collectively affects the quality of life because the available time is spent more on non-productive activities and the university students get less time for sleeping or other healthy activities . Especially the university students that are doing their research work, it is interesting to note that when making complex assignments, university students may feel the need to have more information, and therefore, search massive amount of data from the information which further confuses them . This consequently acts, as having too much information is the same as not having enough required information to perform the specific task. Information overload syndrome also interferes learning and creative problem solving and prolongs the thinking process and problem solving. This affect usually cause a decline in the ability of university students to solve new problems creatively.
Our study makes two theoretical contributions. The first contribution is to the literature on email overload. This literature has primarily considered antecedents of email overload such as the content and frequency of email and organizational norms regarding email use (Brown et al 2004, Dabbish and Kraut 2006). We introduce two new antecedents of email overload – TTF and PPTF. TTF directs attention to the fact that a high-perceived fit of email applications with the individual’s communication tasks will likely be associated with low email overload. The concept of PPTF considers that individuals’ mutual preferences with regard to the use of communication applications can also reduce email overload. These concepts of ‘fit’ are theoretically novel because they highlight the importance of a ‘match’ between the individual’s task characteristics and email, and between colleagues’ mutual preferences for using email. These ideas have not been considered in the literature. Our second contribution is to the literature on IS related fit. This literature has so far considered only the fit between task and technology. We theoretically advance this literature by introducing the new concept of PPTF. This is a socially oriented fit that signifies technology related fit between individuals rather than between the individual and the technology. Future research can extend our study by examining the antecedents and other outcomes of these two constructs. For managers, email overload has been a consistent and festering problem that has eluded effective ways of countering. While we do not suggest that the concepts of TTF and PPTF are the only solutions, we do point managerial attention to these ideas, which do not find evidence in current organizational policies for email use. In considering the findings of our research, organizations struggling with email overload may benefit from implementing policies that develop, measure and manage TTF and PPTF in the workplace.
of choice overload in this vein. In his model, a firm knows that consumers have het- erogeneous preferences and in equilibrium always provides the most popular varieties of a product. Then the average popularity of the available varieties decreases as the number of varieties increases. As a result, uninformed consumers who do not know their own preferences and so have to randomly choose are less likely to purchase. In a similar spirit, Kuksov and Villas-Boas (2010) offer a search model that features choice overload. They consider a Hotelling setup where there are n products located at 2i 2n − 1 , i = 1, · · · , n, respectively (which minimizes the expected consumer travelling distance when information is perfect). Consumers initially do not know which product is in which location, but can learn via a sequential search process. In such a setup, having more products implies more uncertainty of product match. When search is relatively costly, this can induce more consumers to leave the market without purchasing. 7
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transfused were administered to approximately 1.2 million patients. Based on the incidence of fluid overload established in our study (3.2% of patients administered FFP), around 38,400 of these 1.2 million patients could be predicted to experience some form of fluid overload. As we found that fluid overload increased overall hospital costs by $14,062 per visit, our findings conservatively suggest the annual economic burden associated with fluid overload in the US to be around $540 million US. However, FP24 also accounts for 39% (~1.8 million units) of transfused plasma in the US, so the economic burden of fluid overload may be closer to $1 billion US, assuming that FP24 transfusion carries similar Table 2 hospital characteristics
In , the authors have proposed a novel dynamic VM allocation and VM selection policies for reducing energy consumption and SLAV in cloud data centers. The mean and standard deviation of CPU utilization for VM were used to decide which hosts were considered overloaded. In addition, the positive maximum correlation coefficient was used to select VMs from overloaded hosts for migration. The study indicates that the proposed overload detection and selection policies outperform the implemented polices in CloudSim in terms of reduction in SLAV. However, the previous policies in  perform slightly better than the proposed policies in terms of energy consumption.
Furthermore, a lack of response formalities and rules may result in unrealistic expectations regarding response among colleagues, causing ambiguity through unclear communication (Ramsay, Renaud and Hair, 2006). On the other hand, many procedures may increase the time needed to cope with one e- mail, enhancing feelings of overload. Moreover, a lack of user training is proposed in literature. Due to a lack of knowledge on e-mail as a communication system, employees find themselves not to operate on full efficiency (Alberts, 2014). User training could satisfy the need of employees in learning more about technologies, improving satisfaction and work performance (Alberts, 2014). Where there appears to be a lack of training at all, there is also a lack as in what is dealt with in user training (Burgess et al., 2005). Improvement of efficiency and work performance can also be achieved through the use of appropriate filing strategies. Through the use of inappropriate filing strategies, tracing back e-mails is a difficult task. The incapacity to file e-mails on a logical structure results in inefficiency, taking a lot of time to retrieve information. Directly linked to this is the decision whether to use or not use separate folders. The more time is spent on inefficient matters, the less time available to cope with the stream of incoming e- mails, resulting in a feeling of overload. In fact, research conducted by Whittaker and Sidner (1996) and Fisher, Brush, Gleave and Smith (2006) found that the archive has grown by a factor 10 in ten years. Other research supports this, finding that 53% of messages stay in the inbox as being archived (Grevet et al., 2014). Related to this finding, Whittaker and Sidner (1996) identified three distinct user strategies for processing e-mail based on two criteria: whether the participant uses folders to organize his/her e-mail and whether the participant cleans the inbox on a daily basis. When participants make use of folders and try to clean their inbox on a daily basis, they are considered frequent filers. Spring cleaners are participants who use folders and clean their inbox periodically. Lastly, participants that make no use of folders are categorized as no filers (Whittaker & Sidner, 1996). Although search engines support people in tracing back information, the poor use of subject lines and the combination of multiple topics in one e-mail make it a difficult task to file appropriately. These use of poorly formulated or empty subject lines significantly increase the difficulty of prioritizing and handling e-mail appropriately (Burgess et al., 2005). Additionally, the use of poor keywords makes it difficult to trace e-mails back (Xiang, 2009).
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