Short- and intermediate-term survival after extracorporeal membrane oxygenation in children with cardiac disease

ObjectivesIn children with cardiac disease, common indications for extracorporeal membrane oxygenation (ECMO) include refractory cardiopulmonary resuscitation (E-CPR), failure to separate from cardiopulmonary bypass (OR-ECMO), and low cardiac output syndrome (LCOS-ECMO). Despite established acceptance, ECMO outcomes are suboptimal with a survival between 38% and 55%. We evaluated factors associated with significantly increased survival in cardiac patients requiring ECMO.MethodsWe conducted a retrospective investigation of consecutive patients undergoing ECMO between 2006 and 2010. Demographic, pre-ECMO, ECMO, and post-ECMO parameters were analyzed. Neurologic outcomes were assessed with the pediatric overall performance category scale at the latest follow-up.ResultsThere were 3524 admissions, 95 (3%) of which necessitated ECMO; 40 (42%) E-CPR, 31 (33%) OR-ECMO, and 24 (25%) LCOS-ECMO. The overall hospital survival was 73%. The within-groups hospital survival was 75% in E-CPR, 77% OR-ECMO and 62% LCOS-ECMO. In the multivariable logistic regression analysis, chromosomal anomalies (odds ratio [OR], 8; 95% confidence interval [CI], 2-35), single ventricle (OR ,6; 95% CI, 3-33), multiple ECMO runs (OR, 15; 95% CI, 4-42), higher 24-hour ECMO flows (OR, 8; 95% CI, 4-22), decreased lung compliance (OR, 5; 95% CI, 2-16), and need for plasma exchange (OR, 5; 95% CI, 3-18) were all significant factors associated with mortality. From the univariate analysis, a common parameter associated with mortality within all groups was intracranial hemorrhage. At 1.9 years (0.9, 2.9) of follow-up, 66% were still alive, and 89% of survivors had normal function or only mild neurodevelopmental disability.ConclusionsECMO was successfully used in children with cardiac disease with 73% and 66% short- and intermediate-term survival, respectively. The majority of the survivors had normal function or only a minimal neurodevelopmental deficit

Giant aneurysm of the atrial septum associated with premature closure of foramen ovale

Premature closure or restriction of foramen ovale (PCFO) is a rare congenital anomaly that can lead to a wide spectrum of cardiac malformations. This spectrum of secondary malformations appears to depend on the gestational timing of closure of the foramen ovale and to the degree of restriction. Earlier in the gestation, closure of the foramen has been associated with severe hypoplasia of the left ventricle whereas later closure has been associated with right heart failure and rarely with the formation of an aneurysm of the atrial septum. We describe the case of a 1 day old infant in whom PCFO resulted in severe right heart failure in addition to the formation of a giant atrial septal aneurysm

Infancia y aprendizaje

Título, resumen y palabras clave también en inglésResumen basado en el de la publicaciónSe analiza la estructura y el desarrollo del pensamiento algebraico en sus diversas dimensiones. Para ello, 803 estudiantes de entre 10 y 13 años completan una prueba de pensamiento algebraico. De ellos, 101 estudiantes con distintos resultados en la prueba participan en entrevistas semiestructuradas para estudiar en mayor detalle las estrategias que utilizaban y las dificultades a las que se enfrentan. Los resultados confirman la naturaleza polifacética del pensamiento algebraico y revelan que este consta de tres aspectos: razonamiento sobre la covariación, generalización de propiedades aritméticas y capacidades relacionadas directamente con la sintaxis algebraica. Cada uno de estos aspectos se compone de capacidades específicas de pensamiento algebraico como, por ejemplo, formular relaciones utilizando símbolos algebraicos. Se identifican cuatro grupos de estudiantes con distintos perfiles de pensamiento algebraico: ‘pensamiento pre-algebraico’, ‘pensamiento protoalgebraico-procedimental’, ‘pensamiento algebraico simbólico-relacional’ y ‘pensamiento algebraico global-estructural’.Biblioteca del Ministerio de Educación y Formación Profesional; Calle San Agustín, 5 - 3 planta; 28014 Madrid; Tel. +34917748000; [email protected]

Applying adaptive QoS-aware medium access control in priority-based vehicular ad hoc networks

his paper proposes a novel, adaptive medium access control mechanism for vehicular ad hoc networks. A simple, effective, and efficient nonlinear control law is built, based on fuzzy logic control principles, which can be easily adopted in different network environments (e.g. vehicle-to-vehicle (V2V) communication and vehicle-to-infrastructure (V2I) communication). We demonstrate, via simulative evaluation, that the proposed fuzzy control methodology offers inherent robustness with effective control of the system under dense and dynamic conditions, without the need to (re)tune any parameters. The proposed approach offers distinct differentiation among differently prioritized traffic types, thus providing adequate Quality of Service (QoS) in terms of throughput performance, in contrast with the IEEE 802.11p MAC protocol we compared against

Applying delay tolerant networking routing algorithms in maritime communications

The availability of off-the-shelf equipment that facilitates long range wireless connectivity can prove to be useful in maritime communications. By establishing terrestrial wireless links, vessels may exchange data between them or with shore-based stations avoiding the use of costly satellite connectivity. On the other hand, vessel mobility and large distances between its nodes make a wireless maritime network hard to manage; frequent disconnections are expected to be the norm in this primarily low node density environment. As such, maritime communications appear as an ideal environment for delay tolerant networking. To this extent, we use actual vessel mobility data to evaluate some existing delay tolerant networking routing algorithms and identify where they fall short from the perspective of our particular domain. It appears that a hybrid approach in the form of a new routing algorithm that addresses the particular characteristics of a maritime network can prove beneficial

Applying delay tolerant networking routing algorithms in maritime communications

The availability of off-the-shelf equipment that facilitates long range wireless connectivity can prove to be useful in maritime communications. By establishing terrestrial wireless links, vessels may exchange data between them or with shore-based stations avoiding the use of costly satellite connectivity. On the other hand, vessel mobility and large distances between its nodes make a wireless maritime network hard to manage; frequent disconnections are expected to be the norm in this primarily low node density environment. As such, maritime communications appear as an ideal environment for delay tolerant networking. To this extent, we use actual vessel mobility data to evaluate some existing delay tolerant networking routing algorithms and identify where they fall short from the perspective of our particular domain. It appears that a hybrid approach in the form of a new routing algorithm that addresses the particular characteristics of a maritime network can prove beneficial

Dynamically adjusting the min-max contention window for providing quality of service in vehicular networks

This paper proposes a novel, intelligent medium access control mechanism for vehicular ad hoc networks. In particular, the minimum and maximum contention window parameters are dynamically tuned based on network observations, concerning all applications' access categories. The simple, generic, and efficient nonlinear control law built, is based on fuzzy logic control and although we focus on vehicle-to-infrastructure (V2I) communication, the proposed scheme can be easily adapted for vehicle-to-vehicle (V2V) communication. We demonstrate, via simulative evaluation of dense and dynamic conditions, that the proposed scheme offers enhanced differentiation among different applications' access categories; therefore, offering sufficient Quality of Service (QoS) in terms of throughput performance, in contrast with the IEEE 802.11p standard MAC protocol we compared against

A delay tolerant platform for voice message delivery

A voice conversation is predominantly known as a synchronous, delay intolerant form of communication. To complement voice conversations, voice messaging is a form of asynchronous communication used when the called party is unavailable; a delay in message delivery is naturally expected and tolerated. To this extent, a Delay Tolerant Network can be utilized as the underlying data transport mechanism for the delivery of voice messages and in this paper we describe an architecture that combines this technology with the functionality of Voice-over-IP based systems. Our target application concerns the delivery of voice messages that originate from IP-based systems and are destined either for users of other IP-based systems or the Public Switched Telephone Networ

Contention window adaptation for broadcast beaconing in vehicular ad hoc networks

IWCMC 2014 - 10th International Wireless Communications and Mobile Computing Conference, 22 September 2014, Article number 6906498, Pages 1039-1044Vehicular networking major concern is to effectively support intelligent transportation system applications. For that, robust, adaptive techniques for efficient communication and control between vehicles need to be developed. In this paper, the key issue under investigation is the efficient, intelligent provision of medium access control in vehicular ad hoc networks in the case of broadcast beaconing. A well established option is proposed, for controlling nonlinear systems using linguistic information, by utilizing fuzzy logic control. In particular, an intelligent adaptive controller, based on the traffic density, is built to regulate dynamically the contention window during message broadcasting. Simulation results, on dense and dynamic scenarios, reveal the inbuilt robustness and proficient control of the system provided by the proposed controller. This is in contrast with the conventional, IEEE 802.11p standard, solution we compared against, in terms of channel utilization, latency, collisions, beacon reception rate, and beacon inter-arrival time

The need for a system design methodology to address challenges in wireless access in vehicular ad hoc networks

Vehicular networking is nowadays considered as one of the most important enabling technologies as it allows vehicles to communicate with each other (vehicle-to-vehicle (V2V) communication) and/or with roadside infrastructure (vehicle-to-infrastructure (V2I) communication). Vehicular ad hoc networks (VANETs) are ideal candidates for supporting various types of traffic applications, such as traffic safety, traffic efficiency and management applications, and infotainment type of applications. As a result, there is ongoing research concerning the efficient medium access control and multichannel coordination, separately. In this paper, we review a number of schemes proposed and stimulate the discussion on the need for a generic system design methodology to address efficiently the challenges in the wireless access in vehicular ad hoc networks. Specifically, the aim shall be to design an efficient and robust system architecture that deals with the wireless medium access and multichannel coordination in all possible environments (V2V and V2I in urban, suburban, and highway) and allows differently prioritized types of traffic applications to coexist