ECMELLA as a bridge to heart transplantation in refractory ventricular fibrillation: A case report.

Extracorporeal membrane oxygenation (ECMO) is an effective cardiorespiratory support technique in refractory cardiac arrest (CA). In patients under veno-arterial ECMO, the use of an Impella device, a microaxial pump inserted percutaneously, is a valuable strategy through a left ventricular unloading approach. ECMELLA, a combination of ECMO with Impella, seems to be a promising method to support end-organ perfusion while unloading the left ventricle. The present case report describes the clinical course of a patient with ischemic and dilated cardiomyopathy who presented with refractory ventricular fibrillation (VF) leading to CA in the late postmyocardial infarction (MI) period, and who was successfully treated with ECMO and IMPELLA as a bridge to heart transplantation. In the case of CA on VF refractory to conventional resuscitation maneuvers, early extracorporeal cardiopulmonary resuscitation (ECPR) associated with an Impella seems to be the best strategy. It provides organ perfusion, left ventricular unloading, and ability for neurological evaluation and VF catheter ablation before allowing heart transplantation. It is the treatment of choice in cases of end-stage ischaemic cardiomyopathy and recurrent malignant arrhythmias

The ALADIN system and its canonical model configurations AROME CY41T1 and ALARO CY40T1

The ALADIN System is a numerical weather prediction (NWP) system developed by the international ALADIN consortium for operational weather forecasting and research purposes. It is based on a code that is shared with the global model IFS of the ECMWF and the ARPEGE model of Meteo-France. Today, this system can be used to provide a multitude of high-resolution limited-area model (LAM) configurations. A few configurations are thoroughly validated and prepared to be used for the operational weather forecasting in the 16 partner institutes of this consortium. These configurations are called the ALADIN canonical model configurations (CMCs). There are currently three CMCs: the ALADIN baseline CMC, the AROME CMC and the ALARO CMC. Other configurations are possible for research, such as process studies and climate simulations. The purpose of this paper is (i) to define the ALADIN System in relation to the global counterparts IFS and ARPEGE, (ii) to explain the notion of the CMCs, (iii) to document their most recent versions, and (iv) to illustrate the process of the validation and the porting of these configurations to the operational forecast suites of the partner institutes of the ALADIN consortium. This paper is restricted to the forecast model only; data assimilation techniques and postprocessing techniques are part of the ALADIN System but they are not discussed here

Intrapericardial paraganglioma: The role of integrated advanced multi-modality cardiac imaging for the assessment and management of rare primary cardiac tumors

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A tool for predicting the thermal performance of a diesel engine

This paper presents a thermal network model for the simulation of the transient response of diesel engines. The model was adjusted by using experimental data from a completely instrumented engine run under steady-state and transient conditions. Comparisons between measured and predicted material temperatures over a wide range of engine running conditions show a mean error of 7◦C. The model was then used to predict the thermal behavior of a different engine. Model results were checked against oil and coolant temperatures measured during engine warm-up at constant speed and load, and on a New European Driving Cycle. Results show that the model predicts these temperatures with a maximum error of 3◦C.Torregrosa, AJ.; Olmeda González, PC.; Martín Díaz, J.; Romero Piedrahita, CA. (2011). A tool for predicting the thermal performance of a diesel engine. Heat Transfer Engineering. 32(10):891-904. doi:10.1080/01457632.2011.548639S891904321

Heterogeneous Agent Models: Two Simple Case Studies

These notes review two simple heterogeneous agent models in economics and finance. The first is a cobweb model with rational versus naive agents introduced in Brock and Hommes (1997). The second is an asset pricing model with fundamentalists versus technical traders introduced in Brock and Hommes (1998). Agents are boundedly rational and switch between different trading strategies, based upon an evolutionary fitness measure given by realized past profits. Evolutionary switching creates a nonlinearity in the dynamics. Rational routes to randomness, that is, bifurcation routes to complicated dynamical behaviour occur when agents become more sensitive to differences in evolutionary fitness

Distal Versus Conventional Radial Access for Coronary Angiography and Intervention: The DISCO RADIAL Trial.

BACKGROUND: Currently, transradial access (TRA) is the recommended access for coronary procedures because of increased safety, with radial artery occlusion (RAO) being its most frequent complication, which will increasingly affect patients undergoing multiple procedures during their lifetimes. Recently, distal radial access (DRA) has emerged as a promising alternative access to minimize RAO risk. A large-scale, international, randomized trial comparing RAO with TRA and DRA is lacking. OBJECTIVES: The aim of this study was to assess the superiority of DRA compared with conventional TRA with respect to forearm RAO. METHODS: DISCO RADIAL (Distal vs Conventional Radial Access) was an international, multicenter, randomized controlled trial in which patients with indications for percutaneous coronary procedure using a 6-F Slender sheath were randomized to DRA or TRA with systematic implementation of best practices to reduce RAO. The primary endpoint was the incidence of forearm RAO assessed by vascular ultrasound at discharge. Secondary endpoints include crossover, hemostasis time, and access site-related complications. RESULTS: Overall, 657 patients underwent TRA, and 650 patients underwent DRA. Forearm RAO did not differ between groups (0.91% vs 0.31%; P = 0.29). Patent hemostasis was achieved in 94.4% of TRA patients. Crossover rates were higher with DRA (3.5% vs 7.4%; P = 0.002), and median hemostasis time was shorter (180 vs 153 minutes; P < 0.001). Radial artery spasm occurred more with DRA (2.7% vs 5.4%; P = 0.015). Overall bleeding events and vascular complications did not differ between groups. CONCLUSIONS: With the implementation of a rigorous hemostasis protocol, DRA and TRA have equally low RAO rates. DRA is associated with a higher crossover rate but a shorter hemostasis time

Complex Evolutionary Systems in Behavioral Finance

Traditional finance is built on the rationality paradigm. This chapter discusses simple models from an alternative approach in which financial markets are viewed as complex evolutionary systems. Agents are boundedly rational and base their investment decisions upon market forecasting heuristics. Prices and beliefs about future prices co-evolve over time with mutual feedback. Strategy choice is driven by evolutionary selection, so that agents tend to adopt strategies that were successful in the past. Calibration of simple complexity models with heterogeneous expectations to real financial market data and laboratory experiments with human subjects are also discussed