A decade of progress in critical care echocardiography: a narrative review.

INTRODUCTION: This narrative review focusing on critical care echocardiography (CCE) has been written by a group of experts in the field, with the aim of outlining the state of the art in CCE in the 10 years after its official recognition and definition. RESULTS: In the last 10 years, CCE has become an essential branch of critical care ultrasonography and has gained general acceptance. Its use, both as a diagnostic tool and for hemodynamic monitoring, has increased markedly, influencing contemporary cardiorespiratory management. Recent studies suggest that the use of CCE may have a positive impact on outcomes. CCE may be used in critically ill patients in many different clinical situations, both in their early evaluation of in the emergency department and during intensive care unit (ICU) admission and stay. CCE has also proven its utility in perioperative settings, as well as in the management of mechanical circulatory support. CCE may be performed with very simple diagnostic objectives. This application, referred to as basic CCE, does not require a high level of training. Advanced CCE, on the other hand, uses ultrasonography for full evaluation of cardiac function and hemodynamics, and requires extensive training, with formal certification now available. Indeed, recent years have seen the creation of worldwide certification in advanced CCE. While transthoracic CCE remains the most commonly used method, the transesophageal route has gained importance, particularly for intubated and ventilated patients. CONCLUSION: CCE is now widely accepted by the critical care community as a valuable tool in the ICU and emergency department, and in perioperative settings

A time driven readout scheme for PET and CT using APDs and SiPMs

In this paper we present the time-driven readout scheme for photodetectors in the domain of PET/CT applications. In our first test period as partner of the BioCare Consortium supported by the European Commission's FP6 framework program, we put emphasis on a scheme to be used with a LSO-APD detector suitable for both CT and PET, using exclusively electronics circuits developed for the LHC program at CERN. Compared to standard PMT-based systems, the proposed time-based readout method together with CERN ASICs produced comparable performance in terms of energy resolution, i.e. 15% FWHM, but had a markedly inferior timing response of 1.6 ns FWHM in a dual APD system. This is not attributed to the readout scheme itself but to crystal-inherent photon statistics and insufficient photodetector gain of the APDs. However, in our new follow-up test program employing the same electronics and readout scheme, silicon photomultipliers (SiPMs) replacing the previously used APDs showed excellent timing behavior of 420 and 235 ps FWHM for 1 and 3 photoelectrons, respectively. Timing resolution with 511 keV gammas on LSO reached 400 ps FWHM without time walk corrections

The Law and Economics of Organ Procurement

This paper presents an economic analysis of the organ procurement system in the U.S. and examines proposals to alleviate the shortage of transplantable organs. The paper\u27s principal conclusions are: (1) Although non-market solutions deserve the highest priority, demand increases fueled by improvements in transplant technology will probably make some market-based solution necessary in the future. (2) Quality deterioration and coercion will not necessarily be worrisome problems under a market-based procurement system