Deformations of Existing Buildings, Caused by Construction Activities

Construction of a new building (NB) affects existing adjacent old buildings (OB) during pit excavation, piling, footing and NB erection. Two relevant history cases are described. In the first one, the graphs of OB settlements versus distance from the pit are given for the period of pit excavation and the total settlements for the period of NB erection. The second case gives the family of OB settlement time-related graphs versus distance from the pit, in which these settlements were caused by piling operations

Status Of The RBAC Infrastructure And Lessons Learnt From Its Deployment in LHC

The distributed control system for the LHC accelerator poses many challenges due to its inherent heterogeneity and highly dynamic nature. One of the important aspects is to protect the machine against unauthorised access and unsafe operation of the control system, from the low-level front-end machines up to the high-level control applications running in the control room. In order to prevent an unauthorized access to the control system and accelerator equipment and to address the possible security issues, the Role Based Access Control (RBAC) project was designed and developed at CERN, with a major contribution from Fermilab laboratory. Furthermore, RBAC became an integral part of the CERN Controls Middleware (CMW) infrastructure and it was deployed and commissioned in the LHC operation in the summer 2008, well before the first beam in LHC. This paper presents the current status of the RBAC infrastructure, together with an outcome and gathered experience after a massive deployment in the LHC operations. Moreover, we outline how the project evolved over the last three years and give an overview of the major extensions introduced to improve integration, stability and its functionality. The paper also describes the plans of future project evolution and possible extensions, based on gathered users requirements and operational experience

Effects of variable Impella CP® flows on analogue mean systemic filling pressure.

Introduction and rational:Mean systemic filling pressure (Pms) represents the equalization pressure within systemic circulation following cardiac arrest. It is a pressure exerted by the stressed volume of blood on cardiovascular walls, therefore reflecting volume status of the patient and global cardiovascular compliance. There is currently no ideal technique to estimate Pms for patients with preserved systemic blood flow. Analogue mean systemic filling pressure (Pmsa) has been used in research and in limited clinical intensive care settings as a surrogate for Pms and as an alternative estimate of intravascular volume status in humans with beating hearts. It has been used to guide fluid therapy and administration of vasopressors aiming to alter the stressed volume of blood. It is calculated using the equation: Pmsa = (0.96 x CVP) + (0.04 x MAP) + (c x CO)where c is an anthropometric constant. We previously reported c=2.65 ± 1.08 in an ovine model.Impella CP® left ventricular assist device is used for patients with severe left ventricular systolic failure as a temporary mechanical circulatory support. The impact of variable Impella® flows on Pmsa has not been investigated. We hypothesized that Pmsa is unaffected by the variability in flows provided by the Impella®.Methods: We conducted a translational interventional study to investigate the impact of Impella CP® on changes in Pmsa. The study was approved by the University of Sydney (Australia) Animal Research Ethics Committee. Five female adult merino cross sheep underwent implantation of Impella CP® under general anaesthesia following mitral valve surgery as a part of an unrelated investigation. Invasive measurements of haemodynamic parameters were recorded to allow calculation of Pmsa at variable Impella® settings with flows gradually changed from no flow to the maximum achievable by the pump. Total cardiac output was monitored with a Transonic Flowmeter positioned around the main pulmonary artery.Results: A total of 96 sets of flows were analyzed against Pmsa. The mean Pmsa was 22.34 ± 2.27 mmHg at zero Impella® flows and 23.79 ± 1.77 mmHg at maximum. A weak but statistically significant correlation was found between Impella® flows and Pmsa (rho = 0.20, 95% CI 0.004 - 0.389, p=0.046) representing a 1.45 mmHg (6.5%) increase from the baseline Pmsa after reaching maximum flows with Impella CP®.Conclusions: The effect of variable flows of Impella CP® on Pmsa values is small and is unlikely to be clinically significant in terms of guiding fluid or vasomotor therapy. Further data analysis is required to ascertain the validity of the Pmsa equation in patients with Impella® therapy. Acknowledgements:The authors acknowledge the facilities and the scientific and technical assistance of Sydney Imaging, a Core Research Facility at the Charles Perkins Centre, University of Sydney

Implantation of Impella CP left ventricular assist device under the guidance of three-dimensional intracardiac echocardiography

Impella CP is a percutaneously inserted left ventricular assist device indicated for temporary mechanical cardiac support during high risk percutaneous coronary interventions and for cardiogenic shock. The potential application of Impella has become particularly relevant during the current COVID-19 pandemic, for patients with acute severe heart failure complicating viral illness. Standard implantation of the Impella CP is performed under fluoroscopic guidance. Positioning of the Impella CP can be confirmed with transthoracic or transoesophageal echocardiography. We describe an alternative approach to guide intracardiac implantation of the Impella CP using two-dimensional and three-dimensional intracardiac echocardiography. This new technique can be useful in selected groups of patients when fluoroscopy, transthoracic and transoesophageal echocardiography is deemed inapplicable or limited for epidemiological or clinical reasons. Intracardiac three-dimensional echocardiography is a feasible alternative to the traditional techniques for implantation of an Impella CP device but careful consideration must be given to the potential limitations and complications of this technique

Implantation of Impella CP® left ventricular assist device under the guidance of three-dimensional intracardiac echocardiography.

Impella CP is a percutaneously inserted left ventricular assist device indicated for temporary mechanical cardiac support during high risk percutaneous coronary interventions and for cardiogenic shock. The potential application of Impella has become particularly relevant during the current COVID-19 pandemic, for patients with acute severe heart failure complicating viral illness. Standard implantation of the Impella CP is performed under fluoroscopic guidance. Positioning of the Impella CP can be confirmed with transthoracic or transoesophageal echocardiography. We describe an alternative approach to guide intracardiac implantation of the Impella CP using two-dimensional and three-dimensional intracardiac echocardiography. This new technique can be useful in selected groups of patients when fluoroscopy, transthoracic and transoesophageal echocardiography is deemed inapplicable or limited for epidemiological or clinical reasons. Intracardiac three-dimensional echocardiography is a feasible alternative to the traditional techniques for implantation of an Impella CP device but careful consideration must be given to the potential limitations and complications of this technique

Color Doppler dynamics of diastolic left ventricular inflow following mitral valve surgery in ovine model: a pilot investigation.

Rationale: Mitral valve surgery changes diastolic mitral inflow profile and left ventricular inflow vortexes, that is likely to result in changes of myocardial energy expenditure. The precise nature of such changes is unknown. Optimization of surgical technique could contribute to the prevention of heart failure. Color Doppler is widely utilized qualitative echocardiographic technique used to assess intracardiac flows.Objectives: To investigate the feasibility of using Color Doppler echocardiography to assess dynamic changes of diastolic mitral inflow in ovine model following mitral surgery.Methods: This prospective observational study of 11 anaesthetised, ventilated sheep investigated dynamic changes in left ventricular inflow using Color Doppler epicardial echocardiography following open mechanical mitral valve replacement in seven and mitral annuloplasty surgery in four animals, performed under cardiopulmonary bypass without cardioplegia. Results: Color Doppler analysis suggested that the mitral valve replacement with reefed anterior mitral leaflet resulted in 13 degrees increased left ventricular inflow angle and in reduction of anteroseptal flow area by half, with the tendency of returning to the baseline with preservation of the anterior mitral leaflet. Full ring mitral annuloplasty resulted in 21 degrees left ventricular inflow angle increase and 2.5 times reduction in anteroseptal flow area, with the tendency of returning to the baseline with the release of anterior mitral ring. Conclusions: It is feasible to use Color Doppler epicardial echocardiography to assess crude dynamic changes in left ventricular inflow following mitral valve surgery in ovine model

Relationship between mean systemic filling pressure and cardiovascular compliance in post cardiotomy ovine model.

Rationale: Mean systemic filling pressure (MSFP) represent interaction between intravascular volume and global cardiovascular compliance (GCC). The relationship between dynamic changes in MSFP, GCC and left ventricular compliance in sheep is unknown. Objectives: To investigate changes in cardiovascular compliance induced by alterations in mean systemic filling pressure.Methods: Prospective study conducted immediately following euthasia of post cardiotomy adult sheep, investigating the relationships between changes in MSFP induced by rapid intravascular filling with fluids, global cardiovascular compliance and left ventricular compliance. Results: Mean stressed volume before euthanasia was 2050±210 ml and the estimated MSFP 21.6±4 mmHg. Each bolus of fluid resulted in mean MSFP increase of 2.45±0.75 mmHg (r= 0.99, p=0.01), LVV increase of 5.8±2.6 ml (r=0.99, p < 0.04). Mean GCVC was 114±14 ml/mmHg and mean LVC was 2±0.08 mmHg, giving a mean ratio of 55±6. Correlations between volume expansion and changed GCVC and LVC were r=0.98, p=0.04 and r=0.46, p=0.59 respectively.Conclusions: Clinically relevant increase in the intravascular stressed volume resulted in increases in MSFP, LVV and GCVC but no significant change in LVC