In Vitro Evaluation of Ventricular Cannulation for Rotodynamic Cardiac Assist Devices

The influence of positioning and geometry of ventricular cannulas for contemporary continuous flow Left Ventricular Assist Devices (LVADs) was evaluated in a non-beating isolated heart preparation with borescopic visualization. Preload and LVAD flow were varied to evaluate degrees of ventricular decompression up to the point of ventricular collapse. The performance of a flanged cannula was compared to a conventional bevel-tipped cannula: quantitatively by the maximal flow attainable, and qualitatively by visualization of fluid tracer particles within the ventricular chamber. Three forms of ventricular suck-down occurred: concentric collapse, gradual entrainment and instantaneous entrainment. In some circumstances, unstable oscillations of the ventricle were observed prior to complete collapse. Under conditions of low preload, the flanged cannula demonstrated less positional sensitivity, provided greater flow, and exhibited fewer areas of stagnation than the beveled cannula. These observations warrant further consideration of a flanged ventricular cannula to mitigate complications encountered with conventional cannulae.

Dual-loop circuits in postoperative atrial macro re-entrant tachycardias

Background Patients late after open-heart surgery may develop dual-loop reentrant atrial arrhythmias, and mapping and catheter ablation remain challenging despite computer-assisted mapping techniques. Objectives The purpose of the study was to demonstrate the prevalence and characteristics of dual-loop reentrant arrhythmias, and to define the optimal mapping and ablation strategy. Methods Fourty consecutive patients (mean age 52+/-12 years) with intra-atrial reentrant tachycardia (IART) after open-heart surgery (with an incision of the right atrial free wall) were studied. Dual-loop IART was defined as the presence of two simultaneous atrial circuits. Following an abrupt tachycardia change during radiofrequency (RF) ablation, electrical disconnection of the targeted reentry isthmus from the remaining circuit was demonstrated by entrainment mapping. Furthermore, the second circuit loop was localized using electroanatomic mapping and/or entrainment mapping. Results Dual-loop IART was demonstrated in 8 patients (20%, 5 patients with congenital heart disease, 3 with acquired heart disease). Dual-loop IART included an isthmus-dependant atrial flutter combined with a reentry related to the atriotomy scar. The diagnosis of dual-loop IART required the comparison of entrainment mapping before and after tachycardiamodification. Overall, 35 patients had successful RF ablation (88%). Success rates were lower in patients with dual-loop IART than in patient without dual-loop IART. Ablation failures in 3 patients with dual-loop IART were related to the inability to properly transect the second tachycardia isthmus in the right atrial free wall. Conclusions Dual-loop IART is relatively common after heart surgery involving a right atriotomy. Abrupt tachycardia change and specific entrainment mapping maneuvers demonstrate these circuits. Electroanatomic mapping appears to be important to assist catheter ablation of periatriotomy circuits.

Cladophora, mass transport, and the nearshore phosphorus shunt

Excessive Cladophora growth in the Great Lakes has led to beach fouling and the temporary closure of nuclear power plants and has been associated with avian botulism and the persistence of human pathogens. As the growth-limiting nutrient for Cladophora, phosphorus is the appropriate target for management efforts. Dreissenids (zebra and quagga mussels) have the ability to capture particulate phase phosphorus (otherwise unavailable to Cladophora) and release it in a soluble, available form. The significance of this potential nutrient source is, in part, influenced by the interplay between phosphorus flux from the mussel bed and turbulent mixing in establishing the phosphorus levels to which Cladophora is exposed. It is hypothesized that under quiescent conditions phosphorus will accumulate near the sediment-water interface, setting up vertical phosphorus gradients and favorable conditions for resource delivery to Cladophora. These gradients would be eliminated under conditions of wind mixing, reducing the significance of the dreissenid-mediated nutrient contribution. Soluble reactive phosphorus (SRP) levels were monitored over dreissenid beds (densities on the order of 350•m-2 and 3000∙m-2) at a site 8 m deep in Lake Michigan. Monitoring was based on the deployment of Modified Hesslein Samplers which collected samples for SRP analysis over a distance of 34 cm above the bottom in 2.5 cm intervals. Deployment intervals were established to capture a wind regime (calm, windy) that persisted for an interval consistent with the sampler equilibration time of 7 hours. Results indicate that increased mussel density leads to an increased concentration boundary layer; increased wind speed leads to entrainment of the concentration boundary layer; and increased duration of quiescent periods leads to an increased concentration boundary layer. This concentration boundary layer is of ecological significance and forms in the region inhabited by Cladophora

Physical modeling of air injection as a scour remediation technique near gated weir stilling basins

The South Florida Water Management District (SFWMD) manages and operates numerous water control structures that are subject to scour. In an effort to reduce scour downstream of these gated structures, laboratory experiments were performed to investigate the effect of active air-injection downstream of the terminal structure of a gated spillway on the depth of the scour hole. A literature review involving similar research revealed significant variables such as the ratio of headwater-to-tailwater depths, the diffuser angle, sediment uniformity, and the ratio of air-to-water volumetric discharge values. The experimental design was based on the analysis of several of these non-dimensional parameters. Bed scouring at stilling basins downstream of gated spillways has been identified as posing a serious risk to the spillway’s structural stability. Although this type of scour has been studied in the past, it continues to represent a real threat to water control structures and requires additional attention. A hydraulic scour channel comprised of a head tank, flow straightening section, gated spillway, stilling basin, scour section, sediment trap, and tail-tank was used to further this analysis. Experiments were performed in a laboratory channel consisting of a 1:30 scale model of the SFWMD S65E spillway structure. To ascertain the feasibility of air injection for scour reduction a proof-of-concept study was performed. Experiments were conducted without air entrainment and with high, medium, and low air entrainment rates for high and low headwater conditions. For the cases with no air entrainment it was found that there was excessive scour downstream of the structure due to a downward roller formed upon exiting the downstream sill of the stilling basin. When air was introduced vertically just downstream of, and at the same level as, the stilling basin sill, it was found that air entrainment does reduce scour depth by up to 58% depending on the air flow rate, but shifts the deepest scour location to the sides of the channel bed instead of the center. Various hydraulic flow conditions were tested without air injection to verify which scenario caused more scour. That scenario, uncontrolled free, in which water does not contact the gate and the water elevation in the stilling basin is lower than the spillway crest, would be used for the remainder of experiments testing air injection. Various air flow rates, diffuser elevations, air hole diameters, air hole spacings, diffuser angles and widths were tested in over 120 experiments. Optimal parameters include air injection at a rate that results in a water-to-air ratio of 0.28, air holes 1.016mm in diameter the entire width of the stilling basin, and a vertically orientated injection pattern. Detailed flow measurements were collected for one case using air injection and one without. An identical flow scenario was used for each experiment, namely that of a high flow rate and upstream headwater depth and a low tailwater depth. Equilibrium bed scour and velocity measurements were taken using an Acoustic Doppler Velocimeter at nearly 3000 points. Velocity data was used to construct a vector plot in order to identify which flow components contribute to the scour hole. Additionally, turbulence parameters were calculated in an effort to help understand why air-injection reduced bed scour. Turbulence intensities, normalized mean flow, normalized kinetic energy, and anisotropy of turbulence plots were constructed. A clear trend emerged that showed air-injection reduces turbulence near the bed and therefore reduces scour potential.

The Southern Hemisphere at glacial terminations: insights from the Dome C ice core

The many different proxy records from the European Project for Ice Coring in Antarctica (EPICA) Dome C ice core allow for the first time a comparison of nine glacial terminations in great detail. Despite the fact that all terminations cover the transition from a glacial maximum into an interglacial, there are large differences between single terminations. For some terminations, Antarctic temperature increased only moderately, while for others, the amplitude of change at the termination was much larger. For the different terminations, the rate of change in temperature is more similar than the magnitude or duration of change. These temperature changes were accompanied by vast changes in dust and sea salt deposition all over Antarctica. Here we investigate the phasing between a South American dust proxy (non-sea-salt calcium flux, nssCa2+), a sea ice proxy (sea salt sodium flux, ssNa+) and a proxy for Antarctic temperature (deuterium, δD). In particular, we look into whether a similar sequence of events applies to all terminations, despite their different characteristics. All proxies are derived from the EPICA Dome C ice core, resulting in a relative dating uncertainty between the proxies of less than 20 years. At the start of the terminations, the temperature (δD) increase and dust (nssCa2+ flux) decrease start synchronously. The sea ice proxy (ssNa+ flux), however, only changes once the temperature has reached a particular threshold, approximately 5°C below present day temperatures (corresponding to a δD value of −420‰). This reflects to a large extent the limited sensitivity of the sea ice proxy during very cold periods with large sea ice extent. At terminations where this threshold is not reached (TVI, TVIII), ssNa+ flux shows no changes. Above this threshold, the sea ice proxy is closely coupled to the Antarctic temperature, and interglacial levels are reached at the same time for both ssNa+ and δD. On the other hand, once another threshold at approximately 2°C below present day temperature is passed (corresponding to a δD value of −402‰), nssCa2+ flux has reached interglacial levels and does not change any more, despite further warming. This threshold behaviour most likely results from a combination of changes to the threshold friction velocity for dust entrainment and to the distribution of surface wind speeds in the dust source region.

Irrigated-tip catheter ablation of intraatrial reentrant tachycardia in patients late after surgery of congenital heart disease.

OBJECTIVES The aim of this study was to evaluate irrigated-tip catheter for ablation of intraatrial reentrant tachycardias late after surgical repair of congenital heart disease. BACKGROUND In congenital heart disease patients, the right atrium can be markedly enlarged with areas of low blood flow. Radiofrequency (RF) lesion creation may be hampered by insufficient electrode cooling at sites with low blood flow. METHODS Thirty-six consecutive patients with intraatrial reentrant tachycardia refractory to antiarrhythmic therapy from two centers were included in the study. Entrainment pacing and electroanatomic mapping (CARTO) were used to delineate reentrant circuits and critical isthmus sites. RF ablation was performed using an irrigated-tip catheter (Navistar Thermocool). RESULTS Fifty-two intraatrial reentrant tachycardia circuits were identified, and 48 were targeted with RF ablation. RF ablation was performed using a mean of 13 +/- 11 irrigated RF applications per tachycardia isthmus with a mean power of 36 +/- 8 W. In a historical control group of congenital heart disease patients managed with conventional catheter ablation, the number of lesions per isthmus was higher (23 +/- 11) and mean power was lower (27 +/- 14 W). Acute success was achieved in 45 intraatrial reentrant tachycardias (94% of targeted tachycardias and 87% of all tachycardias). After a mean follow-up of 17 +/- 7 months, 33 (92%) of 36 patients were free of recurrence. Five patients (14%) developed paroxysmal atrial fibrillation. CONCLUSIONS The combination of modern techniques including electroanatomic mapping and catheter irrigation allows safe and highly effective ablation of intraatrial reentrant tachycardia in patients with surgically repaired congenital heart disease.

Electroanatomic mapping of the endocardium. Implication for catheter ablation of ventricular tachycardia.

The electroanatomic mapping system Carto((R)) with its combination of anatomic and electrophysiologic information has substantially improved our understanding of arrhythmia mechanisms and substrates in patients with ventricular tachycardia (VT) and structural heart disease. Identification of the individual arrhythmogenic substrate and successful ablation guided by the combination of sinus rhythm voltage mapping and conventional electrophysiologic techniques like pace and activation/entrainment mapping are best described for patients with recurrent VT in remote myocardial infarction. In about 75-90% of the patients, the target VT can be ablated with acute success and the patients remain free of any VT recurrence in up to 75%. First results of electroanatomically guided ablation in patients with arrhythmogenic right ventricular dysplasia are promising. Data on ablation of VT in other structural heart diseases are very limited, since the arrhythmogenic substrate is very diffuse, e. g., in dilated cardiomyopathy, or there are only small patient numbers, e. g., for cardiac sarcoidosis or monomorphic VT after repair of congenital heart disease. In this article, the current status of electroanatomically guided endocardial mapping and ablation of VT in patients with structural heart disease is described.

Lateral sediment sources and knickzones as controls on spatio-temporal variations of sediment transport in an Alpine river

Modern mixed alluvial-bedrock channels in mountainous areas provide natural laboratories for understanding the time scales at which coarse-grained material has been entrained and transported from their sources to the adjacent sedimentary sink, where these deposits are preserved as conglomerates. This article assesses the shear stress conditions needed for the entrainment of the coarse-bed particles in the Glogn River that drains the 400 km2 Val Lumnezia basin, eastern Swiss Alps. In addition, quantitative data are presented on sediment transport patterns in this stream. The longitudinal stream profile of this river is characterized by three ca 500 m long knickzones where channel gradients range from 0·02 to 0·2 m m−1, and where the valley bottom confined into a <10 m wide gorge. Downstream of these knickzones, the stream is flat with gradients <0·01 m m−1 and widths ≥30 m. Measurements of the grain-size distribution along the trunk stream yield a mean D84 value of ca 270 mm, whereas the mean D50 is ca 100 mm. The consequences of the channel morphology and the grain-size distribution for the time scales of sediment transport were explored by using a one-dimensional step-backwater hydraulic model (Hydrologic Engineering Centre – River Analysis System). The results reveal that, along the entire trunk stream, a two to 10 year return period flood event is capable of mobilizing both the D50 and D84 fractions where the Shields stress exceeds the critical Shields stress for the initiation of particle motion. These return periods, however, varied substantially depending on the channel geometry and the pebble/boulder size distribution of the supplied material. Accordingly, the stream exhibits a highly dynamic boulder cover behaviour. It is likely that these time scales might also have been at work when coarse-grained conglomerates were constructed in the geological past.

A reduced model clarifies the role of feedback loops and time delays in the Drosophila circadian oscillator.

Although several detailed models of molecular processes essential for circadian oscillations have been developed, their complexity makes intuitive understanding of the oscillation mechanism difficult. The goal of the present study was to reduce a previously developed, detailed model to a minimal representation of the transcriptional regulation essential for circadian rhythmicity in Drosophila. The reduced model contains only two differential equations, each with time delays. A negative feedback loop is included, in which PER protein represses per transcription by binding the dCLOCK transcription factor. A positive feedback loop is also included, in which dCLOCK indirectly enhances its own formation. The model simulated circadian oscillations, light entrainment, and a phase-response curve with qualitative similarities to experiment. Time delays were found to be essential for simulation of circadian oscillations with this model. To examine the robustness of the simplified model to fluctuations in molecule numbers, a stochastic variant was constructed. Robust circadian oscillations and entrainment to light pulses were simulated with fewer than 80 molecules of each gene product present on average. Circadian oscillations persisted when the positive feedback loop was removed. Moreover, elimination of positive feedback did not decrease the robustness of oscillations to stochastic fluctuations or to variations in parameter values. Such reduced models can aid understanding of the oscillation mechanisms in Drosophila and in other organisms in which feedback regulation of transcription may play an important role.

Necessity of epicardial ablation for ventricular tachycardia after sequential endocardial approach

Background Catheter ablation (CA) of ventricular tachycardia (VT) is an important treatment option in patients with structural heart disease (SHD) and implantable cardioverter defibrillator (ICD). A subset of patients requires epicardial CA for VT. Objective The purpose of the study was to assess the significance of epicardial CA in these patients after a systematic sequential endocardial approach. Methods Between January 2009 and October 2012 CA for VT was analyzed. A sequential CA approach guided by earliest ventricular activation, pacemap, entrainment and stimulus to QRS-interval analysis was used. Acute CA success was assessed by programmed ventricular stimulation. ICD interrogation and 24 h-Holter ECG were used to evaluate long-term success. Results One hundred sixty VT ablation procedures in 126 consecutive patients (114 men; age 65 ± 12 years) were performed. Endocardial CA succeeded in 250 (94%) out of 265 treated VT. For 15 (6%) VT an additional epicardial CA was performed and succeeded in 9 of these 15 VT. Long-term FU (25 ± 18.2 month) showed freedom of VT in 104 pts (82%) after 1.2 ± 0.5 procedures, 11 (9%) suffered from repeated ICD shocks and 11 (9%) died due to worsening of heart failure. Conclusions Despite a heterogenic substrate for VT in SHD, endocardial CA alone results in high acute success rates. In this study additional epicardial CA following a sequential endocardial mapping and CA approach was performed in 6% of VT. Thus, due to possible complications epicardial CA should only be considered if endocardial CA fails.

On the seasonal variations of salinity of the tropical Atlantic mixed layer

The physical processes controlling the mixed layer salinity (MLS) seasonal budget in the tropical Atlantic Ocean are investigated using a regional configuration of an ocean general circulation model. The analysis reveals that the MLS cycle is generally weak in comparison of individual physical processes entering in the budget because of strong compensation. In evaporative regions, around the surface salinity maxima, the ocean acts to freshen the mixed layer against the action of evaporation. Poleward of the southern SSS maxima, the freshening is ensured by geostrophic advection, the vertical salinity diffusion and, during winter, a dominant contribution of the convective entrainment. On the equatorward flanks of the SSS maxima, Ekman transport mainly contributes to supply freshwater from ITCZ regions while vertical salinity diffusion adds on the effect of evaporation. All these terms are phase locked through the effect of the wind. Under the seasonal march of the ITCZ and in coastal areas affected by river (7°S:15°N), the upper ocean freshening by precipitations and/or runoff is attenuated by vertical salinity diffusion. In the eastern equatorial regions, seasonal cycle of wind forced surface currents advect freshwaters, which are mixed with subsurface saline water because of the strong vertical turbulent diffusion. In all these regions, the vertical diffusion presents an important contribution to the MLS budget by providing, in general, an upwelling flux of salinity. It is generally due to vertical salinity gradient and mixing due to winds. Furthermore, in the equator where the vertical shear, associated to surface horizontal currents, is developed, the diffusion depends also on the sheared flow stability.

Modelling woody material transport and deposition in alpine rivers

Recent flood events in Switzerland and Western Austria in 2005 were characterised by an increase in impacts and associated losses due to the transport of woody material. As a consequence, protection measures and bridges suffered considerable damages. Furthermore, cross-sectional obstructions due to woody material entrapment caused unexpected flood plain inundations resulting in severe damage to elements at risk. Until now, the transport of woody material is neither sufficiently taken into account nor systematically considered, leading to prediction inaccuracies during the procedure of hazard mapping. To close this gap, we propose a modelling approach that (1) allows the estimation of woody material recruitment from wood-covered banks and flood plains; (2) allows the evaluation of the disposition for woody material entrainment and transport to selected critical configurations along the stream and that (3) enables the delineation of hazard process patterns at these critical configurations. Results from a case study suggest the general applicability of the concept. This contribution to woody material transport analysis refines flood hazard assessments due to the consideration of woody material transport scenarios.

Hazard index maps for woody material recruitment and transport in alpine catchments

A robust and reliable risk assessment procedure for hydrologic hazards deserves particular attention to the role of transported woody material during flash floods or debris flows. At present, woody material transport phenomena are not systematically considered within the procedures for the elaboration of hazard maps. The consequence is a risk of losing prediction accuracy and of underestimating hazard impacts. Transported woody material frequently interferes with the sediment regulation capacity of open check dams and moreover, when obstruction phenomena at critical crosssections of the stream occur, inundations can be triggered. The paper presents a procedure for the determination of the relative propensity of mountain streams to the entrainment and delivery of recruited woody material on the basis of empirical indicators. The procedure provided the basis for the elaboration of a hazard index map for all torrent catchments of the Autonomous Province of Bolzano/Bozen. The plausibility of the results has been thoroughly checked by a backward oriented analysis on natural hazard events, documented since 1998 at the Department of Hydraulic Engineering of the aforementioned Alpine Province. The procedure provides hints for the consideration of the effects, induced by woody material transport, during the elaboration of hazard zone maps.

Effects of Surface Forcing on Interannual Variability of the Fall Phytoplankton Bloom in the Gulf of Maine Revealed Using a Process-Oriented Model

SeaWiFS (Sea-viewing Wide Field-of-view Sensor) chlorophyll data revealed strong interannual variability in fall phytoplankton dynamics in the Gulf of Maine, with 3 general features in any one year: (1) rapid chlorophyll increases in response to storm events in fall; (2) gradual chlorophyll increases in response to seasonal wind-and cooling-induced mixing that gradually deepens the mixed layer; and (3) the absence of any observable fall bloom. We applied a mixed-layer box model and a 1-dimensional physical-biological numerical model to examine the influence of physical forcing (surface wind, heat flux, and freshening) on the mixed-layer dynamics and its impact on the entrainment of deep-water nutrients and thus on the appearance of fall bloom. The model results suggest that during early fall, the surface mixed-layer depth is controlled by both wind-and cooling-induced mixing. Strong interannual variability in mixed-layer depth has a direct impact on short-and long-term vertical nutrient fluxes and thus the fall bloom. Phytoplankton concentrations over time are sensitive to initial pre-bloom profiles of nutrients. The strength of the initial stratification can affect the modeled phytoplankton concentration, while the timing of intermittent freshening events is related to the significant interannual variability of fall blooms.

Isotope ratios of basalts from ODP Leg 115 holes (Table 1)

Strontium, neodymium, and lead isotope ratios are reported for 13 Leg 115 basalts as well as 3 basalts from Texaco drill hole SM-1 on the Mascarene Plateau. The 87Sr/86Sr ratios and eNd range from 0.70330 to 0.70439 and 5.5 to 7.4, respectively, although 87Sr/86Sr ratios higher than 0.70383 are found only in SM-1 basalts. The high 87Sr/86Sr values are thought to reflect seawater Sr in secondary phases, although all samples were strongly leached in HC1 before analysis. 206Pb/204Pb ratios range from 18.53 to 18.80, and sho high 207Pb/204Pb and 208Pb/204Pb ratios relative to 206Pb/204Pb ratios, typical of Indian Ocean mid-ocean ridge (MORB) and oceanic-island basalts (OIB). Isotopic compositions of Leg 115 basalts generally fall between fields for MORB and Reunion Island basalts, consistent with the conclusion drawn from geochronological studies that Deccan flood basalt volcanism, the Chagos-Laccadive Ridge, and the Mascarene Plateau are all products of the Reunion mantle plume. Isotopic compositions of magmas produced by this plume have varied systematically with time in the direction of less "depleted," less MORB-like isotopic signatures. This compositional change has been accompanied by a decrease in eruption rate. We interpret Deccan volcanism as the voluminous beginning of the plume. Reduced entrainment of asthenosphere following melting of the plume head resulted in less MORB-like isotope ratios in magmas and a decrease in eruptive activity with time.