One of the most fundamental problems in computer science is the reachability problem: Given a directed graph and two vertices s and t, can sreach t via a path? We revisit existing techniques and ...combine them with new approaches to support a large portion of reachability queries in constant time using a linear-sized reachability index. Our new algorithm O’Reach can be easily combined with previously developed solutions for the problem or run standalone.In a detailed experimental study, we compare a variety of algorithms with respect to their index-building and query times as well as their memory footprint on a diverse set of instances. Our experiments indicate that the query performance often depends strongly not only on the type of graph but also on the result, i.e., reachable or unreachable. Furthermore, we show that previous algorithms are significantly sped up when combined with our new approach in almost all scenarios. Surprisingly, due to cache effects, a higher investment in space doesn’t necessarily pay off: Reachability queries can often be answered even faster than single memory accesses in a precomputed full reachability matrix.
Reconfigurable optical topologies promise to improve the performance in datacenters by dynamically optimizing the physical network in a demand-aware manner. State-of-the-art optical technologies ...allow to establish and update direct connectivity (in the form of edge-disjoint matchings) between top-of-rack switches within microseconds or less. However, to fully exploit temporal structure in the demand, such fine-grained reconfigurations also require fast algorithms for optimizing the interconnecting matchings.Motivated by the desire to offload a maximum amount of demand to the reconfigurable network, this paper initiates the study of fast algorithms to find k disjoint heavy matchings in graphs. We present and analyze six algorithms, based on iterative matchings, b-matching, edge coloring, and node-rankings. We show that the problem is generally {\mathcal{N}}{\mathcal{P}}{\text{ - hard}} and study the achievable approximation ratios.An extensive empirical evaluation of our algorithms on both real-world and synthetic traces (88 in total), including traces collected in Facebook datacenters and in HPC clusters reveals that all our algorithms provide high-quality matchings, and also very fast ones come within 95 % or more of the best solution. However, the running times differ significantly and what is the best algorithm depends on k and the acceptable runtime-quality tradeoff.
One of the most fundamental problems in computer science is the reachability problem: Given a directed graph and two vertices s and t, can s reach t via a path? We revisit existing techniques and ...combine them with new approaches to support a large portion of reachability queries in constant time using a linear-sized reachability index. Our new algorithm O'Reach can be easily combined with previously developed solutions for the problem or run standalone. In a detailed experimental study, we compare a variety of algorithms with respect to their index-building and query times as well as their memory footprint on a diverse set of instances. Our experiments indicate that the query performance often depends strongly not only on the type of graph, but also on the result, i.e., reachable or unreachable. Furthermore, we show that previous algorithms are significantly sped up when combined with our new approach in almost all scenarios. Surprisingly, due to cache effects, a higher investment in space doesn't necessarily pay off: Reachability queries can often be answered even faster than single memory accesses in a precomputed full reachability matrix.
Reconfigurable optical topologies promise to improve the performance in datacenters by dynamically optimizing the physical network in a demand-aware manner. State-of-the-art optical technologies ...allow to establish and update direct connectivity (in the form of edge-disjoint matchings) between top-of-rack switches within microseconds or less. However, to fully exploit temporal structure in the demand, such fine-grained reconfigurations also require fast algorithms for optimizing the interconnecting matchings. Motivated by the desire to offload a maximum amount of demand to the reconfigurable network, this paper initiates the study of fast algorithms to find k disjoint heavy matchings in graphs. We present and analyze six algorithms, based on iterative matchings, b-matching, edge coloring, and node-rankings. We show that the problem is generally NP-hard and study the achievable approximation ratios. An extensive empirical evaluation of our algorithms on both real-world and synthetic traces (88 in total), including traces collected in Facebook datacenters and in HPC clusters reveals that all our algorithms provide high-quality matchings, and also very fast ones come within 95% or more of the best solution. However, the running times differ significantly and what is the best algorithm depends on k and the acceptable runtime-quality tradeoff.
Between April and June 2020, i.e., during the first wave of pandemic coronavirus disease 2019 (COVID-19), 55 patients underwent long-term treatment in the intensive care unit at the University ...Hospital of Regensburg. Most of them were transferred from smaller hospitals, often due to the need for an extracorporeal membrane oxygenation system. Autopsy was performed in 8/17 COVID-19-proven patients after long-term treatment (mean: 33.6 days). Autopsy revealed that the typical pathological changes occurring during the early stages of the disease (e.g., thrombosis, endothelitis, capillaritis) are less prevalent at this stage, while severe diffuse alveolar damage and especially coinfection with different fungal species were the most conspicuous finding. In addition, signs of macrophage activation syndrome was detected in 7 of 8 patients. Thus, fungal infections were a leading cause of death in our cohort of severely ill patients and may alter clinical management of patients, particularly in long-term periods of treatment.
Background
Hemodynamic response to successful extracorporeal cardiopulmonary resuscitation (eCPR) is not uniform. Pulse pressure (PP) as a correlate for myocardial damage or recovery from it, might ...be a valuable tool to estimate the outcome of these patients.
Methods
We report retrospective data of a single-centre registry of eCPR patients, treated at the Interdisciplinary Medical Intensive Care Unit at the Medical Centre, University of Freiburg, Germany, between 01/2017 and 01/2020. The association between PP of the first 10 days after eCPR and hospital survival was investigated. Moreover, patients were divided into three groups according to their PP low (0–9 mmHg), mid (10–29 mmHg) and high (≥ 30 mmHg) at each time point.
Results
One hundred forty-three patients (age 63 years, 74.1% male, 40% OHCA, average low flow time 49 min) were analysed. Overall hospital survival rate was 28%. A low PP both early after eCPR (after 1, 3, 6 and 12 h) and after day 1 to day 8 was associated with reduced hospital survival. At each time point (1 h to day 5) the classification of patients into a low, mid and high PP group was able to categorize the patients for a low (5–20%), moderate (20–40%) and high (50–70%) survival rate. A multivariable analysis showed that the mean PP of the first 24 h was an independent predictor for survival (
p
= 0.008).
Conclusion
In this analysis, PP occurred to be a valuable parameter to estimate survival and maybe support clinical decision making in the further course of patients after eCPR.
Graphic abstract
The European Trauma Course (ETC) exemplifies an innovative approach to multispecialty trauma education. This initiative was started as a collaborative effort among the European Society for Emergency ...Medicine, the European Society for Trauma and Emergency Surgery, and the European Society of Anaesthesiology under the auspices of the European Resuscitation Council. With the robust support of these societies, the project has evolved into the independent European Trauma Course Organisation.
Over the past 15 years, the ETC has transcended traditional training by integrating team dynamics and non-technical skills into a scenario-based simulation course, helping to shape trauma care practice and education. A distinctive feature of the ETC is its training of doctors and allied healthcare professionals, fostering a collaborative and holistic approach to trauma care. The ETC stands out for its unique team-teaching approach, which has gained widespread recognition as the standard for in-hospital trauma care training not only in Europe but also beyond. Since its inception ETC has expanded geographically from Finland to Sudan and from Brazil to the Emirates, training nearly 20,000 healthcare professionals and shaping trauma care practice and education across 25 countries. Experiencing exponential growth, the ETC continues to evolve, reflecting its unmet demand in trauma team education.
This review examines the evolution of the ETC, its innovative team-teaching methodology, national implementation strategies, current status, and future challenges. It highlights its impact on trauma care, team training, and the effect on other life support courses in various countries.
Zusammenfassung
Die Leitlinien des European Resuscitation Council 2021 basieren auf einer Reihe systematischer Übersichtsarbeiten, Scoping-Reviews und Aktualisierungen der Evidenz des International ...Liaison Committee on Resuscitation und stellen die aktuellsten evidenzbasierten Leitlinien für die Praxis der Wiederbelebung in ganz Europa dar. Die Leitlinien umfassen die Epidemiologie des Kreislaufstillstands, die Rolle, die Systeme bei der Rettung von Menschenleben spielen, die Basismaßnahmen der Wiederbelebung Erwachsener, die erweiterten Reanimationsmaßnahmen bei Erwachsenen, die Wiederbelebung unter besonderen Umständen, die Postreanimationsbehandlung, die Erste Hilfe, die Versorgung und Reanimation von Neugeborenen, die lebensrettenden Maßnahmen bei Kindern, die Ethik und die Ausbildung.
Abstract
Objective: To determine if cardiopulmonary bypass (CPB), together with inhibition of the sodium-hydrogen exchanger (NHE), limits myocardial and neurological injury and improves recovery ...after prolonged (unwitnessed) cardiac arrest (CA), as NHE inhibition improved recovery after deep hypothermic circulatory arrest. Methods: Twenty-seven pigs (31-39 kg) underwent 15 min of prolonged (no-flow) CA followed by 10 min of cardiopulmonary resuscitation-advanced life support (CPR-ALS). Subjects with restoration of spontaneous circulation (ROSC) during CPR-ALS received either no drug (n = 6) or an inhibitor of the NHE (HOE-642; n = 5). In the 16 unsuccessfully resuscitated animals, peripheral normothermic CPB was instituted, and either no drug (n = 9) or similar HOE-642 (n = 7) therapy started. Hemodynamic data, a species-specific neurological deficit score (0 = normal to 500 = brain death), and mortality were recorded at 24 h, and biochemical variables of organ injury measured. Results: CPR-ALS restored ROSC in 41% (11/27) of animals, but was unsuccessful in 59% (16/27) that required CPB. Without CPB, HOE-642 increased cardiac index and decreased vascular resistance; with CPB, HOE-642 caused higher pump flows (3.4 ± 0.6 l min−1 m−2 vs 2.5 ± 0.7 l min−1 m−2; p ≪ 0.001) and higher post-arrest cardiac index; but animals required more vasopressors (p = 0.019) from drug-induced vasodilation. No differences between biochemical markers of oxidative and organ injury and overall 24-h mortality (20%) were found between groups. Neurological score was improved at 24 h compared with 4 h only after HOE-642 treatment with (150 ± 34 vs 220 ± 43; p = 0.003) or without CPB (162 ± 39 vs 238 ± 48; p ≤ 0.001), but failed to reach statistical difference with respect to the untreated group. Conclusions: CPB is an effective resuscitative tool to treat prolonged CA but there is limited improvement of neurological function. NHE inhibition augments cardiac and neurological function, but its effect was less pronounced than in other studies.
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