Absence Of Congestion Research Articles

Add-On Pricing: A Queueing Perspective

This work is motivated by the practice of add-on services, where an add-on is not valuable unless purchased with a main service. Discrepancies in pricing have been observed in various settings such as restaurants, museums, and attractions regarding whether the add-on should be sold together with the main service, or separately from the main service at an additional charge. While there has been a vast literature on add-on pricing, its application in service-oriented businesses with congestion-prone externalities and delay-sensitive customers is less understood. We develop a queueing model and examine the optimal pricing of add-on services in such systems, and in line with practice, we focus on analyzing two pricing schemes: bundling that charges a single price to sell main and add-on services altogether, and separate selling that charges distinct prices for each service. We establish that in the absence of congestion, separate selling strictly dominates bundling across the board. When there is congestion at the main service but not the add-on, bundling can be more lucrative under a large customer demand. When congestion takes place at both services, separate selling can return to being dominant under a large customer demand. We explain these plots of reversals by illustrating an intricate interplay between pricing, market coverage, and congestion. Collectively, they reveal novel operational advantages of each pricing scheme in exploiting the fundamentals of add-on structures.

Road network free flow speed estimation using microscopic simulation and point-to-point travel times

Roads in mesoscopic traffic simulation models are often parametrized by a free speed attribute, which describes the speed at which a vehicle can traverse a road in the absence of congestion. Unlike microscopic models, mesoscopic models do not typically simulate traffic lights, individual driver behavior or acceleration and deceleration of vehicles. In consequence, the free speed parameter of each road must account for all the aforementioned effects. Modeling free speed accurately is important, as it determines the travel time, which in turn affects the decision-making of agents in the simulation.This paper introduces an approach combining microscopic simulation with machine learning models to estimate road segment free speeds. Using the microscopic simulator SUMO, we generate training data for a model search employing Bayesian optimization. Subsequently, these models undergo fine-tuning via gradient-based optimization using real-world point-to-point travel times. A significant advantage is the adaptability of this approach to diverse road networks, including those from OpenStreetMap, and the ability to incorporate routing data from various online providers independently.Our evaluation illustrates a notable decrease in prediction error between 30% and 60% compared to baseline models that assume a uniform free speed reduction for all urban roads. The fine-tuned models are able to generalize well to unseen regions and are therefore applicable to case studies where data for new or altered roads is unavailable.

Pulmonary Congestion by Conventional Chest Radiography: Relationship With Hemodynamics and Mortality in Patients With Severe Aortic Stenosis

BackgroundThe relationship between chest radiograph (CXR) findings of pulmonary congestion and invasive hemodynamics and clinical outcomes in patients with cardiac diseases is unclear. We assessed the correlation between a CXR-based congestion score (RxCS) and the mean pulmonary artery wedge pressure (mPAWP) and the prognostic impact of RxCS and mPAWP in severe aortic stenosis (AS). MethodsIn 471 patients with severe AS undergoing right heart catheterization and upright CXR, the RxCS was calculated (6 items, maximum score: 10 points) independently by 2 radiologists (average value taken) blinded to clinical data. Congestion was defined as an RxCS > 1. Four patterns were defined based on the presence or absence of congestion (C+ or C–) and elevated (> 15 mm Hg) or normal mPAWP (P+ or P–). ResultsThe median (interquartile range) RxCS was 1 (0-2). Patients with an RxCS > 1 (n = 207) had a higher mean right atrial pressure, mean pulmonary artery pressure, mPAWP, and pulmonary vascular resistance than patients with an RxCS ≤ 1 (n = 264). However, the correlation between the RxCS and the mPAWP was moderate only (r = 0.45). Patients with a C+/P+ pattern had the worst hemodynamics, whereas C–/P– patients had the most favourable constellation. After a median post–valve replacement follow-up of 1361 days, mortality was higher in patients with RxCs > 1 vs ≤ 1 as well as mPAWP > 15 mm Hg vs ≤15 mm Hg. Mortality was highest in C+/P+ patients and lowest in C–/P– patients, whereas it was intermediate in C–/P+ and C+/P– patients. ConclusionsIn AS patients, RxCS and mPAWP have a significant but moderate correlation. Both RxCS and mPAWP provide prognostic information.

Do Sustainability Perceptions Affect Lake Destination Loyalty?

Despite a growing concern over sustainability in tourism, research on this domain, regarding, specifically, lake destinations, is still scarce. Although perceptions on lake destinations have been studied, no study is known that has analyzed the impact of visitors’ perceptions on satisfaction and behavioral intentions. Thus, this paper aims to develop and test a model to analyze the effect of lake visitors’ perceptions of destination’s sustainability on both satisfaction and loyalty towards lake destinations. A questionnaire survey was conducted in the Shchuchinsk-Burabay resort area, an important lake destination in Northern Kazakhstan. The results support the proposed lake destination loyalty model, tested using partial least squares structural equation modelling (PLS-SEM). Sustainability proved to be decisively influential, with water quality being the dimension with the highest impact on satisfaction with the lakes, along with a positive key impact of other dimensions of perceptions of the lakes being the absence of congestion. In addition, both water quality and lack of congestion had, conjointly with other features, a significant indirect impact on satisfaction with lake destinations and on loyalty. Based on the research findings, theoretical conclusions and practical implications are drawn.

#2875 CONGESTION PHENOTYPES AND DECONGESTION PATTERNS ASSESSED BY POCUS IN HAEMODIALYSIS PATIENTS: A PILOT STUDY

Abstract Background and Aims Despite the evolution of hemodialysis (HD) in recent years, cardiovascular diseases continue to be the main cause of death in this group of patients. Congestion is one of the factors associated with the highest morbidity and mortality. Unfortunately, there is no gold standard for the proper assessment of dry weight; in fact, physical examination, and even newer techniques such as bioimpedance have poor sensitivity, are difficult to interpret in some cases and fail to discriminate between tissular and vascular congestion. Recently, the use of Point-of-care Ultrasonography (PoCUS) has emerged as the fifth pillar of the conventional physical examination that allows dynamic assessment of congestion and enables congestion to be phenotyped. The aims of the present study were: 1. to phenotype congestion in HD patients and 2. to establish patterns of decongestion according to changes in phenotypes over the course of a HD session. Method Descriptive study carried out in HD units of two tertiary hospitals. Patients with more than three months on HD were included. Excluding patients with short life expectancy or who had an acute complication. In addition to the congestive composite score (CCS), a PoCUS evaluation was performed at the beginning and the end of the HD session on long dialysis interval. Tissular congestion was assessed by lung ultrasound and vascular congestion was assessed by evaluation of the inferior vena cava diameter and portal vein pulsation by pulsed Doppler. Four phenotypes of congestion were established: phenotype A: no congestion, phenotype B: predominance of tissue congestion, phenotype C: predominance of vascular congestion and phenotype D: mixed congestion. In addition, 4 patterns of decongestion were established: pattern 1: absence of congestion at the beginning and end of the HD session, pattern 2: change of phenotype from B, C or D to A, pattern 3: change in congestion phenotype and pattern 4: persistence in the same congestion phenotype as at the beginning. Results 20 patients were included, mean age: 70.5±11.3 years, 14 (70%) were male, CCS: 3 (1.5 – 7.5), interdialysis weight gain: 2.93±0.95 kg and mean UF: 2,570±868mL. 75% of patients reached the prescribed dry weight. At the beginning of the session the distribution of phenotypes was: phenotype A: 35%, phenotype B: 25%, phenotype C: 25% and phenotype D: 15%. At the end of the HD session: phenotype A: 55%, phenotype B: 30%, phenotype C: 10% and phenotype D: 5%. At the end of the HD session 45% of the patients persisted with ultrasound congestion. As for the patterns of decongestion: pattern 1: 35% of patients, pattern 2: 10%, pattern 3: 10% and pattern 4: 35%. 45% of patients persisted with some phenotype of congestion at the end of the session. An inverse correlation was found between age and phenotype at baseline (Rho: -0.506; p = 0.023). No correlation was found between dry weight and UF with decongestion patterns. Conclusion These results show the persistence of echographic congestion at the end of the HD session in a significant number of patients, suggesting that subclinical congestion is more frequent than clinically observed. Further studies are warranted to confirm these results.

Effect of Ganoderma Fungi and Spirulina Alga in The Liver Tissue of Diabetic Mice Developed with Aloxane and Lead-Induced Anemia

The study was conducted on male mice (Albino mice), which ranged in age from (2-3) months and weights (25 - 30) g. The experiment was conducted in the General Company for the manufacture of medicines and medical supplies - Samarra. And for the period from the beginning of October 2017 to the end of March 2018, Used 42 animals were distributed in seven groups, each containing 6 animals, to determine the effects of both gannoderma and spirulina in laboratory mice induced by diabetes mellitus with a Aloxan at 150 mg / kg Bw. In laboratory mice with anemia with lead acetate of 50 mg / Kg body weight for 30 days (except control group) At the end of the 30-day feeding period.
 
 control group on the regular diet.
 control group infected diabetes and drugs on the regular diet.
 The group of diabetic animals treated with ganoderma fungi powder (47 mg / kg body weight).
 The group of diabetic animals and the treatment of spirulina algae powder (33 mg / kg body weight).
 group of animals infected with anemia and spores on the regular diet and water containing lead acetate
 Group of infected animals and treated with lead acetate + Ganoderma fungi powder (47 mg / kg body weight).
 Group of infected animals and treated with lead acetate + Spirulina algae powder (33 mg / kg body weight).
 
 Histological changes were observed in the Livre tissue: The results of the study of tissues in the group of animals treated with Alloxnesan damage to the overall liver tissue in the form of hepatocytes and hydrolysis and the expansion of the Sinusiod. In the treatment of diabetic animals with ganoderma and spirulina algae, there was improvement in the overall liver tissue in terms of normal hepatocytes, absence of congestion, and normal Sinusiod. the group treated with anemia and treated with lead acetate, we also notice significant damage to the liver tissue. When treated with lead acetate + gannoderma, and spirulina, we did not notice any improvement in liver tissue.

Non-invasive assessment of acute heart failure by Stevenson classification: Does echocardiographic examination recognize different phenotypes?

BackgroundAcute heart failure (AHF) presentation is universally classified in relation to the presence or absence of congestion and the peripheral perfusion condition according to the Stevenson diagram. We sought to evaluate a relationship existing between clinical assessment and echocardiographic evaluation in patients with AHF.Materials and methodsThis is a retrospective blinded multicenter analysis assessing both clinical and echocardiographic analyses during the early hospital admission for AHF. Patients were categorized into four groups according to the Stevenson presentation: group A (warm and dry), group B (cold and dry), group C (warm and wet), and group D (cold and wet). Echocardiographic evaluation was executed within 12 h from the first clinical evaluation. The following parameters were measured: left ventricular (LV) volumes, LV ejection fraction (LVEF); pattern Doppler by E/e1 ratio, pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), and inferior cave vein diameter (ICV).ResultsWe studied 208 patients, 10 in group A, 16 in group B, 153 in group C, and 29 in group D. Median age of our sample was 81 [69–86] years and the patients enrolled were mainly men (66.8%). Patients in groups C and A showed significant higher levels of systolic arterial pressures with respect to groups B and D (respectively, 130 [115–145] mmHg vs. 122 [119–130] mmHg vs. 92 [90–100] mmHg vs. 95 [90–100] mmHg, p < 0.001). Patients in groups A and C (warm) demonstrated significant higher values of LVEF with respect to patients in groups B and D (43 [34–49] vs. 42 [30–49] vs. 27 [15–31] vs. 30 [22–42]%, p < 0.001). Whereas group B experienced significant lower TAPSE values compared with other group (14 [12–17] mm vs. A: 17 [16–21] mm vs. C: 18 [14–20] mm vs. D: 16 [12–17] mm; p = 0.02). Finally, echocardiographic congestion score including PASP ≥ 40 mmHg, ICV ≥ 21, mm and E/e’ > 14 did not differ among groups. Follow-up analysis showed an increased mortality rate in D group (HR 8.2 p < 0.04).ConclusionThe early Stevenson classification remains a simple and universally recognized approach for the detection of congestion and perfusion status. The combined clinical and echocardiographic assessment may be useful to better define the patients’ profile.

Value of a chest X-ray and CT to diagnose acute heart failure in acute patients with dyspnoea: a prospective comparative diagnostic study in the emergency department

Abstract Background and purpose Diagnosing heart failure (HF) remains difficult in the acute setting where multiple diagnoses are in play. Objective evidence of pulmonary congestion by chest X-ray (CXR) is one criteria for the recent universal definition of heart failure (UniHF). But, since CXR is known to have a low diagnostic value, we hypothesized that a chest CT (CT) would outdo the CXR to diagnose decompensated HF in acute breathless patients. This study's primary objective was to examine if the CT has higher accuracy than the CXR to diagnose HF in the acute setting; and, secondly, to identify what pre-test characteristics would predict a false negative CXR or CT. Methods We performed a single-centre, prospective observational study and included consecutive adult patients with dyspnoea in the emergency department. Patients underwent immediate clinical examination, blood tests, CXR, CT and an echocardiogram. Congestion on CXR and CT was defined as the congruent verdict by two expert thorax radiologists, blinded to each others reading and all other clinical data. The absence of congestion was defined as the congruent verdict of “no congestion”. Congestion of CXR and CT was held up against UniHF ascertained by an expert panel of cardiologists where the pulmonary congestion component primarily was based on elevated filling pressures from the simultaneous comprehensive echocardiogram. Univariate- and multivariate logistic analyses identified factors associated with a false negative chest x-ray and CT. Results Of 228 patients with a mean age of 74,5 years, 129 (56,5%) were male, 98 (43%) had UniHF, and 139 (61.0%) had pulmonary disease. Congestion on the CXR diagnosed UniHF with a 54% sensitivity and 95% specificity, with almost similar figures for the CT with 54% and 99% respectively. A marginally better performance of the CT was shown by a significantly lower Akaike Information Criterion for pulmonary congestion by CT than for CXR. However, the net reclassification improvement by CT was 4% (p:0.5586). The CXR and CT were false negative for UniHF in 46% (45/98) for both modalities (Table 1). The only independent pre-test predictor of a false negative radiology examination in multivariable logistic regression analysis was NT-proBNP (CXR: OR 1.670 per log(BNP), p: &amp;lt;0.001) and CT: OR 1.693 per log(BNP), p: &amp;lt;0.001). Conclusions For the first time, CT has been directly compared with CXR to diagnose HF in consecutive breathless patients from the emergency department. The chest CT was marginally more specific than the CXR to diagnose HF, but with a similar sensitivity. Approximately half the patients obeying the universal definition of HF have no definite congestion on CXR nor CT, and these can only be identified by a high proBNP. Funding Acknowledgement Type of funding sources: None. Table 1

Construction of an orthogonal basis based on pseudorandom sequences

In this paper, we consider an approach to constructing an orthogonal transform based on pseudorandom sequences with the purpose of providing noiseless coding. This approach ensures the absence of congestion in the channel thus allowing the problem of restricted access in confidential systems to be solved.

The chicken or the egg? Relationship between venous congestion and hematoma in free flaps

Postoperative hematoma and venous congestion after free tissue transfer may occur independently or concurrently. We aimed to explore the association between these two events. All free flap reconstructions for head and neck (HN) and breast from a single institution between 2004 and 2014 were retrospectively reviewed for reoperation for venous congestion and/or hematoma. There were 2985 free flap cases for HN reconstruction and 2345 cases for breast reconstruction. In HN, 100 patients developed a hematoma (3.4%) and 84 patients developed venous congestion (2.8%). The prevalence of hematoma was 17.8% and 2.9% in the presence and absence of congestion, respectively (p<0.001). Among the 15 patients who had both hematoma and venous congestion were separate events that occurred from 1 to 9 days apart in 8 patients. Hematoma caused the compression of the pedicle vein in 4 patients, while venous congestion possibly caused hematoma in 3 patients. In breast, 56 patients developed a hematoma (2.4%) and 64 patients developed venous congestion (2.7%). The prevalence of hematoma was 12.5% and 2.1% in the presence and absence of congestion, respectively (p<0.001). In the 8 patients who developed both, hematoma and congestion were separate events in 4 patients. Venous congestion caused hematoma in 3 patients, and hematoma caused venous congestion in 1 patient. Although postoperative hematoma and venous congestion often present concurrently, most events are not causally associated. When related, however, venous congestion leading to hematoma is more common in breast reconstruction, while hematoma preceding venous congestion is more common in HN reconstruction.

Влияние Новосибирского водохранилища на уровни воды реки Оби в период весеннего половодья (территория города Камень-на-Оби)

The article considers the issue of the Novosibirsk reservoir impact on the water levels in the Ob River in the area of Kamen-na-Obi during the spring flood period. We have carried out a computer model of the flow in the Ob River section from Kamen-na-Obi to the Novosibirsk hydro power plant dam site based on the two-dimensional unsteady hydrodynamic model (Saint-Venant equations). Variant calculations of water levels for various water discharges in the Ob River and different levels of the Novosibirsk Reservoir in the absence of congestion were performed for the site under consideration. It has been shown that even with forced levels of the Novosibirsk Reservoir, the water levels in the area of Kamen-na-Obi are mainly affected by the discharges of water in the Ob river.

External Costs on The Island of Vis: Comparison of two Traffic Modes

External cost of road traffic, identified as the highest among traffic modes, is an important indicator of the European Union's transport policy to shift traffic off the road to a more environmentally acceptable mode. Ferry traffic generates benefits to each port of call in localities having invested in port infrastructure, and there is an interest of the local community to have their own ferry line, especially on islands. Two alternative ferry lines have been created combining maritime and road traffic on the specific route from the town of Vis to the town of Komiža and compared from the external costs standpoint. The first alternative ferry line comprises one port of call in the town of Vis, combining it with a road modality to and from the town of Komiža. In the second alternative, the road traffic has been excluded and two ferry ports of call have been introduced, one towards the town of Vis and the other by extending the ferry voyage to the town of Komiža. The results show the model of one port of call with the integration of more road traffic on the specific route as a better solution. Despite the use of ultra-low sulphur diesel fuel on ferries, the absence of congestion in road traffic on the island of Vis and generally slow implementation of modern emission standards in maritime traffic, road traffic seems to provide a better solution as an environmentally more acceptable mode on this route.

The price of anarchy of affine congestion games with similar strategies

Affine congestion games are a well-studied model for selfish behavior in distributed systems, such as transportation and communication networks. Seminal influential papers in Algorithmic Game Theory have bounded the worst-case inefficiency of Nash equilibria, termed as price of anarchy, in several variants of these games. In this work, we investigate to what extent these bounds depend on the similarities among the players' strategies. Our notion of similarity is modeled by assuming that, given a parameter θ≥1, the costs of any two strategies available to a same player, when evaluated in absence of congestion, are within a factor θ one from the other. It turns out that, for the non-atomic case, better bounds can always be obtained for any finite value of θ. For the atomic case, instead, θ<3/2 and θ<2 are necessary and sufficient conditions to obtain better bounds in games played on general graph topologies and on parallel link graphs, respectively. It is worth noticing that small values of θ model the behavioral attitude of players who are partially oblivious to congestion and are not willing to significantly deviate from what is their best strategy in absence of congestion.

Signaling Quality via Long Lines and Uninformative Prices

Problem definition: We study the following puzzle: why do firms sometimes nurture long wait lines, rather than raising prices (to eliminate these lines)? Academic/practical relevance: In economic theory, prices are studied as a signal of quality, in absence of congestion (wait lines). We study price signaling when customers not only infer quality information from the price, but also from wait lines. Methodology: We developed a stylized model based on queuing and price signaling theory. The firm, privately informed about its quality (high or low), first determines its price. Next, customers arrive according to a Poisson process, observe the price and the wait line upon arrival, and decide whether to purchase. Results: When the proportion of informed consumers is low, to separate on price a high-quality firm must raise its price above the monopoly price. We show that there exist pooling equilibria in which firms instead charge a price lower than the monopoly price. We characterize two pooling equilibria. In both equilibria, a high-quality firm on average has a longer queue than a low-quality one, and long lines signal high quality. In the first one, the price is sufficiently low that short lines in turn signal low quality, so that the queue length almost perfectly reveals the type of the firm. In the second one, the price is in an intermediate range (but remains lower than the monopoly price), and short lines are an imperfect signal of quality. In each of the pooling equilibria, the high-quality firm earns a higher profit than in the separating equilibrium, despite the longer lines. Managerial implications: An empirical implication of our model is that, over time, when more customers become informed about the quality, the price of a new high-quality good should increase and the expected waiting lines should decrease. Our model integrates elements of price signaling in economics and equilibrium queueing in operations research. We hope that our research stimulates further interest in signaling games in service operations environments.

Modified QUIC protocol for improved network performance and comparison with QUIC and TCP

Congestion control mechanism is solely responsible for maintaining the performance of streaming data. However, when there is no congestion, a regular delivery window update is followed as a step by step process. The process can be improved by individual window update along with acknowledgement (ACK) as feedback to the server even in the absence of congestion. To achieve maximum throughput and minimum delay, we have suggested modification in the existing handshaking mechanism of quick UDP internet connections (QUIC) protocol. This paper presents an investigation of QUIC protocol performance and proposes a modified QUIC (ModQUIC): a modification in existing handshaking mechanism of QUIC to reduce control overhead. Chromium server-client model testbed setup results, show that the proposed technique gives stable output and improves performance in terms of overall throughput and delay over QUIC and transmission control protocol (TCP). Performance has been tested for limited (2 Mbps) and sufficient (10 Mbps) link bandwidth in presence of loss. The validation of results has been carried out with the help of linear regression model. The result show a throughput improvement of 35.66% and 51.93% over QUIC and TCP respectively and also the delay is reduced by 3% to 5% over QUIC and TCP.

Stochastic Unit Commitment With Topology Control Recourse for Power Systems With Large-Scale Renewable Integration

In this paper, we model topology control through transmission switching as a recourse action in the day-ahead operation of power systems with large-scale renewable generation resources. We prove that transmission switching could only reduce the linear objective value of direct current optimal power flow when congestion exists. However, we also show, through a simple example, that unit commitment cost could be reduced by transmission switching even in the absence of congestion. To solve the stochastic unit commitment with topology control within reasonable computational time, we proposed a heuristic that first decomposes a practical system into zones and then solves the problem for each zone in parallel. The benefit of topology control recourse is demonstrated on a network representing the Central European System. We compare the costs of the network with different loading and renewable generation conditions. The cost reduction of the test system can reach 3.34% with heavy load and large-scale renewable generation while in a single zone the cost reduction can be above 7%.

Функція трансплантата правої частки печінки від живого родинного донора

Мета. Порівняння функціональної активності печінки після трансплантації правої частки від живого родинного донора з серединною веною та без неї.&#x0D; Матеріали і методи. Проаналізовано результати 75 трансплантацій правої частки печінки від живого родинного донора у двох групах реципієнтів: 1–ша група – реципієнти (37), яким трансплантовано праву частку печінки з серединною веною, 2–га група – реципієнти (38), яким трансплантовано праву частку печінки без серединної вени. Для аналізу використовували дані біохімічних показників крові в обох групах протягом першого тижня та на 10, 14, 21, 30–ту добу після трансплантації.&#x0D; Результати. Встановлено, що пікові рівні аланінамінотрансферази (АЛТ), аспартатамінотранферази (АСТ) і загального білірубіну були вищими у 2–й групі (відповідно 384,43; 399,77 і 206,70), ніж у 1–й групі (відповідно 212,64; 285,57; 203,18). Суттєвої різниці між рівнями гамаглутамілтранспептидази (ГГТП), лужної фосфотази (ЛФ), показниками протромбінового часу (ПЧ) і міжнародного нормалізованого співвідношення (МНС) не було.&#x0D; Висновки. Формування адекватного венозного відтоку від п’ятого та восьмого сегментів трансплантата правої частки печінки забезпечує ефективність його функціонування. Функція трансплантата правої частки печінки з серединною веною відновлюється більш повноцінно порівняно з трансплантатом без серединної вени за рахунок відсутності венозного застою в правій частці печінки.

Major developments in the 2016 European guidelines for heart failure

The European Society of Cardiology has recently published new guidelines on the diagnosis and treatment of acute and chronic heart failure (HF). This article aims to review these recommendations and their level of scientific evidence and to present the most innovative aspects. The most significant deviations from the 2012 edition are: (1) the introduction of the concept of HF with midrange LVEF (40–49%); (2) a new diagnostic algorithm for chronic HF, initially considering the clinical probability; (3) recommendations on preventing or delaying the apparition of HF; (4) indications for the use of the new sacubitril-valsartan compound, the first angiotensin receptor blocker and neprilysin inhibitor; (5) modification of indications for cardiac resynchronization therapy; and (6) a new algorithm for a combined diagnostic and treatment strategy for acute HF based on the presence or absence of congestion and hypoperfusion.

Principales novedades de las guías europeas de insuficiencia cardiaca del 2016

The European Society of Cardiology has recently published new guidelines on the diagnosis and treatment of acute and chronic heart failure (HF). This article aims to review these recommendations and their level of scientific evidence and to present the most innovative aspects. The most significant deviations from the 2012 edition are: 1) the introduction of the concept of HF with midrange LVEF (40-49%); 2) a new diagnostic algorithm for chronic HF, initially considering the clinical probability; 3) recommendations on preventing or delaying the apparition of HF; 4) indications for the use of the new sacubitril-valsartan compound, the first angiotensin receptor blocker and neprilysin inhibitor; 5) modification of indications for cardiac resynchronisation therapy; and 6) a new algorithm for a combined diagnostic and treatment strategy for acute HF based on the presence or absence of congestion and hypoperfusion.

Optimal Congestion Pricing with Diverging Long-Run and Short-Run Scheduling Preferences

Recent empirical work has suggested that there is an important distinction between short-run versus long-run scheduling behaviour of commuters, reflected in differences in values of time and schedule delays, as well as in preferred arrival moments, for the short-run versus the long-run problem. Peer et al. (2015) for example find that the average value of time when consumers form their routines in the long-run problem may exceed by a factor 6 the short-run value that governs departure time choice given these routines. For values of schedule delay, in contrast, the short-run value exceeds the long-run value, by a factor 2. And, when forming routines, consumers in fact choose a most preferred arrival time that may deviate from the value they would choose in absence of congestion because a change in routines may mean that shorter delays will be encountered. This paper investigates whether this distinction between short-run and long-run scheduling decisions affect optimal pricing of a congestible facility. Using a stochastic dynamic model of flow congestion for describing short-run equilibria and integrating it with a dynamic model of routine formation, it is found that consistent application of short-run first-best optimal congestion pricing does not optimally decentralize the optimal formation of routines in the long-run problem. A separate instrument, next to road pricing, is therefore needed to optimize routine formation.