Early-generation Systems Research Articles

Anatomical Changes after Transcatheter Edge-to-Edge Repair in Functional MR According to MitraClip Generation.

The use of mitral transcatheter edge-to-edge repair (TEER) is rapidly increasing. Anatomical changes have been described after TEER with the MitraClip system in patients with functional mitral regurgitation (MR), although no study has yet evaluated such anatomical impacts in patients treated with the G4 MitraClip generation. This research constituted a prospective, single-center, observational study including consecutive patients with functional MR. Mitral three-dimensional images were obtained transesophageally with echocardiography before and immediately after TEER. Patients receiving the late-generation (G4) system were compared to those receiving early-generation systems. A total of 116 functional MR patients were evaluated, and 40 (34.5%) and 76 (65.5%) received a late-generation (G4) or early-generation device system, respectively. The baseline clinical and echocardiographic features were well-balanced between the groups. Overall, there was a significant reduction in mitral annular size after the intervention, and greater reductions in the anteroposterior diameter (4 mm vs. 3.54 mm, p = 0.03), annular perimeter (11.07 mm vs. 5.29 mm for 3D-perimeter, p = 0.001), and annular area (1.29 cm2 vs. 1.03 cm2, p = 0.002) were found for patients receiving the late G4 device generation compared to the early-generation systems. In patients with functional MR, we observed significant changes in mitral valve anatomy with a reduction in anteroposterior diameter, valve perimeter, and area. In our cohort, the extent of those changes was greater with the use of the new-generation G4 MitraClip system compared to prior device generations.

Improving the Clinical Value and Utility of CGM Systems: Issues and Recommendations: A Joint Statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group.

The first systems for continuous glucose monitoring (CGM) became available over 15 years ago. Many then believed CGM would revolutionize the use of intensive insulin therapy in diabetes; however, progress toward that vision has been gradual. Although increasing, the proportion of individuals using CGM rather than conventional systems for self-monitoring of blood glucose on a daily basis is still low in most parts of the world. Barriers to uptake include cost, measurement reliability (particularly with earlier-generation systems), human factors issues, lack of a standardized format for displaying results, and uncertainty on how best to use CGM data to make therapeutic decisions. This Scientific Statement makes recommendations for systemic improvements in clinical use and regulatory (pre- and postmarketing) handling of CGM devices. The aim is to improve safety and efficacy in order to support the advancement of the technology in achieving its potential to improve quality of life and health outcomes for more people with diabetes.

Improving the clinical value and utility of CGM systems: issues and recommendations : A joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group.

The first systems for continuous glucose monitoring (CGM) became available over 15years ago. Many then believed CGM would revolutionise the use of intensive insulin therapy in diabetes; however, progress towards that vision has been gradual. Although increasing, the proportion of individuals using CGM rather than conventional systems for self-monitoring of blood glucose on a daily basis is still low in most parts of the world. Barriers to uptake include cost, measurement reliability (particularly with earlier-generation systems), human factors issues, lack of a standardised format for displaying results and uncertainty on how best to use CGM data to make therapeutic decisions. This scientific statement makes recommendations for systemic improvements in clinical use and regulatory (pre- and postmarketing) handling of CGM devices. The aim is to improve safety and efficacy in order to support the advancement of the technology in achieving its potential to improve quality of life and health outcomes for more people with diabetes.

Third-generation megahertz-rate pulse burst laser system

The design and performance of a third-generation megahertz-rate pulse burst laser system is described. The third-generation system incorporates two distinct design changes that distinguish it from earlier-generation systems. The first is that pulse slicing is now achieved by using an economical acousto-optic modulator (AOM), and the second is the use of a variable pulse duration flashlamp driver that provides relatively uniform gain over a ~700 mus window. The use of an AOM for pulse slicing permits flexible operation such as pulse-on-demand operation with variable pulse durations ranging from 10 ns to DC. The laser described here is capable of producing a burst of laser pulses at repetition rates as high as 50 MHz and peak powers of 10 kW. Second-harmonic conversion efficiency using a type II KTP crystal is also demonstrated.

Wireless Location Technology–Based Traffic Monitoring

There has been a growing interest in using anonymous tracking of wireless devices as a way to generate travel time and operational data cost-effectively. Unfortunately, there are relatively few independent quantitative evaluations of these systems. Evaluations that do exist are often not widely available, so agencies often enter into deployment agreements with a limited understanding of the abilities and limitations of this technology. This paper provides an overview of the results of past deployments of wireless probe monitoring systems. It also discusses a simulation study of the predominant type of system on the market today, handoff-based monitoring systems. Past deployments show that early-generation systems encountered significant problems in generating accurate speed estimates. More recent tests using handoff-based technology have shown improvement in data quality at some sites, but there are not enough data to characterize fully whether those systems can consistently provide useful operational data. The simulation study indicates that the way in which the cellular network topology overlays the roadway network could be a critical determinant of overall system effectiveness. Simulation results indicate that often with simulated handoff-based systems speeds can be estimated to within 5 mph.

Unconventional shallow biogenic gas systems

Unconventional shallow biogenic gas falls into two distinct systems that have different attributes. Early-generation systems have blanketlike geometries, and gas generation begins soon after deposition of reservoir and source rocks. Late-generation systems have ringlike geometries, and long time intervals separate deposition of reservoir and source rocks from gas generation. For both types of systems, the gas is dominantly methane and is associated with source rocks that are not thermally mature. Early-generation biogenic gas systems are typified by production from low-permeability Cretaceous rocks in the northern Great Plains of Alberta, Saskatchewan, and Montana. The main area of production is on the southeastern margin of the Alberta basin and the northwestern margin of the Williston basin. The huge volume of Cretaceous rocks has a generalized regional pattern of thick, nonmarine, coarse clastics to the west and thinner, finer grained marine lithologies to the east. Reservoir rocks in the lower part tend to be finer grained and have lower porosity and permeability than those in the upper part. Similarly, source beds in the lower units have higher values of total organic carbon. Patterns of erosion, deposition, deformation, and production in both the upper and lower units are related to the geometry of lineament-bounded basement blocks. Geochemical studies show that gas and coproduced water are in equilibrium and that the fluids are relatively old, namely, as much as 66 Ma. Other examples of early-generation systems include Cretaceous clastic reservoirs on the southwestern margin of Williston basin and chalks on the eastern margin of the Denver basin. Late-generation biogenic gas systems have as an archetype the Devonian Antrim Shale on the northern margin of the Michigan basin. Reservoir rocks are fractured, organic-rich black shales that also serve as source rocks. Although fractures are important for production, the relationships to specific geologic structures are not clear. Large quantities of water are coproduced with the gas, and geochemical data indicate that the water is fairly fresh and relatively young. Current thinking holds that biogenic gas was generated, and perhaps continues to be, when glacial meltwater descended into the plumbing system provided by fractures. Other examples of late-generation systems include the Devonian New Albany Shale on the eastern margin of the Illinois basin and the Tertiary coalbed methane production on the northwestern margin of the Powder River basin. Both types of biogenic gas systems have a similar resource development history. Initially, little technology is used, and gas is consumed locally; eventually, sweet spots are exploited, widespread unconventional reservoirs are developed, and transport of gas is interstate or international. However, drilling and completion techniques are very different between the two types of systems. Early-generation systems have water-sensitive reservoir rocks, and consequently water is avoided or minimized in drilling and completion. In contrast, water is an important constituent of late-generation systems; gas production is closely tied to dewatering the system during production. Existing production and resource estimates generally range from 10 to 100 tcf for both types of biogenic gas systems. Although both system types are examples of relatively continuous accumulations, the geologic frameworks constrain most-economic production to large geologic structures on the margins of basins. Shallow biogenic gas systems hold important resources to meet the increased domestic and international demands for natural gas.

Transvenous Endocardial Cardioverter Defibrillator Systems

The development of nonthoracotomy lead systems for the implantable cardioverter defibrillator has ushered in a new era in the field of device therapy for malignant ventricular tachyarrhythmias. Surgical mortality and morbidity are thus significantly reduced, the hospital stay is shortened, and the cost of such therapy is lowered. Although several problems (mainly lead related) were initially encountered with earlier-generation systems, improvements have made this less invasive method of defibrillator therapy an attractive alternative to conventional epicardial implants. It is rapidly becoming a first-choice approach in the treatment of malignant ventricular tachyarrhythmias. Transvenous leads were used in combination with a subcutaneous patch for effective defibrillation in the majority of patients, according to most published reports, while the number of "transvenous only" systems being implanted has been steadily increasing. A description of currently available nonthoracotomy lead defibrillator systems and a discussion of the clinical results, advantages, and limitations of their use are presented herein.

Zbigniew L. Pankowicz: An appreciation

In the sad passing of Zbigniew (Ziggy) Pankowicz, many will mourn the loss of a real pioneer in the field of machine trans lation. The world of MT today has moved well beyond the early-generation systems he fostered in his capacity as U.S. Government Technical Expert in matters MT. But wherever this world of MT takes itself, it will always, I think, remain in his debt. Ziggy was not a progenitor but he fos tered, encouraged, and funded many of the important activities of this field in the U.S., from the early sixties to the mid-seventies. He collaborated with everyone, from Leh mann in Texas to Vauquois in Grenoble. I've seen letters on his desk from the Bun dessprachenamt, from Tanke of Siemens, from the Leibniz committee regarding forthcoming meetings, and so on. His reach was impressive. And virtually the entire world of MT at one time or another paid Ziggy their respects at his humble back water office in the Rome Air Development Center in Rome, NY (not an easy place to get to!). It was a ritual act especially for anyone hoping for government funding. People came with proposals in hand, and Ziggy, donning his heavy black-rimmed glasses, with characteristic squint, would start thumbing the pages. If it looked inter esting, dinner would follow. If that went well, it would lead to after-dinner drinks and probably to nightcaps in the wee hours, trading war stories, MT gossip, and political jokes in about equal measure. Ziggy was a Polish nobleman, a young cavalry officer who led a charge against a machine gun emplacement and survived to fight in the underground, who wound up in both Auschwitz and Buchenwald and who in later life showed the tattoo on his arm with a strange lack of bitterness. He was in the full Kierkegaardian sense of the word a 'solitary man'. He lived alone and few truly knew him. All, however, respected him and enjoyed him and will surely remember him with the utmost fondness for his precise scholarly manner, his scrupulosity (he al ways paid for the dinner), his tireless supply of jokes, his basic decency. He was a man many will mourn, because without him the SYSTRANs, the METALs, the LOGOS' most probably would not be around today. Especially we at LOGOS. May God rest his soul!