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Background: Clarity about indications and techniques in extracorporeal life support (ECLS) in trauma is essential for timely and effective deployment, and to ensure good stewardship of an important resource. Extracorporeal life support deployments in a tertiary trauma center were reviewed to understand the indications, strategies, and tactics of ECLS in trauma., Methods: The provincial trauma registry was used to identify patients who received ECLS at a Level I trauma center and ECLS organization-accredited site between January 2014 and February 2021. Charts were reviewed for indications, technical factors, and outcomes following ECLS deployment. Based on this data, consensus around indications and techniques for ECLS in trauma was reached and refined by a multidisciplinary team discussion., Results: A total of 25 patients underwent ECLS as part of a comprehensive trauma resuscitation strategy. Eighteen patients underwent venovenous ECLS and seven received venoarterial ECLS. Nineteen patients survived the ECLS run, of which 15 survived to discharge. Four patients developed vascular injuries secondary to cannula insertion while four patients developed circuit clots. On multidisciplinary consensus, three broad indications for ECLS and their respective techniques were described: gas exchange for lung injury, extended damage control for severe injuries associated with the lethal triad, and circulatory support for cardiogenic shock or hypothermia., Conclusion: The three broad indications for ECLS in trauma (gas exchange, extended damage control and circulatory support) require specific advanced planning and standardization of corresponding techniques (cannulation, circuit configuration, anticoagulation, and duration). When appropriately and effectively integrated into the trauma response, ECLS can extend the damage control paradigm to enable the management of complex multisystem injuries., Level of Evidence: Therapeutic/Care Management; Level IV., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Continuous monitoring of left ventricular stroke work (LVSW) may improve the medical management of patients with rotary left ventricular assist devices (LVAD). However, implantable pressure-volume sensors are limited by measurement drift and hemocompatibility. Instead, estimator algorithms derived from rotary LVAD signals may be a suitable alternative. An LVSW estimator algorithm was developed and evaluated in a range of in vitro and ex vivo cardiovascular conditions during full assist (closed aortic valve [AoV]) and partial assist (opening AoV) mode. For full assist, the LVSW estimator algorithm was based on LVAD flow, speed, and pump pressure head, whereas for partial assist, the LVSW estimator combined the full assist algorithm with an estimate of AoV flow. During full assist, the LVSW estimator demonstrated a good fit in vitro and ex vivo (R 2 : 0.97 and 0.86, respectively) with errors of ± 0.07 J. However, LVSW estimator performance was reduced during partial assist, with in vitro : R 2 : 0.88 and an error of ± 0.16 J and ex vivo : R 2 : 0.48 with errors of ± 0.11 J. Further investigations are required to improve the LVSW estimate with partial assist; however, this study demonstrated promising results for a continuous estimate of LVSW for rotary LVADs., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © ASAIO 2023.)

Purpose: Mammography, breast ultrasound (US), and US-guided breast biopsy are essential services for breast cancer early detection and diagnosis. This study undertook a comprehensive evaluation to determine population-level access to these services for breast cancer early detection and diagnosis in Nigeria using a previously validated geographic information system (GIS) model., Methods: A comprehensive list of public and private facilities offering mammography, breast US, and US-guided breast biopsy was compiled using publicly available facility data and a survey administered nationally to Nigerian radiologists. All facilities were geolocated. A cost-distance model using open-source population density (GeoData Institute) and road network data (OpenStreetMap) was used to estimate population-level travel time to the nearest facility for mammography, breast US, and US-guided biopsy using GIS software (ArcMAP)., Results: In total, 1,336 facilities in Nigeria provide breast US, of which 47.8% (639 of 1,336) are public facilities, and 218 provide mammography, of which 45.4% (99 of 218) are public facilities. Of the facilities that provide breast US, only 2.5% (33 of 1,336) also provide US-guided breast biopsy. At the national level, 83.1% have access to either US or mammography and 61.7% have access to US-guided breast biopsy within 120 minutes of a continuous one-way travel. There are differences in access to mammography (64.8% v 80.6% with access at 120 minutes) and US-guided breast biopsy (49.0% v 77.1% with access at 120 minutes) between the northern and southern Nigeria and between geopolitical zones., Conclusion: To our knowledge, this is the first comprehensive evaluation of breast cancer detection and diagnostic services in Nigeria, which demonstrates geospatial inequalities in access to mammography and US-guided biopsy. Targeted investment is needed to improve access to these essential cancer care services in the northern region and the North East geopolitical zone.

Background: Centralization of vascular surgery care for Ruptured Abdominal Aortic Aneurysms (RAAAs) to high-volume tertiary centers may hinder access to timely surgical intervention for patients in remote areas. The objective of this study was to determine the association between distance from vascular care and mortality from RAAAs in the province of Nova Scotia, Canada., Methods: A retrospective cohort study of all RAAAs in Nova Scotia between 2005 and 2015 was performed through linkage of administrative databases. Patients were divided into groups by estimated travel time from their place of residence to the tertiary center (<1 hr and ≥1 hr) using geographic information software. Baseline and operative characteristics were identified for all patients through available databases and completed through chart review. Mortality at home, during transfer to the vascular center, and overall 30-day mortality were compared between groups using t-test and chi-squared test, as appropriate. Multivariable logistic regression analysis was used to calculate the independent effect of travel time on survival outcomes., Results: A total of 567 patients with RAAA were identified from 2005-2015, of which 250 (44%) resided <1 hr travel time to the tertiary center and 317 (56%) resided ≥1 hr. On multivariable analysis, travel time ≥1 hr from vascular care was an independent predictor of mortality at home (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.07-2.63, P = 0.02), mortality prior to operation (OR 2.64, 95% CI 1.81-3.83, P < 0.001), and overall 30-day mortality (OR 1.61, 95% CI 1.10-2.37, P = 0.02). In patients who received an operation (n = 294), there was no association between increased travel time and mortality (OR 1.02, 95% CI 0.60-1.73, P = 0.94)., Conclusions: Travel time ≥1 hr to the tertiary center is associated with significantly higher mortality from ruptured abdominal aortic aneurysm (AAA). However, there was no difference in overall chance of survival between groups for patients that underwent AAA repair. Therefore, strategies to facilitate early detection, and timely transfer to a vascular surgery center may improve outcomes for patients with RAAA., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: Firearm-related trauma is a significant cause of preventable mortality. In 2020, Nova Scotia experienced the largest mass shooting in Canadian history. The objective of this study was to describe the epidemiology of firearm-related injury and death in Nova Scotia and to assess for factors associated with mortality., Methods: A retrospective observational study of all major trauma patients in Nova Scotia who sustained firearm-related injuries between 2001 and 2020 was conducted. Data was collected from the Nova Scotia Trauma Registry and the Nova Scotia Medical Examiner Service. Injury rates were evaluated over time, by age/sex, and by intent (assault/homicide, self-harm, other), and were mapped by municipality. Characteristics of survivors and non-survivors were compared using t-tests and chi-square analysis. A multivariate logistic regression model was created to assess for predictors of mortality., Results: A total of 776 firearm-related injuries occurred over the 19-year study period, for an overall age- and sex-adjusted firearm injury rate of 4.44 per 100,000 population. Patients ranged in age from 6 to 92 years (mean 45.0±19.2 years) and most were male (95.6%; 742/776). Injuries were predominantly self-inflicted (65%; 504/776). The majority of patients died from their injuries (72%; 558/776); 64% (497/776) died at the scene. The overall age- and sex-adjusted firearm mortality rate was 3.18 per 100,000. Most non-survivors had injuries that were self-inflicted (83.2%; 464/558). Increasing age (OR 1.02, 95% CI 1.00-1.04) and increasing Injury Severity Score (OR 1.11, 95% CI 1.07-1.15) were associated with greater likelihood of mortality. Activation of the trauma team was associated with survival (OR 0.04, 95% CI 0.02-0.10)., Conclusion: Trauma patients with firearm-related injuries were predominantly male and most injuries were self-inflicted among middle-aged to older patients. Younger patients tended to be victims of homicide/assault and were more likely to survive their injuries., Competing Interests: Conflicts of Interest The authors declare they have no conflicts of interest, financial or otherwise., (Copyright © 2022. Published by Elsevier Ltd.)

Background: Cardiac arrhythmias in exercising horses are the focus of much interest, both in terms of what is considered normal and potential associations with poor performance and sudden cardiac death. One barrier to performing large-scale studies is the lack of an easily applicable device, to allow recording of large numbers of high-quality exercising electrocardiograms (ECGs). The Equimetre TM is a new wearable device which records a single lead ECG, amongst other parameters. Validation of such wearable devices is essential before further studies are undertaken., Objectives: To evaluate the quality of ECG using the Equimetre TM and compare arrhythmia detection during exercise with the reference Televet TM system., Study Design: Prospective blinded clinical study., Methods: Simultaneous ECGs were recorded with both systems in 49 healthy horses during exercise. High intensity exercise (>40km/h) was performed by 29 racehorses, and lower intensity exercise for the remainder of the racehorses and show jumpers. Tracings were excluded if >10% artefact was present (duration of artefact relative to duration of exercise). For included ECGs, the duration of artefact was recorded and compared. ECGs were evaluated using Kubios premium software. Arrhythmia detection (yes/no) and arrhythmia classification (sinus arrhythmia, narrow complex of similar morphology to the sinus complexes or wide complex with a different morphology) were compared using Cohen's Kappa coefficient., Results: Nine Televet TM ECGs and 3 Equimetre TM ECGs were excluded due to artefact >10%. Televet TM ECGs included significantly more artefact during exercise than Equimetre TM ECGs (5% vs. 0.25% p<0.001). Arrhythmia analysis was performed on 38 horses' paired ECGs. The Kappa coefficient was excellent for arrhythmia detection (K=0.97) and arrhythmia classification (K=0.93)., Main Limitations: Relatively low numbers of horses with arrhythmias (n=21) were included. The ECG recordings only provided one lead, making arrhythmia classification challenging in some cases., Conclusions: The Equimetre device provides a reliable ECG for arrhythmia detection during exercise. This system may be useful clinically and for future large-scale investigations into the occurrence and significance of exercising arrhythmias., (This article is protected by copyright. All rights reserved.)

Objective: To examine the degree to which neighborhood socioeconomic deprivation influences the risk of youth assault injury., Study Design: Population-based retrospective study of youth aged 10-24 years seeking emergency medical care between 2012 and 2019 at 14 hospitals in Vancouver, Canada. Neighborhood material and social deprivation were examined as independent predictors of assault injury, accounting for spatial autocorrelation and controlling for neighborhood drinking establishment density., Results: Our data included 4166 assault injuries among 3817 youth. Male sex, substance use, and mental health disorders were common among victims of assault. Relative to the least deprived quintile of neighborhoods, assault injury risk was 2-fold higher in the most materially deprived quintile of neighborhoods (incidence rate ratio per quintile increase, 1.17; 95% CI 1.06-1.30; P < .05), and risk in the most socially deprived quintile was more than 3-fold greater than in the least deprived quintile (incidence rate ratio per quintile increase, 1.35; 95% CI 1.21-1.50; P < .001). Assault risk was 147-fold greater between 2 and 3 AM on Saturday relative to the safest hours of the week., Conclusions: Neighborhood socioeconomic deprivation substantially increases the risk of youth assault injury. Youth violence prevention efforts should target socioeconomically deprived neighborhoods., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Production of bonded permanent magnets (PMs) by processing a mixture of neodymium-iron-boron (Nd-Fe-B) (spherical and flake) and polyamide-12 powders using selective laser sintering (SLS) has focused on increasing the magnetic powder loading fraction to improve the magnetic performance of PMs. However, when using SLS to produce PMs from mixed feedstock, the likelihood of the areas between the magnetic particles being infiltrated by the liquefied binder inducing particle bonding is reduced as binder content is reduced. This decreases mechanical strength and introduces upper limits to the attainable loading fraction of the magnetic powder. The present study investigated the mechanical properties and provided an insight into the residual induction, of loading fractions between 10% and 90% of spherical and flake powders when producing PMs using SLS. The maximum attainable loading fractions were 80%/vol and 70%/vol for the flake and spherical powders, respectively. The PMs produced from the flakes reached a maximum density and residual induction at 50%/vol loading fraction. The PMs produced from spherical powder reached maximum density and residual induction at 70%/vol loading fraction; however, a knee point at 30%/vol loading fraction demonstrated only minor improvements to density (8.8%) and residual induction (13.4%) with further increases in loading fraction. Although PMs produced from flakes demonstrated superior mechanical properties, the elastic modulus and strain limit rapidly decreased with increases in powder loading fraction for both powder types. This study demonstrated the application-specific balance between mechanical and magnetic strength that must be considered when producing PMs by using SLS., Competing Interests: No competing financial interests exist., (Copyright 2021, Mary Ann Liebert, Inc., publishers.)

Purpose: Rotary blood pumps (RBPs) employed as ventricular assist devices are developed to support the ventricles of patients suffering from heart failure. Computational Fluid Dynamics (CFD) is frequently used to predict the performance and haemocompatibility of these pumps during development, however different simulation techniques employed by various research groups result in inconsistent predictions. This inconsistency is further compounded by the lack of standardised model validation, thus it is difficult to determine which simulation techniques are accurate. To address these problems, the US Food and Drug Administration (FDA) proposed a simplified centrifugal RBP benchmark model. The aim of this paper was to determine simulation settings capable of producing accurate predictions using the published FDA results for validation., Methods: This paper considers several studies to investigate the impact of simulation options on the prediction of pressure and flow velocities. These included evaluation of the mesh density and interface position through steady simulations as well as time step size and turbulence models (k-ε realizable, k-ω SST, k-ω SST Intermittency, RSM ω-based, SAS and SBES) using a sliding mesh approach., Results: The most accurate steady simulation using the k-ω turbulence model predicted the pressure to within 5% of experimental results, however experienced issues with unphysical velocity fields. A more computationally expensive transient simulation that used the Stress-Blended Eddy Simulation (SBES) turbulence model provided a more accurate prediction of the velocity field and pressure rise to within experimental variation., Conclusion: The findings of the study strongly suggest that SBES can be used to better predict RBP performance in the early development phase.

Background: The majority of women in Nigeria present with advanced-stage breast cancer. To address the role of geospatial access, we constructed a geographic information-system-based model to evaluate the relationship between modeled travel time, stage at presentation, and overall survival among patients with breast cancer in Nigeria., Methods: Consecutive patients were identified from a single-institution, prospective breast cancer database (May 2009-January 2019). Patients were geographically located, and travel time to the hospital was generated using a cost-distance model that utilized open-source data. The relationships between travel time, stage at presentation, and overall survival were evaluated with logistic regression and survival analyses. Models were adjusted for age, level of education, and socioeconomic status., Results: From 635 patients, 609 were successfully geographically located. The median age of the cohort was 49 years (interquartile range [IQR], 40-58 years); 84% presented with ≥stage III disease. Overall, 46.5% underwent surgery; 70.8% received systemic chemotherapy. The median estimated travel time for the cohort was 45 minutes (IQR, 7.9-79.3 minutes). Patients in the highest travel-time quintile had a 2.8-fold increase in the odds of presenting with stage III or IV disease relative to patients in the lowest travel-time quintile (P = .006). Travel time ≥30 minutes was associated with an increased risk of death (HR, 1.65; P = .004)., Conclusions: Geospatial access to a tertiary care facility is independently associated with stage at presentation and overall survival among patients with breast cancer in Nigeria. Addressing disparities in access will be essential to ensure the development of an equitable health policy., (© 2020 American Cancer Society.)

Design methods for large industrial pumps are well developed, but they cannot be relied upon when designing specialised miniature pumps, due to scaling issues. Therefore, the design and development phase of small pumps demand numerous experimental tests to ensure a viable prototype. Of initial interest is hydraulic design in the form of pump performance and efficiency curves. This project aimed to produce an automated test rig capable of generating both the performance (P-Q - pressure vs. flow rate) and efficiency curves that are reliable and repeatable. The apparatus is largely customizable and suitable for a range of smaller pump sizes. The pump impeller and volute were 3D printed, allowing for design flexibility and rapid prototyping and testing. The test loop was automated which allowed the flow rate to be incremented from 0 L/min to the maximum flow rate. At each step the pressure, flow rate, voltage and current were recorded to generate the P - Q and efficiency curves. Repeatability results showed low variations of ±3 mmHg (400 Pa) in pressure and ± 2% in hydraulic efficiency. The given setup can be used to compare and evaluate the hydraulic performance of various pump designs., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Author(s).)

Purpose: The left atrium and left ventricle are the primary inflow cannulation sites for heart failure patients supported by rotary blood pumps (RBPs). Haemodynamic differences exist between inflow cannulation sites and have been well characterized at rest, yet the effect during exercise with the same centrifugal RBP has not been previously well established. The purpose of this study was to investigate the hemodynamic effect of inflow cannulation site during rest and exercise with the same centrifugal RBP., Methods: In a numerical cardiorespiratory model, a simulated heart failure patient was supported by a HeartWare HVAD RBP in left atrial (LAC) and left ventricular cannulation (LVC). The RBP was operated at constant speed and sinusoidal co- and counter-pulse and was investigated in cardiovascular conditions of steady state rest and 80-watt bike graded exercise., Results: Cardiac output was 5.0 L min -1 during rest and greater than 6.9 L min -1 during exercise for all inflow cannulation sites and speed operating modes. However, during exercise, LAC demonstrated greater pressure-volume area and lower RBP flow (1.41, 1.37 and 1.37 J and 5.03, 5.12 and 5.03 L min -1 for constant speed and co- and counter-pulse respectively) when compared to LVC (pressure-volume area: 1.30, 1.27 and 1.32 J and RBP flow: 5.56, 5.71 and 5.59 L min -1 for constant speed and co- and counter-pulse respectively)., Conclusion: For a simulated heart failure patient intending to complete exercise, LVC seems to assure a better hemodynamic performance in terms of pressure-volume area unloading and increasing RBP flow.

Due to manufacturer implemented processing parameter restrictions and the cost prohibitive nature of selective laser sintering (SLS) machines, researchers have limited opportunities to explore the processing of new materials using this additive manufacturing (3D printing) process. Accordingly, this article aimed to overcome these limitations by describing the build and operation of a customizable low-cost polymer SLS machine. The machine boasts a three piston powder bed with the center build piston heated by PID controlled ceramic heaters. Thermal energy for powder consolidation was provided via a 2.44 W solid state diode laser which was mechanically traversed using stepper motor driven belt drives. New layers of powder were deposited by a counter-rotating roller system. The SLS machine was controlled by executing G-code in Mach3 allowing full customization of processing parameters. The machine demonstrated the production of parts from polyamide-12 reaching densities of 918 ± 9 kg/m 3 while achieving an elastic modulus of 358.36 ± 3.04 MPa and elongation at break of 11.13 ± 0.02%. With part properties similar to those achievable with a commercial machine, this low-cost SLS machine could be a vital tool in assisting researchers to explore the processing of new materials., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Author(s).)

Controlled and repeatable in vitro evaluation of cardiovascular devices using a mock circulation loop (MCL) is essential prior to in vivo or clinical trials. MCLs often consist of only a systemic circulation with no autoregulatory responses and limited validation. This study aimed to develop, and validate against human data, an advanced MCL with systemic, pulmonary, cerebral, and coronary circulations with autoregulatory responses. The biventricular MCL was constructed with pneumatically controlled hydraulic circulations with Starling responsive ventricles and autoregulatory cerebral and coronary circulations. Hemodynamic repeatability was assessed and complemented by validation using impedance cardiography data from 50 healthy humans. The MCL successfully simulated patient scenarios including rest, exercise, and left heart failure with and without cardiovascular device support. End-systolic pressure-volume relationships for respective healthy and heart failure conditions had slopes of 1.27 and 0.54 mm Hg mL -1 (left ventricle), and 0.18 and 0.10 mm Hg mL -1 (right ventricle), aligning with the literature. Coronary and cerebral autoregulation showed a strong correlation (R 2 : .99) between theoretical and experimentally derived circuit flow. MCL repeatability was demonstrated with correlation coefficients being statistically significant (P < .05) for all simulated conditions while MCL hemodynamics aligned well with human data. This advanced MCL is a valuable tool for inexpensive and controlled evaluation of cardiovascular devices., (© 2020 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

Due to improved durability and survival rates, rotary blood pumps (RBPs) are the preferred left ventricular assist device when compared to volume displacement pumps. However, when operated at constant speed, RBPs lack a volume balancing mechanism which may result in left ventricular suction and suboptimal ventricular unloading. Starling-like controllers have previously been developed to balance circulatory volumes; however, they do not consider ventricular workload as a feedback and may have limited sensitivity to adjust RBP workload when ventricular function deteriorates or improves. To address this, we aimed to develop a Starling-like total work controller (SL-TWC) that matched the energy output of a healthy heart by adjusting RBP hydraulic work based on measured left ventricular stroke work and ventricular preload. In a mock circulatory loop, the SL-TWC was evaluated using a HeartWare HVAD in a range of simulated patient conditions. These conditions included changes in systemic hypertension and hypotension, pulmonary hypertension, blood circulatory volume, exercise, and improvement and deterioration of ventricular function by increasing and decreasing ventricular contractility. The SL-TWC was compared to constant speed control where RBP speed was set to restore cardiac output to 5.0 L/min at rest. Left ventricular suction occurred with constant speed control during pulmonary hypertension but was prevented with the SL-TWC. During simulated exercise, the SL-TWC demonstrated reduced LVSW (0.51 J) and greater RBP flow (9.2 L/min) compared to constant speed control (LVSW: 0.74 J and RBP flow: 6.4 L/min). In instances of increased ventricular contractility, the SL-TWC reduced RBP hydraulic work while maintaining cardiac output similar to the rest condition. In comparison, constant speed overworked and increased cardiac output. The SL-TWC balanced circulatory volumes by mimicking the Starling mechanism, while also considering changes in ventricular workload. Compared to constant speed control, the SL-TWC may reduce complications associated with volume imbalances, adapt to changes in ventricular function and improve patient quality of life., (© 2019 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

The potential of peripheral nerves to regenerate under the effect of axial tensile forces was not previously extensively explored due to the lack of capabilities of translating ex vivo axonal stretch-growth to in vivo studies, until the development of a nerve stretcher . The nerve stretcher , which we have designed and manufactured recently, is a device that uses a controlled amount of axial tensile force (vacuum/negative gauge pressure) applied directly to a sectioned peripheral nerve in vivo to expedite nerve regrowth rate. Using this platform, a series of experiments was carried out to observe the effect of in vivo axial stretch on axonal lengthening. During these experiments, a few challenges necessitated redesigning the device like a sudden loss of stretching force due to vacuum leakage, erroneous feedback from vacuum sensor due to sensor drift, and inability to control and operate the device remotely. Here we present an improved design of the nerve stretcher along with its integration with a state-of-the-art online vacuum monitoring facility to control, collect, process, and visualize negative gauge pressure data in real-time., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Author(s).)

Rotary ventricular assist devices (VADs) operated clinically under constant speed control (CSC) cannot respond adequately to changes in patient cardiac demand, resulting in sub-optimal VAD flow regulation. Starling-like control (SLC) of VADs mimics the healthy ventricular flow regulation and automatically adjusts VAD speed to meet varying patient cardiac demand. The use of a fixed control line (CL - the relationship between ventricular preload and VAD flow) limits the flow regulating capability of the controller, especially in the case of exercise. Adaptive SLC (ASLC) overcomes this limitation by allowing the controller to adapt the CL to meet a diverse range of circulatory conditions. This study evaluated ASLC, SLC and CSC in a biventricular supported mock circulation loop under the simulated conditions of exercise, sleep, fluid loading and systemic hypertension. Each controller was evaluated on its ability to remain within predefined limits of VAD flow, preload, and afterload. The ASLC produced superior cardiac output (CO) during exercise (10.1 L/min) compared to SLC (7.3 L/min) and CSC (6.3 L/min). The ASLC produced favourable haemodynamics during sleep, fluid loading and systemic hypertension and could remain within a predefined haemodynamic range in three out of four simulations, suggesting improved haemodynamic performance over SLC and CSC., (© 2019 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)