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morning everybody I think that started where people will come so thanks for coming we are lucky today to have dr. Daniel Sims Vermontamp;#39;s jours of dr. Sims is an associate professor of medicine and must for medical center malumat College of Medicine dr. Sims did his meds rule and residency at Emory did his cardiology fellowship at Columbia include his advanced department transmitted out certain advanced heart failure training there as well understand now is medical director of the cardiac intensive care unit at Montefiore and as a member of the cardiac transplants LVAD team dr. Sims now research focuses in heart failure shock LVAD and itamp;#39;s here to talk about an updated thank you very much appreciate it itamp;#39;s really a great to be here today thank you all for being youamp;#39;re early so disclosure is on the Mets fan which if you work in the Bronx that actually is a big disclosure to be immense man and not ent fan otherwise that no disclosures so objectives today I