Results of staged reconstruction for hypoplasia of the left heart: an experience of 12 years from one institution

2003 ◽  
Vol 13 (6) ◽  
pp. 509-518 ◽  
Author(s):  
Wolf-Ruediger Thies ◽  
Thomas Breymann ◽  
Dietmar Boethig ◽  
Ute Blanz ◽  
Hans Meyer ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Fontan Procedure ◽  
Fontan Circulation ◽  
Left Heart ◽  
Second Stage ◽  
The Third ◽  
Third Stage ◽  
Staged Reconstruction ◽  
The Impact ◽  
Standard Risk

Background:We reviewed our 12-year experience with staged reconstruction for hypoplasia of the left heart, examining the results of each surgical step and the impact of the year of the Norwood operation on survival. We compared survival of patients with hypoplasia of the left heart subsequent to completion of the Fontan circulation to survival of patients with a dominant left ventricle undergoing a Fontan procedure.Patients:Between 1989 and 2001, we performed a first stage procedure in 89 patients. Their median age was 9 days, with a range from 2 to 140 days, and the median weight was 3.4 kg, with a range from 2.4 to 5.4 kg.Results:Survival at 1, 4, and 10 years was 55%, 49%, and 49%, respectively. We experienced 23 early deaths (26%), and 12 deaths between the stages of the Norwood cascade. Of our patients, 42 underwent the second stage, and 30 the third stage. Prior to the first stage, symptoms of necrotising enterocolitis, and of obstructed pulmonary venous return, influenced survival significantly. The latter was eliminated as risk factor when surgery was performed within the first week of life. During the later part of our experience, survival at the first stage operation improved significantly, with survival at 3 years increasing from 42% to 75% for the patients at standard-risk (p = 0.017), and from 17% to 42% for those deemed to be at high-risk (p = 0.1). No deaths occurred in 23 patients older than 3 years of age, all of whom had proceeded through the third stage. After completion of the Fontan circulation, the survival of the patients with hypoplasia of the left heart at 4 years was comparable to the survival of patients undergoing the Fontan procedure with a dominant left ventricle (88% versus 90%, p = 0.8).Conclusions:Early and intermediate survival has improved significantly over the period of 12 years. Late death has been uncommon, and none of our patients are listed for cardiac transplantation.

scholarly journals Expert Approach Methodology as Basis for Sailing Boat Outfitting Improvement – Case Study

2018 ◽  
Vol 2 (Special edition 2) ◽  
pp. 155-166
Author(s):  
Tin Matulja ◽  
Marko Hadjina
Keyword(s):  
Methodological Approach ◽  
Optimal Solution ◽  
Cfd Analysis ◽  
Fourth Stage ◽  
Second Stage ◽  
The Third ◽  
Third Stage ◽  
The Impact ◽  
Sailing Boat

The market conditions demanded the adaptation of exclusively touristic sailing yachts to specific race requirements. The hydrodynamic aspects of this problem have been successfully solved using modern tools for CFD analysis. But, the practical aspects of outfitting such vessels to meet the highest tourist requirements while respecting specific racing requirements for deck equipment required a different methodological approach. In fulfilling these requirements, the author indirectly participates in multi-year cooperation with the prominent European manufacturer of sailboats. For the purpose of cooperation, a special methodology was developed for the improvement of the equipment of the defined sailing boat in four stages. In the first stage, an analysis of the impact of sailing equipment and deck configuration of the existing B40S model on sailing performance is suggested using RaceQs computing application and expert approaches for different sea and wind conditions. In the second stage, the analysis of the collected data is carried out by expert approach towards guidelines for improvement. The third stage impacts on redesigning the existing model by implementing the obtained results. In the fourth stage, the effects on the upgraded new B41S model are analyzed repeating the first stage. The methodology is iterative and converges to the optimal solution for the defined criteria.

scholarly journals The impact of the temperature of rapeseed oil methyl esters on nitrogen oxides emissions

2020 ◽  
Vol 171 ◽  
pp. 01002
Author(s):  
Weronika Gracz ◽  
Mirosław Czechlowski ◽  
Damian Marcinkowski ◽  
Wojciech Golimowski ◽  
Patrycja Pochwatka
Keyword(s):  
Nitrogen Oxides ◽  
Rapeseed Oil ◽  
Power Grid ◽  
Methyl Esters ◽  
Second Stage ◽  
The Third ◽  
Maximum Value ◽  
Third Stage ◽  
The Impact ◽  
Rapeseed Oil Methyl Esters

The purpose of the tests described in this publication was to examine the effect of the temperature of the biodiesel burned, resulting from the transesterification of rapeseed oil with methanol, on the level of nitrogen oxides emissions. The tests were carried out on a test stand equipped with a 9.5 kW engine. Electricity was transffered directly to the power grid. The measurements were started after the engine has warmed up, when the oil temperature exceeded 85°C. In the first stage, the engine was loaded with the maximum achievable torque (100%), in the second stage the torque was set at 75% of the maximum value, and for measurements in the third stage the torque was 50% of the maximum value. Three tests were carried out, one for each of the three fuel temperatures: 20, 40 and 55°C.

scholarly journals Manajemen Masalah Teknologi Informasi Berdasarkan Kerangka Kerja ITIL V3 dan COBIT 5

2018 ◽  
Vol 8 (2) ◽  
pp. 43
Author(s):  
Faried Effendy ◽  
Eva Hariyanti
Keyword(s):  
Management Strategy ◽  
Standard Operating Procedure ◽  
Problem Management ◽  
Second Stage ◽  
The Third ◽  
Third Stage ◽  
Standard Operating ◽  
Three Stages ◽  
The Impact ◽  
First In First Out

In this study, we attempted to develop Information Technology (IT) document of problem management for the export company. This document used as guidance for the company’s employees to manage IT problem. Not every company's IT division has IT problem management strategy, the priority of problem-solving is usually done by the First In first out (FIFO) method by not considering the impact and the problem urgency. COBIT 5 and ITIL V3 DSS03 related to Problem management were used as standards to review and benchmark on how problem management activities should be done. The output of this research is a Standard Operating Procedure (SOP) document. The Problem management SOP document consists of three stages, the first stage is the preparation of  SOP with 5 sub-stages, namely: list activity of ITIL V3 and COBIT 5 DSS03, mapping activity of ITIL V3 and COBIT 5 DSS03, verification of company new activities, mapping of activity actor based on RACI DSS02 and mapping of workproduct. The second stage is the adjustment of SOP documents with 2 sub-stages, namely: interviews for identification of needs and mapping of activity actor with the company's organizational structure. The third stage is the verification of SOP documents. The SOP documents contain 11 procedure with five actors. Overall SOP document can eventually become a reference for the company to manage IT problem. 

scholarly journals Manajemen Masalah Teknologi Informasi Berdasarkan Kerangka Kerja ITIL V3 dan COBIT 5

2018 ◽  
Vol 8 (2) ◽  
pp. 157
Author(s):  
Faried Effendy ◽  
Eva Hariyanti
Keyword(s):  
Management Strategy ◽  
Standard Operating Procedure ◽  
Problem Management ◽  
Second Stage ◽  
The Third ◽  
Third Stage ◽  
Standard Operating ◽  
Three Stages ◽  
The Impact ◽  
First In First Out

In this study, we attempted to develop Information Technology (IT) document of problem management for the export company. This document used as guidance for the company’s employees to manage IT problem. Not every company's IT division has IT problem management strategy, the priority of problem-solving is usually done by the First In first out (FIFO) method by not considering the impact and the problem urgency. COBIT 5 and ITIL V3 DSS03 related to Problem management were used as standards to review and benchmark on how problem management activities should be done. The output of this research is a Standard Operating Procedure (SOP) document. The Problem management SOP document consists of three stages, the first stage is the preparation of  SOP with 5 sub-stages, namely: list activity of ITIL V3 and COBIT 5 DSS03, mapping activity of ITIL V3 and COBIT 5 DSS03, verification of company new activities, mapping of activity actor based on RACI DSS02 and mapping of workproduct. The second stage is the adjustment of SOP documents with 2 sub-stages, namely: interviews for identification of needs and mapping of activity actor with the company's organizational structure. The third stage is the verification of SOP documents. The SOP documents contain 11 procedure with five actors. Overall SOP document can eventually become a reference for the company to manage IT problem. 

scholarly journals Evaluasi Program Kredit Koperasi Primer Anggota (KKPA) PT Perkebunan Nusantara V

Sosio e-kons ◽  
2017 ◽  
Vol 9 (1) ◽  
pp. 9
Author(s):  
Dian Sari
Keyword(s):  
Case Studies ◽  
Program Implementation ◽  
Good Condition ◽  
Second Stage ◽  
The Third ◽  
Job Opportunities ◽  
Third Stage ◽  
The Government ◽  
The Impact ◽  
Payment Credit

<p align="center"><strong><em>ABSTRACT</em></strong><strong><em> </em></strong></p><p><em>The evaluation of program Kredit Koperasi Primer Anggota (KKPA) PT Perkebunan Nusantara V (Case studies: KUD Hidup Baru</em><em> </em><em>in the Sungai Pagar District Kampar Kiri Hilir Subdistrict Kampar Regency)</em><em> </em><em>has problems such as being late on planting of the plantation, the payment credit of the first stage is unpaid on last 2011, the plantation in stage third is cannot harvest. These problems make me attract to do discuss in this research. The purpose of this research is to evaluate the program of KKPA PT Perkebunan Nusantara V (Case studies: KUD Hidup Baru</em><em> in </em><em>the Sungai Pagar District – Kampar Regency). The research use theory of David Easton (1984) about the policy as a process.</em><em> </em><em>Based on the result of this research, I can conclude that Input of program implementation has been corresponding with the demands of society and the support of the government. The process of the program has many problems such as the first stage to the second stage has been planting but it is too late, the distribution of areal first stage has been delayed, some groups of Sungai Pagar society claimed that area KKPA in the second stage belongs to them, and area in the third stage is often flooded. The condition area of the first stage and the second stage has good condition and productive, but the condition area of the third stage is classified failed to harvests because the area that flooded and 75% palm plantation cannot harvest. The outcome had been accepted by a member of KUD Hidup Baru, their income from selling TBS in the first stage and second stage. The impact of this program in society is changing in income, using time, and educational needs increasing prosperity in the society and there are job opportunities in a program</em><em>.</em></p><p><em>Keywords</em><em>: Input, Process of Policy, Output, Outcome, Impact</em><em>.</em></p><p><strong>ABSTRAK</strong><strong> </strong></p><p>Evaluasi Program Kredit Koperasi Primer Anggota (KKPA) PT Perkebunan Nusantara V (Studi Kasus KUD Hidup BARU di Kelurahan Sungai Pagar Kecamatan Kampar Kiri Hilir Kabupaten Kampar) terjadi beberapa masalah seperti terjadinya keterlambatan waktu penanaman, pembayaran kredit tahap I yang belum lunas pada akhir tahun 2011 dan lahan tidak produktif pada lahan tahap III. Hal inilah yang membuat saya tertarik untuk membahasnya dalam penelitian saya ini. Tujuan penelitian ini adalah untuk mengevaluasi program Kredit Koperasi Primer Anggota (KKPA) PT Perkebunan Nusantara V Kelurahan Sungai Pagar, Kecamatan Kampar Kiri Hilir, Kabupaten Kampar (Studi Kasus  KUD Hidup Baru). Dalam penelitian ini menggunakan teori David Easton (1984) tentang kebijakan sebagai suatu proses. Berdasarkan hasil penelitian pada penelitian ini, dapat disimpulkan bahwa Input dalam pelaksanaan sudah sesuai dengan tuntutan masyarakat dan dukungan, proses pelaksanaan dari tahap I hingga tahap II terjadi keterlambatan penanaman satu hingga dua tahun, pelaksanaan terjadi permasalahan mulai dari pembagian lahan kepada masyarakat yang lambat oleh tim penjaringan. Kondisi lahan pada tahap I dan tahap II digolongkan baik dan produktif, namun pada kondisi lahan tahap III digolongkan gagal panen (puso) karena lahan digenangi banjir sehingga 75% tanaman mati. Outcome sudah diterima oleh masyarakat berupa hasil tahap TBS tahap I dan tahap II. Dampak dalam masyarakat terjadi perubahan dalam hal pendapatan, pemanfaatan waktu, dan kebutuhan pendidikan.</p><p><em>Kata Kunci  : Input, Proses Kebijakan, Output, Outcome, Dampak</em><em>.</em></p>

The Coherence of Mary Barton: Romance, Realism, and Utopia

2015 ◽  
Vol 5 (3) ◽  
pp. 185-200
Author(s):  
Robert Z. Birdwell
Keyword(s):  
Thomas Carlyle ◽  
The Novel ◽  
Second Stage ◽  
The Third ◽  
Third Stage ◽  
Three Stages ◽  
Mode Of Production

Critics have argued that Elizabeth Gaskell's first novel, Mary Barton (1848), is split by a conflict between the modes of realism and romance. But the conflict does not render the novel incoherent, because Gaskell surpasses both modes through a utopian narrative that breaks with the conflict of form and gives coherence to the whole novel. Gaskell not only depicts what Thomas Carlyle called the ‘Condition of England’ in her work but also develops, through three stages, the utopia that will redeem this condition. The first stage is romantic nostalgia, a backward glance at Eden from the countryside surrounding Manchester. The second stage occurs in Manchester, as Gaskell mixes romance with a realistic mode, tracing a utopian drive toward death. The third stage is the utopian break with romantic and realistic accounts of the Condition of England and with the inadequate preceding conceptions of utopia. This third stage transforms narrative modes and figures a new mode of production.

How well do voice-hearing assessment measures capture the positive experiences of individuals?

2019 ◽  
Author(s):  
Lucy Armstrong ◽  
Lorna Hogg ◽  
Pamela Charlotte Jacobsen
Keyword(s):  
Systematic Review ◽  
Lived Experience ◽  
Second Stage ◽  
The Third ◽  
Third Stage ◽  
Hearing Assessment ◽  
Positive Experiences ◽  
Assessment Measures ◽  
Stage 1 ◽  
The Voice

The first stage of this project aims to identify assessment measures which include items on voice-hearing by way of a systematic review. The second stage is the development of a brief framework of categories of positive experiences of voice hearing, using a triangulated approach, drawing on views from both professionals and people with lived experience. The third stage will involve using the framework to identify any positve aspects of voice-hearing included in the voice hearing assessments identified in stage 1.

Reconstruction of Tragus and External Auditory Meatus using Remnant Auricle during Microtia Reconstruction

2018 ◽  
Vol 34 (02) ◽  
pp. 227-229
Author(s):  
Yi-gao Hu ◽  
Wei Ding ◽  
Jun Tan ◽  
Xin Chen ◽  
Tao Luo ◽  
...  
Keyword(s):  
Skin Flap ◽  
Skin Grafting ◽  
External Auditory Meatus ◽  
Reconstruction Technique ◽  
External Ear ◽  
Flap Necrosis ◽  
Second Stage ◽  
The Third ◽  
Third Stage ◽  
Thin Skin

AbstractThis article investigates an effective method with which to reconstruct the tragus and external auditory meatus for microtia reconstruction. The external ear was reconstructed using a delayed postauricular skin flap in patients with congenital microtia. After the first stage of delaying the postauricular skin flap and the second stage of otoplasty with ear framework fabricated from autogenous rib cartilage draping with the delayed skin flap, the third stage involved tragus and external auditory meatus canaloplasty. After designing the remnant auricle flap, the lower part was trimmed and the tragus was reconstructed. The upper part was trimmed into a thin skin flap, which was rotated and used to cover the hollowed wound posterosuperior to the tragus so as to mimic the external auditory meatus. If remnant wounds were present, skin grafting was conducted. In total, 121 patients with congenital microtia were treated from March 2010 to March 2016. The reconstructed tragus and external auditory meatus were well formed, and all wounds healed well. No severe complications such as flap necrosis occurred. Six months postoperatively, the morphology of the reconstructed tragus and external auditory meatus was good. Overall, the patients and their families were satisfied. The use of remnant auricle to reconstruct the tragus and external auditory meatus is an effective auricular reconstruction technique.

FACES OF V.M. SHUKSHIN: MARTIN IDEN, HAMLET, STEPAN RAZIN

2021 ◽  
pp. 59-65
Author(s):  
Т.А. Богумил
Keyword(s):  
Early Stage ◽  
Socialist Realism ◽  
Crowding Out ◽  
Behavioral Models ◽  
Cluster Approach ◽  
Second Stage ◽  
The Third ◽  
Third Stage ◽  
Early Departure ◽  
First Time

В статье предлагается концепция жизни и творческого роста В.М. Шукшина сквозь призму тезаурусного и кластерного подходов. Объяснительными «персональными моделями» для интерпретации биографического текста писателя являются кластеры Мартина Идена, Гамлета и Степана Разина. Ранее биографы и литературоведы указывали на важность этих персон для Шукшина, но разрозненно. Впервые предпринята попытка свести указанные персональные модели воедино, в целостный сюжет становления писателя в пространстве культуры. На разных этапах эволюции автора доминирует одна из указанных моделей, последовательно сменяя друг друга, но не вытесняя, а «внахлест». Ранний этап творчества, ориентированный на стратегию Мартина Идена, является попыткой «вписаться» в наличный культурный мейнстрим. Выражено это в следовании поэтике соцреализма. Второй этап подспудно начинается с реабилитации отца Шукшина в 1956 года, когда актуализируется «гамлетовский комплекс», проявляющийся в чувстве вины перед отцом, через стратегию утаивания подлинного «я», мотивы чудаковатости. Третий этап связан с личностью реального исторического лица, Степана Разина, и выражается в открытом протесте против власти. Все важные для В.М. Шукшина поведенческие модели объединены мотивом одинокого противостояния враждебному социуму и имеют трагический финал, что обусловило ранний уход писателя и порождение мифов о насильственном характере его смерти. В.М. Шукшин одновременно был фигурой неординарной и типичной, что позволило его биографии стать «персональной моделью» для последующих авторов, выходцев из сельской глубинки. The article proposes the concept of life and creative growth of V.M. Shukshin through the prism of the thesaurus and cluster approach. The explanatory "personal models" for interpreting the biographical text of the writer are clusters of Martin Eden, Hamlet and Stepan Razin. Earlier, biographers and literary critics pointed out the importance of these people for Shukshin, but it was scattered. For the first time, an attempt was made to bring these personal models together into an integral plot of the formation of the writer in the space of culture. At different stages of the writer’s evolution, one of these models dominates, successively replacing each other, but not crowding out, but “overlapping”. The early stage of creativity, focused on Martin Eden’s strategy, is an attempt to “fit in” the current cultural mainstream. This is expressed in following the poetics of socialist realism. The second stage implicitly begins with the rehabilitation of Shukshin’s father in 1956, when the “Hamletian complex” is actualized. It is manifested in a sense of guilt towards his father, the strategy of concealing the true “I”, eccentricities. The third stage is connected with the personality of a real historical person, Stepan Razin, and is expressed in an open protest against the authorities. All important for V.M. Shukshin's behavioral models are united by the motive of a lonely confrontation with a hostile society and have a tragic ending, which led to the early departure of the writer and the generation of myths about the violent nature of his death. V.M. Shukshin was an extraordinary and typical figure at the same time. That allowed his biography to become a “personal model” for subsequent authors who came from the rural outback.

Sign in / Sign up

Export Citation Format

Share Document