scholarly journals Comparative computed flow dynamic analysis of different optimization techniques in left main either provisional or culotte stenting

2017 ◽  
Vol 5 (4) ◽  
pp. 205-212 ◽  
Author(s):  
Gianluca Rigatelli ◽  
Fabio Dell’Avvocata ◽  
Marco Zuin ◽  
Sara Giatti ◽  
Khanh Duong ◽  
...  
Keyword(s):  
Dynamic Analysis ◽  
Surface Area ◽  
Fluid Dynamic ◽  
Optimization Techniques ◽  
The Other ◽  
Left Main ◽  
Flow Dynamic ◽  
Physiological Profile ◽  
Provisional Stenting ◽  
The Impact

Abstract Background and Objectives Provisional and culotte are the most commonly used techniques in left main (LM) stenting. The impact of different post-dilation techniques on fluid dynamic of LM bifurcation has not been yet investigated. The aim of this study is to evaluate, by means of computational fluid dynamic analysis (CFD), the impact of different post-dilation techniques including proximal optimization technique (POT), kissing balloon (KB), POT-Side-POT and POT–KB-POT, 2-steps Kissing (2SK) and Snuggle Kissing balloon (SKB) on flow dynamic profile after LM provisional or culotte stenting. Methods We considered an LM-LCA-LCX bifurcation reconstructed after reviewing 100 consecutive patients (mean age 71.4 ± 9.3 years, 49 males) with LM distal disease. The diameters of LAD and LCX were modelled according to the Finnet’s law as following: LM 4.5 mm, LAD 3.5 mm, LCX 2.75 mm, with bifurcation angle set up at 55°. Xience third-generation stent (Abbot Inc., USA) was reconstructed and virtually implanted in provisional/cross-over and culotte fashion. POT, KB, POT-side-POT, POT-KB-POT, 2SK and SKB were virtually applied and analyzed in terms of the wall shear stress (WSS). Results Analyzing the provisional stenting, the 2SK and KB techniques had a statistically significant lower impact on the WSS at the carina, while POT seemed to obtain a neutral effect. In the wall opposite to the carina, the more physiological profile has been obtained by KB and POT with higher WSS value and smaller surface area of the lower WSS. In culotte stenting, at the carina, POT-KB-POT and 2SK had a very physiological profile; while at the wall opposite to the carina, 2SK and POT–KB-POT decreased significantly the surface area of the lower WSS compared to the other techniques. Conclusion From the fluid dynamic point of view in LM provisional stenting, POT, 2SK and KB showed a similar beneficial impact on the bifurcation rheology, while in LM culotte stenting, POT-KB-POT and 2SK performed slightly better than the other techniques, probably reflecting a better strut apposition.

P2690Safety and effectiveness of thin-strut DES for bifurcated coronary lesions not involving left main: a RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) sub-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Angelini ◽  
O De Filippo ◽  
F D'Ascenzo ◽  
E Cerrato ◽  
P Omede' ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Real Life ◽  
Target Lesion ◽  
Drug Eluting Stent ◽  
Left Main ◽  
Clinical Safety ◽  
Intracoronary Imaging ◽  
Coronary Lesions ◽  
Provisional Stenting ◽  
The Impact

Abstract Background Thinner stent struts of new DES (drug eluting stent) are associated with shorter time of reendothelialization, a reduction of shear stress and inflammation of coronary walls. Despite this great innovations their clinical safety and efficacy in challenging scenarios as non left main bifurcation coronary lesions has not been tested. Methods RAIN is a multicenter registry enrolling patients treated on bifurcated coronary lesions and left main with thin-strut DES. Baseline characteristics and procedural data were recorded. Target lesion revascularization (TLR) was the primary endpoint, whereas major adverse clinical events (MACE; composite of all-cause death, myocardial infarction (MI), target vessel revascularization (TVR), TLR and stent thrombosis (ST)) along with its single components were the secondary endpoints. A multivariate analysis to identify predictors of TLR and sub-analysis according to stenting strategy (provisional vs 2-stent technique), use of final kissing balloon (FKB) and IVUS/OCT optimization were performed. Results Data from 1803 patients (59% ACS, 61% stable CAD) treated on bifurcations were retrospectively evaluated. Follow up was available for 1685 (94%) patients for a median of 12 months (IQR 7–18). TLR occurred globally in 2.5% of cases (2.2% in provisional stenting, 3.5% in 2-stent technique). The rate of MACE was 9.4%, whereas all-cause death and MI, occurred in 4.1% and 3.2% of cases respectively. TVR and definite ST incidence were 3.7% and 1.1%. At multivariate analysis, chronic kidney disease (CKD) negatively influenced the main endpoint (HR 1.95, 95% CI 1.06–3.6, p=0.03), whereas post-dilatation (HR 0.56, 95% CI 0.3–0.93, p=0.04) and provisional stenting resulted being protective factors. FKB reduced TLR occurrence at FU only in 2-stent technique (p=0.03), whereas intracoronary imaging (performed in 29% of patients) were uninfluential. Conclusion Very thin-strut DES represents a highly effective solution in bifurcation lesions. The risk of TLR is reduced by post-dilatation and provisional stenting. FKB is recommended in 2-stent technique, whereas further studies are required to address the impact of intracoronary imaging in this setting.

scholarly journals Scope of Intelligence Approcahes for Unit Commitment Under Uncertain Sustainable Energy Environment For Effective Vehicle To Grid Operations-A Comprehensive Review

2020 ◽  
Vol 184 ◽  
pp. 01034
Author(s):  
Dinesh Dhawale ◽  
Vikram Kumar Kamboj
Keyword(s):  
Electric Vehicles ◽  
Unit Commitment ◽  
Sustainable Energy ◽  
Optimization Techniques ◽  
The Other ◽  
Power Demand ◽  
Unit Commitment Problem ◽  
Vehicle To Grid ◽  
The Impact ◽  
Selection Of

Electric vehicles are getting popularity as these are eco-friendly and could be a part of power sector in the future. Electric Vehicles are the smart hybrid vehicles, which stores electric power during their operation, which could be stored in storage cells. These electric vehicles may be plug-in electric vehicles or battery operated electric vehicles. The concept of aggregators may be utilized, wherein the stored energy in vehicles could be supplied to grid during parking hours .This also facilitate the consumers to sale power during the high power demand and purchase power during low power demand. Thus, a bi-directional flow of power could be possible either from vehicle to grid or vice-versa. A large penetration of electric vehicles could result in increase in power demand which could be compensated by proper coordinated unit commitment and optimization techniques. The increasing load on grid by the impact of demand and trends in small generating units which require proper selection of number of generating units to put in line and other units in off condition calls for the concept of unit commitment. It is the selection of more efficient units to be in service and shutting down the other unit while maintaining all the other constraint constant. This would result in effective power flow in an economic manner, simultaneously maintaining the adequacy and reliability of the system. The proposed research represents the scope of intelligence algorithm for unit commitment problem with effective solution of vehicle to grid operations along with sustainable energy for realistic power system.

Modernism, Empiricism, and Rationalism

2016 ◽  
Vol 46 (1) ◽  
pp. 38-47
Author(s):  
Geoffrey Squires
Keyword(s):  
Twentieth Century ◽  
The Other ◽  
Modern Poetry ◽  
Philosophical Perspective ◽  
Irish Poetry ◽  
Dimensional Spectrum ◽  
Culture History ◽  
The World ◽  
The Impact ◽  
Rule Out

Modernism is usually defined historically as the composite movement at the beginning of the twentieth century which led to a radical break with what had gone before in literature and the other arts. Given the problems of the continuing use of the concept to cover subsequent writing, this essay proposes an alternative, philosophical perspective which explores the impact of rationalism (what we bring to the world) on the prevailing empiricism (what we take from the world) of modern poetry, which leads to a concern with consciousness rather than experience. This in turn involves a re-conceptualisation of the lyric or narrative I, of language itself as a phenomenon, and of other poetic themes such as nature, culture, history, and art. Against the background of the dominant empiricism of modern Irish poetry as presented in Crotty's anthology, the essay explores these ideas in terms of a small number of poets who may be considered modernist in various ways. This does not rule out modernist elements in some other poets and the initial distinction between a poetics of experience and one of consciousness is better seen as a multi-dimensional spectrum that requires further, more detailed analysis than is possible here.

HOME VISITS DURING THE FIRST MONTH OF DELIVERY FOR RECENTLY DELIVERED WOMEN IN UTTAR PRADESH, INDIA

2020 ◽  
Vol 6 (5) ◽  
pp. 1183-1189
Author(s):  
Dr. Tridibesh Tripathy ◽  
Dr. Umakant Prusty ◽  
Dr. Chintamani Nayak ◽  
Dr. Rakesh Dwivedi ◽  
Dr. Mohini Gautam
Keyword(s):  
Large Scale ◽  
National Level ◽  
Uttar Pradesh ◽  
Life Time ◽  
Structured Interview ◽  
The Other ◽  
Registration System ◽  
Action Group ◽  
Current Article ◽  
The Impact

The current article of Uttar Pradesh (UP) is about the ASHAs who are the daughters-in-law of a family that resides in the same community that they serve as the grassroots health worker since 2005 when the NRHM was introduced in the Empowered Action Group (EAG) states. UP is one such Empowered Action Group (EAG) state. The current study explores the actual responses of Recently Delivered Women (RDW) on their visits during the first month of their recent delivery. From the catchment area of each of the 250 ASHAs, two RDWs were selected who had a child in the age group of 3 to 6 months during the survey. The response profiles of the RDWs on the post- delivery first month visits are dwelled upon to evolve a picture representing the entire state of UP. The relevance of the study assumes significance as detailed data on the modalities of postnatal visits are available but not exclusively for the first month period of their recent delivery. The details of the post-delivery first month period related visits are not available even in large scale surveys like National Family Health Survey 4 done in 2015-16. The current study gives an insight in to these visits with a five-point approach i.e. type of personnel doing the visit, frequency of the visits, visits done in a particular week from among those four weeks separately for the three visits separately. The current study is basically regarding the summary of this Penta approach for the post- delivery one-month period.     The first month period after each delivery deals with 70% of the time of the postnatal period & the entire neonatal period. Therefore, it does impact the Maternal Mortality Rate & Ratio (MMR) & the Neonatal Mortality Rates (NMR) in India and especially in UP through the unsafe Maternal & Neonatal practices in the first month period after delivery. The current MM Rate of UP is 20.1 & MM Ratio is 216 whereas the MM ratio is 122 in India (SRS, 2019). The Sample Registration System (SRS) report also mentions that the Life Time Risk (LTR) of a woman in pregnancy is 0.7% which is the highest in the nation (SRS, 2019). This means it is very risky to give birth in UP in comparison to other regions in the country (SRS, 2019). This risk is at the peak in the first month period after each delivery. Similarly, the current NMR in India is 23 per 1000 livebirths (UNIGME,2018). As NMR data is not available separately for states, the national level data also hold good for the states and that’s how for the state of UP as well. These mortalities are the impact indicators and such indicators can be reduced through long drawn processes that includes effective and timely visits to RDWs especially in the first month period after delivery. This would help in making their post-natal & neonatal stage safe. This is the area of post-delivery first month visit profile detailing that the current article helps in popping out in relation to the recent delivery of the respondents.   A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted in the villages of the respective districts with the help of a pre-tested structured interview schedule with both close-ended and open-ended questions.  The current article deals with five close ended questions with options, two for the type of personnel & frequency while the other three are for each of the three visits in the first month after the recent delivery of respondents. In addition, in-depth interviews were also conducted amongst the RDWs and a total 500 respondents had participated in the study.   Among the districts related to this article, the results showed that ASHA was the type of personnel who did the majority of visits in all the four districts. On the other hand, 25-40% of RDWs in all the 4 districts replied that they did not receive any visit within the first month of their recent delivery. Regarding frequency, most of the RDWs in all the 4 districts received 1-2 times visits by ASHAs.   Regarding the first visit, it was found that the ASHAs of Barabanki and Gonda visited less percentage of RDWs in the first week after delivery. Similarly, the second visit revealed that about 1.2% RDWs in Banda district could not recall about the visit. Further on the second visit, the RDWs responded that most of them in 3 districts except Gonda district did receive the second postnatal visit in 7-15 days after their recent delivery. Less than half of RDWs in Barabanki district & just more than half of RDWs in Gonda district received the third visit in 15-21 days period after delivery. For the same period, the majority of RDWs in the rest two districts responded that they had been entertained through a home visit.

Wacana Kolonial dalam Novel Max Havelaar: Sebuah Kajian Poskolonial

Metahumaniora ◽  
2017 ◽  
Vol 7 (3) ◽  
pp. 411
Author(s):  
Abu Bakar Ramadhan Muhamad
Keyword(s):  
Point Of View ◽  
The Other ◽  
The Novel ◽  
Colonial Discourse ◽  
The Impact ◽  
The Voice

AbstrakHegemoni kolonialisme dalam budaya poskolonial merupakan alasan penelitian inikemudian mengkaji wacana kolonial dalam novel Max Havellar (MH) khususnya dampakditimbulkannya. Dampak dimaksud adalah posisi keberpihakan pemikiran tersirat darikarya tersebut. Hasil pembahasan menunjukkan, secara temporal maupun permanen MHmenyuarakan ketidakadilan dalam kondisi-kondisi kolonial menyangkut penindasan sangpenjajah terhadap terjajah. Hanya saja, upaya mengatasnamakan atau mewakili suarakaum terjajah terbukti mengimplikasikan ciri ideologis statis kerangka kolonialisme(orientalisme); yakni cara pandang Eropasentris, di mana “Barat” sebagai self adalah superior,dan “Timur” sebagai other adalah inferior. Dalam konteks poskolonialisme, MH dengan sifatkritisnya yang berupaya “menyuarakan” nasib pribumi terjajah, justru menampilkan stigmapenguatan kolonialitas itu sendiri secara hegemonik. Artinya, “menyuarakan” nasib pribumidimaknai sebagai keberpihankan kolonial yang kontradiktif, di mana stigma penguatankolonialitas justru lebih terasa, ujung-ujungnya melanggengkan hegemoni kolonial. Tidakmembela yang terjajah, tetapi memperhalus cara kerja mesin kolonial.AbstractThe hegemony of colonialism in the culture of postcolonial society is the reason this studythen examines the colonial discourse in the novel Max Havellar (MH) in particular the impactit brings. The impact in question is the implied position of thought in the work. The resultsof the discussion show that, temporarily or permanently, MH voiced injustice in the colonialconditions regarding the oppression of the colonist against the colonized. However, the effort toname or represent the voice of the colonized has proven to imply a static ideological characterin the framework of colonialism (orientalism); ie Eropacentric point of view, in which “West” asself is superior, and “East” as the other is the inferior. In the context of postcolonialism, MH withits critical nature that seeks to “voice” the fate of the colonized natives, actually presents thestigma of strengthening coloniality itself hegemonicly. That is, “voicing” the fate of the pribumiis interpreted as a contradictory colonial flare, where the stigma of strengthening colonialityis more pronounced, which ultimately perpetuates the hegemony of colonialism. No longerdefending the colonized, but refining the workings of the colonial machinery.

Gifted Students' Motivation and its Impact on the Development of their Giftedness

2018 ◽  
Vol 3 (1) ◽  
Author(s):  
Hussein SALEM MUBARAK BARABWD ◽  
Mohammad YUSOFF BIN MOHD NOR ◽  
Noriah Mohd Ishak
Keyword(s):  
Extrinsic Motivation ◽  
Gifted Students ◽  
Qualitative Approach ◽  
The Other ◽  
Phenomenological Method ◽  
Self Confidence ◽  
Verbal Praise ◽  
Intrinsic Motivations ◽  
The Impact ◽  
Intrinsic And Extrinsic Motivations

The aim of the current study is to examine the intrinsic and extrinsic motivations of the gifted students from Hadhramout Gifted Center HGC in Yemen, and to investigate the impact of these intrinsic and extrinsic motivations on their giftedness development. A qualitative approach was adopted; data has been collected through an open- ended questionnaire that was prepared by the researcher and distributed among a sample of gifted students who were chosen purposively from HGC. The interpretative phenomenological method has been used to analyze the data using, Atlas ti. The results indicate that the majority of the participants consider it interesting to explore new things, and experience curiosity and desire to achieve their goals as their intrinsic motivations. Whereas, the minority consider preference to serve the community, competition preference and self-confidence as their intrinsic motivations. On the other hand, half of the participants consider rewards as their extrinsic motivation, whereas 40 % of them consider exams scores, verbal praise, parents and environment as their extrinsic motivations. Regarding the impact of intrinsic and extrinsic motivations on the development of giftedness, the majority of the participants believe that intrinsic and extrinsic motivations affect positively the development of their giftedness development. Finally, based on the findings, some recommendations were provided. 

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