Stimulating Interactive Apps in Conserving Batik Block Pattern

<p>Argumentative writing plays an important role in academic writing at university level. However, learners mostly find that writing this essay a challenging and effortful task. This present study aims at exploring the structures of argumentative essay written by Indonesian EFL students from one university in Jakarta Indonesia. Moreover, it investigates their difficulty and constraints during composing the essay. Using a descriptive qualitative design, the authors selected writing assignment and questionnaire for collecting data. A layout of Toulmin model of arguments was used in analyzing the essays. The findings of the study show that the argumentative papers cover the main elements: claim (thesis statement), data, rebut, and rebuttal data using either in block pattern or point-by-point pattern. The elements show diverse in types. Logical analysis and explanation are the most frequently used on the papers. Though they present acceptable thesis with well-organized essay, some information is unrelated and data for supporting the claim are seemingly insufficient. In addition, the students think that this essay as difficult task. In general, lack of knowledge, vocabulary and practice cause the constraints. In specific level, the students report that giving argument, finding support and working on counterargument become source of difficulty and constraints.</p>

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A rare complication of implantable cardiac defibrillator placement

10.21203/rs.2.21549/v1 ◽

2020 ◽

Author(s):

João Ferreira ◽

Célia Marques Domingues ◽

Susana Isabel Costa ◽

Maria Fátima Franco Silva ◽

Lino Manuel Martins Gonçalves

Keyword(s):

Heart Failure ◽

Right Bundle Branch Block ◽

Left Ventricular Systolic Dysfunction ◽

Rare Complication ◽

Systolic Dysfunction ◽

Lateral Wall ◽

Left Ventricular ◽

Refractory Ascites ◽

Bundle Branch Block ◽

Block Pattern

Abstract Background Implantable cardiac defibrillators (ICD) are a popular and effective option in heart failure with left ventricular systolic dysfunction patients. Although frequently underdiagnosed, inadvertent malposition can lead to endocardial damage and thrombotic events. As ICD implants tend to increase in the following years, the recognition of their complications is critical. Case presentation The authors present a case of a 64-year-old woman with advanced heart failure and ICD malposition. This accidental discovery was denounced by the presence of a right bundle branch block pattern and later confirmed by echocardiography which showed the lead tip in contact with the mid segment of the left ventricular antero-lateral wall. As the patient hospitalisation was complicated with refractory ascites and cardiogenic shock, she underwent cardiac transplantation, with no recurrence of heart failure symptoms. Conclusions An electrocardiogram showing a right bundle branch block pattern during VVI pacing should arise the suspicion of inadvertent placement of a pacing/ICD lead. The many facets of echocardiography should be used for the diagnosis of this complication, as they were paramount in this case, as highlighted.

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