This document provides an overview of commonly used risk stratification models in cardiac surgery, including the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Society of Thoracic Surgeons (STS) algorithms. It discusses the development and components of EuroSCORE II and limitations of existing models in accurately predicting outcomes, especially as patient populations and surgical practices have evolved. The objective is to review risk models used in preoperative assessment and quality improvement in cardiac surgery.
This document discusses fractional flow reserve (FFR), which is a technique used to functionally assess the significance of coronary artery stenosis. FFR is defined as the ratio of maximum blood flow in a stenotic artery to maximum blood flow if there was no stenosis. It is calculated as the ratio of mean distal coronary pressure (Pd) to mean aortic pressure (Pa) during maximal hyperemia induced by pharmacological agents. An FFR value below 0.75 is associated with inducible ischemia, while a value above 0.80 indicates an insignificant stenosis in most cases. FFR has advantages over angiography alone in evaluating stenosis as it accounts for vessel characteristics like length and takes collateral flow into consideration.
Echocardiography is a key tool for diagnosing and evaluating mitral stenosis (MS). It is essential to use an integrative approach when grading MS severity by combining Doppler, 2D imaging, and measurements, rather than relying on one alone. Echocardiography plays a major role in MS by confirming diagnosis, quantifying severity, analyzing consequences, and examining valve anatomy. Mitral valve planimetry directly measures valve area and is considered the reference standard, but additional measurements like pressure gradient and half-time are also useful. Echocardiography aids clinical decision making for patients with MS.
The document discusses various techniques for assessing myocardial viability, including stress echocardiography, single photon emission computed tomography (SPECT), positron emission tomography (PET), and cardiac magnetic resonance imaging (MRI). Stress echocardiography evaluates contractile reserve through techniques like dobutamine stress echocardiography. SPECT assesses viability by detecting thallium or technetium uptake, which relies on intact cell membranes. PET detects FDG uptake indicating active glucose metabolism. MRI evaluates viability through detection of late gadolinium enhancement, indicating scar tissue, and can also assess contractile reserve with stress MRI. A combined approach utilizing multiple techniques can provide complementary information on viability.
This document discusses trans-septal puncture, which involves puncturing the septum between the right and left atria to access the left side of the heart. It outlines the evolving indications for trans-septal puncture including interventions for mitral valve disease, closure of defects, left atrial procedures, and arrhythmia ablation. The key steps are reviewed - having the proper anatomical landmarks, hardware including sheaths and needles, and imaging guidance. Complications are discussed and how to successfully perform the puncture is summarized as being familiar with the anatomy, hardware, and vigilance for potential complications.
This document provides an overview of commonly used risk stratification models in cardiac surgery, including the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Society of Thoracic Surgeons (STS) algorithms. It discusses the development and components of EuroSCORE II and limitations of existing models in accurately predicting outcomes, especially as patient populations and surgical practices have evolved. The objective is to review risk models used in preoperative assessment and quality improvement in cardiac surgery.
This document discusses fractional flow reserve (FFR), which is a technique used to functionally assess the significance of coronary artery stenosis. FFR is defined as the ratio of maximum blood flow in a stenotic artery to maximum blood flow if there was no stenosis. It is calculated as the ratio of mean distal coronary pressure (Pd) to mean aortic pressure (Pa) during maximal hyperemia induced by pharmacological agents. An FFR value below 0.75 is associated with inducible ischemia, while a value above 0.80 indicates an insignificant stenosis in most cases. FFR has advantages over angiography alone in evaluating stenosis as it accounts for vessel characteristics like length and takes collateral flow into consideration.
Echocardiography is a key tool for diagnosing and evaluating mitral stenosis (MS). It is essential to use an integrative approach when grading MS severity by combining Doppler, 2D imaging, and measurements, rather than relying on one alone. Echocardiography plays a major role in MS by confirming diagnosis, quantifying severity, analyzing consequences, and examining valve anatomy. Mitral valve planimetry directly measures valve area and is considered the reference standard, but additional measurements like pressure gradient and half-time are also useful. Echocardiography aids clinical decision making for patients with MS.
The document discusses various techniques for assessing myocardial viability, including stress echocardiography, single photon emission computed tomography (SPECT), positron emission tomography (PET), and cardiac magnetic resonance imaging (MRI). Stress echocardiography evaluates contractile reserve through techniques like dobutamine stress echocardiography. SPECT assesses viability by detecting thallium or technetium uptake, which relies on intact cell membranes. PET detects FDG uptake indicating active glucose metabolism. MRI evaluates viability through detection of late gadolinium enhancement, indicating scar tissue, and can also assess contractile reserve with stress MRI. A combined approach utilizing multiple techniques can provide complementary information on viability.
This document discusses trans-septal puncture, which involves puncturing the septum between the right and left atria to access the left side of the heart. It outlines the evolving indications for trans-septal puncture including interventions for mitral valve disease, closure of defects, left atrial procedures, and arrhythmia ablation. The key steps are reviewed - having the proper anatomical landmarks, hardware including sheaths and needles, and imaging guidance. Complications are discussed and how to successfully perform the puncture is summarized as being familiar with the anatomy, hardware, and vigilance for potential complications.
Mechanical circulatory support devices such as left ventricular assist devices (LVADs) are increasingly being used as an alternative to cardiac transplantation for patients with advanced heart failure. LVADs are mechanical pumps that are implanted to support the left ventricle and improve cardiac output. They can be used as a bridge to transplantation, destination therapy for those ineligible for transplant, or potentially as a bridge to recovery in some cases. Common LVAD devices are continuous flow pumps that are more pulsatile than earlier generation pulsatile pumps. LVADs have been shown to improve symptoms, quality of life and survival for advanced heart failure patients.
In this ppt, I am going to discuss the role of ICD in the patient with Non-ischemic cardiomyopathy. I am going to discuss all the major trials done in the patient with non-ischemic cardiomyopathy.
M-mode echocardiography uses rapid sampling of a region to create sequential parallel data lines, producing continuous horizontal lines representing points of brightness. This allows visualization of motion patterns over distance and time. Measurements of structures like the mitral valve can assess morphology, movement, velocity, and timing of cardiac events. Findings include increased wall thickness, reduced valve excursion, and fluttering indicating conditions like hypertrophy, stenosis, and regurgitation.
This document discusses various parameters used to evaluate cardiac structure and function using echocardiography. It describes parameters such as ejection fraction, mitral inflow patterns, pulmonary venous flow, tissue Doppler imaging, and color M-mode measurements that are used to assess global and regional left ventricular function as well as diastolic function. The parameters are grouped into categories of ventricular structure and systolic function, diastolic function evaluation, and stages of diastolic dysfunction. Normal ranges for various measurements are also provided.
The STITCH trial evaluated the effect of CABG plus optimal medical therapy (OMT) versus OMT alone on mortality in patients with left ventricular dysfunction and coronary artery disease. A sub-study examined the role of assessing myocardial viability to identify patients who benefit most from CABG. Of 601 patients who underwent viability testing, 487 had viable myocardium and 114 did not. There was no significant interaction between viability status and treatment assignment on mortality or other outcomes. Assessing viability did not identify patients with differential survival benefit from CABG versus OMT alone.
Hypertrophic cardiomyopathy (HCM) is defined by a thickened left ventricular wall without an identifiable cause. It can range from asymptomatic to causing heart failure, arrhythmias, or sudden cardiac death. Treatment depends on whether the left ventricular outflow tract (LVOT) is obstructed. For symptomatic patients with LVOT obstruction despite maximum medical therapy, septal reduction procedures like alcohol septal ablation or surgical myectomy are recommended. Alcohol septal ablation involves injecting alcohol into a septal perforator artery to ablate tissue and reduce the gradient. Surgical myectomy directly resects septal muscle. Both procedures significantly reduce gradients and improve symptoms but surgical myectomy provides better gradient and symptom reduction with a lower risk of
The document discusses the history and technique of transseptal puncture (TSP). It describes how TSP provides direct access to the left atrium and has become a routine skill for electrophysiologists performing procedures like atrial fibrillation ablation. The technique involves using a Brockenbrough needle and Mullins sheath inserted via the femoral or jugular vein to puncture the interatrial septum, usually at the fossa ovalis. Landmarks, equipment, steps of the procedure, challenges, and complications are reviewed in detail. The summary emphasizes the importance and increasing use of TSP as well as reviews key aspects of the technique and potential complications.
This document discusses Eisenmenger syndrome, a condition where pulmonary hypertension develops due to increased blood flow through defects between the systemic and pulmonary circulations. It provides details on causes, clinical features, pathology findings, and treatments. Key points include:
- Eisenmenger syndrome is caused by defects like VSDs, ASDs, and PDA that allow high blood flow to the lungs and cause pulmonary hypertension over time.
- Common causes of death include hemoptysis from pulmonary artery ruptures, heart failure, and complications from attempted defect repair surgery.
- Pathological findings show thickened pulmonary arteries that resemble the fetal pattern and contribute to high pulmonary vascular resistance.
- Medical treatments are generally ineffective once int
The document discusses assessment of mechanical dyssynchrony for cardiac resynchronization therapy. It defines electrical and mechanical dyssynchrony, and describes the deleterious hemodynamic effects of left ventricular dyssynchrony. It then summarizes various echocardiographic tools for assessing atrioventricular dyssynchrony, interventricular dyssynchrony, and intraventricular dyssynchrony, including M-mode, tissue Doppler imaging, and three-dimensional echocardiography. Measurement techniques for different dyssynchrony parameters such as septal-posterior wall motion delay, lateral wall postsystolic displacement, and time to peak systolic velocity are outlined.
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction characterized by a non-traumatic separation of the coronary arterial wall. It most commonly affects younger women and the left anterior descending artery. SCAD results from an intimal tear or bleeding of vasa vasorum that leads to the formation of a false lumen filled with blood. This can cause the artery to narrow and restrict blood flow. SCAD is increasingly recognized and can be caused by conditions affecting connective tissue or hormonal factors during pregnancy. Angiography is used to diagnose SCAD but findings may be subtle, with long diffuse narrowing being most common. Management involves conservative treatment but revascularization may be needed for ongoing ischemia
Cardiac catheteriztion, Oximetery study in a patient with VSDPRAVEEN GUPTA
In this ppt i am going to discuss how to do cardiac catheterisation study, oximetry study and how to analyse its data in a patient with VSD who came to our hospital
The document discusses subcutaneous implantable cardioverter defibrillators (S-ICDs) and leadless pacemakers as alternatives to transvenous ICD systems. S-ICDs avoid the risks of transvenous leads but do not provide antitachycardia pacing or bradycardia support. Studies show S-ICDs effectively detect and treat ventricular arrhythmias similar to transvenous ICDs. However, S-ICDs have a higher risk of inappropriate shocks and pocket infections compared to transvenous ICDs. Leadless pacemakers eliminate transvenous leads but have not yet demonstrated long-term reliability.
Intravascular ultrasound (IVUS) uses sound waves to visualize the inside of arteries. There are two types of IVUS systems - mechanical systems using a rotating internal cable and solid-state systems using externally mounted transducers. Both produce 360-degree images with a resolution of 100-150 μm. IVUS is used to assess plaque, vessel dimensions, stent deployment, and more. It produces cross-sectional images showing the lumen, layers of the artery wall, and plaque composition and size. Measurements include diameters, areas, plaque burden, and indices of eccentricity. IVUS helps identify vulnerable plaque and has diagnostic and interventional applications.
Inherited aortopathy can cause complications like aortic dissection and repeated surgeries. This document discusses inherited aortopathies associated with congenital heart defects. Primary aortic dilatation is mainly associated with coarctation of the aorta, bicuspid aortic valve, and conotruncal abnormalities. Secondary dilatation can occur after congenital heart surgery when non-aortic tissue is used. The most serious complication is aortic dissection. Guidelines exist for investigating and treating this life-threatening event, with consideration of underlying hereditary disorders.
This document discusses various types and assessment of left ventricular dyssynchrony. It defines electrical and mechanical dyssynchrony. It describes different types of dyssynchrony including atrioventricular, interventricular, and intraventricular dyssynchrony. It discusses various echocardiography techniques to demonstrate and quantify each type of dyssynchrony, including M-mode, tissue Doppler, speckle tracking, and 3D echocardiography. It also mentions the use of MRI to assess dyssynchrony. The key application of assessing dyssynchrony is to predict response to cardiac resynchronization therapy in patients with heart failure.
1. Contrast agents enhance ultrasound images by increasing the backscatter of blood allowing visualization of small vessels. They oscillate non-linearly when exposed to ultrasound, emitting harmonic frequencies not seen in tissue.
2. Harmonic imaging exploits non-linear backscatter to identify the contrast agent signal and suppress tissue echoes, enabling visualization of microvascular flow.
3. Care must be taken in injecting contrast agents to avoid destroying bubbles, and infusion may provide a longer enhancement window for some studies compared to a bolus injection.
This document provides an overview of echocardiographic assessment of mitral regurgitation. It describes the anatomy of the mitral valve including the leaflets, annulus, chordae, and papillary muscles. It discusses Carpentier's functional classification system for describing the mechanism of mitral valve dysfunction. Methods for assessing severity are covered, including color flow imaging, continuous wave Doppler, vena contracta width, proximal isovelocity surface area, and volumetric assessment. Key points are made about evaluating jet direction, duration, and velocity in context of blood pressure. The importance of assessing left ventricular and left atrial size and function is also highlighted.
The document discusses various coronary artery anomalies including anomalies of origination, course, and intrinsic anatomy. Some key points include:
- Coronary artery anomalies have a global incidence of 5.64% and incidence of sudden death is 0.6%
- Anomalous origination of the left main coronary artery from the pulmonary artery (ALCAPA) is a rare but serious anomaly if left untreated
- Certain anomalous coronary artery courses, such as between the aorta and pulmonary artery, are associated with higher risks of sudden cardiac death
- Other anomalies discussed include single coronary arteries, coronary hypoplasia, ectasia/aneurysms, and intramural coronary arteries
2013.04.25 Using Digital & Social Media_MSEA_RetiredNEA
This document summarizes a presentation on using digital and social media to engage members. The presentation covered the current social media landscape, examples of effective social media use by organizations and politicians, and which platforms are most popular. It provided tips on using tools like Twitter, suggested ways for unions to improve their social media presence, and reviewed dos and don'ts of social media. The presentation concluded with recommendations for social media books and additional resources.
Fossil Hill Middle School scored in the "Developing" range in four categories of the Texas STaR Chart assessment of technology integration: Teaching & Learning, Educator Preparation & Development, Leadership/Administration/Support, and Infrastructure. The weakest areas included online learning, access to professional development, and older classroom technology infrastructure. To advance, the school aims to improve educator preparation and technology through investments in new devices and web-based learning over the next two to ten years.
Mechanical circulatory support devices such as left ventricular assist devices (LVADs) are increasingly being used as an alternative to cardiac transplantation for patients with advanced heart failure. LVADs are mechanical pumps that are implanted to support the left ventricle and improve cardiac output. They can be used as a bridge to transplantation, destination therapy for those ineligible for transplant, or potentially as a bridge to recovery in some cases. Common LVAD devices are continuous flow pumps that are more pulsatile than earlier generation pulsatile pumps. LVADs have been shown to improve symptoms, quality of life and survival for advanced heart failure patients.
In this ppt, I am going to discuss the role of ICD in the patient with Non-ischemic cardiomyopathy. I am going to discuss all the major trials done in the patient with non-ischemic cardiomyopathy.
M-mode echocardiography uses rapid sampling of a region to create sequential parallel data lines, producing continuous horizontal lines representing points of brightness. This allows visualization of motion patterns over distance and time. Measurements of structures like the mitral valve can assess morphology, movement, velocity, and timing of cardiac events. Findings include increased wall thickness, reduced valve excursion, and fluttering indicating conditions like hypertrophy, stenosis, and regurgitation.
This document discusses various parameters used to evaluate cardiac structure and function using echocardiography. It describes parameters such as ejection fraction, mitral inflow patterns, pulmonary venous flow, tissue Doppler imaging, and color M-mode measurements that are used to assess global and regional left ventricular function as well as diastolic function. The parameters are grouped into categories of ventricular structure and systolic function, diastolic function evaluation, and stages of diastolic dysfunction. Normal ranges for various measurements are also provided.
The STITCH trial evaluated the effect of CABG plus optimal medical therapy (OMT) versus OMT alone on mortality in patients with left ventricular dysfunction and coronary artery disease. A sub-study examined the role of assessing myocardial viability to identify patients who benefit most from CABG. Of 601 patients who underwent viability testing, 487 had viable myocardium and 114 did not. There was no significant interaction between viability status and treatment assignment on mortality or other outcomes. Assessing viability did not identify patients with differential survival benefit from CABG versus OMT alone.
Hypertrophic cardiomyopathy (HCM) is defined by a thickened left ventricular wall without an identifiable cause. It can range from asymptomatic to causing heart failure, arrhythmias, or sudden cardiac death. Treatment depends on whether the left ventricular outflow tract (LVOT) is obstructed. For symptomatic patients with LVOT obstruction despite maximum medical therapy, septal reduction procedures like alcohol septal ablation or surgical myectomy are recommended. Alcohol septal ablation involves injecting alcohol into a septal perforator artery to ablate tissue and reduce the gradient. Surgical myectomy directly resects septal muscle. Both procedures significantly reduce gradients and improve symptoms but surgical myectomy provides better gradient and symptom reduction with a lower risk of
The document discusses the history and technique of transseptal puncture (TSP). It describes how TSP provides direct access to the left atrium and has become a routine skill for electrophysiologists performing procedures like atrial fibrillation ablation. The technique involves using a Brockenbrough needle and Mullins sheath inserted via the femoral or jugular vein to puncture the interatrial septum, usually at the fossa ovalis. Landmarks, equipment, steps of the procedure, challenges, and complications are reviewed in detail. The summary emphasizes the importance and increasing use of TSP as well as reviews key aspects of the technique and potential complications.
This document discusses Eisenmenger syndrome, a condition where pulmonary hypertension develops due to increased blood flow through defects between the systemic and pulmonary circulations. It provides details on causes, clinical features, pathology findings, and treatments. Key points include:
- Eisenmenger syndrome is caused by defects like VSDs, ASDs, and PDA that allow high blood flow to the lungs and cause pulmonary hypertension over time.
- Common causes of death include hemoptysis from pulmonary artery ruptures, heart failure, and complications from attempted defect repair surgery.
- Pathological findings show thickened pulmonary arteries that resemble the fetal pattern and contribute to high pulmonary vascular resistance.
- Medical treatments are generally ineffective once int
The document discusses assessment of mechanical dyssynchrony for cardiac resynchronization therapy. It defines electrical and mechanical dyssynchrony, and describes the deleterious hemodynamic effects of left ventricular dyssynchrony. It then summarizes various echocardiographic tools for assessing atrioventricular dyssynchrony, interventricular dyssynchrony, and intraventricular dyssynchrony, including M-mode, tissue Doppler imaging, and three-dimensional echocardiography. Measurement techniques for different dyssynchrony parameters such as septal-posterior wall motion delay, lateral wall postsystolic displacement, and time to peak systolic velocity are outlined.
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction characterized by a non-traumatic separation of the coronary arterial wall. It most commonly affects younger women and the left anterior descending artery. SCAD results from an intimal tear or bleeding of vasa vasorum that leads to the formation of a false lumen filled with blood. This can cause the artery to narrow and restrict blood flow. SCAD is increasingly recognized and can be caused by conditions affecting connective tissue or hormonal factors during pregnancy. Angiography is used to diagnose SCAD but findings may be subtle, with long diffuse narrowing being most common. Management involves conservative treatment but revascularization may be needed for ongoing ischemia
Cardiac catheteriztion, Oximetery study in a patient with VSDPRAVEEN GUPTA
In this ppt i am going to discuss how to do cardiac catheterisation study, oximetry study and how to analyse its data in a patient with VSD who came to our hospital
The document discusses subcutaneous implantable cardioverter defibrillators (S-ICDs) and leadless pacemakers as alternatives to transvenous ICD systems. S-ICDs avoid the risks of transvenous leads but do not provide antitachycardia pacing or bradycardia support. Studies show S-ICDs effectively detect and treat ventricular arrhythmias similar to transvenous ICDs. However, S-ICDs have a higher risk of inappropriate shocks and pocket infections compared to transvenous ICDs. Leadless pacemakers eliminate transvenous leads but have not yet demonstrated long-term reliability.
Intravascular ultrasound (IVUS) uses sound waves to visualize the inside of arteries. There are two types of IVUS systems - mechanical systems using a rotating internal cable and solid-state systems using externally mounted transducers. Both produce 360-degree images with a resolution of 100-150 μm. IVUS is used to assess plaque, vessel dimensions, stent deployment, and more. It produces cross-sectional images showing the lumen, layers of the artery wall, and plaque composition and size. Measurements include diameters, areas, plaque burden, and indices of eccentricity. IVUS helps identify vulnerable plaque and has diagnostic and interventional applications.
Inherited aortopathy can cause complications like aortic dissection and repeated surgeries. This document discusses inherited aortopathies associated with congenital heart defects. Primary aortic dilatation is mainly associated with coarctation of the aorta, bicuspid aortic valve, and conotruncal abnormalities. Secondary dilatation can occur after congenital heart surgery when non-aortic tissue is used. The most serious complication is aortic dissection. Guidelines exist for investigating and treating this life-threatening event, with consideration of underlying hereditary disorders.
This document discusses various types and assessment of left ventricular dyssynchrony. It defines electrical and mechanical dyssynchrony. It describes different types of dyssynchrony including atrioventricular, interventricular, and intraventricular dyssynchrony. It discusses various echocardiography techniques to demonstrate and quantify each type of dyssynchrony, including M-mode, tissue Doppler, speckle tracking, and 3D echocardiography. It also mentions the use of MRI to assess dyssynchrony. The key application of assessing dyssynchrony is to predict response to cardiac resynchronization therapy in patients with heart failure.
1. Contrast agents enhance ultrasound images by increasing the backscatter of blood allowing visualization of small vessels. They oscillate non-linearly when exposed to ultrasound, emitting harmonic frequencies not seen in tissue.
2. Harmonic imaging exploits non-linear backscatter to identify the contrast agent signal and suppress tissue echoes, enabling visualization of microvascular flow.
3. Care must be taken in injecting contrast agents to avoid destroying bubbles, and infusion may provide a longer enhancement window for some studies compared to a bolus injection.
This document provides an overview of echocardiographic assessment of mitral regurgitation. It describes the anatomy of the mitral valve including the leaflets, annulus, chordae, and papillary muscles. It discusses Carpentier's functional classification system for describing the mechanism of mitral valve dysfunction. Methods for assessing severity are covered, including color flow imaging, continuous wave Doppler, vena contracta width, proximal isovelocity surface area, and volumetric assessment. Key points are made about evaluating jet direction, duration, and velocity in context of blood pressure. The importance of assessing left ventricular and left atrial size and function is also highlighted.
The document discusses various coronary artery anomalies including anomalies of origination, course, and intrinsic anatomy. Some key points include:
- Coronary artery anomalies have a global incidence of 5.64% and incidence of sudden death is 0.6%
- Anomalous origination of the left main coronary artery from the pulmonary artery (ALCAPA) is a rare but serious anomaly if left untreated
- Certain anomalous coronary artery courses, such as between the aorta and pulmonary artery, are associated with higher risks of sudden cardiac death
- Other anomalies discussed include single coronary arteries, coronary hypoplasia, ectasia/aneurysms, and intramural coronary arteries
2013.04.25 Using Digital & Social Media_MSEA_RetiredNEA
This document summarizes a presentation on using digital and social media to engage members. The presentation covered the current social media landscape, examples of effective social media use by organizations and politicians, and which platforms are most popular. It provided tips on using tools like Twitter, suggested ways for unions to improve their social media presence, and reviewed dos and don'ts of social media. The presentation concluded with recommendations for social media books and additional resources.
Fossil Hill Middle School scored in the "Developing" range in four categories of the Texas STaR Chart assessment of technology integration: Teaching & Learning, Educator Preparation & Development, Leadership/Administration/Support, and Infrastructure. The weakest areas included online learning, access to professional development, and older classroom technology infrastructure. To advance, the school aims to improve educator preparation and technology through investments in new devices and web-based learning over the next two to ten years.
The document discusses the results of an annual STaR survey that assesses a school's integration of technology. It provides details on what the STaR chart measures, such as teaching and learning, educator preparation, leadership, and infrastructure. The document then compares the school's STaR results over three years, finding that while the school was previously rated as advanced in many areas, its most recent ratings had dropped to developing. It concludes that continuing to improve technology integration is needed to fully prepare students.
The document discusses perceptions of the American West, both past and present. It describes how the West was initially viewed as rugged but was later promoted as sophisticated to attract settlers. While Western heritage is celebrated, the realities of the past included ethnic cleansing of Native Americans and racism. The West today faces tensions between traditions and changes like urbanization and diversity. Perceptions of an idealized Western past coexist with recognition of the region's complex history and evolving identity.
Male XLR connectors are outputs used to connect microphones to mixing desks or recorders, while female XLR connectors are inputs used for the same purpose. Phono jacks, also called RCA jacks, connect hi-fi equipment with male connectors on each end of the lead and carry left and right audio channels. Guitar jacks are used for both input and output to connect guitars to amplifiers and are considered a semi-professional audio connector.
The document provides information about HIV/AIDS including how it is transmitted, ways to protect oneself, myths and facts about transmission, statistics about those affected, and resources for testing and getting involved. It encourages getting tested, wearing a red ribbon on World AIDS Day to raise awareness, and volunteering or attending events to learn more and honor those lost to the disease.
How To Stay Covered in the Mobile Work DownpourCitrix Online
Once upon a time people went to the office five days a week. They commuted and were only able to complete their work at the office. Find out what happened when the digital rains arrived, empowering people to connect to their work from other locations.
1) The document announces an event called "IVY '09" organized by IBMR Business School to celebrate social media and web 3.0 technologies.
2) The event will feature presentations by industry speakers and students on harnessing social media power, and how companies are using social media.
3) It will be promoted through social media platforms like Facebook, LinkedIn, Twitter and YouTube as well as press releases in major publications.
The document outlines the vision and potential features of the Peripatetic School of Vedanta. The vision includes establishing the Indian Institute of Vedic Science & Research to teach various topics from Vedic sciences including Ayurveda, Vedic mathematics, astrology, architecture, economics, politics and martial arts. It proposes that the school could operate as a peripatetic (traveling) school, visiting different colleges weekly to deliver short introductory courses on Vedanta to graduation students for a nominal fee.
Driving Growth and Cutting Costs in 2010 with Online CollaborationCitrix Online
Web conferencing can drive business success by enabling collaboration and cutting costs. It allows employees to reduce travel for meetings by holding them online instead. This cuts organizations' costs significantly while maintaining productivity. Web conferencing also streamlines processes like sales, support, marketing and training by facilitating remote collaboration. When delivered as a hosted service, it provides benefits like quick implementation, reduced downtime, predictable costs and freeing up internal IT resources.
This document describes the Texas Teacher STaR Chart, a tool for teachers to self-assess their progress in meeting the goals of Texas's Long-Range Plan for Technology. The STaR Chart evaluates teachers across four key areas: Teaching and Learning, Educator Preparation and Development, Leadership/Administration/Instructional Support, and Infrastructure for Technology. The summary provides an example assessment, showing one teacher named Moss at the "Developing Technology Stage" in the first three areas and the "Advanced Technology Stage" in Infrastructure. The STaR Chart is meant to help teachers identify needs, determine funding, and conceptualize technology visions for their campus or district.
THIS MAGAZINE IS CREATED TO UPLIFT, EDUCATE, NETWORK, AND CELEBRATE LIFE, ESPECIALLY EMPHASIZING THE THICK GIRL MOVEMENT, AND SHOWING THE WORLD, WE ARE ONE.
A 72-year-old man underwent EVAR for an abdominal aortic aneurysm on November 7, 2015. He developed postoperative complications including pneumonia and renal failure. A CT scan on December 5th showed a rupture above the stent graft, so he underwent a chimney stent graft procedure to repair it on December 7th. However, he then developed diarrhea and signs of bowel ischemia. Another procedure on December 14th found kinking of the chimney graft to the superior mesenteric artery. Despite a rescue procedure, the patient went into shock and died, with the cause of death determined to be bowel ischemia.
A 31-year-old male was admitted to the emergency room after being found unconscious in a dirty river. He was intubated and placed on VV-ECMO for severe ARDS. Over the following days, he developed septic shock, multiple organ failure, and worsening infection despite broad-spectrum antibiotics. His condition continued to deteriorate and he suffered cardiac arrest on November 14, 2015. The cause of death was determined to be septic shock and multiple organ failure resulting from aspiration pneumonia and infection.
Aortic dissection--Introduction to OR staffRobert Chen
Aortic dissection is a serious condition where the inner layer of the aorta tears away from the middle layer, allowing blood to flow between the layers. It can be life-threatening as it risks rupturing the aorta. Symptoms may include chest pain, tearing pain in the back or abdomen, and difficulty breathing.
Research Methdology in Cardiovascular SurgeryRobert Chen
This document outlines a proposed clinical research study using data from CVS databases. It discusses potential data sources, variables that could be analyzed, and example topics that could be studied. The study would analyze data from CVS databases to benchmark outcomes and operational risks and submit papers on findings. Variables discussed include demographic data, pre-op risk factors, procedures, complications, and outcomes. Example topics proposed for papers include comparing MICS to conventional surgery and analyzing outcomes of mechanical vs. bioprosthetic valves. The document provides details on the data collection and analysis process that would be followed.
1. The document describes the development and use of a clinical database to analyze outcomes from cardiac surgeries at Cheng-Hsin General Hospital.
2. Variables were collected from medical records and organized in the database, including demographics, diagnoses, procedure details, and postoperative outcomes.
3. Analysis of the database showed that higher EuroSCORE values, which estimate surgical risk, predicted worse outcomes such as mortality and complications. The database allowed identification of factors associated with postoperative complications.
The document describes plans to develop a cardiovascular surgery database and conduct data analysis. It discusses objectives like risk assessment, outcome prediction, and statistical analysis. It outlines the content that would be included in the database, such as demographics, medical history, procedures, and outcomes. Challenges are noted around integrating different data sources and conducting advanced exploratory analysis. The goal is to use the database for research, quality improvement, and clinical decision making.
A speech given in Yodak Hospital, the 6th International Symposium of Cardiac Thorascopic Surgery, 10/25/2014; a report of endoscopic cardiac surgery in Taiwan
Minimally invasive cardiac surgery in TaiwanRobert Chen
This document discusses minimally invasive cardiac surgery techniques, specifically videoscope-assisted cardiac surgery (VACS). It notes that VACS uses 2D imaging without tactile feedback compared to direct vision in more invasive surgeries. Issues discussed include patient positioning, cannulation methods, myocardial protection routes, the ability to perform equivalent procedures, and hemostasis challenges. The document outlines the benefits and risks of VACS and robotic-assisted surgeries for procedures like CABG, mitral valve, aortic valve, and robotic mitral valve repair. Preoperative variables that may make a patient a good candidate for minimally invasive procedures are also examined.
Induced Pluripotent Stem Cells and Somatic Cardiac Regeneration— An Explorato...Robert Chen
This document summarizes an exploratory bioinformatic analysis of the interplay between induced pluripotent stem cells and somatic cardiac regeneration. The analysis identified molecules like nucleostemin that interact with key transcription factors involved in inducing pluripotency. Pathway analysis revealed networks linking nucleostemin and these factors to processes involved in cardiovascular development and the maintenance of pluripotency. Specifically, nucleostemin was found to interact with NANOG, a critical pluripotency factor, via the molecules TP53 and FGF. These findings provide potential targets for further research on using iPS cells to enable postnatal cardiac regeneration.