Ventricular arrhythmia in coronary artery disease: limits of a risk stratification strategy based on the ejection fraction alone and impact of infarct localization.

AIMS: Estimates of the left ventricular ejection fraction (LVEF) in patients with life-threatening ventricular arrhythmias related to coronary artery disease (CAD) have rarely been reported despite it has become the basis for determining patient's eligibility for prophylactic defibrillator. We aimed to determine the extent and distribution of reduced LVEF in patients with sustained ventricular tachycardia or ventricular fibrillation. METHODS AND RESULTS: 252 patients admitted for ventricular arrhythmia related to CAD were included: 149 had acute myocardial infarction (MI) (Group I, 59%), 54 had significant chronic obstructive CAD suggestive of an ischaemic arrhythmic trigger (Group II, 21%) and 49 patients had an old MI without residual ischaemia (Group III, 19%). 34% of the patients with scar-related arrhythmias had an LVEF > or =40%. Based on pre-event LVEF evaluation, it can be estimated that less than one quarter of the whole study population had a known chronic MI with severely reduced LVEF. In Group III, the proportion of inferior MI was significantly higher than anterior MI (81 vs. 19%; absolute difference, -62; 95% confidence interval, -45 to -79; P < or = 0.0001), though median LVEF was higher in inferior MI (0.37 +/- 10 vs. 0.29 +/- 10; P = 0.0499). CONCLUSION: Patients included in defibrillator trials represent only a minority of the patients at risk of sudden cardiac death. By applying the current risk stratification strategy based on LVEF, more than one third of the patients with old MI would not have qualified for a prophylactic defibrillator. Our study also suggests that inferior scars may be more prone to ventricular arrhythmia compared to anterior scars.

Evaluation of Bond Retainage in Portland Cement Concrete Overlays Using Infrared Thermography and Ground Penetrating Radar, HR-537, Final Report, 1989

When concrete deterioration begins to occur in highway pavement, repairs become necessary to assure the rider safety, extend its useful life and restore its riding qualities. One rehabilitation technique used to restore the pavement to acceptable highway standards is to apply a thin portland cement concrete (PCC) overlay to the existing pavement. First, any necessary repairs are made to the existing pavement, the surface is then prepared, and the PCC overlay is applied. Brice Petrides-Donohue, Inc. (Donohue) was retained by the Iowa Department of Transportation (IDOT) to evaluate the present condition with respect to debonding of the PCC overlay at fifteen sites on Interstate 80 and State Highway 141 throughout the State of Iowa. This was accomplished by conducting an infrared thermographic and ground penetrating radar survey of these sites which were selected by the Iowa Department of Transportation. The fifteen selected sites were all two lanes wide and one-tenth of a mile long, for a total of three lane miles or 190,080 square feet. The selected sites are as follows: On Interstate 80 Eastbound, from milepost 35.25 to 35.35, milepost 36.00 to 36.10, milepost 37.00 to 37.10, milepost 38.00 to 38.10 and milepost 39.00 to 39.10, on State Highway 141 from milepost 134.00 to 134.10, milepost 134.90 to milepost 135.00, milepost 135.90 to 136.00, milepost 137.00 to 137.10 and milepost 138.00 to 138.10, and on Interstate 80 Westbound from milepost 184.00 to 184.10, milepost 185.00 to 185.10, milepost 186.00 to 186.10, milepost 187.00 to 187.10, and from milepost 188.00 to 188.10.

HR-asiantuntijapalveluiden käyttö PK-yrityksissä. Case: Virvo Oy palveluiden tarjoajana

Tutkielma on kvalitatiivinen haastattelututkimus, jonka tavoitteena on tarkastella HR-asiantuntijapalveluiden;konsultoinnin, ulkoistamisen ja vuokrajohtajuuden käyttöä sekä mahdollisuuksia PK-sektorilla. Tutkimuksessa perehdytään myös työn toimeksiantajan, case-yritys Virvon liiketoimintaan HR-asiantuntijapalveluiden markkinoilla ja siihen, miten Virvo pystyy vastaamaan näihin haasteisiin. HR-asiantuntijapalveluiden markkinoiden selvittämiseksi on haastateltu neljää HR-asiantuntijaa. Tämän pohjalta on tehty 15 PK-yrityksen toimitusjohtajan haastattelua HR-asiantuntijapalveluiden käytön selvittämiseksi. Tehdyt haastattelut ovat olleet puolistrukturoituja, jolloin on käytetty valmiita kysymyspohjia. Tutkimuksessa on selvinnyt, että HR-asiantuntijamarkkinat ovat vasta muotoutumassa ja että ala on varsin uusi. PK-yritysten HR-toimintojen haasteisiin pystytään parhaiten vastaamaan HR-asiantuntijapalveluilla, jotka ovat selkeitä kokonaisuuksia ja järkevästi hinnoiteltuja. Tärkeinä asioina on nähty esimerkiksi käytännön toteutus sekä lisäajan saaminen varsinaisen liiketoiminnan hoitamiseen. Palveluiden käyttö korostuu erityisesti erilaisissa muutostilanteissa kuten esimerkiksi yrityksen kasvuvaiheessa. Voidaan todeta myös, että liiketoiminnan tila vaikuttaa HR-asiantuntijapalveluiden käyttöön.

A 3-step therapeutic strategy for severe alveolar proteinosis.

Pulmonary alveolar proteinosis (PAP) is characterized by accumulation of lipoproteinaceous material in the terminal airways. Whole lung lavage (WLL) remains the gold standard treatment but may be particularly challenging in cases of severe hypoxemia. We present a 3-step strategy that was used in a patient with PAP-associated refractory hypoxemia and that combined venovenous extracorporeal membrane oxygenation (vvECMO), double-lumen orotracheal intubation, and bilateral multisegmental sequential lavage (MSL). The procedure was well tolerated and permitted weaning from the ventilator.

Product placement in integrated marketing communications strategy

Perinteisten markkinointiviestintäkanavien menettäessä jatkuvasti tehoaan mediakentän ja kohderyhmien sirpaloituessa yhä pienempiin yksiköihin markkinointiorganisaatiot etsivät vaihtoehtoisia tapoja tavoittaakseen kohdeyleisönsä. Yksi vaihtoehtoinen markkinointiviestintäkeino on tuotesijoittelu (product placement), jossa (merkki)tuotteita sijoitetaan erilaisten viihdetuotantojen, kuten elokuvien, televisio-ohjelmien ja tietokonepelien, tarinan yhteyteen, jotta yhä medialukutaitoisempi kohdeyleisö ei pystyisi välttämään kaupallista viestiä esimerkiksi vaihtamalla televisiokanavaa tai kääntämällä lehden sivua. Koska tuote on sijoitettu kerrottavan tarinan sisään, markkinointiviestin — eli tuotteen havaitsemisen — välttäminen on huomattavasti vaikeampaa kuin perinteisten markkinointiviestintämenetelmien kohdalla. Lisäksi, sijoitellut tuotteet ovat tavallisesti kiinteässä yhteydessä tarinan juonen ja henkilöhahmojen kanssa siten, että tuote saa näistä yhteyksistä positiivista vahvistusta imagolleen. Pro Gradu-tutkielman tarkoituksena oli selvittää tuotesijoittelun käyttökelpoisuutta markkinointiviestinnässä sekä miten kulutushyödykemarkkinoijat voivat hyödyntää menetelmää markkinointiviestintästrategioissaan. Tuotesijoittelun poikkeava luonne markkinointiviestintävälineenä tuotti kysymyksen miten tuotesijoittelua voitaisiin hyödyntää yhteistyössä muiden markkinointiviestintäkeinojen kanssa. Tätä varten tutkimuksessa tuotesijoittelu yhdistettiin integroidun markkinointiviestinnän (IMC) viitekehykseen. IMC-konsepti syntyi markkinointiviestinnässä vastaamaan samaan tarpeeseen kuin tuotesijoittelukin: pirstaloitunut mediakenttä ja yksittäiset kohderyhmät vaativat kehittyneempää ja yhtenäisempää markkinointiviestinnän suunnittelua ja toteutusta. Tutkimuksen johtopäätöksenä tuotesijoittelu todettiin käyttökelpoiseksi markkinointiviestintäkeinoksi mikäli viestinnän tavoitteena on muu kuin tuotteen myyntiin suorasti vaikuttaminen. Tuotesijoittelu on sen sijaan erittäin tehokas tuotetietoisuuden lisäämisessä, erityisesti tunnistamisen kohdalla. Tuotesijoittelu voi myös tuottaa suoran ostotarpeen mutta tällöin viestin vastaanottajalla täytyy olla vallitseva tarve kyseisen tuoteryhmän osalta ennen altistumista ko. markkinointiviestille. Tuotesijoittelu voidaan sisällyttää IMC-suunnitteluprosessiin markkinointiviestintästrategian kiinteänä osana. Integraatio markkinointiviestinnässä siten, että tuotesijoittelua tuettaisiin muilla viestintäkeinoilla yhtenäisen kampanjan kehittämiseksi on kuitenkin paljon ennakoitua harvinaisempaa, johtuen ehkä eniten tuotesijoittelun poikkeuksellisesta luonteesta ja kyseisen viestintämuodon vaikeasta hallittavuudesta markkinoijan taholta. Tutkimus toteutettiin normatiivisena case-tutkimuksena pääasiassa sekundäärisiä tietolähteitä hyödyntäen. Case-tutkimuksia varten kerättiin primääristä tietoa kyselylomakkeella kahdesta tuotesijoittelua käyttävästä kansainvälisestä yhtiöstä, jonka lisäksi myös sekundäärisiä tietolähteitä hyödynnettiin case-osan tiedonkeruussa.

International Partnering strategy for e-learning provider in emerging economies: Evidence from East Africa learning institutions

International partnership has received growing interest in the literature during the past decades due to globalization, increased technological approaches and rapid changes in competitive environments. The study specifically determines the support provided by international partners on promotion of e-learning in East Africa, assess the motives of partner selection criteria, the determinants of selecting partners, partner models and partner competence of e-learning provider. The study also evaluates obstacles of e-learning partnering strategy in East Africa learning institutions. The research adopts a descriptive survey design. Target population involved East Africa learning institutions with a list of potential institutions generated from the Ministry of Higher Education database. Through a targeted reduction of the initial database, consisting of all learning institutions, both public and private, the study created a target sample base of 200 learning institutions. Structured questionnaires scheduled were used to collect primary data. Study findings showed the approach way East African communities in selecting their e-learning partners depend on international reputation of partners, partner with ability to negotiate with foreign governments, partner with international and local experiences, nationality of foreign partner and partners with local market knowledge.

Implementing a question-generation strategy with bilingual students: exploring the perspectives of a beginning teacher /

This study examined the challenges associated with the explicit delivery of questiongeneration strategy with 8 Arab Canadian students from the perspective of a bilingual beginning teacher. This study took place in a private school and involved 2 stages consisting of 9 instructional sessions, and individual interviews with the students. Data gathered from these interviews and the researcher's field notes from the sessions were used to gain insights about the participants' understanding and use of explicit instruction. The themes that emerged from the data included "teacher attitude," "students' enhanced metacognitive awareness and strategy use," "listening skills," and "instructional challenges." Briefly, teacher's attitude demonstrated how teacher's beliefs and knowledge influenced her willingness and perseverance to teach explicitly. Students' enhanced metacognitive awareness and strategy use included students' understanding and use of the question-generation strategy. The students' listening skills suggested that culture may influence their response to the delivery of explicit instruction. Here, the cultural expectations associated with being a good listener reinforced students' willingness to engage in this strategy. Students' prior knowledge also influenced their interaction with the question-generation strategy. Time for process versus covering content was a dominant instructional challenge. This study provides first hand information for teachers when considering how students' cultural backgrounds may affect their reactions to explicit strategy instruction.

A school-based cognitive behavior modification intervention strategy for learned helpless mentally retarded students

This study assessed the usefulness of a cognitive behavior modification (CBM) intervention package with mentally retarded students in overcoming learned helplessness and improving learning strategies. It also examined the feasibility of instructing teachers in the use of such a training program for a classroom setting. A modified single subject design across individuals was employed using two groups of three subjects. Three students from each of two segregated schools for the mentally retarded were selected using a teacher questionnaire and pupil checklist of the most learned helpless students enrolled there. Three additional learned helplessness assessments were conducted on each subject before and after the intervention in order to evaluate the usefulness of the program in alleviating learned helplessness. A classroom environment was created with the three students from each school engaged in three twenty minute work sessions a week with the experimenter and a tutor experimenter (TE) as instructors. Baseline measurements were established on seven targeted behaviors for each subject: task-relevant speech, task-irrelevant speech, speech denoting a positive evaluation of performance, speech denoting a negative evaluation of performance, proportion of time on task, non-verbal positive evaluation of performance and non-verbal negative evaluation of performance. The intervention package combined a variety of CBM techniques such as Meichenbaum's (1977) Stop, Look and Listen approach, role rehearsal and feedback. During the intervention each subject met with his TE twice a week for an individual half-hour session and one joint twenty minute session with all three students, the experimentor and one TE. Five weeks after the end of this experiment one follow up probe was conducted. All baseline, post-intervention and probe sessions were videotaped. The seven targeted behaviors were coded and comparisons of baseline, post intervention, and probe testing were presented in graph form. Results showed a reduction in learned helplessness in all subjects. Improvement was noted in each of the seven targeted behaviors for each of the six subjects. This study indicated that mentally retarded children can be taught to reduce learned helplessness with the aid of a CBM intervention package. It also showed that CBM is a viable approach in helping mentally retarded students acquire more effective learning strategies. Because the TEs (Tutor experimenters) had no trouble learning and implementing this program, it was considered feasible for teachers to use similar methods in the classroom.

Explicit versus implicit spelling strategy instruction and its effects on grade one children's invented spellings

The intent of this study was to investigate .the effectiveness of teaching thirty-five Grade One children a variety of effective spelling strategies in comparison to tradit~onal spelling instruction. Strategy instruction included training in phonology, imagery and analogy. In addition, the type of instruction pro~ided (implicit versus explicit) was also examined. Children were seen in small groups of four or five, for four, twenty-five minute sessions. All children were tested prior and immediately following the training sessions, as well as at 14-day follow-ups. Pretest and posttest measures included a dictated spelling test (based on words used in training), a developmental spelling test and a sample of each child's writing. In addition, children completed a metacognitive spelling test as a measure of their strategy awareness. Performance scores on the pretest and posttest measures were compared to determine if any differences existed between the three spelling instruction groups using the Dunn-Bonferroni and Dunnett procedures. Findings revealed that explicit strategy instruction was the most effective spelling program for improving Grade One children's invented spellings. Children who received this instruction were able to spell targeted words more accurately, even after a 14-day follow-up, and were able to recall more effective spelling strategies than children who received either implicit strategy instruction or traditional strategy instruction.

Improving grade eight students' spelling performance with a triad strategy approach

Thesis (M.Ed.)-- Brock University, 1996.

Preadjunct questions as a learning strategy for older adults

This study investigated the effectiveness of comprehension level preadjunct questions as a learning strategy for older adults in a classroom setting. Fifty-five adults from 55 to 70 years of age were randomly assigned to two groups, the preadjunct question group and a no-question control group. They viewed a video on high blood pressure and completed a recall posttest immediately after viewing the video and again seven days tater. Results demonstrated that there was no significant difference between groups. However, the no-question control group obtained a higher mean score on both the immediate and delayed recall tests than did the preadjunct question group. Nevertheless, significant differences in posttest scores were found related to educational levels and prior knowledge about high blood pressure. Results obtained were explained in terms of resource theory of cognitive aging.

Spelling performance of third grade students : a comparison of whole-language-plus-strategy instruction, strategy instruction only, and the whole language approach

This study investigated three methods for teaching children how to spell. Third grade students were divided into three conditions for a one-week training period consisting of 15- to 20-minute lessons. One of the two experimental conditions used a whole language approach along with explicit strategy instruction. The second condition used strategy instruction within a traditional setting. The control used strictly a whole language approach to le~ing hO\\l to spell. The spelling perfonnance of all three conditions improved after the one-week training period. However, students in the strategy instruction groups did significantly better on the study "'7ords than the whole language only group. The students in whole-Ianguage-plusstrateg)! instruction outperformed both other groups. Significantly better spelling perfonnance was observed even at the nine-week posttest. This study frrst supported the hypothesis that children can make significantly greater improven1ents in their spelling when explicitly taught how to use spelling strategies. Secondl)', this study indicated that whole language provided a relevant context for the study words, clearly giving the students in the whole-Ianguage-plus-strategy condition an additional advantage.

The effectiveness of explicit strategy instruction on the top level structure of a text

Thesis (M.Ed.)-- Brock University, 1995.

The effects of teaching a mathematics problem solving strategy on the problem solving ability of grade nine students

Forty grade 9 students were selected from a small rural board in southern Ontario. The students were in two classes and were treated as two groups. The treatment group received instruction in the Logical Numerical Problem Solving Strategy every day for 37 minutes over a 6 week period. The control group received instruction in problem solving without this strategy over the same time period. Then the control group received the treat~ent and the treatment group received the instruction without the strategy. Quite a large variance was found in the problem solving ability of students in grade 9. It was also found that the growth of the problem solving ability achievement of students could be measured using growth strands based upon the results of the pilot study. The analysis of the results of the study using t-tests and a MANOVA demonstrated that the teaching of the strategy did not significaritly (at p s 0.05) increase the problem solving achievement of the students. However, there was an encouraging trend seen in the data.