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The Cocoon patent foramen ovale (PFO) occluder is a new device especially designed for transcatheter closure of PFO. This occluder has some distinctive structural modifications aimed at reducing the risk of major complications of transcatheter PFO closure. In this report we present our initial experience to evaluate the efficacy and safety of the Cocoon PFO occluder in 253 patients who underwent transcatheter PFO closure.

The new technological evolution has influenced the global business with the use and application of business intelligence tools that provide information accuracy and conformity to managerial decisions, leading to organisational efficiency and corporate performance. In the global business environment, there is a need of social awareness for the improvement of the human well-being. Managers need to create a knowledge base with the purpose to understand the needs of the global society. This paper aims to present literature insights, from both philosophical and IT dimension, proposing initial research undertakings that should enhance our understanding of the new managerial self-actualisation era. Thus, it is argued that corporate performance is a well-balanced combination between technological trends and human values based on the self-actualisation continuous managerial decision process.

Objective: To close perimembranous ventricular septal defects (PMVSDs) in children with the new Amplatzer asymmetric ventricular septal defect occluder (AAVSDO). Patients and design: 10 children, aged 1.5-12 years, with PMVSDs [...]

Background: The design of devices currently used for closure of persistent ductus arteriosus (PDA) with high pulmonary artery pressure is not ideal and there is a risk of embolisation into [...]

Summary After reviewing more than 100 Publications on business in Japan, the conclusion is that three characteristics predominate in Japanese management thinking: harmony and group loyalty, consensus decision making, and [...]

The Cocoon septal occluder (CSO) is a new generation double disk occluder device for catheter closure of the secundum atrial septal defect (ASD). Initial clinical evaluations with the use of this device have shown quite satisfactory results but large follow-up studies are missing. In this international multicenter study, we present procedural and follow-up data from 4008 patients with secundum ASD who underwent catheter closure with the use of CSO.

Technology development has made a decisive contribution to the digitisation of businesses, which makes it easier for them to work more efficiently. However, in recent years, data leakages have shown an increasing trend. To investigate the level of awareness among Cypriot accountancy firms about cyber-related risks, we use the data from a recent survey of Cypriot professional accountants' members of Institute of Certified Public Accountants of Cyprus (ICPAC). The categorical nature of the data and the purpose of our research led us to use methods of multidimensional statistical analysis. The emergence of intense differences between accounting companies in relation to the issue as we will present is particularly interesting.

ABSTRACTThis study aims to examine the extent to which crop landraces (LRs) can serve as viable alternatives for farming within the ongoing economic crisis, especially for potential young farmers. A conceptual framework based on farm economic sustainability and the diversification strategies of farm-households is applied to four different LRs. Drawing on original data from field surveys, the economic analysis shows that LRs provide various gains for local communities as well as a series of private benefits for the farmers involved in their cultivation. Many of the examined farms are economically sustainable, even with small farm sizes. The integration of LRs into both domestic and export markets and the embeddedness of LRs’ products into the local culture and diet are two critical prerequisites for their on-farm conservation. The examined LRs are low-labour-input crops, obtaining the necessary labour mainly from family members. An LR can be the sole cultivation of a farm, part of mixed farming systems, as well as part of various strategies pursued by farm-households to diversify their sources of income. There is scope for improvement, especially by ensuring the uniqueness of LR products, establishing new marketing channels and creating special brand names. Supportive policy measures are also discussed.

Planning often is erroneously conceived as an exclusively preliminary activity. While the planning process is essential to the initial design of the ways and means of meeting objectives, it should [...]

Foliage and litter samples of twelve Medicagospecies (medics) (Fabaceae) were collected for the study of Thysanoptera from mainland and insular Greece between 2007–2013. The species composition, population dynamics and spatial distribution of thrips were also evaluated based on two similarly managed experimental plots, except the number of cuttings, within an alfalfa hay field in Kopais Valley (Central Greece) between 2007–2008. Nine thrips species were recorded from nine medics, two of which (Pseudodendrothrips moriand Sericothrips bicornis) are new to the Greek fauna. Eight species of Thysanoptera were recorded on alfalfa and five species in the rest of the medics, among which Medicago strasseriis an endemic shrub of Crete. Data regarding the quantitative part of the study demonstrated that Frankliniella occidentalis, which was the most abundant thrips species in both plots, presented a seasonal pattern of population fluctuation and also tended to aggregate. The mean population density of this species significantly differed between the above-mentioned plots, but no such a difference was estimated for the larvae of Thripidae.

Foliage and litter samples of twelve Medicago species (medics) (Fabaceae) were collected for the study of Thysanoptera from mainland and insular Greece between 2007-2013. The species composition, population dynamics and spatial distribution of thrips were also evaluated based on two similarly managed experimental plots, except the number of cuttings, within an alfalfa hay field in Kopais Valley (Central Greece) between 2007-2008. Nine thrips species were recorded from nine medics, two of which (Pseudodendrothrips mori and Sericothrips bicornis) are new to the Greek fauna. Eight species of Thysanoptera were recorded on alfalfa and five species in the rest of the medics, among which Medicago strasseri is an endemic shrub of Crete. Data regarding the quantitative part of the study demonstrated that Frankliniella occidentalis, which was the most abundant thrips species in both plots, presented a seasonal pattern of population fluctuation and also tended to aggregate. The mean population density of this species significantly differed between the above-mentioned plots, but no such a difference was estimated for the larvae of Thripidae.

Abstract: This study focusses on the estimation of seismic fragility curves for all common bridge types found in modern greek motorways. At first a classification scheme is developed in order to classify the existing bridges into a sufficient number of classes. A total of 11 representative bridge classes resulted, based on the type of piers, deck, and pier-to-deck connection. Then an analytical methodology for deriving fragility curves is proposed and applied to the representative bridge models. This procedure is based on pushover analysis of the entire bridge and definition of damage states in terms of parameters of the bridge pushover curves. The procedure differentiates the way of defining damage according to the seismic energy dissipation mechanism in each bridge, i.e. bridges with yielding piers of the column type and bridges with bearings (with or without seismic links) and non-yielding piers of the wall type. The activation of the abutment-backfill system due to closure of the gap between the deck and the abutments is also taken into account. The derived fragility curves are subjected to a first calibration against empirical curves based on damage data from the US and Japan.

Purpose: Severe pulmonary hypertension (PH) is a major cause of right ventricular (RV) dysfunction. Various iv vasodilator modalities have been used with limited results because of lack of pulmonary selectivity. The aim of the present controlled study was to evaluate the efficacy of inhaled iloprost, a synthetic prostacyclin analogue, in patients with elevated pulmonary vascular resistance (PVR) immediately after separation from cardiopulmonary bypass (CPB). Methods: Twelve patients with persistent PH after discontinuation of CPB were included in the study. In all patients standard hemodynamic monitoring was used. Inhaled iloprost was administered via nebulized aerosol at a cumulative dose of 0.2 μg·kg−1for a total duration of 20 min. Complete sets of hemodynamic measurements were performed before inhalation (baseline), during and after cessation of the inhalation period. Echocardiographic monitoring of RV function was also used. Results: Inhaled iloprost induced a reduction in the transpulmonary gradient at the end of the inhalation period in comparison to baseline (9.33 ± 3.83 mmHg vs 17.09 ± 6.41 mmHg, P < 0.05). The mean pulmonary artery pressure to systemic artery pressure ratio decreased over this period (0.28 ± 0.08 vs 0.45 ±0.17, P < 0.05). A statistically significant decrease of the PVR to systemic vascular resistance ratio was also observed (0.15 ± 0.05 vs 0.21 ± 0.05, P < 0.05). Improved indices of RV function were observed in echocardiographic monitoring. Conclusion: Inhaled iloprost appears to be a selective pulmonary vasodilator and may be effective in the initial treatment of PH and the improvement of RV performance in the perioperative setting.

Between May 1997 and June 2000, 69 patients, ages 0.1 to 34 years, underwent attempted anterograde transcatheter closure of a patent ductus arteriosus (PDA) using the Amplatzer Duct Occluder (ADO). The ADO is a cone‐shaped, self‐centering, and repositionable occluder made of nitinol wire mesh. A 5Fr to 7Fr sheath was used for the delivery of the device. The mean PDA diameter (at the pulmonary end) was 4.6 ± 1.9 mm (range 1 mm‐8.5 mm). Sixty‐seven of the 69 patients had successful device placement. The mean ADO smallest diameter was 6.9 ± 1.8 mm (range 4 mm‐12 mm). Complete angiographic closure occurred in 62 (92.5%) of 67 patients (95% confidence interval, 88.22%–98.77%). In five patients, there was a trivial residual shunt immediately after the procedure. At 24 hours, color Doppler flow imaging revealed complete closure in all 67 (100%) patients. The unsuccessful attempts occurred in two patients with a small, I‐mm diameter native PDA and residual PDA after surgical occlusion. Fluoroscopy time was 7.6 ± 1.8 minutes (4 min‐18 min). No complications were observed. At a median follow‐up of 1.5 years (range 0.25 to 3.2 years), all patients had complete closure without complications. We conclude that transcatheter closure using the ADO is a highly effective and safe treatment for most patients with PDA. (J Interven Cardiol 2001;14:247–254)

We report a successful outcome on an acute adenovirus myocarditis treated with a 24-hour high-dose intravenous immunoglobulin (24-HDIVIG) in a 4.5-year-old girl. A postviral etiology of acute myocarditis was assessed on the basis of the polymerase chain reaction technique. Among other early markers of cardiac injury, cardiac isoform of troponin-I (cTnI) was significantly correlated to the left ventricular ejection fraction (r=−0.86, p< 0.0001). Follow-up of cTnI, which might also be correlated to the short-term outcome, allows fast, easy, and noninvasive estimation of response to the aggressive treatment with 24-HDIVIG in acute adenovirus myocarditis in children.

ObjectiveTo report the initial and intermediate term results of stent implantation in children with coarctation of the aorta.Patients and design17 patients with coarctation of the aorta underwent stent implantation (median age 11 years, range 0.4-15 years); six were treated for isolated coarctation, nine for recurrent coarctation (five after surgical repair and four after balloon dilatation), and two for complex long segment coarctation.InterventionsThe procedure was guided by a second catheter placed transseptally in the left ventricle or the aorta proximal to the coarctation site, for angiographic and haemodynamic monitoring during the procedure. Twenty two stents were implanted in 17 patients. One of the patients with long segment coarctation received four stents and the other three. Palmaz 4014 stents were placed in 11 patients, Palmaz 308 in five, and Palmaz 154 in one.ResultsImmediately after stent implantation the peak systolic gradient (mean (SD)) fell from 50.0 (24.5) to 2.1 (2.4) mm Hg (p &lt; 0.05). The diameter of the stenotic lesion increased from 5.1 (1.5) mm to 13.9 (2.4) mm (p &lt; 0.05). There were no deaths or procedure related complications. At a median follow up of 33 months, no cases of recoarctation were identified, either clinically (0/17; 0%, 95% confidence interval (CI) 0% to 19%) or angiographically (0/13; 0%, 95% CI 0% to 25%).ConclusionsStent implantation for the treatment of coarctation of the aorta appears to have very low morbidity and mortality, and reasonable intermediate term results. Long term freedom from recoarctation using this method remains to be determined in comparison with simple balloon dilatation.

OBJECTIVE

Children with acute meningococcemia may have impaired myocardial function resulting in low cardiac output despite normal intravascular volume. Severe meningococcal infection has been associated with acute interstitial myocarditis, endocarditis, and pericarditis, but not with myocardial infarction.

ObjectiveTo assess the efficacy and complications of device occlusion of atrial septal defects in adults, using the Amplatzer septal occluder (ASO). DesignA prospective interventional study. SettingPaediatric cardiology departments in two European teaching hospitals. PatientsThe first 20 patients accepted for atrial septal defect device occlusion, on the basis of transoesophageal echocardiography. Sixteen patients had larger defects with right heart dilatation, while the primary indication for closure in four was a history of early paradoxical embolism. InterventionsTranscatheter atrial septal defect occlusions performed under transoesophageal echocardiography and fluoroscopic guidance between December 1996 and June 1998. Outcome measuresSuccess of deployment of ASO devices, procedure and fluoroscopic times, complications, and symptoms. ResultsThe ASO device was successfully implanted in all 20 patients (14 female), median age 44.2 years, with no complications. Of the 16 patients with right heart dilatation, the median Qp:Qs was 2.5:1. Defects measured 11-22 mm (median 18) on transoesophageal echocardiography, with balloon sized diameter (and device size) of 13-28 mm (median 20). For all 20 patients, the procedure time ranged from 38-78 minutes (median 61), and fluoroscopy 8.4-24.7 minutes (median 15.2). There were residual shunts in three patients at the end of the procedure, which were trivial (≤ 1 mm) as assessed by transoesophageal echocardiography, and persisted for more than six months in only one patient. Follow up ranged from 0.1-1.5 years (median 0.7). There have been no late complications. ConclusionsThe ASO device can be used successfully to close selected oval fossa defects in adults, with minimal procedural morbidity and excellent early results.

OBJECTIVES

Prostaglandin E2 was administered to 22 newborns with ductus-dependent cyanotic congenital heart disease. Twelve patients had pulmonary atresia and ten simple dextrotransposition of the great arteries. Patients were classified into two groups: group 1 (n=11) received prostaglandin E2 by the intravenous route (dose: 0.01–0.05 µg/kg per min); group 2 (n=11) received prostaglandin E2 by the oral route (dose: 35–65 µg/kg per 1–4 h). Treatment lasted for 1–90 days. All infants except one of group 2 showed a significant (>10 Torr) increase in PaO2 following PGE2 administration. The mean increase in PaO2 was higher (P<0.01) in group 1 (21.8±1.7, Torr) than in group 2 (15.8±1.5, Torr). PaO2 fell significantly (P<0.01) in five patients of group 1 who continued treatment orally with satisfactory (>30 Torr) levels in four of them. Severe side effects were observed only in group 1. The data show that similarly to prostaglandin E1 infusions, prostaglandin E2, given i.v. or orally, is useful in the management of infants with ductus-dependent cyanotic congenital heart disease. Oral prostaglandin E2, administration is less effective than i.v. infusions, but can be used for long-term, therapy being more convenient and causing minimal morbidity.

ABSTRACTIn this paper the components of an undergraduate International Business (IB) course, developed and taught according to corporate suggestions, are related to the importance attached to each of the components by the students taking the class. In the continuation, areas of positive or negative student predispositions are identified and suggestions and remedial actions on how to improve delivery of this course are proposed.

Summary Two patients with pulmonary atresia had a loud holosystolic murmur and an obstructed ventricular septal defect. Case 1 simulated pulmonary atresia with intact ventricular septum, presenting at 3 months of age with venous congestion, severe tricuspid regurgitation, and suprasystemic right ventricular pressure. Case 2 had a right ventricular systolic pressure that was initially at the systemic level but had increased to a suprasystemic level by 3 years of age. Autopsy showed that the ventricular septal defect was large in each case but was obstructed by tricuspid valve tissue in case 1 and by a hypertrophied septal band in case 2.

Objectives. This study reports our clinical experience with transcatheter closure of secundum atrial septal defects (ASDs) in children, using the Amplatzer, a new occlusion device.

A significant component of overseas travel is the pilgrimage to the ancestral lands of ethnic groups in the United States. This article examines variables that correlate (and those that do not) with this tedious and expensive purchase by studying a specific ethnic group in North America.

This pilot study measures levels of cross-cultural understanding and ethnocentricity of college students and tests the hypothesis that students exhibit increased levels of cross-cultural understanding and lower levels of ethnocentricity after taking a university course in international business. Two matched-demographic groups of students are surveyed, one before taking the course, and t l' e other following completion of the course. The findings indicate some tendency to change in ,a positive direction with increased exposure to international business issues. The study also uses a factor analytical approach to examine the underlyin structures of attitudes relating to cmss-cultural understanding andethnocentricity. In this respect, differences in cross-cultural understanding and ethnocentricity are found to exist among sub-groups of the research population, with women and cosmopolitans scoring higher in terms of cross-cultural understanding and lower in ethnocentric- . Practical implications and suggestions for further research are a '7 so offered.

No abstract available for this article.

• Hyperviscosity, or decreased fluidity secondary to increased numbers of red blood cells, leads to tissue hypoperfusion. We report the case of an infant with hyperviscosity who died from necrotizing enterocolitis (NEC), and describe the presumptive association between NEC and hyperviscosity.(Am J Dis Child 129:1192-1194, 1975)

Anomalous origin of the right pulmonary artery from the ascending aorta (AORPA) with severe right ventricular dysfunction in a neonate was completely diagnosed by echocardiography. Cardiac catheterization was performed to explore further right ventricular dysfunction, which is extremely rare at this age. Following cardiac catheterization, the patient died. We suggest that in critically ill infants with the aforementioned condition surgical repair guided by modern echocardiography must be the chosen management.

The possible existence of a chemical substance with cross-reactivity to digoxin antibodies in the neonatal serum or plasma was investigated in this study. Our data show that in contrast to previous reports, the levels of a “digoxin-like substance” in the serum or plasma of healthy newborns are negligable and probably would not affect the reliability of digoxin radioimmunoassay tests.