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Przedmiotem tego artykułu są refleksje dotyczące funkcjonowania warsztatów terapii zajęciowej (WTZ) jako przestrzeni umożliwiającej zmiany funkcjonowania osób z niepełno(sprawnością). Opracowanie zawiera wskazania do optymalizacji działalności praktycznej, ukierunkowanej na świadome tworzenie kontekstu służącego zmianie i rozwojowi jednostek. Ważnym elementem takich oddziaływań wydaje się być proces „sygnifikacji”, czyli nadawania znaczeń doświadczeniom jednostek będących podmiotem różnorodnych oddziaływań o charakterze edukacyjnym, wychowawczym czy też terapeutycznym. Istotą owego procesu jest kreowanie konstruktywnych narracji, opowieści dotyczących określonych sytuacji wychowawczych. Wzrost świadomości personelu co do ważności i zasadności tworzenia przestrzeni semiotycznej do nadawania konstruktywnych znaczeń doświadczeniom uczestników WTZ.

Despite its apparently simple nature with four valence electrons, the strontium dimer constitutes a challenge for modern electronic structure theory. Here we focus on excited electronic states of Sr$_2$, which we investigate theoretically up to 25000 cm$^{-1}$ above the ground state, to guide and explain new spectroscopic measurements. In particular, we focus on potential energy curves for the $1^1\Sigma^{+}_{u}$, $2^1\Sigma^{+}_{u}$, $1^1\Pi_{u}$, $2^1\Pi_{u}$, and $1^1\Delta_{u}$ states computed using several variants of advanced \textit{ab initio} methods to benchmark them. In addition, a new experimental study of the excited $2^1\Sigma^{+}_{u}$ state using polarisation labelling spectroscopy is presented, which extends knowledge of this state to high vibrational levels, where perturbation by higher electronic states is observed. The available experimental observations are compared with the theoretical predictions and help to assess the accuracy and limitations of employed theoretical models. The present results pave the way for future more accurate theoretical and experimental spectroscopic studies., Comment: 11 pages, 5 figures

We report a systematic study of the C(2)

Polarisation labelling spectroscopy technique was employed to study the 3

The C(3)

We report on spectroscopic studies of hot and ultracold RbSr molecules, and combine the results in an analysis that allows us to fit a potential energy curve (PEC) for the X(1)

Although the short-term results after radiofrequency (RF) catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT), accessorry pathway (AP), atrioventricular junction (AVJ) and common atrial flutter (Aflu) have been widely reported, there is insufficient data on long-term outcome.To evaluate the long-term efficacy of RF ablation of cardiac arrhythmias in a single center.The study population consisted of 349 consecutive patients (mean age 49.5 years) who underwent RF ablation of AP (136 patients), AVNRT (105 patients), AVJ (86 patients) or Aflu (15 patients). In 4 patients two AP and in 3 patients AP and AVNRT were ablated during the same session. The patients were subsequently followed-up for an average of 44.3 months (12-76 months).Ablation was successful in 341 patients (97.7%). Major complications occurred in 8 patients (2.3%) and included av block (6 patients), ventricular fibrillation (1 patient) and cardiac tamponade (1 patient). Tachycardia recurrences were observed in 21 patients (6.2%) after successful ablation. All the recurrences occurred within 10 months (mean 2.3 months) after ablation. The recurrence rate was 5.8% (6 patients) in the AVNRT group, 9.2% (12 patients) in the AP group, 1.2% in the AVJ group (1 patient) and 13% (2 patients) in the Aflu group. The differences between groups were insignifficant.(1) The immediate success rate of RF ablation of AVNRT, AP, AVJ or Aflu was high and there was a low incidence of complications. (2) The recurrence rate during long-term observation is low. (3). All the recurrences occurred within 10 months after successful ablation.

VDD stimulation is accepted as alternative mode of cardiac pacing to DDD in patients with atrio-ventricular (AV) conduction block and preserved sinus node function (SA).An attempt has been made to determine the relationship between width and amplitude of the P wave obtained during assessment the patient for the implantation procedure and the effectiveness of AV synchronization (PAS).The study involved a group of 65 patients (43 male, 22 female), aged 66.6 +/- 12.7 with clinically significant disturbances of AV conduction, who did not reveal symptoms of concomitant disturbance in SA node automaticity. The width and amplitude of the P wave of the surface ECG were studied prior to the implantation procedure. Follow-up was carried out 3-4 days and 1, 3, 6 and 12 months after the procedure. The effectiveness of PAS was estimated by event counter read-out.Over the 12-month follow-up, the average value of the PAS coefficient was 95% for the entire group of patients. In 74% (subgroup A) synchronization was highly effective (PASor = 95%); in the remaining 26% (subgroup B) PAS occasionally fell below 95%. A statistically significant correlation between the width of the P wave of the surface ECG and the effectiveness of PAS was clearly demonstrated. In subgroup B, P wave was longer than in subgroup A (105 +/- 16 vs. 94 +/- 14 ms; p0.005). The width of P wave above 100 ms was the cutoff value of the ROC curve predicting PAS95%.The width of P wave obtained from surface ECG is correlated with effective AV synchronization. The value above 100 ms was predisposed to atrial undersensing.

The VDD/R pacing is accepted as an alternative to DDD/R pacing in patients with atrioventricular conduction block (AVB) and intact sinus node function.To determine the relationship between parameters obtained during assessment of the patient for the implantation procedure, using electrocardiographic (ECG) and echocardiographic (ECHO) data, and the effectiveness of AV synchronisation.The study involved a group of 65 patients (43 males, 22 females), aged 66.6 + 12.7 with clinically significant disturbances of AV conduction, who did not reveal symptoms of concomitant abnormalities in sinus node automaticity. Selected ECG and ECHO parameters were studied prior to the implantation procedure. Repeat examinations were done at 3-4 days and at 1, 3, 6 and 12 months after the procedure. The effectiveness of AV synchronisation (PAS) has been estimated by event counter read-out and ECG Holter monitoring.In 74% patients (subgroup A) synchronisation was highly effective (PAS _ 95%); in the remaining 26% subjects (subgroup B) PAS occasionally fell below 95%. In subgroup B, the P wave was longer than that in subgroup A (105 +/- 16 vs. 92 _ 13 ms; p0.05). The dimensions of the right and left heart chambers were greater in subgroup B. Patients in subgroup B had lower ejection fraction (49.4 +/- 13.7% in B vs. 58.2 +/- 11.3% in A) and revealed symptoms of heart failure. The following cut-off values for each echocardiographic and electrocardiographic parameter predisposing to PAS95% during VDD/R pacing ('undersensing') were identified: RVEDd26 mm, RVESd24 mm, LVEDd59 mm, LVESd37.3 mm, APD LA44 mm, SID RA52 mm, LMD RA48 mm, RAvol54 ml, RAarea19 cm2, SID LA57 mm, LMD LA46 mm, EF52%, P wave width100 ms. Significant predictors of PAS95% in the univariate analysis were RVEDd, RVESd, LVEDd, LMD RA, SID RA, RAvol, RAarea, EF, and in the multivariate analysis RVEDd, RVESd, LMD RA, RAarea, EF.Selected parameters obtained from ECG (P wave width) and echo examinations are correlated with effective AV synchronisation. Enlargement of the right and left heart chambers (atrial, ventricular), reduction of the ejection fraction and congestive heart failure are associated with impaired AV synchronisation in VDD/R pacemakers. In multivariate analysis, only the higher dimensions of the right ventricle and atrium and the lower ejection fraction of the left ventricle were significantly associated with the PAS95%.

In patients with drug refractory atrial fibrillation radiofrequency (RF), ablation of the atrioventricular (AV) junction and pacemaker implantation is an alternative procedure. The aim of this study was to assess the left ventricular systolic function, exercise tolerance and quality of life (QOL) in patients who underwent RF AV junction ablation and permanent pacemaker implantation.24 patients (14 male, 10 female, 64.8 +/- 11.0 years) underwent RF ablation. The duration of symptoms was 4 +/- 1.9 years prior to ablation. Post ablation, the selected pacing mode was DDDR for the 4 patients with paroxysmal AF and VVIR for the 20 patients with chronic AF. The underlying heart disease was coronary artery disease (17 CAD), arterial hypertension (15 AH) and heart failure (9 HF). Prior to the ablation and after 6 months follow-up--an ECHO, exercise tolerance (the six minute walk -M6) and QOL assessment (the questionnaire of SF-36, functional symptomatology scale, DASI scale) were performed. The NYHA class was also evaluated.The patients showed a significant improvement in NYHA class (p0.005), in QOL (SF-36, p0.0025; symptomatic score, p0.025; DASI, p0.01) and in the M6 (p0.01). We did not find significant changes in left ventricular performance. The significant correlation was observed between the SF-36 and functional symptomatology (r = 0.71) and DASI (r = 0.53). We divided our patients into two groups: Group A (patients with the higher NYHA class, p0.025) with significant improvement QOL and Group B with insignificant improvement of QOL. Post ablation in group A we--observed significant improvement in NYHA class and M6 (p0.01).1. In patients with drug refractory atrial fibrillation, RF AV junction ablation and permanent pacemaker implantation significantly improve the QOL, M6 and NYHA class. 2. Significant improvement of QOL as well as in M6 can be expected after RF ablation with pacemaker implantation, especially in patients with more advanced hart failure (higher NYHA class).

Transcutaneous RF catheter ablation of the atrioventricular junction (AVJ) in pts with ventricular pacemaker (VVIR) implantated is an accepted treatment for drug-intolerant or drug refractory atrial fibrillation. The ventricular arrhythmias and sudden cardiac death may be associated with increased of QT dispersion (QTD), mainly in pts with reduced LV function (low ejection fraction - EF) after AVJ ablation. The present study evaluates the dynamic of the changes of QTD in response to a sudden pacing rate drop from 80/min to 40/min in follow up 1 day, 3, 6 and 9 months after ablation (1d, 3m, 6m, 9m).The 12-lead ECGs were recorded on 22 pts (mean age 72.6+/-5.4 yrs) (10 with low EF (50%) - group A, 12 with normal EF (or =50%) - group B) on the 1 day, 3, 6 and 9 months following AVJ ablation during a sudden drop in ventricular pacing rate from 80 to 40 beats/min. The maximum QT interval (QTM), minimum QT interval (QTm), and QTD were measured on the last 5 beats prior to the rate drop (QTM-80, QTm-80, QTD-80) and on the first 5 beats after the rate drop (QTM-40, QTm-40, QTD-40). These QT parameters were compared. The echocardiographical studies were performed on the 1d, 3m, 6m and 9m following AVJ ablation.In response to a sudden paced heart rates drop from 80 to 40 beats/min, the DeltaQTM (QTM-40 - QTM-80) increased during follow-up in both groups, while the DeltaQTm (QTm-40-QTm-80) increased in group B(23.3+/-25.7 in 1d, 27,5+/-20.1ms in 9m; p0.001), but not in group A (1+/-16.6 in 1d, 5+/-25.1ms in 9m). Consequently, the AQTD (QTD-40 - QTD-80) increased significantly in group A at 6 months (29+/-31.1ms; p0.05) but not in group B (9.2+/-17.3msl. The negative correlation between QTD-40, QTD-80 and EF was observed in group A.Following AVJ ablation, QTD increased during a sudden rate drop in pts with reduced LV function, but not in pts with EFor = 50%. The significant correlation between QTD and paced rate was found in pts with LV dysfunction. The increased QTD in response to a sudden heart rate drop in pts with low EF was due to a failure of the expected prolongation of the QTm.

In the performed experiment we trap simultaneously in the Magneto-Optical Trap cold atoms of 7 Li with cold sodium atoms and cold 6 Li atoms with cold 23 Na atoms. We investigated in detail heteronuclear interactions between cold isotopes of lithium atoms and cold sodium atoms in presence of the laser light.

Radiofrequency catheter ablation (RFCA) may cause myocardial injury.To assess changes in myocardial enzymes levels following RFCA.Creatine kinase (CK), CK-MB, aspartate aminotransferase (GOT), alanine aminotransferase (GPT), troponin I and myoglobin levels were assessed in 53 patients (33 females, 20 males, mean age 53 years, range 23-78 years) before and 20 hours after successful RFCA (WPW type A = 13, WPW type B = 10, atrio-ventricular nodal tachycardia n = 17, atrial fibrillation or flutter n = 5, atrial tachycardia n = 2 and complex arrhythmias n = 6).The mean number of RF applications was 10.4, cumulative energy - 22 671 J, duration of application - 468 sec, and temperature - 58 degrees C. A significant post-RFCA increase in the troponin I and myoglobin levels was found whereas the changes in CK and GOT levels were less pronounced. A significant correlation between troponin I elevation and RFCA energy, particularly in males, was documented. There was a trend towards a decrease in the GPT and CK-MB levels. Troponin I and myoglobin levels increased regardless of the site of RF energy application.Troponin I and myoglobin are useful for the assessment of RFCA-induced myocardial injury, regardless of the site of RFCA application.

Eleven resting patients with an implanted DDD pacemaker were studied. After 30 minutes of AV sequentiai pacing at a rate of 80 beats/min with three consecutive atrioventricular delays (AVDs; 100, 150, and 200 msec) peripheral venous blood was drawn for further analyses by specific radioimmunoassays of atrial natriuretic peptide (ANP) and the ANP second messenger, cyclic guanosine monophosphate (cGMP). Relative changes in left ventricular (LV) stroke volume following alterations of AVD were assessed by means of pulsed-Doppler echocardiography through measurement of LV outflow time-velocity integrals (TVI). The optimal AVD (oA VD) was defined in individual patients as that which was associated with the greatest TVI and with improvement over both other AVDs of more than 4%. The oA VD was found in nine patients. For these nine patients no significant differences in either plasma ANP or cGMP between various AVDs were observed. However, we found such differences with respect to values measured at oAVD; both ANP and cGMP levels were lowest at oAVD. Pooling together the data obtained in 11 patients at three AVDs, a positive correlation between ANP and cGMP levels was found (r = 0.7, P < 0.0001. n = 33). Moreover, changes of plasma ANP and cGMP induced by every A VD increment of 50 msec were also correlated (r = 0.6, P < 0.01, n = 22). It is concluded that in AV sequential pacing at rest piasma ANP reaches minimal levels at the AVD, which provides the best LV performance. Although levels of cGMP changed in parallel with those of ANP, low relative values of cGMP differences may limit the usefulness of cGMP assays in optimization of the AVD.