A Goal Programming Model For Facility Location Planning

The aim of this paper is to apply Goal Programming in facility location. The feasibility project of a project idea on building an economic object is a defining moment in the decision making of the party that is investing on a certain project. Generally, the feasibility is done based on the global data extracted by the practical experience of building and functioning of similar existing object. However, it is understandable that the accuracy of the feasibility results is increased when different points of view are used in combination with exact methods of calculation. In this aspect, it is important to predict the income from the use of the object’s capacities. This leads to an intermediary problem which consists in predicting the most result oriented use of the object’s capacities. If the use of these capacities can be mathematically modeled through optimization models, then the basis of the data for evaluating the feasibility of the object becomes clearer. In this study was considered the possibility of using a mathematical model for the basin used by a yacht harbor. As a result, it is shown that the optimal use of a basin by a yacht harbor can be modeled as an objective function problem, which according to previously known methods can turn into a mathematical programming problem

Entrapment of dissection flap and intimal tissue cleavage during rotational atherectomy

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The Impact of the Second Generation Everolimus-eluting Stent in Daily Clinical Practice

Clinical studies with first-generation sirolimus-eluting stents (SES) and paclitaxel- eluting stents (PES) have demonstrate a dramatic reduction in restenosis rates compared with bare-metal stents (BMS)1,2, however, reintervention rates were still high in patients with complex coronary artery disease3, and an ongoing propensity for stent thrombosis (ST) beyond one year raised further concerns regarding safety issues with these devices4. Furthermore, as both of these devices were relatively high-profile stainless steel stents, they were difficult to deliver in complex anatomy, and the SES in particular was prone to a high fracture rate, contributing to late adverse events. The everolimus-eluting stent (EES), (XIENCE V, Abbott Vascular, CA, USA; also distributed as the PROMUS stent by Boston Scientific, MA, USA) is a secondgeneration drug-eluting stent (DES) designed to overcome the limitations of earlier DES

ANALISIS FAKTOR-FAKTOR YANG MEMPENGARUHI BRAND PREFERENCE UNTUK MENINGKATKAN KEPUTUSAN PEMBELIAN SECARA ONLINE PADA SITUS KASKUS

The increasing public access to the Internet, especially on sites kaskus. Where in kaskus site, provided space for sale and purchase transaction of a product. This means that there is a phenomenon concerning the purchase of products through the site on line kaskus developed in the community. Problem within this research are "how Kaskus Indonesian can compete with global e-commerce shareholding arrangements, such as Ebay, which has more members in the world?". This research aims obtain empirical evidence effects of Trust, ease of uses, and Competitive Price, to Brand Preference, impact on Online buying decision. The sample of this research is the people who never make purchases of products through the site Kaskus totaling 150 people. This research used quantitative analysis method with multiple linear regression. The result of this research showed that trust, ease of uses and competitive price have positive effect on brand preference with regression coefficient Y1 = 0,254X1 + 0,295X2 + 0,363X3. While trust, ease of uses, competitive price, and brand preference have positive effect on Online buying decision with regression coefficient Y2 = 0,166X1 + 0,173X2 + 0,199X3 + 0,432Y

A prospective, randomized, open-label trial of 6-month versus 12-month dual antiplatelet therapy after drug-eluting stent implantation in ST-elevation myocardial infarction: Rationale and design of the \u201cDAPT-STEMI trial\u201d

Background The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention with second-generation drug eluting stents (DESs) is unclear. Because prolonged DAPT is associated with higher bleeding risk and health care costs, establishing optimal DAPT duration is of paramount importance. No other randomized controlled trials have evaluated the safety of shorter DAPT duration in ST-elevation myocardial infarction (STEMI) patients treated with second-generation DESs and latest P2Y12 platelet receptor inhibitors. Hypothesis Six months of DAPT after Resolute Integrity stent implantation in STEMI patients is not inferior to 12 months of DAPT in clinical outcomes. Study design The Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation In ST-elevation Myocardial Infarction (DAPT-STEMI) trial is a randomized, multicenter, international, open-label trial designed to examine the safety (noninferiority) of 6-month DAPT after Resolute Integrity stent implantation in STEMI patients compared with 12-month DAPT. Event-free patients on DAPT at 6month will be randomized (1:1 fashion) between single (aspirin only) versus DAPT for an additional 6 months and followed until 2 years after primary percutaneous coronary intervention. The primary end point is a patient-oriented composite endpoint of all-cause mortality, any myocardial infarction, any revascularization, stroke, and major bleeding (net adverse clinical events [NACE]) at 18 months after randomization. To achieve a power of 85% for a noninferiority limit of 1.66, a total of 1100 enrolled patients are required. Summary The DAPT-STEMI trial aims to assess in STEMI patients treated with second-generation DESs whether discontinuation of DAPT after 6 months of event-free survival is noninferior to routine 12-month DAPT

Factors associated with deferred lesion failure following fractional flow reserve assessment in patients with diabetes mellitus

Objective: To explore the predictors of deferred lesion failure (DLF) in patients with diabetes mellitus (DM) and lesions with a fractional flow reserve (FFR) >0.80 and to examine whether a predictive relationship between negative FFR values (>0.80\u20131.00) and DLF exists. Background: DM is associated with rapidly progressive atherosclerosis and predictors of DLF in FFR negative lesions in this high-risk group are unknown. Methods: All DM patients who underwent FFR-assessment between 1/01/2010 and 31/12/2013 were included, and followed until 1/7/2015. Patients carrying 651 FFR negative lesion(s) were assessed for DLF, and multivariate models used to identify independent factors associated with DLF. Results: A total of 205 patients with 252 FFR >0.80 lesions were identified. At a mean follow-up of 3.1 \ub1 1.4 years, DLF occurred in 29/205 (14.1%) patients, 31/252 (12.3%) lesions. Using marginal Cox regression multivariate analysis, insulin requiring DM [HR 2.24 (95%CI; 1.01\u20134.95), P = 0.046] and prior revascularization [HR 2.70 (95%CI 1.21\u20136.01), P = 0.015] were identified as being associated with a higher incidence of DLF. Absolute FFR values in FFR negative lesions in DM patients are not predictive of DLF (receiver operating characteristics curve analysis: area under the curve: 0.57 \ub1 0.06, 95%CI 0.46\u20130.69). Conclusions: In DM patients with FFR negative lesions, insulin requiring DM and prior revascularization are predictors for DLF. In contrast to non-DM patients, no predictive relationship between absolute negative FFR values (ranging >0.80\u20131.00) and the risk of DLF exists in DM patients

Coronary plaque redistribution after stent implantation is determined by lipid composition: A NIRS-IVUS analysis

Background: The composition of plaque impacts the results of stenting. The following study evaluated plaque redistribution related to stent implantation using combined near-infrared spectroscopy and intravascular ultrasound (NIRS-IVUS) imaging. Methods: The present study included 49 patients (mean age 66 ± 11 years, 75% males) presenting with non-ST elevation myocardial infarction (8%), unstable angina (49%) and stable coronary artery disease (43%). The following parameters were analyzed: mean plaque volume (MPV, mm3), plaque burden (PB, %), remodeling index (RI), and maximal lipid core burden index in a 4 mm segment (maxLCBI4mm). High-lipid burden lesions (HLB) were defined as by maxLCBI4mm > 265 with positive RI. Otherwise plaques were defined as low-lipid burden lesions (LLB). Measurements were done in the target lesion and in 4 mm edges of the stent before and after stent implantation. Results: MPV and maxLCBI4mm decreased in both HLB (MPV 144.70 [80.47, 274.25] vs. 97.60 [56.82, 223.45]; maxLCBI4mm: 564.11 ± 166.82 vs. 258.11 ± 234.24, p = 0.004) and LLB (MPV: 124.50 [68.00, 186.20] vs. 101.10 [67.87, 165.95]; maxLCBI4mm: 339.07 ± 268.22 vs. 124.60 ± 160.96, p < 0.001), but MPV decrease was greater in HLB (28.00 [22.60, 57.10] vs. 13.50 [1.50, 28.84], p = 0.019). Only at the proximal stent edge of LLB, maxLCBI4mm decreased (34 [0, 207] vs. 0 [0, 45], p = 0.049) and plaque burden increased (45.48 [40.34, 51.55] vs. 51.75 [47.48, 55.76], p = 0.030). Conclusions: NIRS-IVUS defined HLB characterized more significant decreases in plaque volume by stenting. Plaque redistribution to the proximal edge of the implanted stent occurred only in LLB

Combined optical coherence tomography morphologic and fractional flow reserve hemodynamic assessment of non- culprit lesions to better predict adverse event outcomes in diabetes mellitus patients: COMBINE (OCT–FFR) prospective study. Rationale and design

Contains fulltext : 172158.pdf (publisher's version ) (Open Access)BACKGROUND: Fractional flow reserve (FFR) is a widely used tool for the identification of ischaemia-generating stenoses and to guide decisions on coronary revascularisation. However, the safety of FFR-based decisions in high-risk subsets, such as patients with Diabetes Mellitus (DM) or vulnerable stenoses presenting thin-cap fibro-atheroma (TCFA), is unknown. This study will examine the impact of optical coherence tomography (OCT) plaque morphological assessment and the identification of TCFA, in combination with FFR to better predict clinical outcomes in DM patients. METHODS: COMBINE (OCT-FFR) is a prospective, multi-centre study investigating the natural history of DM patients with >/=1 angiographically intermediate target lesion in three subgroups of patients; patients with FFR negative lesions without TCFA (group A) and patients with FFR negative lesions with TCFA (group B) as detected by OCT and to compare these two groups with each other, as well as to a third group with FFR-positive, PCI-treated intermediate lesions (group C). The study hypothesis is that DM patients with TCFA (group B) have a worse outcome than those without TCFA (group A) and also when compared to those patients with lesions FFR </=0.80 who underwent complete revascularisation. The primary endpoint is the incidence of target lesion major adverse cardiac events (MACE); a composite of cardiac death, myocardial infarction or rehospitalisation for unstable/progressive angina in group B vs. group A. CONCLUSION: COMBINE (OCT-FFR) is the first prospective study to examine whether the addition of OCT plaque morphological evaluation to FFR haemodynamic assessment of intermediate lesions in DM patients will better predict MACE and possibly lead to new revascularisation strategies. Trial Registration Netherlands Trial Register: NTR5376

Optimal Timing of Coronary Invasive Strategy in Non–ST-Segment Elevation Acute Coronary Syndromes

Background: The optimal timing of coronary intervention in patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different risk profiles of the studied populations. Purpose: To do the most comprehensive meta-analysis of current evidence on early versus delayed invasive treatment in NSTE-ACS. Data Sources: MEDLINE, PubMed Central, and Google Scholar databases; conference proceedings; ClinicalTrials.gov registry; and Current Controlled Trials registry through May 2012. Study Selection: Available randomized, controlled trials (RCTs) and observational studies comparing early versus delayed intervention in the NSTE-ACS population. Data Extraction: Data were extracted for populations, interventions, outcomes, and risk of bias. All-cause mortality was the prespecified primary end point. The longest follow-up available in each study was chosen. The odds ratio with 95% CI was the effect measure. Data Synthesis: Seven RCTs (5370 patients) and 4 observational studies (77 499 patients) were included. Early intervention was less than 20 hours after hospitalization or randomization for RCTs and 24 hours or less for observational studies. Meta-analysis of the RCTs was inconclusive for a survival benefit associated with the early invasive strategy (odds ratio, 0.83 [95% CI, 0.64 to 1.09]; P 0.180); a similar result emerged from the observational studies. With early versus late intervention, the odds ratios in the RCTs were 1.15 (CI, 0.65 to 2.01; P 0.63) and 0.76 (CI, 0.56 to 1.04; P 0.090) for myocardial infarction and major bleeding during follow-up, respectively. Limitation: Current evidence from RCTs is limited by the small overall sample size, low numbers of events in some trials, and heterogeneity in the timing of intervention and in patient risk profiles. Conclusion: At present, there is insufficient evidence either in favor of or against an early invasive approach in the NSTE-ACS population. A more definitive RCT is warranted to guide clinical practice. Primary Funding Source: None