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Introduction: Isolated redo‐mitral valve replacement (iMVR) is underreported and often mixed up with endocarditis in the present literature. The present study compares first with redo iMVR in noninfective mitral disease. Patients and Methods: A total of 3821 mitral valve procedures were analyzed. The study was restricted to isolated and noninfective mitral valve replacements done by sternotomy. Finally, 402 patients are included, consisting of 102 redo‐ and 300 first surgeries. The mean patient's age was 65.9 ± 10.4 years; the mean EuroSCORE II was 3.0 ± 2.2%. Median follow‐up was 221 days, ranging up to 9.9 years with a total of 367 patient‐years. Results: Redo's had higher EuroSCORE II (5.1 ± 2.9% vs. 2.3 ± 1.4%; p < .01), more atrial fibrillation (31.1% vs. 46.1%; p = .01), chronic obstructive pulmonary disease (7.3% vs. 17.6%; p = .05), coronary artery disease (7.3% vs. 17.6%; p = .03) and more frequently reduced ejection fraction < 30% (3.0% vs. 11.8%; p = .02). Main outcomes showed comparable 30‐days mortality (first: 4.1%, redo: 6.9%; p = .813). Postoperative morbidity of the redo's was associated with increased postoperative bleeding (p < .01) resulting in increased transfusions of packed red blood cells and fresh frozen plasma (each p < .01), more re‐explorations (p < .01) and longer primary intensive care unit stay (p < .01). Postoperative occurrence of stroke, respiratory or renal failure, and myocardial infarction as well as hospital stay differed not significantly. Estimated 5‐years survival was 65.5 ± 12.3% for all patients with no significant differences between the groups. Multivariate logistic regression respiratory failure as relevant for hospital (odds ratio [OR]: 12.3 [1.1–158]; p = .029) and stroke (OR: 4.8 [1.1–12.3]; p = .021) as relevant for long‐term mortality. Conclusion: iMVR for noninfective reasons is infrequent and rare. Compared to primary surgery, redo's suffer mainly from bleeding‐associated morbidity. This does not translate into prolonged hospital stay or inferior immediate or long‐term outcomes. Redo mitral valve replacement can be performed at no significantly increased surgical risk compared with first surgery and the results are particularly not limited by the surgery itself.

Los patrones de usabilidad son un aspecto central en el desarrollo de software, pues estos son los encargados de sentar las bases de un conjunto de principios validados y establecidos para la creación de una apropiada interfaz de usuario. En este sentido el esfuerzo por desarrollar un modelo de patrones de usabilidad esta justificado y permite sumar una instancia mas al proceso de automatización en el desarrollo de software. En esta tesis doctoral se propone un mecanismo que ha evolucionado desde los patrones hasta una arquitectura de usabilidad, detallando el proceso evolutivo que ha llevado el mismo, define en detalle el patrón de usabilidad UNDO/REDO y construye los cimientos para extender este modelo a otros patrones de usabilidad. / Usability patterns are a central aspect of software development, as these are responsible for laying the foundations of a set of validated and established principles for creating an appropriate user interface. In this sense the effort to develop a model of usability patterns is justified and can then add another instance to process automation in software. This PhD thesis proposes a mechanism that has evolved from an architecture patterns to usability, detailing the evolutionary process that has led it defines in detail the usability pattern UNDO/REDO and builds the foundation for extending this model to other usability patterns. / La tesis contó con la doble dirección de la Dr. Patricia Pesado (UNLP) y del Prof. Oscar Dieste (UPM).

The objective of this study was to investigate the effects on a student’s metacognition, reflection, and learning in a specifically designed educational simulation supported by unique technology. The simulation allows players’ actions to be recorded for the purpose of review to identify mistakes. The simulation also allows students to start at and redo actions while fixing previous mistakes instead of starting over at the beginning of a new scenario. When starting at the mistake or point of failure, as identified by a facilitator, during the redo of the initial saved scenario, students reflect on the actions performed during the initial scenario. Student thinking during a redo of a scenario, after the initial scenario reflection, may be called reflective redo when the simulation technology can support starting from the point of failure. This research investigated how metacognition, reflection, and learning were affected by reflective redo. Two key findings were identified when analyzing reflective redo in how students. learn the content and how they learn about their own use of metacognition and reflection. The first key finding relating to the influence of reflective redo on learning was that participants used reflection at levels that matched their need as a support mechanism. The second key finding was that the students’ abilities to place themselves in the problem space contributed to the amount of contextual information they needed to be successful— in this case, either starting from the beginning or from the point of failure.

Background “valve-in-valve” TAVR (VIV-TAVR) is established and provides good initial clinical and hemodynamic outcomes. Lacking long-term durability data baffle the expand to lower risk patients. For those purposes, the present study adds a hemodynamic 3-years follow-up. Methods A total of 77 patients underwent VIV-TAVR for failing aortic bioprosthesis during a 7-years period. Predominant mode of failure was stenosis in 87.0%. Patients had a mean age of 79.4 ± 5.8 years and a logistic EuroSCORE of 30.8 ± 15.7%. The Society of Thoracic Surgeons-PROM averaged 5.79 ± 2.63%. Clinical results and hemodynamic outcomes are reported for 30-days, 1-, 2-, and 3-years. Completeness of follow-up was 100% with 44 patients at risk after 3-years. Follow-up ranged up to 7.1 years. Results Majority of the surgical valves were stented (94.8%) with a mean labeled size of 23.1 ± 2.3 mm and true-ID of 20.4 ± 2.6 mm. A true-ID ≤21 mm had 58.4% of the patients. Self-expanding valves were implanted in 68.8% (mean labeled size 24.1 ± 1.8 mm) and balloon-expanded in 31.2% (mean size 24.1 ± 1.8 mm). No patient died intraoperatively. Hospital mortality was 1.3% and three-years survival 57.1%. All patients experienced an initial significant dPmean-reduction to 16.8 ± 7.1 mmHg. After 3-years mean dPmean raised to 26.0 ± 12.2 mmHg. This observation was independent from true-ID or type of transcatheter aortic valve replacement (TAVR)-prosthesis. Patients with a true-ID ≤21 mm had a higher initial (18.3 ± 5.3 vs. 14.9 ± 7.1 mmHg; p = .005) and dPmean after 1-year (29.2 ± 8.2 vs. 13.0 ± 6.7 mmHg; p = .004). There were no significant differences in survival. Conclusions VIV-TAVR is safe and effective in the early period. In surgical valves with a true-ID ≤21 mm inferior hemodynamic and survival outcomes must be expected. Nonetheless, also patients with larger true-IDs showed steadily increasing transvalvular gradients. This raises concern about durability.

During past thirty years, several models for non-linear undo models have been presented, but almost none solves undoing and redoing actions in environments, where multiple history buffers are involved and when there are causal dependencies among separate actions. This thesis focuses on developing a new model, which allows a user to select any action from any history buffer. The key part of the model is a smart command design and undo manager, which searches for dependencies and offers possible solutions to the user. The results are presented in the context of the DaemonX framework.

Software rebuilding is the process of deriving a deployable software system from its primitive source objects. A build tool helps maintain consistency between the derived objects and source objects by ensuring that all necessary build steps are re-executed in the correct order after a set of changes is made to the source objects. It is imperative that derived objects accurately represent the source objects from which they were supposedly constructed; otherwise, subsequent testing and quality assurance is invalidated. This thesis aims to advance the state-of-the-art in tool support for automated software rebuilding. It surveys the body of background work, lays out a set of design considerations for build tools, and examines areas where current tools are limited. It examines the properties of a next-generation tool concept, redo, conceived by D. J. Bernstein; redo is novel because it employs a purely top-down approach to software rebuilding that promises to be simpler, more flexible, and more reliable than current approaches. The details of a redo prototype written by the author of this thesis are explained including the central algorithms and data structures. Lastly, the redo prototype is evaluated on some sample software systems with respect to migration effort between build tools as well as size, complexity, and performances aspects of the resulting build systems.

Software rebuilding is the process of deriving a deployable software system from its primitive source objects. A build tool helps maintain consistency between the derived objects and source objects by ensuring that all necessary build steps are re-executed in the correct order after a set of changes is made to the source objects. It is imperative that derived objects accurately represent the source objects from which they were supposedly constructed; otherwise, subsequent testing and quality assurance is invalidated. This thesis aims to advance the state-of-the-art in tool support for automated software rebuilding. It surveys the body of background work, lays out a set of design considerations for build tools, and examines areas where current tools are limited. It examines the properties of a next-generation tool concept, redo, conceived by D. J. Bernstein; redo is novel because it employs a purely top-down approach to software rebuilding that promises to be simpler, more flexible, and more reliable than current approaches. The details of a redo prototype written by the author of this thesis are explained including the central algorithms and data structures. Lastly, the redo prototype is evaluated on some sample software systems with respect to migration effort between build tools as well as size, complexity, and performances aspects of the resulting build systems.

Sjukskrivningstalen pga. stress och psykiskohälsa fortsätter att stiga varje år. Inom arbetsterapi anses ett balanserat aktivitetsmönster att vara en viktig komponent för upplevelsen av hälsa. Inte enbart balans mellan aktivitet och vila, utan även mellan t ex meningsfulla och nödvändiga aktiviteter eller olika upplevda värden i aktivitet. Syftet: med denna studie är att undersöka vilka samband som finns mellan upplevelse av aktivitetsvärde och självskattad subjektiv hälsa, respektive sociodemografiska faktorer, för personer som har behov av att förändra sin vardag och är eller riskerar att bli sjukskrivna pga. psykisk ohälsa. Metoden som användes var en kvantitativ tvärsnittsstudie där data från 97 kvinnor insamlades med hjälp av enkäter vid baslinjen av en arbetsterapeutiskintervention. De enkäter som användes var Oval-pd, EQ5D samt sociodemografiskdata. Resultatet visar att personerna inför interventionen upplevde låga aktivitetsvärden samt låg självskattad hälsa. Det fanns en tydlig statistisk signifikant korrelation mellan upplevd hälsa och aktivitetsvärde, men inte mellan de analyserade sociodemografiska faktorerna och upplevt aktivitetsvärde. Slutsats. Det finns ett tydligt samband mellan hur personerna upplever sina aktivitetsvärden och hur de skattar sin hälsa. Även om inget samband kunde identifieras mellan sociodemografiska faktorer och aktivitetsvärde så är detta ett område som behöver fortsatt forskning kring vad som kan påverka, och vara en bidragande orsak till att personer utvecklarpsykisk ohälsa pga. sin vardag.

Undo is a command that users rely on in most software applications. Its importance in multi-user CAD is no different. However, due to its unique nature, users may have different expectations regarding how undo should behave. This research seeks to better understand users' expectations regarding undo in multi-user CAD by having users participate in collaborative design exercises and then asking them how they would expect undo to behave. In addition, users participated in a survey in which they watched 8 videos showing users interacting within multi-user CAD and were then asked about how they would want undo to behave. Based on these findings, various recommendations are made for how undo ought to be implemented in multi-user CAD. These include recommendations regarding the user experience/user interface as well as proposing an equation that seeks to quantify whether a user expects to share an undo stack with another user or if they should only be able to undo their own actions.