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which leads to a paced QRS complex that has a left bundle branch block morphology with negative concordance or a late transition in the precordial leads and a superior axis (Fig 153) With the realization that pacing from the right ventricular apex can produce deleterious hemodynamic effects in some patients, many implanting physicians place ventricular leads in the mid septum or high septum Pacing from the mid septum or high septum of the right ventricle still produces a QRS with a left bundle branch block morphology in V1, but usually with a more normal precordial transition and a normal or slightly rightward axis (Fig 153) Fluoroscopy is important for permanent lead placement Figure 154 shows uoroscopic positions of right ventricular leads placed at the midseptal region and the inferior apex A coronary sinus venogram shows the position of the coronary sinus os and the left-sided chambers.

The type definition is for a NameType type contained in SimpleTypeLib.xsd. Because it has been included in the SimpleStaff.xsd schema, however, we use

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In the rst two panels uoroscopic images of a de brillator lead in the midseptum and a pacing lead in the right ventricular apex are shown in the left anterior oblique (LAO) and right anterior oblique (RAO) orientations In the third panel, an LAO image of a lead that has been inadvertently placed in the left ventricle is shown In this panel, a temporary pacing lead can be seen in the right ventricle These images emphasize the importance of evaluating uoroscopic images in the left anterior oblique position to con rm appropriate placement of pacing leads Sometimes permanent pacing leads will become partially or completely dislodged, or associated with poor pacing function due to the development of scar tissue around the lead An example of intermittent capture of a right ventricular lead is shown in Fig 155.

Comings and goings are disruptive and costly. Good firms have low staff turnovers. For example, Microsoft was rated the number one employer in the United Kingdom in 2003 (The Sunday Times 100 Best Companies to Work for survey, March 2, 2003) and only had a 5 percent annual staff turnover. One of the principal reasons why people in the IT industry change jobs is overwork. They may not mind it, but their family and children certainly will. Eventually, they cave in to outside pressure and start looking around. It doesn t make for good longterm productivity, and it denies you the ability to go into overdrive when you meet a real problem. We can all name colleagues who continually work a 14-hour day. There s always some new panic owing to bad planning and indifferent supervision. The result is that the employee gets tired and irritable and starts making bad decisions. Their home life disintegrates because they don t have one. Boyfriends, girlfriends, wives, and husbands leave, and then they really do have a problem, and so do you. A company that has gotten itself into this position finds it very hard to reward employees for exceptional work because the exception has become the rule. What do the employees do They do the only thing they can; they leave.

The ventricular lead is placed relatively high in the right ventricular septum (QRS with a left bundle branch block morphology and an inferior axis) Intermittently the ventricular pacing stimulus.

<Aeroplane> elements in the same place in the content model as <Vehicle> elements are permitted. Notice that the content model for the <Car> and <Aeroplane> elements is the same as the content model for the <Vehicle> element shown earlier in Listing 7.9. XSD Schema enables us to specify a collection of elements that are allowed as substitutes for the <Vehicle> element. In the following schema, the collection of substitution elements will contain two elements. In this context, the <Vehicle> element is termed the head element. Listing 7.12 shows a schema that describes Listing 7.11. Notice that the schema has been modified. The <Vehicle> element has been declared as a global element declaration (it has to be, if substitution is to work correctly). It also now has an abstract attribute with the value of true. You will notice, too, the two new global element declarations for the <Car> and <Aeroplane> elements. The type attribute of each of those <xsd:element> elements specifies the datatype to be the same as that of the <Vehicle> element. The substitutionGroup attribute denotes that each of the two elements can be substituted in an instance document in the same position in the content model as the <Vehicle> element is allowed.

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