Durability assessment of polymer trileaflet heart valves

The durability of a polymer trileaflet valve is dependent on leaflet stress concentrations, so valve designs that reduce stress can, hypothetically, increase durability. Design aspects that are believed to contribute to reduced leaflet stress include stent flexibility, parabolic coaptation curvature, and leaflet anisotropy. With this in mind, the purpose of this investigation was to elucidate what specific combinations of these parameters promote optimal acute and long-term valve function. A combination of four stent designs, seven leaflet reinforcement materials, and three coaptation geometries were evaluated through a combination of experimentation and modeling. Static tensile and Poisson’s ratio tests and dynamic tensile fatigue testing were used to evaluate the individual leaflet components; and hydrodynamic testing and accelerated valve fatigue was used to assess complete valve prototypes. The two most successful designs included a 0.40 mm thick knit-reinforced valve with a fatigue life of 10.35 years, and a 0.20 mm thick knit-reinforced valve with a 28.9 mmHg decrease in pressure drop over the former. A finite element model was incorporated to verify the impact of the above-mentioned parameters on leaflet stress concentrations. Leaflet anisotropy had a large impact on stress concentrations, and matching the circumferential modulus to that of the natural valve showed the greatest benefit. Varying the radial modulus had minimal impact. Varying coaptation geometry had no impact, but stent flexibility did have a marked effect on the stress at the top of the commissure, where a completely rigid stent resulted in a higher peak stress than a flexible stent (E = 385 MPa). In conclusion, stent flexibility and leaflet anisotropy do effect stress concentrations in the SIBS trileaflet valve, but coaptation geometry does not. Regions of high stress concentrations were linked to failure locations in vitro, so a fatigue prediction model was developed from the S/N curves generated during dynamic tensile testing of the 0.20 mm knit-reinforced leaflets. Failure was predicted at approximately 400 million cycles (10 years) at the top of the commissure. In vitro fatigue of this valve showed failure initiation after approximately 167 million cycles (4.18 years), but it was related to a design defect that is subsequently being changed.

The Influence of Psychological Predictors and Cognitive Behavioral Stress Management Intervention on Antiretroviral Therapy (ART) Adherence Among HIV-Positive Female Haitian Alcohol Users

Purpose: Over half the HIV-infected persons in the Caribbean, the second most HIV-impacted region in the world, live in Haiti. Using secondary data from a parent study, this research assessed the effects of psychological and social factors on antiretroviral therapy (ART) adherence among Haitian, HIV-positive, female alcohol users. Theoretical Foundation and Research Questions: Using the Theory of Planned Behavior/Reasoned Action and the Information, Motivation, Behavior skills model as guiding theoretical frameworks, the study examined the effectiveness of an adapted cognitive behavioral stress management (CBSM-A) intervention in improving ART adherence. The effect of psychological factors (depression, anxiety, beliefs about medicine, and social support), social factors (stigma, relationship status, and educational attainment), and alcohol on adherence to ART was assessed. Methods: The sample consisted of 116 female ART patients who were randomly assigned to the CBSM-A intervention or the wait-list control group. Participants completed intervention sessions as well as pre- and post-test assessments. Analyses of variance, t-tests, and point biserial correlations were used to test hypotheses. Results: Surprisingly, ART adherence rates significantly decreased for both groups combined [F (1, 108) = 8.79, p = .004]; there was no significant difference between the intervention and control groups with regard to the magnitude of change between baseline and post assessment. On average, depression decreased significantly among participants in the CBSM-A group only [(t (62) = 5.54, p < .001)]. For both groups combined, alcohol use significantly decreased between baseline and post-assessment [(F (1, 78) = 34.70, p < .001)]; there was no significant difference between the intervention and control groups with regard to the magnitude of change between baseline and post-assessment. None of the variables were significantly correlated with ART adherence. Discussion: Adherence to ART did not improve in this sample, nor were any of the variables significantly associated with adherence. The findings suggest that additional supportive and psychological services may be needed in order to promote higher adherence to ART among HIV-positive females. More research may be needed on this sample; a focus on mental health issues, partner conflict, family and sexual history may allow for better targeting and more successful interventions.

Acceptable vs. marginal police officers' psychological ratings : a longitudinal comparison of job performance

Archival research was conducted on the inception of preemployment psychological testing, as part of the background screening process, to select police officers for a local police department. Various issues and incidents were analyzed to help explain why this police department progressed from an abbreviated version of a psychological battery, to a much more sophisticated and comprehensive set of instruments. While doubts about psychological exams do exist, research has shown that many are valid and reliable in predicting job performance of police candidates. During a three year period, a police department hired 162 candidates (133 males and 29 females) who received "acceptable" psychological ratings and 71 candidates (58 males and 13 females) who received "marginal" psychological ratings. A document analysis consisted of variables that have been identified as job performance indicators which police psychological testing tries to predict, and "screen in" or "screen out" appropriate applicants. The areas of focus comprised the 6-month police academy, the 4-month Field Training Officer (FTO) Program, the remaining probationary period, and yearly performance up to five years of employment. Specific job performance variables were the final academy grade average, supervisors' evaluation ratings, reprimands, commendations, awards, citizen complaints, time losses, sick time usage, reassignments, promotions, and separations. A causal-comparative research design was used to determine if there were significant statistical differences in these job performance variables between police officers with "acceptable" psychological ratings and police officers with "marginal" psychological ratings. The results of multivariate analyses of variance, t-tests, and chi-square procedures as applicable, showed no significant differences between the two groups on any of the job performance variables.

Durability Assessment of Polymer Trileaflet Heart Valves

The durability of a polymer trileaflet valve is dependent on leaflet stress concentrations, so valve designs that reduce stress can, hypothetically, increase durability. Design aspects that are believed to contribute to reduced leaflet stress include stent flexibility, parabolic coaptation curvature, and leaflet anisotropy. With this in mind, the purpose of this investigation was to elucidate what specific combinations of these parameters promote optimal acute and long-term valve function. A combination of four stent designs, seven leaflet reinforcement materials, and three coaptation geometries were evaluated through a combination of experimentation and modeling. Static tensile and Poisson’s ratio tests and dynamic tensile fatigue testing were used to evaluate the individual leaflet components; and hydrodynamic testing and accelerated valve fatigue was used to assess complete valve prototypes. The two most successful designs included a 0.40 mm thick knit-reinforced valve with a fatigue life of 10.35 years, and a 0.20 mm thick knit-reinforced valve with a 28.9 mmHg decrease in pressure drop over the former. A finite element model was incorporated to verify the impact of the above-mentioned parameters on leaflet stress concentrations. Leaflet anisotropy had a large impact on stress concentrations, and matching the circumferential modulus to that of the natural valve showed the greatest benefit. Varying the radial modulus had minimal impact. Varying coaptation geometry had no impact, but stent flexibility did have a marked effect on the stress at the top of the commissure, where a completely rigid stent resulted in a higher peak stress than a flexible stent (E = 385 MPa). In conclusion, stent flexibility and leaflet anisotropy do effect stress concentrations in the SIBS trileaflet valve, but coaptation geometry does not. Regions of high stress concentrations were linked to failure locations in vitro, so a fatigue prediction model was developed from the S/N curves generated during dynamic tensile testing of the 0.20 mm knit-reinforced leaflets. Failure was predicted at approximately 400 million cycles (10 years) at the top of the commissure. In vitro fatigue of this valve showed failure initiation after approximately 167 million cycles (4.18 years), but it was related to a design defect that is subsequently being changed.

The impact of the Florida state -mandated Basic Skills Exit Tests at Miami -Dade Community College

The purpose of this study was to explore the impact of the Florida State-mandated Basic Skills Exit Tests (BSET) on the effectiveness of remedial instruction programs to adequately serve the academically underprepared student population. The primary research question concerned whether the introduction of the BSET has resulted in remedial completers who are better prepared for college-level coursework. ^ This study consisted of an ex post facto research design to examine the impact of the BSET on student readiness for subsequent college-level coursework at Miami-Dade Community College. Two way analysis of variance was used to compare the performance of remedial and college-ready students before and after the introduction of the BSET requirement. Chi-square analysis was used to explore changes in the proportion of students completing and passing remedial courses. Finally, correlation analysis was used to explore the utility of the BSET in predicting subsequent college-level course performance. Differences based on subject area and race/ethnicity were explored. ^ The introduction of the BSET did not improve the performance of remedial completers in subsequent college-level courses in any of the subject areas. The BSET did have a negative impact on the success rate of students in remedial reading and mathematics courses. There was a significant decrease in minority students' likelihood of passing remedial reading and mathematics courses after the BSET was introduced. The reliability of the BSET is unacceptably low for all subject areas, based on estimates derived from administrations at M-DCC. Nevertheless, there was a significant positive relationship between BSET score and grade point average in subsequent college-level courses. This relationship varied by subject area and ethnicity, with the BSET reading score having no relationship with subsequent course performance for Black non-Hispanic students. ^ The BSET had no discernable positive effect on remedial student performance in subsequent college-level courses. In other words, the BSET has not enhanced the effectiveness of the remedial programs to prepare students for later coursework at M-DCC. The BSET had a negative impact on the progress and success of students in remedial reading and mathematics. ^

Power Study on Testing Epidemic Alternatives

Detecting change points in epidemic models has been studied by many scholars. Yao (1993) summarized five existing test statistics in the literature. Out of those test statistics, it was observed that the likelihood ratio statistic showed its standout power. However, all of the existing test statistics are based on an assumption that population variance is known, which is an unrealistic assumption in practice. To avoid assuming known population variance, a new test statistic for detecting epidemic models is studied in this thesis. The new test statistic is a parameter-free test statistic which is more powerful compared to the existing test statistics. Different sample sizes and lengths of epidemic durations are used for the power comparison purpose. Monte Carlo simulation is used to find the critical values of the new test statistic and to perform the power comparison. Based on the Monte Carlo simulation result, it can be concluded that the sample size and the length of the duration have some effect on the power of the tests. It can also be observed that the new test statistic studied in this thesis has higher power than the existing test statistics do in all of cases.