A novel organ-slice culturing system to simulate meniscal repair: Proof of concept using a synovium-based pool of meniscoprogenitor cells.

Meniscal injuries can occur secondary to trauma or be instigated by the changes in knee-joint function that are associated with aging, osteo- and rheumatoid arthritis, disturbances in gait and obesity. Sixty per cent of persons over 50 years of age manifest signs of meniscal pathology. The surgical and arthroscopic measures that are currently implemented to treat meniscal deficiencies bring only transient relief from pain and effect but a temporary improvement in joint function. Although tissue-engineering-based approaches to meniscal repair are now being pursued, an appropriate in-vitro model has not been conceived. The aim of this study was to develop an organ-slice culturing system to simulate the repair of human meniscal lesions in vitro. The model consists of a ring of bovine meniscus enclosing a chamber that represents the defect and reproduces its sequestered physiological microenvironment. The defect, which is closed with a porous membrane, is filled with fragments of synovial tissue, as a source of meniscoprogenitor cells, and a fibrin-embedded, calcium-phosphate-entrapped depot of the meniscogenic agents BMP-2 and TGF-ß1. After culturing for 2 to 6 weeks, the constructs were evaluated histochemically and histomorphometrically, as well as immunohistochemically for the apoptotic marker caspase 3 and collagen types I and II. Under the defined conditions, the fragments of synovium underwent differentiation into meniscal tissue, which bonded with the parent meniscal wall. Both the parent and the neoformed meniscal tissue survived the duration of the culturing period without significant cell losses. The concept on which the in-vitro system is based was thus validated. This article is protected by copyright. All rights reserved.

The Role of Cells in Meniscal Guided Tissue Regeneration: A Proof of Concept Study in a Goat Model.

OBJECTIVE Successful repair of defects in the avascular zone of meniscus remains a challenge in orthopedics. This proof of concept study aimed to investigate a guided tissue regeneration approach for treatment of tears in meniscus avascular zone in a goat model. DESIGN Full-depth longitudinal tear was created in the avascular zone of the meniscus and sutured. In the two treatment groups, porcine collagen membrane was wrapped around the tear without (CM) or with injection of expanded autologous chondrocytes (CM+cells), whereas in the control group the tear remained only sutured. Gait recovery was evaluated during the entire follow-up period. On explantation at 3 and 6 months, macroscopic gross inspection assessed healing of tears, degradation of collagen membrane, potential signs of inflammation, and osteoarthritic changes. Microscopic histology scoring criteria were developed to evaluate healing of tears, the cellular response, and the inflammatory response. RESULTS Gait recovery suggested protective effect of collagen membrane and was supported by macroscopical evaluation where improved tear healing was noted in both treated groups. Histology scoring in CM compared to suture group revealed an increase in tear margins contact, newly formed connective tissue between margins, and cell formations surrounded with new matrix after 3 months yet not maintained after 6 months. In contrast, in the CM+cells group these features were observed after 3 and 6 months. CONCLUSIONS A transient, short-term guided tissue regeneration of avascular meniscal tears occurred upon application of collagen membrane, whereas addition of expanded autologous chondrocytes supported more sustainable longer term tear healing.

Hole in the Head: a Play, Accompanied by a Conspectus of Knowledge, Both Repressed and Researched, that Directly Influenced the Playwright in Her Development of a New Work

"Hole in the Head" is a play about a woman who wakes up. Maude wakes up in the first act, and in every subsequent scene she undergoes some form of physical or emotional awakening as characters walk in and out of her front door."Hole in the Head" is accompanied by an introduction that attempts to understand the interplay between creativity and academia through an analysis of theatre, feminist and queer theory, and science.

An ecologic comparison study of the impact of economic disadvantage on Texas Assessment of Knowledge and Skills performance, graduation rates, and readiness for higher education for students attending public and charter schools in Texas from 2004 to 2006

Purpose. No Child Left Behind aimed to "improve the academic achievement of the disadvantaged." The primary research question considered how academic achievement of those from economic disadvantage compared to those not from disadvantage? ^ Economically disadvantaged students can potentially have added academic disadvantage. Research shows low academic achievement can potentially result in drug abuse, youth violence, and teen pregnancy. ^ Methods. To compare the student populations, measures included TAKS results and academic indicator data collected by the Texas Education Agency. ^ Results. T-test analyses showed a significant difference between the economically and non-economically disadvantaged student populations in meeting the TAKS passing standard, graduation, and preparation for higher education.^ Conclusions. The achievement gap between students remained as indicated by the Texas testing program. More research and time are needed to observe if the desired impact on those from economic disadvantage will be reflected by academic achievement data.^

Evaluation of Knowledge Regarding Diagnostic Strategies for Genetic Diseases in Select Residents

Genetics education for physicians has been a popular publication topic in the United States and in Europe for over 20 years. Decreasing numbers of medical genetics professionals and an increasing volume of genetic information has created a dire need for increased genetics training in medical school and in clinical practice. This study aimed to assess how well pediatrics-focused primary care physicians apply their general genetics knowledge to clinical genetic testing using scenario-based questions. We chose to specifically focus on knowledge of the diagnostic applicability of Chromosomal Microarray (CMA) technology in pediatrics because of its recent recommendation by the International Standard Cytogenomic Array (ISCA) Consortium as a first-tier genetic test for individuals with developmental disabilities and/or congenital anomalies. Proficiency in ordering baseline genetic testing was evaluated for eighty-one respondents from four pediatrics-focused residencies (categorical pediatrics, pediatric neurology, internal medicine/pediatrics, and family practice) at two large residency programs in Houston, Texas. Similar to other studies, we found an overall deficit of genetic testing knowledge, especially among family practice residents. Interestingly, residents who elected to complete a genetics rotation in medical school scored significantly better than expected, as well as better than residents who did not elect to complete a genetics rotation. We suspect that the insufficient knowledge among physicians regarding a baseline genetics work-up is leading to redundant (i.e. concurrent karyotype and CMA) and incorrect (i.e. ordering CMA to detect achondroplasia) genetic testing and is contributing to rising health care costs in the United States. Our results provide specific teaching points upon which medical schools can focus education about clinical genetic testing and suggest that increased collaboration between primary care physicians and genetics professionals could benefit patient health care overall.

Sociocultural context of knowledge and beliefs about cardiovascular disease among Latino women

We formed an academic-community partnership with the Salsa Caliente program to undertake a project to better understand how Latina women with cardiovascular disease (CVD) or at risk of CVD view and understand CVD. This study's research question examines the sociocultural factors that influence and inform Latino women's perceptions and beliefs about CVD. Seven out the eleven participants in the Salsa Caliente program consented to be interviewed. The data was collected through recorded interviews, which were transcribed and then analyzed for common themes found among all the participants' narratives. The content analysis looking into common themes yielded four: 1) increased awareness of CVD, 2) trust in doctor, 3) delay in doctor visits, and 4) awareness of health. Implications for interventions and further research are discussed.^

AN ASSESSMENT OF KNOWLEDGE AND ATTITUDES OF GENETIC COUNSELING SERVICES IN U.S. HTCs

Hemophilia is a hereditary bleeding disorder which requires lifelong specialized care. A network of Hemophilia Treatment Centers (HTCs) exists to meet the medical needs of patients affected by hemophilia. Genetic counseling services are an integral part of the HTC model of care; however, many HTCs do not have genetic counselors on staff. As a result, the duty to provide these services must fall to other healthcare providers within the HTC. To assess the knowledge and attitudes of these providers we developed a 49 question survey that was distributed electronically to hematologists and nurses at U.S. HTCs. The survey consisted of a three sections: demographic information, knowledge of hemophilia genetics, and attitudes towards genetic services. A total of 111 complete responses were received and analyzed. The average knowledge score among all participants was 74.8% with a total of 81 participants receiving a passing score of 70% or above. Thirty participants scored below 70% in the knowledge section. In general, attitude scores were high indicating that the majority of hematologists and nurses in HTCs feel confident in their ability to provide genetic counseling services. Over 90% of participants reported that they have some form of access to genetic counseling services at their center. Hematologists and nurses practicing in U.S. HTCs demonstrate sufficient knowledge of the genetics of hemophilia, and they generally feel confident in their ability to provide genetic counseling services to their patients. While their knowledge is sufficient, the average knowledge score was lower than 75%. Certain questions covering new genetic technologies and testing practices were more commonly missed than questions asking about more basic aspects of hemophilia genetics, such as inheritance and carrier testing. Finally, many clinics report having access to a counselor, but it is oftentimes a hematologist or nurse who is providing genetic counseling services to patients. Given the inconsistency in knowledge among providers coupled with the high confidence in one’s ability to counsel patients, it leaves room to question whether information about the genetics of hemophilia is being communicated to patients in the most appropriate and accurate manner.

Impact of knowledge brokering on performance heterogeneity among business models

Purpose – The strategic management literature lacks a comprehensive explanation as to why seemingly similar business models in the same industry perform differently. This paper strives to explain this phenomenon. Design/methodology/approach – The model is conceptualized and accompanied by a case study on the airline industry to explain knowledge brokerage that creates value from the effective utilization of knowledge resources acquired from intra- and inter-firm environments. Findings – The model explains a cyclical view of business model flexibility in which the knowledge-based resource accumulation of the business model is spread across the intra- and inter-firm environments. Knowledge brokerage strategies from the inter- and intra-firm environments result in improved performance of the business model. The flexibility that the business model acquires is determined by how efficiently resource accumulation is aligned with its external environment. Originality/value – The paper effectively integrates the concepts of knowledge brokerage and business models from a resource accumulation-based view and simultaneously arrives at the performance heterogeneity of seemingly similar business models within the same industry. It has performance implications for firms that start out without any distinct resources of their own, or that use an imitated business model, to attain better performance through business model evolution aligned with successful knowledge brokerage strategies. It adds to the resource accumulation literature by explaining how resources can be effectively acquired to create value.