The Proinflammatory Environment in Potential Heart and Lung Donors: Prevalence and Impact of Donor Management and Hormonal Therapy

BACKGROUND: Brain stem death can elicit a potentially manipulable cardiotoxic proinflammatory cytokine response. We investigated the prevalence of this response, the impact of donor management with tri-iodothyronine (T3) and methylprednisolone (MP) administration, and the relationship of biomarkers to organ function and transplant suitability. METHODS: In a prospective randomized double-blinded factorially designed study of T3 and MP therapy, we measured serum levels of interleukin-1 and -6 (IL-1 and IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive protein, and procalcitonin (PCT) levels in 79 potential heart or lung donors. Measurements were performed before and after 4 hr of algorithm-based donor management to optimize cardiorespiratory function and +/-hormone treatment. Donors were assigned to receive T3, MP, both drugs, or placebo. RESULTS: Initial IL-1 was elevated in 16% donors, IL-6 in 100%, TNF-alpha in 28%, CRP in 98%, and PCT in 87%. Overall biomarker concentrations did not change between initial and later measurements and neither T3 nor MP effected any change. Both PCT (P =0.02) and TNF-alpha (P =0.044) levels were higher in donor hearts with marginal hemodynamics at initial assessment. Higher PCT levels were related to worse cardiac index and right and left ventricular ejection fractions and a PCT level more than 2 ng x mL(-1) may attenuate any improvement in cardiac index gained by donor management. No differences were observed between initially marginal and nonmarginal donor lungs. A PCT level less than or equal to 2 ng x mL(-1) but not other biomarkers predicted transplant suitability following management. CONCLUSIONS: There is high prevalence of a proinflammatory environment in the organ donor that is not affected by tri-iodothyronine or MP therapy. High PCT and TNF-alpha levels are associated with donor heart dysfunction. (C) 2009 Lippincott Williams & Wilkins, Inc.

Protein deposition at polymer surfaces:the bulk and surface structure-property effects of hydrogels

The primary objective of this research has been to investigate the interfacial phenomenon of protein adsorption in relation to the bulk and surface structure-property effect s of hydrogel polymers. In order to achieve this it was first necessary to characterise the bulk and surface properties of the hydrogels, with regard to the structural chemistry of their component monomers. The bulk properties of the hydrogels were established using equilibrium water content measurements, together with water-binding studies by differential scanning calorimetry (D.S.C.). Hamilton and captive air bubble-contact angle techniques were employed to characterise the hydrogel-water interface and from which by a mathematical derivation, the interfacial free energy (ðsw) and the surface free energy components (ð psv, ðdsv, ðsv) were obtained. From the adsorption studies using the radio labelled iodinated (125I) proteins of human serum albumin (H.S.A.) and human fibrinogen (H.Fb.), it was Found that multi-layered adsorption was occurring and that the rate and type of this adsorption was dependent on the physico-chemical behaviour of the adsorbing protein (and its bulk concentration in solution), together with the surface energetics of the adsorbent polymer. A potential method for the invitro evaluation of a material's 'biocompatibility' was also investigated, based on an empirically observed relationship between the adsorption of albumin and fibrinogen and the 'biocompatibility' of polymeric materials. Furthermore, some consideration was also given to the biocompatibility problem of proteinaceous deposit formation on hydrophilic soft' contact lenses and in addition a number of potential continual wear contact lens formulations now undergoing clinical trials,were characterised by the above techniques.

Evaluating and improving the performance of video content distribution in lossy networks

The contributions in this research are split in to three distinct, but related, areas. The focus of the work is based on improving the efficiency of video content distribution in the networks that are liable to packet loss, such as the Internet. Initially, the benefits and limitations of content distribution using Forward Error Correction (FEC) in conjunction with the Transmission Control Protocol (TCP) is presented. Since added FEC can be used to reduce the number of retransmissions, the requirement for TCP to deal with any losses is greatly reduced. When real-time applications are needed, delay must be kept to a minimum, and retransmissions not desirable. A balance, therefore, between additional bandwidth and delays due to retransmissions must be struck. This is followed by the proposal of a hybrid transport, specifically for H.264 encoded video, as a compromise between the delay-prone TCP and the loss-prone UDP. It is argued that the playback quality at the receiver often need not be 100% perfect, providing a certain level is assured. Reliable TCP is used to transmit and guarantee delivery of the most important packets. The delay associated with the proposal is measured, and the potential for use as an alternative to the conventional methods of transporting video by either TCP or UDP alone is demonstrated. Finally, a new objective measurement is investigated for assessing the playback quality of video transported using TCP. A new metric is defined to characterise the quality of playback in terms of its continuity. Using packet traces generated from real TCP connections in a lossy environment, simulating the playback of a video is possible, whilst monitoring buffer behaviour to calculate pause intensity values. Subjective tests are conducted to verify the effectiveness of the metric introduced and show that the results of objective and subjective scores made are closely correlated.

"Girls Who Do Boys Like They’re Girls": gender and call centre’s junior management

This paper focuses on the structuring of work and organization by exploring the hierarchical and gendered nature of the division of labour within a contemporary service-based organization. Central to our account is the role of the ‘team leader’, which we argue, as a junior management position, occupies a key role in understanding and accounting for the gendered hierarchical terrain of the organization. In exploring the role of team leaders, a position that empirically, tends overwhelming to be held by female members of staff, we draw attention to the perception of the gendered nature of the role by subordinate members of the organization, team-leaders themselves, and more senior members of staff. The specific constitution and character of the team leader position is brought into sharp relief through comparison with the subordinate role of ‘problem manager’, a position which was overwhelming held by men. Our ethnographic approach attempts to draw attention to that which is both ‘said’ and ‘done’ within the organizational context and the account of junior managers that emerges is highly gendered. The paper seeks to map this account onto the existing and on-going debate within Gender and Organizational research, which explores, documents and challenges Masculinities at work.

Evaluating and developing project-based learning:an empirical approach to evaluating CDIO

As a global profession, engineering is integral to the maintenance and further development of society. Indeed, contemporary social problems requiring engineering solutions are not only a consequence of natural and ‘manmade’ disasters (such as the Japanese earthquake or the oil leakage in the Gulf of Mexico) but also encapsulate 21st Century dilemmas around sustainability, poverty and pollution [2,6,7]. Given the complexity of such problems and the constant need for innovation, the demand for engineering education to provide a ready supply of suitably qualified engineering graduates, able to make innovative decisions has never been higher [3,5]. Bearing this in mind, and taking account problems of attrition in engineering education [1,6,4] innovation in the way in which the curriculum is developed and delivered is crucial. CDIO [Conceive, Design, Implement, Operate] provides a potentially ground-breaking solution to such dilemmas. Aimed at equipping students with practical engineering skills supported by the necessary theoretical background, CDIO could potentially change the way engineering is perceived and experienced within higher education. Aston University introduced CDIO into its Mechanical Engineering and Design programmes in October 2011. From its induction, engineering education researchers have ‘shadowed’ the staff responsible for developing and teaching the programme. Utilising an Action Research Design, and adopting a mixed methodological research design, the researchers have worked closely with the teaching team to critically reflect on the processes involved in introducing CDIO into the curriculum. Concurrently, research has been conducted to capture students’ perspectives of CDIO. In evaluating the introduction of CDIO at Aston, the researchers have developed a distinctive research strategy with which to evaluate CDIO. It is the emergent findings from this research that form the basis of this paper. Although early-on in its development CDIO is making a significant difference to engineering education at the University. The paper draws attention to pedagogical, practical and professional issues – discussing each one in turn and in doing so critically analysing the value of CDIO from academic, student and industrial perspectives. The paper concludes by noting that whilst CDIO represents a forwardthinking approach to engineering education, the need for constant innovation in learning and teaching should not be forgotten. Indeed, engineering education needs to put itself at the forefront of pedagogic practice. Providing all-rounded engineers, ready to take on the challenges of the 21st Century!