Extracorporeal membrane oxygenation support after heart explantation: a proposal on how to deal with hyperacute rejection of heart transplant

Purpose: In extreme situations, such as hyperacute rejection of heart transplant or major bleeding per-operating complications, an urgent heart explantation might be the only means of survival. The aim of this experimental study was to improve the surgical technique and the hemodynamics of an Extracorporeal Membrane Oxygenation (ECMO) support through a peripheral vascular access in an acardia model. Methods: An ECMO support was established in 7 bovine experiments (59±6.1 kg) by the transjugular insertion to the caval axis of a self-expanded cannula, with return through a carotid artery. After baseline measurements of pump flow and arterial and central venous pressure, ventricular fibrillation was induced (B), the great arteries were clamped, the heart was excised and right and left atria remnants, containing the pulmonary veins, were sutured together leaving an atrial septal defect (ASD) over the cannula in the caval axis. Measurements were taken with the pulmonary artery (PA) clamped (C) and anastomosed with the caval axis (D). Regular arterial and central venous blood gases tests were performed. The ANOVA test for repeated measures was used to test the null hypothesis and a Bonferroni t method for assessing the significance in the between groups pairwise comparison of mean pump flow. Results: Initial pump flow (A) was 4.3±0.6 L/min dropping to 2.8±0.7 L/min (P B-A= 0.003) 10 minutes after induction of ventricular fibrillation (B). After cardiectomy, with the pulmonary artery clamped (C) it augmented not significantly to 3.5±0.8 L/min (P C-B= 0.33, P C-A= 0.029). Finally, PA anastomosis to the caval axis was followed by an almost to baseline pump flow augmentation (4.1±0.7 L/min, P D-B= 0.009, P D-C= 0.006, P D-A= 0.597), permitting a full ECMO support in acardia by a peripheral vascular access. Conclusions: ECMO support in acardia is feasible, providing new opportunities in situations where heart must urgently be explanted, as in hyperacute rejection of heart transplant. Adequate drainage of pulmonary circulation is pivotal in order to avoid pulmonary congestion and loss of volume from the normal right to left shunt of bronchial vessels. Furthermore, the PA anastomosis to the caval axis not only improves pump flow but it also permits an ECMO support by a peripheral vascular access and the closure of the chest.

Measuring Shared Value: How to Unlock Value by Linking Social and Business Results

Competitividad y valor compartido

Mentorships and co-op placements as a means of heightening the need for a secondary school diploma to the education of at-risk students.--

Both educators and politicians appear to be quite concerned about a dropout rate in Ontario's public schools of some 30 percent. With the basic understanding that a high dropout rate is costly both in economic terms and in human terms, something quite obviously needs to be done to reduce the dropout rate in Ontario schools and, in doing so, ensuring Ontario and its graduates an active role in a growing global economy. This study is an exploratory pilot study in that it examined mentoring and the role that mentoring can play in assisting a student in staying in school and graduating from secondary school. Also incorporated in this is co-operative education and the role it can play, through mentoring, in making students aware of lifestyle level of employment, and of the skills necessary to obtain gainful, meaningful employment. In order to gain information on student attitudes, needs and expectations of a mentoring situation, a series of three questionnaires was used. Also, a questionnaire was distributed to the various co-operative education employers. The intent of this questionnaire was to probe the attitudes, needs and expectations of a mentoring situation from the perspective of an employer. The findings of this study indicated that co-operative education and mentoring are a very valuable and useful component in education. There exist certain factors in a co-operative education setting that serve to enhance and to augment the traditional or "theoretical" setting of the classroom. In addition, a mentoring situation tends to add a sense of relevance to education that students seem to require. Also, an opportunity is offered that allows a student to practice and further refine the skills that have been taught over the course of the student's academic life. Results from this study suggested that a mentoring situation, occurring through a co-operative education situation, adds relevance and a sense of "application" to the traditional or classroom schooling situation. The whole idea of mentoring bodes well for the future of education and of the student. Many advantages are identified in a mentoring situation. One of the advantages is that the schools are able to work quite closely with the community and business in order to stay current and informed on the needs and expected needs of the business community. Co-operative education has now gone beyond being an "experimental" mode of education. All students can benefit from being involved in the program. Certainly at-risk students are aided with staying in school. Those students who are said to be not at-risk can also benefit from being enrolled in the program by gaining hands-on work experience and some of the necessary skills to ensure a place in a growing world economy.

This infinite, unanimous dissonance : a study in mathematical existentialism through the work of Jean-Paul Sartre and Alain Badiou

This thesis seeks to elucidate a motif common to the work both of Jean-Paul Sartre and Alain Badiou (with special attention being given to Being and Nothingness and Being and Event respectively): the thesis that the subject 's existence precedes and determines its essence. To this end, the author aims to explicate the structural invariances, common to both philosophies, that allow this thesis to take shape. Their explication requires the construction of an overarching conceptual framework within which it may be possible to embed both the phenomenological ontology elaborated in Being and Event and the mathematical ontology outlined in Being and Event. Within this framework, whose axial concept is that of multiplicity, the precedence of essence by existence becomes intelligible in terms of a priority of extensional over intensional determination. A series of familiar existentialist concepts are reconstructed on this basis, such as lack and value, and these are set to work in the task of fleshing out the more or less skeletal theory of the subject presented in Being and Event.

Paradigms and prisons: a narrative of translation and transformation : my hero's journey from "at-risk" youth to teacher/learner in a jail setting /

All life is suffering. Life is the pursuit ofhappiness. These are two foundational Buddhist dictums that, in their simplicity, I have entirely misunderstood regarding their depth, misreading them as contradictory. Indeed, my superficial interpretations led me to Thoreau's life ofquiet desperation and deep depression. We come to know and bring understanding to our lives by storying them. My own Hero's Journey, the path from my egoic selftoward the universal Self, can be understood as the resultant translations and transformations. Inevitably each of us is involved in such a story, though most are unaware of the stages along our own Hero's journey. ' Narrative honours writing as a means of knowing. The contemplative reflection allows insight into our imprisoning paradigms, beliefs, behaviours, and blind spots. My research revisits and explores nodal experiences along my Hero's Journey through 4 categories: self, society, soil, and Self. While the value of this process of narrative inquiry lay in its ability to come to know and understand one's self, perhaps its greater value is of a more universal nature. My inquiry, while adding to the body of academic educational narrative literature, may also illuminate a path to educators, students, and all interested, encouraging a response to the call of their own Hero's journey. I am a teacher/learner in a jail setting, working with youth between the ages of 12 and 18 who have committed crimes such as armed robbery, assault, rape, and murder. As this thesis follows my continual development from egoic self/teacher/learner to universal Self/Teacher/Learner, it also enables me to both consciously and unconsciously open the ways in which I expand my care, compassion, and love to work with at-risk youth.

An inquiry into the barriers to participation within the fitness industry for people living with mobility challenges

This qualitative study was designed to inquire about the barriers to participation within the fitness industry for people living with mobility challenges. i\n examination of the insights, stolies~ and experiences with barriers through interviews gi ven by 4 people living with mobility challenges (PMC) formed the core of the research. An analysis of the interviews from the 4 PMC informants was performed at t\\/O levels. First, a content analysis served to identify general and specific categories related to barrier issues within various fitness environments. Secondly, in-depth thematic analyses of the entries related to the insights and stories from the 4 informants which emerged from the content analysis of the data gave rise to fi ve thematic statements. From the thematic statements a fitness industry awareness protocol was created in the fonn of a statement response questionnaire. The protocol, which was given to 4 fitness assessors/trainers, \vas used to provide a snapshot of the fitness industry's readiness to work vvith disability. Throughout the process, the four PNIC informants formed a collaborati vely involved group of coresearchers, adding their voices to the narrative of the fitness-barrier experience. The result of the study suggests that barriers to participation within the fitness industry for PMC exist in various forms and levels of severity. The results also suggest that the fitness industry needs to better prepare their people and environment for working with people with physical disabilities, such as PMC, and provide a more open and positi ve environment for participation. Within the context of any fitness-related environment, recognizing that barriers to participation do exist, and acknowledging and accepting people with disabilities for who they are as indi viduals, will serve to develop a relationship where fitness practitioners and people with disabilities can work towards creating an inviting, inclusive, accessible, and barrier-free fitness environment for all.

Job satisfaction among nurses and its relationship to reflective practice /

This study was undertaken to explore job satisfaction among nurses and its relationship to reflective practice. It is a qualitative study that listens to the perspectives of 7 mental health nurses who work In a conmiunity hospital in southern Ontario. A pilot survey was conducted prior to the face-to -face interviews in order to develop meaningful questions to utilize in the interviews. Nurses participating in the study were ensured anonjnnlty and an opportunity to have their own personal perspectives heard. A convenient sample was obtained from the hospital in which the researcher worked as an educator and professional practice consultant. The concept of job satisfaction was found to be driven by the desire to do important work and to make a difference in patients' lives. The nurses articulated that it is directly related to other factors, such as the opportunity to work in one's area, of preference, involvement in decisionmaking processes, better patient/ staff ratios, and affordable, accessible continuing educational opportunities. Those nurses who have embraced reflective practice for many years seem to be able to sort out that which drives them to stay in nursing and that which will influence them to leave. The constraints of the study cO-e that it is a small qualitative study; therefore, the results are not generallzable. Reflection is integral to the practice of mental heallth nursing find a tool that is used extensively in therapy with patients. Future research could involve studing a different group of nurses who may be more task focused than mental health nurses.

A Foucaultian analysis of power relations in child protection case work with youth and families

This thesis takes some steps in examining the child protection system from a position that is rarely discussed. Specifically, I explore how Foucault's concept of disciplinary power can be used to demonstrate how power operates within the client/worker relationship. This relationship is shown to be quite complex with power flowing bidirectionally, rather than hierarchically. Instead of viewing power imbalances as a function of state control, I show how the client/worker relationship is constituted by the worker, the client, the organization and the social body. A postmodern auto ethnography is used to document my journey as I expose the disciplinary practices and instruments that I was subject to and used with my clients. 2 Given that the child protection system is constantly shifting and changing in order to improve its ability to safeguard children a greater emphasis is required to examine how workers operate within this complex, overwhelming and multi-dimensional world. This thesis has shown that by engaging in a reflexive examination of my position of power different approaches to making intervention beneficial to all involved become available. This is important if child protection work aims to work with clients rather than on clients.

The Gentleman's Magazine and Historical Chronicle - 1812 July to December Index and Supplement

Specific pages related to the War of 1812 include: Pages 655, 656, 657: Battles on the Niagara Frontier, with the death of Major General Sir Isaac Brock at the Battle of Queenston Heights on October 13, 1812. Page 670: Oct 13 - Obituary for Major General Sir Isaac Brock. Click on the pdf links to the right to view the monthly issue. The Gentleman's Magazine and Historical Chronicle was a monthly periodical published in England during the years of 1736-1833. The volumes of interest from 1812-1815 were written and compiled by Sylvanus Urban, Gentleman. These volumes were printed in London by Nichols, Son and Bentley at Cicero's Head, Red Lion Passage and Fleet Street. The magazine contains accounts of important historical events, abstracts of foreign occurrences, letters from noted figures, articles on geography, biographical entries for prominent people, poems, statistics, obituaries, reviews of books and more.

The Gentleman's Magazine and Historical Chronicle - 1813 January to June - Index and Supplements

The Gentleman's Magazine and Historical Chronicle was a monthly periodical published in England during the years of 1736-1833. The volumes of interest from 1812-1815 were written and compiled by Sylvanus Urban, Gentleman. These volumes were Printed in London by Nichols, Son and Bentley at Cicero's Head, Red Lion Passage and Fleet Street. Click on the pdf links to the right to view the monthly issue. This bound volume has been divided by months. The page divisions are as listed. Index pages 673-700 January pages 1-96 February pages 97-192 March pages 193-296 April pages 297-400 Prefix to May pages 401-408 * May pages 401-504 June pages 505-600 Supplement pages 601-672 *Pages 401-408 are duplicated. Please check both the Prefix to May and May for these pages listed in the Index.

The Gentleman's Magazine and Historical Chronicle - 1813 July to December Index and Supplements

The Gentleman's Magazine and Historical Chronicle was a monthly periodical published in England during the years of 1736-1833. The volumes of interest from 1812-1815 were written and compiled by Sylvanus Urban, Gentleman. These volumes were Printed in London by Nichols, Son and Bentley at Cicero's Head, Red Lion Passage and Fleet Street. Click on the pdf links to the right to view the monthly issue. This bound volume has been divided by months. The page divisions are as listed. Index pages 705-728 July pages 1-96 August pages 97-200 September pages 201-304 October pages 305-408 November pages 409-512 December pages 529-632 Supplement pages 633-704

The Gentleman's Magazine and Historical Chronicle - 1814 January to June Index and Supplements

The Gentleman's Magazine and Historical Chronicle was a monthly periodical published in England during the years of 1736-1833. The volumes of interest from 1812-1815 were written and compiled by Sylvanus Urban, Gentleman. These volumes were Printed in London by Nichols, Son and Bentley at Cicero's Head, Red Lion Passage and Fleet Street. Click on the pdf links to the right to view the monthly issue. This bound volume has been divided by months. The page divisions are as listed. Index pages 705-732 January pages 1-104 February pages 105-208 March pages 209-312 April pages 313-424 May pages 425-528 June pages 529-632 Supplement pages 633-704

The Gentleman's Magazine and Historical Chronicle - 1814 July to December Index and Supplements

The Gentleman's Magazine and Historical Chronicle was a monthly periodical published in England during the years of 1736-1833. The volumes of interest from 1812-1815 were written and compiled by Sylvanus Urban, Gentleman. These volumes were Printed in London by Nichols, Son and Bentley at Cicero's Head, Red Lion Passage and Fleet Street. Click on the pdf links to the right to view the monthly issue. This bound volume has been divided by months. The page divisions are as listed. Index pages 705-732 July pages 1-96 August pages 97-200 September pages 201-304 October pages 305-408 November pages 409-512 December pages 513-632 Supplement pages 633-704

The Gentleman's Magazine and Historical Chronicle - 1815 January to June Index and Selected Pages

The Gentleman's Magazine and Historical Chronicle was a monthly periodical published in England during the years of 1736-1833. The volumes of interest from 1812-1815 were written and compiled by Sylvanus Urban, Gentleman. These volumes were Printed in London by Nichols, Son and Bentley at Cicero's Head, Red Lion Passage and Fleet Street. Click on the pdf links to the right to view the monthly issue. This bound volume has been divided by months. The page divisions are as listed. *In this volume only the Index and selected relevant pages have been digitized, for the full Periodical please contact the Brock University Special Collections and Archives. Listed are the pages that have been digitized. Index pages 653-680 Supplement page 577 January pages 1-96 February page 97 March pages 193,260-272 April pages 289,353-357 May pages 385,463,576 June page 481

Exploring the Ethical Decision-Making Processes of Community Care Providers

While there has been a recent shift away from isolated, institutionalized living conditions, persons with Intellectual Disabilities (ID) may still experience restricted access to choice when it comes to making decisions about the basic aspects of their lives. A tension remains between protecting individuals from harm and promoting their right to independence and personal liberties. This tension creates complex questions and ethical concerns for care providers supporting persons with ID. This study explored the ethical decision-making processes of care providers and specifically, how care providers describe the balance of protecting supported individuals from harm while promoting their right to self-determination. Semi-structured interviews were conducted with six care providers employed by a local community agency that supports young and older adults with ID. Data were analysed using thematic analysis and broader themes were developed following phases of open and selective coding. Results indicated that care providers described ethical decision-making processes as frequent, complex, subjective, and uncomfortable. All participants described the importance of promoting independent decision-making among the individuals they support and assisting supported individuals to make informed decisions. Participants also reported work colleagues and supervisors as primary sources of information when resolving ethical concerns. This suggests that complex ethical decision-making processes are being taken seriously by care providers and supervising staff. The results of this study are well-positioned to be applied to the development of a training program for frontline care providing staff supporting individuals in community care settings.