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.

Assessment of biodegradable magnesium alloys for enhanced mechanical and biocompatible properties

Biomaterials have been used for more than a century in the human body to improve body functions and replace damaged tissues. Currently approved and commonly used metallic biomaterials such as, stainless steel, titanium, cobalt chromium and other alloys have been found to have adverse effects leading in some cases, to mechanical failure and rejection of the implant. The physical or chemical nature of the degradation products of some implants initiates an adverse foreign body reaction in the tissue. Some metallic implants remain as permanent fixtures, whereas others such as plates, screws and pins used to secure serious fractures are removed by a second surgical procedure after the tissue has healed sufficiently. However, repeat surgical procedures increase the cost of health care and the possibility of patient morbidity. This study focuses on the development of magnesium based biodegradable alloys/metal matrix composites (MMCs) for orthopedic and cardiovascular applications. The Mg alloys/MMCs possessed good mechanical properties and biocompatible properties. Nine different compositions of Mg alloys/MMCs were manufactured and surface treated. Their degradation behavior, ion leaching, wettability, morphology, cytotoxicity and mechanical properties were determined. Alloying with Zn, Ca, HA and Gd and surface treatment resulted in improved mechanical properties, corrosion resistance, reduced cytotoxicity, lower pH and hydrogen evolution. Anodization resulted in the formation of a distinct oxide layer (thickness 5-10 μm) as compared with that produced on mechanically polished samples (~20-50 nm) under ambient conditions. It is envisaged that the findings of this research will introduce a new class of Mg based biodegradable alloys/MMCs and the emergence of innovative cardiovascular and orthopedic implant devices.^

Eastern oysters (Crassostrea virginica) as an indicator for restoration of Everglades Ecosystems

The Comprehensive Everglades Restoration Plan (CERP) attempts to restore hydrology in the Northern and Southern Estuaries of Florida. Reefs of the Eastern oyster Crassostrea virginica are a dominant feature of the estuaries along the Southwest Florida coast. Oysters are benthic, sessile, filter-feeding organisms that provide ecosystem services by filtering the water column and providing food, shelter and habitat for associated organisms. As such, the species is an excellent sentinel organism for examining the impacts of restoration on estuarine ecosystems. The implementation of CERP attempts to improve: the hydrology and spatial and structural characteristics of oyster reefs, the recruitment and survivorship of C. virginica, and the reef-associated communities of organisms. This project links biological responses and environmental conditions relative to hydrological changes as a means of assessing positive or negative trends in oyster responses and population trends. Using oyster responses, we have developed a communication tool (i.e., Stoplight Report Card) based on CERP performance measures that can distinguish between responses to restoration and natural patterns. The Stoplight Report Card system is a communication tool that uses Monitoring and Assessment Program (MAP) performance measures to grade an estuary's response to changes brought about by anthropogenic input or restoration activities. The Stoplight Report Card consists of both a suitability index score for each organism metric as well as a trend score (− decreasing trend, +/− no change in trend, and + increasing trend). Based on these two measures, a component score (e.g., living density) is calculated by averaging the suitability index score and the trend score. The final index score is obtained by taking the geometric score of each component, which is then translated into a stoplight color for success (green), caution (yellow), or failure (red). Based on the data available for oyster populations and the responses of oysters in the Caloosahatchee Estuary, the system is currently at stage “caution.” This communication tool instantly conveys the status of the indicator and the suitability, while trend curves provide information on progress towards reaching a target. Furthermore, the tool has the advantage of being able to be applied regionally, by species, and collectively, in concert with other species, system-wide.

An assessment of novel biodegradable magnesium alloys for endovascular biomaterial applications

Magnesium alloys have been widely explored as potential biomaterials, but several limitations to using these materials have prevented their widespread use, such as uncontrollable degradation kinetics which alter their mechanical properties. In an attempt to further the applicability of magnesium and its alloys for biomedical purposes, two novel magnesium alloys Mg-Zn-Cu and Mg-Zn-Se were developed with the expectation of improving upon the unfavorable qualities shown by similar magnesium based materials that have previously been explored. The overall performance of these novel magnesium alloys has been assessesed in three distinct phases of research: 1) analysing the mechanical properties of the as-cast magnesium alloys, 2) evaluating the biocompatibility of the as-cast magnesium alloys through the use of in-vitro cellular studies, and 3) profiling the degradation kinetics of the as-cast magnesium alloys through the use of electrochemical potentiodynamic polarization techqnique as well as gravimetric weight-loss methods. As compared to currently available shape memory alloys and degradable as-cast alloys, these experimental alloys possess superior as-cast mechanical properties with elongation at failure values of 12% and 13% for the Mg-Zn-Se and Mg-Zn-Se alloys, respectively. This is substantially higher than other as-cast magnesium alloys that have elongation at failure values that range from 7-10%. Biocompatibility tests revealed that both the Mg-Zn-Se and Mg-Zn-Cu alloys exhibit low cytotoxicity levels which are suitable for biomaterial applications. Gravimetric and electrochemical testing was indicative of the weight loss and initial corrosion behavior of the alloys once immersed within a simulated body fluid. The development of these novel as-cast magnesium alloys provide an advancement to the field of degradable metallic materials, while experimental results indicate their potential as cost-effective medical devices.^

English Language Learners: A Correlational Study of the Relationship Between A Proficiency Level Assessment and End of Course Test Scores at one Georgia High School

Understanding the language of one’s cultural environment is important for effective communication and function. As such, students entering U.S. schools from foreign countries are given access to English to Speakers of Other Languages (ESOL) programs and they are referred to as English Language Learner (ELL) students. This dissertation examined the correlation of ELL ACCESS Composite Performance Level (CPL) score to the End of Course tests (EOCTs) and the Georgia High School Graduation Tests (GHSGTs) in the four content courses (language arts, mathematics, science, and social studies). A premise of this study was that English language proficiency is critical in meeting or exceeding state and county assessment standards. A quantitative descriptive research design was conducted using Cross-sectional archival data from a secondary source. There were 148 participants from school years 2011-2012 to 2013- 2014 from Grades 9-12. A Pearson product moment correlation was run to assess the relationship between the ACCESS CPL (independent variable) and the EOCT scores and the GHSGT scores (dependent variables). The findings showed that there was a positive correlation between ACCESS CPL scores and the EOCT scores where language arts showed a strong positive correlation and mathematics showed a positive weak correlation. Also, there was a positive correlation between ACCESS CPL scores and GHSGT scores where language arts showed a weak positive correlation. The results of this study indicated that that there is a relationship between the stated variables, ACCESS CPL, EOCT and GHSGT. Also, the results of this study showed that there were positive correlations at varying degrees for each grade levels. While the null hypothesis for Research Question 1 and Research Question 2 were rejected, there was a slight relationship between the 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.

Development of a Lab-on-a-Chip Device for Rapid Nanotoxicity Assessment In Vitro

Increasing useof nanomaterials in consumer products and biomedical applications creates the possibilities of intentional/unintentional exposure to humans and the environment. Beyond the physiological limit, the nanomaterialexposure to humans can induce toxicity. It is difficult to define toxicity of nanoparticles on humans as it varies by nanomaterialcomposition, size, surface properties and the target organ/cell line. Traditional tests for nanomaterialtoxicity assessment are mostly based on bulk-colorimetric assays. In many studies, nanomaterials have found to interfere with assay-dye to produce false results and usually require several hours or days to collect results. Therefore, there is a clear need for alternative tools that can provide accurate, rapid, and sensitive measure of initial nanomaterialscreening. Recent advancement in single cell studies has suggested discovering cell properties not found earlier in traditional bulk assays. A complex phenomenon, like nanotoxicity, may become clearer when studied at the single cell level, including with small colonies of cells. Advances in lab-on-a-chip techniques have played a significant role in drug discoveries and biosensor applications, however, rarely explored for nanomaterialtoxicity assessment. We presented such cell-integrated chip-based approach that provided quantitative and rapid response of cellhealth, through electrochemical measurements. Moreover, the novel design of the device presented in this study was capable of capturing and analyzing the cells at a single cell and small cell-population level. We examined the change in exocytosis (i.e. neurotransmitterrelease) properties of a single PC12 cell, when exposed to CuOand TiO2 nanoparticles. We found both nanomaterials to interfere with the cell exocytosis function. We also studied the whole-cell response of a single-cell and a small cell-population simultaneously in real-time for the first time. The presented study can be a reference to the future research in the direction of nanotoxicity assessment to develop miniature, simple, and cost-effective tool for fast, quantitative measurements at high throughput level. The designed lab-on-a-chip device and measurement techniques utilized in the present work can be applied for the assessment of othernanoparticles' toxicity, as well.

The effect of a reform on a school organizational culture after receiving a failing Florida Comprehensive Assessment Test rating

The purpose of this research was to explore the effects of a reform that took place in an elementary school during 2000/2001 as a result of a failure rating on the Florida Comprehensive Assessment Test on the structure and the personnel of the organization. The exploration took place over a period of 10 months starting in August 2000 until June 2001. It focused on the effect of the failure rating on the: (a) structure and operation of the school; (b) morale, beliefs, behaviors, and daily lives of teachers and the principal; and (c) the effect of the reform effort on the leadership style of the principal, whether she became a transactional or a transformative leader. The researcher assumed the role of a participant observer. Data sources were her personal recollections of major events that took place during the year of the reform, interviews, observations, and school documents. The sample included 15 teachers present during the time of the reform. Ten taught second through fifth grade. The remaining five participants were the music teacher, the counselor, and the writing, reading and technology specialists. Together they represented the instructional team or represented special education areas. The findings indicated that the reform effort had an effect on the structure and the operation of the school. The changes included reorganization of the physical set up, changes in curriculum and instruction, changes in the means of communication among the staff, and the addition of new staff members including an official agent of change. The reform had a greater effect on the daily lives of teachers and their morale than on their beliefs and behaviors. Teachers reported that during the effort their daily lives were stressful and their morale very low due to the enormous expectations that they had to meet. On the other hand, the reform effort had a positive effect on the daily life, morale, beliefs, and behaviors of the principal. It energized her. She spoke positively about the change. She functioned as an effective, positive, resilient transactional leader who did what was necessary in order to enable the teachers to cope with the complex situation.

Physical, Geochemical, Geomechanical, Geophysical and Hydrodynamic Characterization and Anisotropy Assessment of Corvio Sandstone

Corvio sandstone is a ~20 m thick unit (Corvio Formation) that appears in the top section of the Frontada Formation (Campoó Group; Lower Cretaceous) located in Northern Spain in the southern margin of the Basque-Cantabrian Basin. Up to 228 plugs were cored from four 0.3 x 0.2 x 0.5 m blocks of Corvio sandstone, to perform a comprehensive characterization of the physical, mineralogical, geomechanical, geophysical and hydrodynamic properties of this geological formation, and the anisotropic assessment of the most relevant parameters. Here we present the first data set obtained on 53 plugs which covers (i) basic physical and chemical properties including density, porosity, specific surface area and elementary analysis (XRF - CHNS); (ii) the curves obtained during unconfined and confined strengths tests, the tensile strengths, the calculated static elastic moduli and the characteristic stress levels describing the brittle behaviour of the rock; (iii) P- and S-wave velocities (and dynamic elastic moduli) and their respective attenuation factors Qp and Qs, electrical resistivity for a wide range of confining stress; and (iv) permeability and transport tracer tests. Furthermore, the geophysical, permeability and transport tests were additionally performed along the three main orthogonal directions of the original blocks, in order to complete a preliminary anisotropic assessment of the Corvio sandstone.

Caminhos para a avaliação da formação em odontologia: desenvolvimento, validação e aplicação de critérios

The need for universal access to health and the failure of the pedagogical model centered on the transmission of knowledge has led to changes in the training of health professionals. The objective of this study was to provide a new alternative for evaluating dental students through the development, validation and application of evaluation criteria based on the National Curriculum Guidelines (DCN in Brazil). Therefore, the study was conducted in three phases: development and validation of evaluation criteria of Dentistry courses based on the DCN; a pilot study to verify the applicability of the validated criteria and evaluation of the dentistry courses in the Northeast. In the first stage, a logical model was formulated, allowing for the construction of a criteria matrix, validated by a modified Delphi consensus technique. The validated matrix has the following dimensions: Profile of graduates, health care guidance, teaching and service integration, and pedagogical approach. The pilot study was conducted in five dental courses through a documentary study of the pedagogical project course (PPC), and application of validated questionnaires and interviews with course coordinators. The results of the pilot study indicate the possibility of being verified by means of validated criteria and using different methodological proposals, advances and curricular limitations facing the proposed reorientation of training recommended by DCN. The evaluation of Northeast Dentistry courses was carried out by applying a questionnaire validating a matrix of 30 course coordinators, including public and private institutions. The data were submitted to descriptive analysis, and also tested the difference between means and the correlation between the assessment of the coordinators in the dimensions and sub-dimensions with each other, among the general evaluation of courses and between the following variables: administrative category, time since last curriculum updating, participation in reorienting the training of health professionals programs, ENADE and CPC (Preliminary Concepts of the Course) scores in the year 2013. Positive correlation (p <0.01) was found between the means obtained by the perception of the coordinators in most dimensions, and also between them and the overall performance of the course. There were no significant differences between the coordinators’ perception about course performance and the administrative category (public / private). This difference is slightly higher when the average performance is compared with respect to time due to the last curriculum update, getting better performance in courses with the latest updated curriculum, even with there not 11 being this significant difference between dimensions. Better averages of performance were obtained in courses that do not participate in reorientation programs of professional training, with a significant difference (p<0.05) for the overall score and for all dimensions except the dimensions of teaching-service Integration (p = 0.064). There was no significant correlation between the assessment of coordinators in all dimensions, in the overall assessment or ENADE and CPC scores in 2013. The final instrument proposed in this study is a different alternative assessment for health training of both dentists and other professionals, considering that the DCN providing for the training and graduation of professionals is focused on the health needs of the population, integrated with the SUS (the National Brazilian Health System) and based on student-centered learning.

A simple and rapid approach to post-earthquake assessment of bridge condition and damage

Peer reviewed

Two parallel, pragmatic, UK multicentre, randomised controlled trials comparing surgical options for upper compartment (vault or uterine) pelvic organ prolapse (the VUE Study) : study protocol for a randomised controlled trial

The VUE study is funded by the National Institute for Health Research Health Technology Assessment programme (project number 11/129/183).

Quality planning based on risk assessment

Product quality planning is a fundamental part of quality assurance in manufacturing. It is composed of the distribution of quality aims over each phase in product development and the deployment of quality operations and resources to accomplish these aims. This paper proposes a quality planning methodology based on risk assessment and the planning tasks of product development are translated into evaluation of risk priorities. Firstly, a comprehensive model for quality planning is developed to address the deficiencies of traditional quality function deployment (QFD) based quality planning. Secondly, a novel failure knowledge base (FKB) based method is discussed. Then a mathematical method and algorithm of risk assessment is presented for target decomposition, measure selection, and sequence optimization. Finally, the proposed methodology has been implemented in a web based prototype software system, QQ-Planning, to solve the problem of quality planning regarding the distribution of quality targets and the deployment of quality resources, in such a way that the product requirements are satisfied and the enterprise resources are highly utilized. © Springer-Verlag Berlin Heidelberg 2010.

The Burden of Burnout: An Assessment of Burnout Among Internal Medicine Residents After the 2011 Duty Hour Changes.

This study sought to determine burnout prevalence and factors associated with burnout in internal medicine residents after introduction of the 2011 ACGME duty hour rules. Burnout was evaluated using an anonymized, abbreviated version of the Maslach Burnout Inventory. Surveys were collected biweekly for 48 weeks during the 2013-2014 academic year. Burnout severity was compared across subgroups and time. A score of 3 or higher signified burnout. Overall, 944 of 3936 (24%) surveys were completed. The mean burnout score across all surveys was 2.8. Categorical residents had higher burnout severity than noncategorical residents (2.9 vs 2.7, P = .005). Postgraduate year 2 residents had the highest burnout severity by year (3.1, P < .001). Residents on inpatient rotations had higher burnout severity than residents on outpatient or consultation rotations (3.1 vs 2.2 vs 2.2, P < .001). Night float rotations had the highest severity (3.8). Burnout remains a significant problem even with recent duty hour modifications.

Thrombolysis in myocardial infarction risk score in an observation unit setting.

OBJECTIVE: The Thrombolysis in Myocardial Infarction (TIMI) score is a validated tool for risk stratification of acute coronary syndrome. We hypothesized that the TIMI risk score would be able to risk stratify patients in observation unit for acute coronary syndrome. METHODS: STUDY DESIGN: Retrospective cohort study of consecutive adult patients placed in an urban academic hospital emergency department observation unit with an average annual census of 65,000 between 2004 and 2007. Exclusion criteria included elevated initial cardiac biomarkers, ST segment changes on ECG, unstable vital signs, or unstable arrhythmias. A composite of significant coronary artery disease (CAD) indicators, including diagnosis of myocardial infarction, percutaneous coronary intervention, coronary artery bypass surgery, or death within 30 days and 1 year, were abstracted via chart review and financial record query. The entire cohort was stratified by TIMI risk scores (0-7) and composite event rates with 95% confidence interval were calculated. RESULTS: In total 2228 patients were analyzed. Average age was 54.5 years, 42.0% were male. The overall median TIMI risk score was 1. Eighty (3.6%) patients had 30-day and 119 (5.3%) had 1-year CAD indicators. There was a trend toward increasing rate of composite CAD indicators at 30 days and 1 year with increasing TIMI score, ranging from a 1.2% event rate at 30 days and 1.9% at 1 year for TIMI score of 0 and 12.5% at 30 days and 21.4% at 1 year for TIMI ≥ 4. CONCLUSIONS: In an observation unit cohort, the TIMI risk score is able to risk stratify patients into low-, moderate-, and high-risk groups.