Outcomes of a Novel Approach to Transcatheter and Hybrid Pulmonary Valve Replacement for Congenital Heart Disease in a Single Center

Purpose: This dissertation was designed to build my expertise in working with large datasets and to apply that knowledge to congenital heart disease patient problems. Relationships in a large dataset were examined using a nursing theory approach to identify relationships that would benefit from further research as a preliminary skill-building step. Outcomes from transcatheter (TC) and hybrid pulmonary valve replacement (PVR) versus surgical PVR were explored in the literature and finally in a study to begin to provide information to help health care providers tailor education and recommendations to patients/families selecting a treatment strategy for pulmonary regurgitation and/or stenosis. Design: A quasi-meta-analysis (Manuscript I) was undertaken to compare outcomes from TC and surgical PVR using the Wilson and Cleary (1995) conceptual model of health-related quality of life (HRQOL). In Manuscript II the Omaha System was used to analyze data from an existing leg ulcer database (no appropriate congenital heart disease database was available) to increase my skills at handling large databases and applying nursing theory to identify relationships that would benefit from further research. Visualization techniques (heat maps) were then used to examine new relationships among the variables. Models were developed to test the relationships between variables in predicting adherence to leg ulcer treatment and predicting leg ulcer development. Gaps identified in the literature from Manuscript I and the skills learned from the Manuscript II project were then used to design a single-center study to examine TC (n=32) and hybrid (n=15) PVR outcomes (procedural, mid-term, heart remodeling/function, arrhythmia, symptom, functional, and HRQOL as well as cost outcomes) (Manuscript III). The results were compared to the surgical literature and TC and surgical meta-analysis outcomes. Findings: Gaps identified in the quasi-meta-analysis (Manuscript I) were that hybrid PVR outcomes were limited to procedural outcomes. There were limited symptom and HRQOL outcomes for both TC and hybrid PVR. There were few reports of diastolic heart function for either TC or surgical PVR. The study (Manuscript III) showed hybrid PVR had similar heart remodeling outcomes as TC. There were no changes in heart function, arrhythmias, or exercise capacity for TC or hybrid PVR; this was similar to surgical PVR outcomes. Dyspnea and exercise intolerance decreased. Functional class improved but was only significant in the TC group which compares to surgical PVR. Length of stay was significantly shorter for TC and hybrid PVR than surgical PVR but costs were higher. Manuscript II demonstrated that the Omaha System was useful in aligning nursing theory and terminology to identify patterns between psychosocial characteristics and leg ulcers that could be investigated further. These skills in extracting and categorizing variables were used in designing the study reported in Manuscript II. Conclusions: The findings from Manuscripts I and III should help health care providers to begin to educate patients/families about the best PVR treatment options given individual patient anatomy, physiology, and preferences. Manuscript II demonstrated that the Omaha System was useful with large datasets to link theory and data to identify potential new hypotheses to test. This theory could be used to identify possible hypotheses to test with congenital heart disease databases

The relationship between cell size and cell fate in Volvox carteri

In Volvox carteri development, visibly asymmetric cleavage divisions set apart large embryonic cells that will become asexual reproductive cells (gonidia) from smaller cells that will produce terminally differentiated somatic cells. Three mechanisms have been proposed to explain how asymmetric division leads to cell specification in Volvox: (a) by a direct effect of cell size (or a property derived from it) on cell specification, (b) by segregation of a cytoplasmic factor resembling germ plasm into large cells, and (c) by a combined effect of differences in cytoplasmic quality and cytoplasmic quantity. In this study a variety of V. carteri embryos with genetically and experimentally altered patterns of development were examined in an attempt to distinguish among these hypotheses. No evidence was found for regionally specialized cytoplasm that is essential for gonidial specification. In all cases studied, cells with a diameter > approximately 8 microns at the end of cleavage--no matter where or how these cells had been produced in the embryo--developed as gonidia. Instructive observations in this regard were obtained by three different experimental interventions. (a) When heat shock was used to interrupt cleavage prematurely, so that presumptive somatic cells were left much larger than they normally would be at the end of cleavage, most cells differentiated as gonidia. This result was obtained both with wild-type embryos that had already divided asymmetrically (and should have segregated any cytoplasmic determinants involved in cell specification) and with embryos of a mutant that normally produces only somatic cells. (b) When individual wild-type blastomeres were isolated at the 16-cell stage, both the anterior blastomeres that normally produce two gonidia each and the posterior blastomeres that normally produce no gonidia underwent modified cleavage patterns and each produced an average of one large cell that developed as a gonidium. (c) When large cells were created microsurgically in a region of the embryo that normally makes only somatic cells, these large cells became gonidia. These data argue strongly for a central role of cell size in germ/soma specification in Volvox carteri, but leave open the question of how differences in cell size are actually transduced into differences in gene expression

What are the enablers of economic participation in remote and very remote Australia, and how can we identify them?

Learning Communities: International Journal of Learning in Social Contexts by https://www.cdu.edu.au/northern-institute/lcj is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.In this paper we discuss some of the key learnings from the Cooperative Research Centre for Remote Economic Participation (CRC REP), Remote Education Systems, Pathways to Employment and Aboriginal and Torres Strait Islander Tourism Product research projects. While we do not deny the importance of global markets for remote Australians, we see value in opportunity structures that move beyond the confines of traditional economic and human capital theories. It is through acknowledging and building on local residents' social, identity, cultural and natural capital strengths that, we argue, has a greater potential for supporting increased economic engagement and sustainable participation. Framing our learnings through a theoretical lens of different forms of capital we argue a shift in discourse from one of 'disadvantage' to one of remote advantage would be more supportive of education, employment and enterprise outcomes for local Aboriginal and/or Torres Strait Islander residents. While such a shift will not contribute significantly to the Gross National Product we argue that it would have important tangible and economic benefits for local people and the nation

International Legal Scholarship in Canada

International law scholarship in Canada is largely limited to a small group of decentralized writers facing a vast and ill-defined field. In those areas in which significant work has been undertaken - the law of the sea, for example - Canadian scholarship is limited by a commitment to a national perspective rather than a recognition of the interests of the global community. The work is largely descriptive, and avoids a deeper theoretical analysis. International law is seen as a fringe discipline, and is presently unable to support the specialized effort necessary to produce the fundamental research that is badly needed if the significance of the area is to be recognize

Identification of Remaining Oil Resource Potential in the Frio Fluvial/Deltaic Sandstone Play, South Texas

The Frio Fluvial/Deltaic Sandstone (Vicksburg Fault Zone) oil play of South Texas has produced nearly 1 billion stock tank barrels (BSTB) of oil, yet still contains about 1.2 BSTB of unrecovered mobile oil and an even greater amount of residual oil resources (1.5 BSTB). More than half of the reservoirs in this depositionally complex play have been abandoned, and large volumes of oil may remain unproduced unless advanced characterization techniques are applied to define incompletely drained and untapped reservoirs as suitable targets for near-term recovery. Interwell-scale geological facies models of Frio fluvial/deltaic reservoirs will be combined with engineering assessments and geophysical evaluations to characterize Frio fluvial/deltaic reservoir architecture, flow unit boundaries, and the controls that these characteristics exert on the location and volume of unrecovered mobile and residual oil. These results will lead directly to the identification of specific opportunities to exploit these heterogeneous reservoirs for incremental recovery by recompletion and strategic infill drilling. Reservoir attribute data were statistically analyzed from oil and gas fields throughout the geographic area covered by the Frio Fluvial/Deltaic Sandstone oil play. General reservoir attributes analyzed in detail included porosity, initial water saturation, residual oil saturation, net pay, reservoir area, and fluid characteristics. Statistical analysis of variance demonstrated no difference between oil reservoir attributes and gas reservoir attributes, indicating that oil and gas reservoirs are subsets of a larger genetically similar population. Probability functions that describe attribute frequency distributions were determined for use in risk-adjusting resource calculations. Different functions were found to be most applicable for the various petrophysical reservoir attributes.Bureau of Economic Geolog

Revitalizing a Mature Oil Play: Strategies for Finding and Producing Unrecovered Oil in Frio Fluvial-Deltaic Reservoirs of South Texas

Advanced reservoir characterization techniques are being applied to selected reservoirs in the Frio Fluvial-Deltaic Sandstone (Vicksburg Fault zone) oil play of South Texas to maximize the productivity of resources in this mature oil play. This mature play has already produced nearly 1 billion barrels (Bbbl) of oil, yet still contains about 1.6 Bbbl of unrecovered mobile oil and nearly the same amount of residual oil resources. More than half of the reservoirs in this depositionally complex play have already been abandoned, and large volumes of oil may remain unproduced unless advanced characterization techniques are applied to define untapped, incompletely drained, and new pool reservoirs as suitable targets for near-term recovery methods. Primary technical objectives of this project are to develop interwell-scale geological facies models of Frio fluvial-deltaic reservoirs and combine them with engineering assessments and geophysical evaluations in order to characterize the Frio fluvial-deltaic reservoir architecture and flow unit boundaries and to determine the controls that these characteristics exert on the location and volume of unrecovered mobile and residual oil. These results will lead directly to the identification of specific opportunities to exploit these heterogeneous reservoirs for incremental recovery by recompletion and strategic infill drilling.Bureau of Economic Geolog

A Committee to Manage Innovative Learning Spaces: Balancing Committee Size, Cross-Campus Representation, and Decision-Making Power

The growth in active learning classrooms represents a major shift in the pedagogy and built environment of higher education. While a robust literature exists to discuss the development, use, and evaluation of these innovative learning spaces, the practical considerations of managing innovative learning spaces has not received the same level of attention. This article describes the management model at _____ University, outlining key workflow considerations: committee size, cross-campus representation, and decision-making power. The conclusion sets out future research opportunities related to the institutional dynamics of innovative learning space management

Reach- and catchment-scale determinants of the distribution of freshwater mussels (Bivalvia: Unionidae) in south-eastern Michigan, U.S.A.

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73643/1/j.1365-2426.2003.01165.x.pd