Cardiac regenerative medicine: insights from healthy and diseased engineered tissues

Cardiovascular disease remains the leading cause of mortality in the United States. Current tissue engineering approaches have fallen short of promoting fully functional cardiovascular cells and the post-myocardial infarction microenvironment is still not well understood. These gaps in knowledge are addressed in this dissertation through the development of in vitro engineered cardiac tissues using electroactive materials to enhance the differentiation of pluripotent stem cell derived cardiomyocytes and through the development of in vitro myocardial inflammation models dedicated to understanding cardiomyocytes and macrophages interactions. Specifically, piezoelectric poly (vinylidene fluoride-trifluoroethylene) (PVDF-TrFE) supports the attachment and survival of mouse embryonic stem cell derived cardiomyocytes (mES-CM) and endothelial cells (mES-EC). Characterization of mES-CM confirms expression of classical cardiac specific marker such as cTnT and Cx43, as well as efficient calcium handling properties when cultured on PVDF-TrFE including response to ryanodine receptor and β-adrenergic stimulation. MES-EC also retain their ability to uptake low density lipoprotein when cultured on PVDF-TrFE scaffolds and express classical endothelial cell specific markers such as eNOS and PECAM-1. Additionally, a novel graphene composite scaffold (PCL+G) exhibiting even distribution of graphene particles within the matrix allowing miniscule amounts of graphene to increase conductivity is developed and characterized. MES-CM seeded on conductive PCL+G scaffolds attach well and begin migrating into the scaffold matrix. They exhibit well-registered sarcomeres, express cardiac specific markers such as cTnT, MHC and Cx43 and spontaneous beat for up to two weeks. MES-CM on PCL+G scaffolds can be electrically paced and respond to ryanodine receptor and β-adrenergic stimulation. The combination of highly aligned fiber orientation and the presence of graphene promoted significantly improve calcium cycling efficiency by a fractional release of over 40%. Finally, in vitro myocardial inflammation models are developed to examine both direct and indirect co-culture of mES-CM with polarized macrophage subpopulations present in the post-MI microenvironment. Direct co-culture with macrophage subsets cause significant changes in mES-CM calcium handling function, especially in store operated calcium entry (SOCE), which is accompanied by significant increases in matricellular protein secretion, osteopontin (OPN). A pathway connecting OPN to SOCE response through ERK1/2 activation is analyzed through indirect co-culture with macrophage conditioned media and found to be affected by OPN inhibition, suggesting this pathway is involved with calcium homeostasis in the post-MI microenvironment, specifically in the pro-healing, anti-inflammatory phase. Taken together, the presented results expand the current state of research in cardiac regenerative medicine by demonstrating the potential of two electroactive biomaterials for the formation of functional cardiac tissues and by illuminating a novel target involved in changes in cardiomyocytes calcium homeostasis during post-MI healing through an in vitro engineered diseased model

Bye-bye Bluebook?

In March 2000, Aspen Law & Business published a new citation manual, the ALWD Citation Manual-A Professional System of Citation.\u27 Developed mostly as a restatement of citation, the ALWD Citation Manual not only provides the legal academy with a text that simplifies teaching legal citation, but also provides judges and lawyers with a helpful desktop reference book. This article explains why a new citation manual was created and highlights some of its significant features

Competency frameworks, nursing perspectives, and interdisciplinary collaborations for good patient care: Delineating boundaries

Abstract: To enhance patient care in the inevitable conditions of complexity that exist in contemporary healthcare, collaboration among healthcare professions is critical. While each profession necessarily has its own primary focus and perspective on the nature of human healthcare needs, these alone are insufficient for meeting the complex needs of patients (and potential patients). Persons are inevitably contextual entities, inseparable from their environments, and are subject to institutional and social barriers that can detract from good care or from accessing healthcare. These are some of the reasons behind current movements to develop competency frameworks that can enhance cross‐disciplinary communication and collaboration. No single profession can claim the big picture. Effective teamwork is essential and requires members of diverse professions to understand the nature of each other's knowledge, skills, roles, perspectives, and perceived responsibilities so that they are optimally utilized on behalf of patients and their families. Interdisciplinary approaches to care permit different aspects of a person's needs to be addressed seamlessly and facilitate the removal of obstacles by engaging the range of resources exemplified by the different professions. Additionally, collaborative efforts are needed to influence policy changes on behalf of individual and social good and to address root causes of poor health especially as these impact society's most vulnerable. Here, we explore both the benefits and the risks of an uncritical acceptance of competency frameworks as a way to enhance interdisciplinary communication. We highlight the importance of anchoring proposed competency domains in the reason for being of a given profession and exemplify one way this has been accomplished for advanced practice nursing. Additionally, we argue that having this mooring, permits integration of the various competencies that both enhances professional moral agency and facilitates interdisciplinary collaboration to further the mutual goals of the healthcare professions on behalf of quality patient care

Cultural Assessment: A Study of Midwives’ Knowledge, Attitude and Self-reported Practice in Uganda

Background: Cultural assessment is critical due to the increased movement and resettlement of people across the globe, and diverse cultural groups in Uganda. This is putting the health care delivery systems serving the communities under pressure to recognize the different attitudes of people towards health and to develop care systems that are effective in meeting diverse needs. However, despite the importance of cultural assessment in nursing literature, little is known about the cultural assessment competence of Ugandan midwives. This study assessed the knowledge, attitude, and practice of midwives in this assessment process. Methods: A descriptive correlational design was used to generate data for the study from a convenience sample of midwives in three hospitals using a structured questionnaire. Data were analysed using SPSS version 20. Results: Forty-nine midwives participated in the study. Over half of the respondents [57%, n = 28], demonstrated a positive attitude, however, their knowledge level was low. Almost all the midwives 90% (n = 44) had not been trained on transcultural or cross-cultural midwifery during their basic midwifery programmes. The majority of the midwives cared for at least 1 – 5 mothers a month from a culture different from their own and occasionally (once a month) [65%, n = 32] experienced difficulties or problems attributed to cultural differences. Despite the diversity of the midwives’ clients and their experiences, over half of the midwives [55%, n = 27] reported that they did not record cultural data during the assessment of mothers in labour. Where the data were recorded, it was limited to biographic information such as name, age, religion, tribe, and next of kin. These data were used to plan a client’s care. The major barrier to cultural assessment practice cited by the respondents was lack of time. Conclusion: Overall, the midwives knowledge level about cultural assessment was low. With a culturally diverse population living in Uganda, providing culturally congruent care to all women will continue to be a challenge and necessity. It is, therefore, recommended that a culture-based curriculum and in-service training on cultural assessment be developed for midwives

Come ‘RAP’ With Us: Improving the Retention of Academically-Qualified Persons (RAP) with GPAs of 3.0 or Higher

Retention is an important area of concern for Virginia Commonwealth University (VCU). This project involves devising initiatives to identify and retain students with a high potential for academic success as outlined in the Strategic Plan for the Future of Virginia Commonwealth University, Phase II. It is theorized that by concentrating efforts on students (both in-state and out-of-state) with a cummulative GPA of 3.0 or higher, an improvement in the six-year graduation and freshmen retention rates can be realized. This would serve to enhance VCU’s status in the academic community (moving from Tier 3 to Tier 2 status) since twenty percent of the determining ranking of the U.S. News and World Report’s rankings are derived from the category of retention

An Assessment of Customers’ Adaptability to Technological Innovations in Kenya’s Banking Industry: Effects of Customers Perceptions

To keep abreast of changes in the global financial environment, Kenya has experienced a weighty transformation in most of its industries, including the banking sector. The major changes witnessed in the sector have been immense advances in financial technological innovations which are as a result of uproars in the global financial environment. With the rapid and extensive increase in technological innovations, new distribution channels in the financial sector are coming up speedily. These include Automated Teller Machines, Mobile Banking and Internet Banking. These have made accessibility of money easy to bank customers since they can get it at their convenience. The evenly spread of Automated Teller Machines in most parts of the country has further made it easier for bank customers to withdraw and deposit money and/ or cheques at their convenience. These facts notwithstanding, it has been observed that most Kenyans bank customers have not fully embraced the technological innovations. This has been largely caused by bank customers’ negative perceptions towards technological innovations. As a result, most bank customers have clung to the old traditions which make them resistant and non-adaptable to technological innovations. These have been witnessed in the behaviors of most bank customers whereby they are still queuing in the banking halls despite the availability of Mobile Banking, Automated Teller Machines, and Internet Banking. The general objective of the study was an assessment of customers’ adaptability to the technological innovations in Kenya’s banking industry with the effects of customers’ perceptions. A specific objective was derived from the main objective. Two questionnaires were designed which were used to collect the views of the respondents. The population of the study comprised of senior managers from ten Commercial banks and bank customers employed in different organizations and those who were self-employed. The banking customers were selected at random. A cross-sectional ex-post facto research design was applied. Findings revealed a significant relationship between technological innovations and customers’ adaptability in Kenya’s banking sector. The significant moderating effect of customers’ perceptions on the relationship between technological innovations and customers’ adaptability in Kenya’s banking sector. The study suggested that bank management should intensify their campaign on awareness stressing the benefits that accrue from the use of financial technological innovations; tighten their securities especially in ATMs and Internet Banking and charge minimum amounts for the services. Prior studies hitherto concentrated on the benefits of technological innovations to the banking sectors and their employees; the extent by which technological innovations improved the financial performance of the banking sector and developed Kenya’s technological industry. The studies greatest contribution to knowledge is that to attain maximum technological innovations, bank customers’ negative perceptions and resistance to change should undergo a complete overhaul. Keywords: Automated Teller Machines, Internet banking, Mobile Banking, financial Technological Innovations, Banking Sector, Customers Perceptions DOI: 10.7176/RJFA/11-10-02 Publication date:May 31st 202

Analysis of traditional Chinese architecture

Thesis (M. Arch.)--Massachusetts Institute of Technology, Dept. of Architecture, 1983.MICROFICHE COPY AVAILABLE IN ARCHIVES AND ROTCHIncludes bibliographical references (p. 152-155).This thesis deals with a process of analyzing specific examples in traditional Chinese architecture in an attempt to understand and identify the underlying principles that make it essentially Chinese. The basic intent is that the development of this process of observation would later inform a process of design that would generate a 'new' architecture which could be worthily referred to as a continuum of the traditional architecture. The examples studied range from Palace and Temple architecture to Chinese gardens. To varying degrees, these places have been analyzed in terms of their spatial organization, degrees of public and private, structural systems, use of light, method of composition, system of proportions and system of circulation.by Pamela Grace Chang Sing.M.Arch

El derecho a la salud en los establecimientos penitenciarios peruanos, y la necesidad de adecuar a la normativa a los estándares internacionales

El presente trabajo de investigación titulado “La deficiente garantía del derecho fundamental a la salud en los establecimientos penitenciarios peruanos, y la necesidad de adecuar a la normativa nacional los Estándares Internacionales Sobre Tratamiento de las Personas Privadas de libertad” busca exteriorizar la forma cómo se protege o garantiza el derecho fundamental a la salud en los establecimientos penitenciarios peruanos, mostrando tanto las deficiencias, así como los factores que contribuyen a la desprotección de este derecho fundamental hacia las personas privadas de libertad. Asimismo, pretende mostrar las necesidades que tienen los establecimientos penitenciarios peruanos en cuanto a las prestaciones de salud para la garantía de este derecho fundamental, ello con el propósito de adecuar los Estándares Internacionales Sobre Tratamiento de las Personas Privadas de Libertad a la normativa nacional, a fin de mejorar la protección del derecho fundamental a la salud de los internos e internas en los diferentes establecimientos penitenciarios peruanos. En ese orden de ideas, la presente tesis incluye información que demuestra la falta de garantía del derecho fundamental a la salud en los establecimientos penitenciarios peruanos, así como jurisprudencia nacional e internacional, tanto del Tribunal Constitucional como de la Corte Interamericana de Derechos Humanos, que tiene por objeto mostrar la vulnerabilidad en la que se encuentran las personas privadas de libertad en nuestro país

Evaluación de la respuesta sísmica no lineal de reservorios elevados tipo intze

Los reservorios elevados son estructuras esenciales para el abastecimiento de agua de una población, por lo que no deberían quedar inoperativos luego de ocurrido un sismo. No obstante, la experiencia ha demostrado que para sismos de gran magnitud estas estructuras presentan daños, llegando incluso a colapsar. En esta tesis se ha realizado el análisis de dos reservorios tipo INTZE, considerando la no linealidad a flexocompresión del fuste con el objetivo de analizar la respuesta no lineal frente a diferentes solicitaciones símicas. Los reservorios (R-1 y R-2) fueron modelados con elementos tipo frame en el programa Sap2000 a los cuales se les asignó masas concentradas resultantes de la discretización del fuste y la cuba. Para el análisis del fuste se consideraron secciones agrietadas y no agrietadas. La plasticidad fue considerada en los dos primeros tramos mediante una rótula plástica como elemento tipo hinge. Las dimensiones de los reservorios y el refuerzo vertical y horizontal de los fustes se obtuvieron de los planos estructurales provistos por la empresa de agua potable SEDAPAL. Los diagramas momento curvatura asignados a las rótulas fueron calculados con el programa Sap2000 a partir de las dimensiones del fuste, refuerzo vertical del fuste, carga vertical y comportamiento no lineal del material, y fueron validados previamente con una hoja de cálculo. Para modelar el agua se empleó el modelo simplificado de Housner que considera una masa convectiva y otra impulsiva. El análisis se realizó a partir de cuatro acelerogramas peruanos (sismos de 1966, 1970, 1974 y 2007) normalizados de acuerdo a lo indicado en el ASCE/SEI 07-5 para el sismo de diseño y el sismo máximo considerado. Se utilizó el método de integración numérica de Newmark. Por otro lado, se realizó el análisis dinámico lineal con el espectro de respuesta obtenido con los parámetros de la NTE E.030 y el ACI350.3. Las respuestas de interés a analizar fueron los momentos volcantes, la fuerza cortante basal, el desplazamiento en el extremo del reservorio y la ductilidad demandada en el fuste. Se concluyó que para los acelerogramas analizados el momento volcante y la fuerza cortante basal de los reservorios R-1 y R-2 muestran una tendencia decreciente a medida que disminuye el volumen de agua. El desplazamiento máximo en el extremo de los reservorios no siempre se obtiene para el caso del reservorio lleno, pero el promedio de los desplazamientos da resultados mayores para dicho caso. En ese sentido, considerar sólo el caso de carga lleno para reservorios de similares características resulta conservador para el cálculo de la demanda de corte, momento y desplazamiento. No se observó una tendencia para el caso de la ductilidad demandada. Con respecto a las capacidades, el reservorio R-1 tiene mayor resistencia que el reservorio R-2, en una proporción similar al refuerzo vertical colocado (dos a uno). A su vez el reservorio R-2 tiene una mayor ductilidad que reservorio R-2, pero la diferencia va disminuyendo a medida que se aumenta la carga vertical. Con respecto al análisis dinámico de superposición modal, se observó que las respuestas están por debajo del promedio de la demanda obtenida a partir de los acelerogramas. Se recomienda reevaluar el factor de reducción espectral de la masa inductiva empleado para los reservorios elevados con soporte tipo fuste, si es que se emplea el espectro peruano de la Norma E.030 para el análisis. El acelerograma del sismo del año 1974 entregó las mayores demandas sísmicas para el caso de los reservorios llenos, ya que los periodos de dichas estructuras se encuentran dentro de su rango de periodos predominantes. El rango de periodos predominantes del sismo del año 2007 se encuentra por debajo de los periodos obtenidos para los reservorios vacío, semilleno y lleno, aunque el resultado depende también del periodo convectivo del agua, el cual puede coincidir con algunos de los picos del espectro de Fourier del acelerograma estudiado, incrementando la respuesta. Por otro lado, también se realizó el análisis de los reservorios sin considerar el efecto hidrodinámico del agua, y se obtuvo respuestas más conservadoras. Para el caso analizado eso significó un incremento de la curvatura demandada en más del doble. Por ello, si se realiza el análisis no lineal de reservorios para determinar la ductilidad demandada, se recomienda tomar en cuenta el comportamiento hidrodinámico del agua. Se determinó que para estructuras poco esbeltas como las estudiadas el efecto P-Δ es despreciable, ya que la relación entre el desplazamiento máximo en el extremo del reservorio con respecto al diámetro del fuste es pequeña. Finalmente, se indica que el refuerzo por corte colocado en ambos fustes cumple con los criterios de resistencia, considerando un factor de reducción igual a tres. Sin embargo, el refuerzo existente no cumple con los criterios de capacidad, en donde se busca asegurar que la estructura resista la demanda de corte asociado a su máximo momento resistente en el fuste.Tesi