Assessment of Metabolic Phenotypes in Patients with Non-ischemic Dilated Cardiomyopathy Undergoing Cardiac Resynchronization Therapy

Studies of myocardial metabolism have reported that contractile performance at a given myocardial oxygen consumption (MVO2) can be lower when the heart is oxidizing fatty acids rather than glucose or lactate. The objective of this study is to assess the prognostic value of myocardial metabolic phenotypes in identifying non-responders among non-ischemic dilated cardiomyopathy (NIDCM) patients undergoing cardiac resynchronization therapy (CRT). Arterial and coronary sinus plasma concentrations of oxygen, glucose, lactate, pyruvate, free fatty acids (FFA), and 22 amino acids were obtained from 19 male and 2 female patients (mean age 56 ± 16) with NIDCM undergoing CRT. Metabolite fluxes/MVO2 and extraction fractions were calculated. Flux balance analysis (FBA) was performed with MetaFluxNet 1.8 on a metabolic network of the cardiac mitochondria (189 reactions, 230 metabolites) reconstructed from mitochondrial proteomic data (615 proteins) from human heart tissue. Non-responders based on left ventricular ejection fraction (LVEF) demonstrated a greater mean FFA extraction fraction (35% ± 17%) than responders [18 ± 10%, p = 0.0098, area under the estimated ROC curve (AUC) was 0.8238, S.E. 0.1115]. Calculated adenosine triphosphate (ATP)/MVO2 using FBA correlated with change in New York Heart Association (NYHA) class (rho = 0.63, p = 0.0298; AUC = 0.8381, S.E. 0.1316). Non-responders based on both LVEF and NYHA demonstrated a greater mean FFA uptake/MVO2 (0.115 ± 0.112) than responders (0.034 ± 0.030, p = 0.0171; AUC = 0.8593, S.E. 0.0965). Myocardial FFA flux and calculated maximal ATP synthesis flux using FBA may be helpful as biomarkers in identifying non-responders among NIDCM patients undergoing CRT

Conflicting logics of online higher education

The advent of massive open online courses and online degrees offered via digital platforms has occurred in a climate of austerity. Public universities worldwide face challenges to expand their educational reach, while competing in international rankings, raising fees and generating third-stream income. Online forms of unbundled provision offering smaller flexible low-cost curricular units have promised to disrupt this system. Yet do these forms challenge existing hierarchies in higher education and the market logic that puts pressure on universities and public institutions at large in the neoliberal era? Based on fieldwork in South Africa, this article explores the perceptions of senior managers of public universities and of online programme management companies. Analysing their considerations around unbundled provision, we discuss two conflicting logics of higher education that actors in structurally different positions and in historically divergent institutions use to justify their involvement in public–private partnerships: the logic of capital and the logic of social relevance

Work Order Selection and Assignment

235 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 1968.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD