Saint Paul Technical College

Background Intravascular cardiac pacemakers are an established therapy for bradycardic indications. Recently, a new class of leadless pacemakers have mitigated some of the complications related to pacemaker leads. In this study, we evaluate the implantation and performance of a novel extravascular technology that delivers epicardial pacing through a subxiphoidal approach. Methods Fifteen patients undergoing non-emergent open-heart surgery were enrolled. A midline incision was made just below the xiphoid process, and substernal tunneling was used to create a pocket for the device and to access the anterior pericardium over the right ventricle. The test device (Calyan Technologies, Oakdale, MN) was temporarily inserted underneath the ribcage and clipped to the xiphoid process. The sensing and pacing electrode (FlexArm) was positioned on the anterior pericardium. Ventricular sensing and pacing capture thresholds were measured. Results The test device was successfully implanted in all 15 patients. There were no device or procedure-related adverse events. The first five implanted patients had no pacing capture at maximum stimulation intensity. Design changes were made to the device, including different electrode size and shape, and successful ventricular capture was achieved in 9 of the subsequent 10 patients. In these patients, pacing threshold was 3.8 ± 1.6 mA with a pulse width of 0.5 ms. All devices were successfully explanted at the end of the procedure. Conclusions In a first-in-human experience with a novel extravascular pacemaker, this study demonstrated the feasibility of pericardial ventricular pacing via a subxiphoidal approach. Further chronic studies are required to evaluate the safety and performance of this novel pacing technology.

Background Traditional cardiac pacemakers commonly have a range of complications related to the presence of intracardiac leads. A new class of extravascular and leadless pacemakers has recently emerged with the potential to mitigate these complications and expand access to cardiac pacing. The objective of this study is to evaluate the implantation, short-term chronic safety, and performance of a novel subxiphoidal extracardiac pacemaker. Methods Normal Yorkshire Cross swine (n = 16) were implanted with the subxiphoidal pacemaker. The pacemaker was inserted through a midline chest incision and clipped to the underside of the sternum, with the stimulation electrode placed on the anterior pericardium. Animals were chronically paced and followed for 90 days post-implant, with periodic measurement of pacing capture threshold (PCT) and electrode impedance. Results All 16 animals were successfully implanted with the study device. At implant, a consistent average PCT of 2.2 ± 0.4 V at a pulse width of 1.0 ms was observed in all animals, with an average implant impedance of 648 ± 44 Ω. Chronic pacing was programmed at a rate of 60 bpm, an amplitude of 3.4 ± 0.7 V, and a pulse width of 1.0 ms. PCT rose to 4.6 ± 0.8 V at 14 days and stabilized; at 90 days, PCT was 3.8 ± 1.2 V and electrode impedance was 533 ± 105 Ω. All implanted animals completed the study with no clinically significant findings, no clinically significant abnormalities, and with no adverse events that affected animal welfare. Conclusions This study demonstrated the safety and feasibility of a novel subxiphoidal extracardiac pacemaker to deliver short-term chronic extravascular therapy. Further studies are required to assess the safety, feasibility, and long-term chronic pacing performance in human subjects.

Despite increased philosophical and psychological work on practical wisdom, contemporary interdisciplinary wisdom research provides few specifics about how to develop wisdom (Kristjánsson 2022). This lack of practically useful guidance is due in part to the difficulty of determining how to combine the tools of philosophy and psychology to develop a plausible account of wisdom as a prescriptive ideal. Modeling wisdom on more ordinary forms of expertise is promising, but skill models of wisdom (Annas 2011; De Caro, Vaccarezza, and Niccoli 2018; Swartwood 2013b; Tsai 2023) have been challenged on the grounds that there are important differences between wisdom and expert skills (Hacker-Wright 2015, 986; Kristjánsson 2015, 98, 101; Stichter 2015; 2016; 2018). I'll argue that we can both vindicate the promise of skill models of wisdom and begin to specify practically-useful strategies for wisdom development by attending to a reflective process that I call Case-Based Critical Reflection. I begin by demonstrating the process as it arose in a notable example from everyday life, illustrating how the process can be usefully applied to a case study of interest to wisdom scientists, and explaining its philosophical pedigree. After isolating the key features that make it relevant to wisdom development, I argue that attending to the importance of Critical Reflection can defuse prominent objections to skill models of wisdom.

Digital specimens collected by community members are a largely untapped source of entomological data. By mining and curating data from photo observations uploaded to online community data repositories, researchers can utilize this wealth of information to address questions about predator–prey interactions, phenotypic variation within species, plant–pollinator interactions, and a host of other topics. We mined data from photo observations on the community science website iNaturalist to investigate patterns in host plant availability and affiliation by 2 species of soldier beetles, Chauliognathus marginatus (F.) and Chauliognathus pensylvanicus (De Geer). Chauliognathus marginatus was observed with white flowers more than expected based on their potential availability, while C. pensylvanicus was observed with yellow flowers over all other flower colors and more than expected based on their potential availability. Communities of flowers available to, and observed with, C. marginatus and C. pensylvanicus differed significantly at the family and genus levels. To our knowledge, this is the first study to utilize a dataset mined and curated from community science photo observations to address species-specific behavior and ecology questions. With appropriate study design and analytical methods, these types of data could prove invaluable in future investigations of a variety of entomological and ecological questions.

A dealbreaker, in the sense developed in this essay, is a relationship between a person's psychology and an aspect of an artwork to which they are exposed. When a person has a dealbreaking aversion to an aspect of a work, they are blocked from embracing the work's aesthetically positive features. I characterize dealbreakers, distinguish this response from other negative responses to an artwork, and argue that the presence or absence of a dealbreaker is in some cases an appropriate target of moral evaluation. I then use the concept of dealbreakers to develop a new approach to the question of our moral obligations with respect to the work of immoral artists, arguing that there is no general obligation binding us to cultivate or eliminate a dealbreaking aversion to their work. I conclude by suggesting several other philosophical debates that could benefit from a focus on dealbreakers .

Campus sexual misconduct (CSM) continues to be a significant public health concern on U.S. college campuses. Updates to Title IX now allow informal resolution of reported cases of CSM, including the use of restorative justice (RJ) processes. This qualitative study sought to understand the experiences of early adopters of RJ for CSM through semistructured interviews with 10 current and former administrators who have adopted RJ for CSM. Findings suggest that RJ for CSM is a promising practice, one which requires key stakeholder engagement, thoughtful training for RJ facilitators, and extensive preparation of the parties for successful implementation.

In this article, I trace the history of the substitution of education reform for economic reform in order to ask, and answer, this question: why do we continue to imagine that (higher) education is where we, finally, achieve equality? The substitution of education reform for economic reform begins in the early 1960’s with the landmark “Coleman Report.” I argue that this report, and others that followed, show conclusively that economic inequality simply reproduces itself, and no amount of educational reform can make up for its devastating effects. However, at this very same time, education reformers begin to believe that educational “achievement” is the cause of increased economic opportunity and equality, rather than an effect of (un)equal economic status. This confusion of cause and effect not only distracts us from meaningful economic reform, it also puts tremendous pressure on teachers and institutions. Finally, and fatally, substituting educational reform for economic reform remakes equality itself into something that is earned rather than given.

In this article we make an improvement in the Banach contraction using a controlled function in controlled metric like spaces, which generalizes many results in the literature. Moreover, we present an application on Fredholm type integral equation.

Waste treatment is an important part of the future global energy portfolio. Challenges associated with implementing energy recovery technology at waste treatment sites include interwoven technical, economic, and policy considerations. This work focuses on the tradeoff of input waste energy content to output electrical power, i.e. efficiency for waste-to-energy systems. Also presented is an approach for conversion technology selection based on characteristics of the waste stream, energy content of biogas generated from anaerobic waste treatment, and commercial applicability of five major prime movers across a large gradient of power output including: gas turbines, steam turbines, microturbines, reciprocating internal combustion engines, and solid oxide fuel cells. An efficiency model developed from fundamental thermodynamic principles is used to estimate the amount of power available from a waste treatment site, using data from a comprehensive data set of prime mover characteristics. A case study is presented, illustrating prime mover selection for three types of waste systems in Minnesota, United States: wastewater treatment plants, landfill sites and dairy farms. The results show that gas and steam turbines are recommended for large-scale systems with millions of gallons per day of wastewater generation, up to 60% of waste treatment sites. For small-scale systems applicable to distributed waste treatment and wastewater treatment facilities processing less than 10,000 gallons of water per day, fuel cells are recommended solely based on their high efficiency. Given the potential growth of decentralized waste-to-energy, the scarcity of highly efficient, affordable and fuel flexible power generation options necessitates further innovation in small-scale prime mover technologies.

Unmet need for family planning (FP) remains prevalent worldwide. In Tanzania, 21.7% of women desire to delay pregnancy, but do not use modern contraception despite its free availability at local clinics. Our prior data suggest that this is related to complex gender and religious dynamics in rural communities. To understand how education about FP could be improved, we developed a discrete choice experiment (DCE) to rank preferences of six attributes of FP education. Results were stratified by gender. Sixty-eight women and 76 men completed interview-assisted DCEs. Participants significantly preferred education by a clinician (men = 0.62, p < .001; women = 0.38, p < .001) and education in mixed-gender groups (men = 0.55, p < .001; women = 0.26, p < .001). Women also significantly preferred education by a religious leader (0.26, p = .012), in a clinic versus church, mosque, or community centre (0.31, p = .002), and by a female educator (0.12, p = .019). Men significantly preferred a male educator (0.17, p = .015), whom they had never met (0.25, p < .001), and educating married and unmarried people separately (0.22, p = .002). Qualitative data indicate women who had not previously used contraception preferred education led by a religious leader in a church or mosque. FP education tailored to these preferences may reach a broader audience, dispel misconceptions about FP and ultimately decrease unmet need.

Dual enrollment (DE) is a common method for high schools to offer postsecondary preparation, exposure to college-level expectations, and, potentially, college credit. Some dual-enrollment students enter college with 24 semester hours. Upon matriculation, these high-credit DE (HCDE) students present unique challenges to college academic advisors. This study examined the experiences of these advisors by utilizing semi-structured interviews with academic advisors from Colorado who work with HCDE students. Advisors frequently had to address implications of DE credits on time to graduation, degree planning, potential costs savings, and tradeoffs with on-campus experiences. Implications include the need for four-year institutions to better communicate with high school students and counselors and to improve planning for the complexities of HCDE students.

Differentiation of human pluripotent stem cells (hPSCs) [1‐3] into ectoderm provides neurons and glia useful for research, disease modeling, drug discovery, and potential cell therapies. In current protocols, hPSCs are traditionally differentiated into an obligate rostro‐dorsal ectodermal fate expressing PAX6 after 6 to 12 days in vitro when protected from mesendoderm inducers [4], [5‐8]. This rate‐limiting step has performed a long‐standing role in hindering the development of rapid differentiation protocols for ectoderm‐derived cell types, as any protocol requires 6 to 10 days in vitro to simply initiate. Here we report efficient differentiation of hPSCs into a naive early ectodermal intermediate within 24 hours using combined inhibition of bone morphogenic protein (BMP) and fibroblast growth factor (FGF) signaling. The induced population responds immediately to morphogen gradients to upregulate rostro‐caudal neurodevelopmental landmark gene expression in a generally accelerated fashion. This method can serve as a new platform for the development of novel, rapid, and efficient protocols for the manufacture of hPSC‐derived neural lineages. © AlphaMed Press 2020 This submission reports a major advance in the ability to direct the differentiation human pluripotent stem cells (hPSCs) into neural precursors in culture. This study describes that inhibiting selected signaling pathways enables the immediate exit from pluripotency and converts the stem cells within 24 hours into precursor cells that can be rapidly directed to generate desired neural populations desirable for research and potential cell therapies. This work removes a historical bottleneck that has prevented improving the control and speed of making neural cells from hPSCs and will likely change the way human neurons are generated in the future. Efficient conversion into primal ectoderm by treatment with BGJ398 and LDN193189 accelerates neural induction in human pluripotent stem cells.

Wisdom, long a topic of interest to moral philosophers, is increasingly the focus of social science research. Philosophers have historically been concerned to develop a rationally defensible account of the nature of wisdom and its role in the moral life, often inspired in various ways by virtue theoretical accounts of practical wisdom (phronesis). Wisdom scientists seek to, among other things, define wisdom and its components so that we can measure them. Are the measures used by wisdom scientists actually measuring what philosophers have in mind when they discuss practical wisdom? I argue that they are not. Contemporary measures of wisdom and its components may pick out some necessary prerequisites of practical wisdom, but they do not measure a philosophically plausible practical wisdom or its components. After explaining the argument and defending it against objections, I consider its implications. Should wisdom scientists ignore the philosophical conception of practical wisdom in favor of other conceptions, revise their methods to try to measure it, or continue the interdisciplinary study of practical wisdom without expecting to measure it? I make a preliminary argument for the third option.

In her short story “Stable Strategies for Middle Management,” Eileen Gunn imagines a future in which Margaret, an office worker, seeks radical genetic enhancements intended to help her secure the middle‐management job she wants. One source of the story’s tension and dark humor is dramatic irony: readers can see that the enhancements Margaret buys stand little chance of making her life go better for her; enhancing is, for Margaret, probably a prudential mistake. This paper argues that our positions in the real world are sufficiently similar to Margaret’s position in Gunn’s fictional world that we should take this story seriously as grounding an argument from analogy for the conclusion that radical genetic enhancements are, for us, probably a prudential mistake. The paper then defends this method. When the question at hand is one of speculative ethics, there is no method better fit to the purpose than argument from analogy to speculative fiction.

Background Use of family planning (FP) saves the lives of mothers and children, and contributes to better economic outcomes for households and empowerment for women. In Tanzania, the overall unmet need for FP is high. This study aimed: (1) to use focus group data to construct a theoretical framework to understand the multidimensional factors impacting the decision to use FP in rural Tanzania; (2) to design and pilot-test an educational seminar, informed by this framework, to promote uptake of FP; and (3) to assess acceptability and further refine the educational seminar based on focus group data collected 3 months after the education was provided. Methods We performed a thematic analysis of 10 focus group discussions about social and religious aspects of FP from predominantly Protestant church attenders prior to any intervention, and afterwards from six groups of church leaders who had attended the educational seminar. Results Key interpersonal influences included lack of support from husband/partner, family members, neighbours and church communities. Major intrapersonal factors impeding FP use were lack of medical knowledge and information, misconceptions, and perceived incompatibility of FP and Christian faith. Post-seminar, leaders reported renewed intrapersonal perspectives on FP and reported teaching these perspectives to community members. Conclusions Addressing intrapersonal barriers to FP use for leaders led them to subsequently address both intrapersonal and interpersonal barriers in their church communities. This occurred primarily by increasing knowledge and support for FP in men, family members, neighbours and church communities.

Many people suspect it is morally wrong to watch the graphically violent horror films colloquially known as gorefests. A prominent argument vindicating this suspicion is the Argument from Reactive Attitudes (ARA). The ARA holds that we have a duty to maintain a well‐functioning moral psychology, and watching gorefests violates that duty by threatening damage to our appropriate reactive attitudes. But I argue that the ARA is probably unsound. Depictions of suffering and death in other genres typically do no damage to our appropriate reactive attitudes, and until we locate a relevant difference between these depictions in gorefests and in other genres, we should assume that the depictions in gorefests do no damage. I consider and reject three candidate differences: in artistic merit, meaningfulness, and audience orientation. Until genre sceptics identify a relevant difference, we should accept the taste for gory fictions as we would any other morally innocuous variation in taste.