The development of perceptual-cognitive processes during infancy has been traditionally studied using visual habituation and paired-comparison techniques. There has been extensive work within the field of infant attention that has focused on the development of visual attention. Within this field, it has been well established that there are two distinct classifications of infants' visual behavior; infants with short visual fixations who perform well in a recognition task following familiarization and infants with long visual fixation with impaired performance. There are two hypotheses for the differences underlying these groups. First, that visual fixation duration is reflective of the speed of information processing such that long-looking infants process information more slowly than short-looking infants. The second hypothesis is that infants who are long-looking have difficulty disengaging and shifting their attention to another location. There has not been any work exploring how these differences manifest themselves in other modalities. Thus, this project has three purposes: (1) to explore whether group differences emerge in an auditory recognition task similar to those found in the visual recognition phase of the paired-comparison task, (2) to better understand how performance differences in the visual task correspond to any observed differences in an auditory task, and (3) to identify any potential mechanisms which may account for the observed differences in group performance on an auditory task. / Ph. D.

Emotion regulation is processes by which individuals influence which emotions they have, when they have them, and how they experience and express those emotions. In the field of developmental psychology, there is a large literature on affect regulation focused almost exclusively on infants and young children with a focus on temperamental differences in reactivity, both affective and physiological, and accompanying regulatory strategies. The purpose of the current study was to examine the role of two dimensions of temperament, negative affect (NA) and effortful control (EC), and how these dimensions relate to physiology, self-report of emotion, and behavior during resting and stressor tasks (Stroop, video game, hand cold pressor, and delayed gratification), the latter in which emotion suppression instructions were given. Using the Adult Temperament Questionnaire (ATQ) to screen 656 subjects, 24 males and 53 females were recruited to take part in the second phase of the study, creating four groups with their screening ATQ scores: high NA/high EC, low NA/low EC, high NA/low EC, low NA/high EC. Physiological measures derived from electrocardiogram (ECG) and impedance cardiography were recorded during each task and behaviors were coded using the Emotion Expressive Behavior Coding System. EC Group and NA Group were not significant for the majority of the physiological, self-report, and behavioral variables. However, the EC subscale inhibitory control was predictive of lower resting HRV for females only, and the Extraversion/Surgency subscale Sociability was a significant predictor of cardiac sympathetic activity during the tasks, with low sociability subjects showing a stronger sympathetic response. Neither self-report of emotion nor behavioral variables show a clear group difference in response to the tasks. Future studies will examine the use of other types of regulatory tasks, such as social interactions, as well as the need for a balance between emotion expressivity and emotion regulation. / Ph. D.

The outcome of 121 children who underwent palliative cardiac surgery at the Red Cross War Memorial Children's Hospital over a 5 year period, 1980 1984, was retrospectively examined. 79 children had systemic artery to pulmonary artery shunt operations (SPS), 40 had pulmonary artery bands (PAB) and 2 had surgical septectomies. SPS was most often done for children with Tetralogy of Fallot (TOF, 26 cases) or complex univentricular hearts with right ventricular outflow tract obstruction (27 cases). PAB was done chiefly for ventricular septa! defects, alone (VSD, 8 cases) or with coarctation of the aorta (9 cases). Children were referred from a wide area with 63 cases being referred from other major centres and foreign countries. Overall, 36 children died (30 % mortality): 5 died at surgery, 6 within 48 hours of surgery, a further 5 within 31 days; and 20 died after 31 days. SPS and PAB had the same early mortality rates ( 13 % ) • SPS had higher late and overall mortality rates (20 and 33 %) than PAB (10 and 23 %). Age at operation was found to be the most significant determinant of the overall mortality rate: children less than six months had a mortality of 42 % and those over 6 months, 13 % • The children were grouped into those with lesions which were probably correctable and those that were unlikely to be so, based on diagnosis and age at surgery: those with correctable lesions had a lower overall mortality (22 %) than those with uncorrectable lesions (43 %). Where the surgery was performed as an emergency, there was a higher overall and early mortality (55 and 35 respectively), compared to those operations which were performed electively ( 25 and 9 % ) • The presence of other medical conditions, for example congenital abnormalities and infections, was also a determinant of death (44 % mortality if other medical condition present, 26 % if absent). sex, population group, home address and type of surgery performed did not significantly affect mortality when examined by multivariate analysis. Using routine methods of follow up, it was initially thought that 17 % of all patients (22 % of survivors) were lost to follow up. An important determinant of this was the referral centre. 31 % of cases from other major centres and 20 % of foreign cases were lost, as compared to 8 % of cases from smaller towns near Cape Town and 2 % of children from Cape Town. Population group (35 % Blacks, 14 % Coloureds and 7 % Whites were lost), and palliative operation (23 % SPS, and 5 % PAB lost) were also significant determinants. It was possible to trace 12 of the 20 children who were thought to be lost to follow. 8 had died, 3 were still awaiting correction and 1 was traced and received corrective surgery. The records of the children who underwent cardiac surgery in 1987 were also analysed. There was no difference in the demographic characteristics of either group, and the early mortality was the same. This study shows that the outcome after palliative cardiac surgery is poor, with a high mortality rate and children often being lost to follow up. The decision to palliate rather than to correct a congenital heart defect must be made after balancing these risks with those of early correction for the particular surgical team. Should palliative surgery be undertaken, careful follow up is essential to ensure that complications of palliation do not set in and that corrective surgery is done at the optimal time.

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The rate of hospital readmissions within 30 days of discharge of heart failure (HF) patients affects patient outcomes, the financial stability of the health care facility, and the economy. Hospitals focus on strategies that will decrease the HF readmission rates by cultivating evidence-based interventions that improve patients' transition from the hospital to the community, including promoting self-management of their condition. The purpose of this quality improvement project was to develop, implement, and evaluate the use of health information technology along with written forms of plans of care to assist HF patients in managing their care, divert the HF patients to the physician's office rather than the emergency room, and decrease the hospitalization readmission rate within 30 days of discharge. A multidisciplinary team consisting of HF nurses, a cardiologist, and a pharmacist, utilized the Agency for Healthcare Research and Quality guidelines to develop a HF checklist to assist in data collection. Nurses communicated with HF patients post discharge using electronic devices to reinforce discharge instructions, assess medication compliance, and encourage self-management. The less than 30-day readmission rate for the 10 patients in the pilot group was 20%, an improvement over the hospital rate of 30%. The 20% that were readmitted did not used their written discharge instructions, but the 80% that were not readmitted used their written discharge instructions with their electronic devices. This DNP project will promote positive social change by improving HF patients' outcomes and quality of life, and present health care provider interventions to decrease HF hospital readmission rates.

Ultrasonic techniques were used to detect hollow heart in potatoes nondestructively. Fifty Russet Burbank potatoes were evaluated physically and sonically. A pair of dry-coupling 50-kHz ultrasonic transducers were used to generate an ultrasonic pulse with a power level of 0.22 W for the test of acoustic transmission through whole potato tuber in a transverse direction at different locations along the longitudinal axis with a certain interval distance. It was found that the waveform analyses in time domain for a series of transmitted signals along the longitudinal axis of potato tuber, yielded the potential in detecting hollow heart in potatoes noninvasively. The transmission losses for potatoes having hollow heart were found to be greater than 0.28 dB/mm. This value was used as a criterion to indicate potatoes with hollow heart at an accuracy of 98 percent. The ability to detect hollow heart in potatoes was limited to a minimum cavity size of 0.5 cm3 because the interval distance between locations of measurement was relatively large compared to the size of the projected area of hollow heart. The accuracy of the detection would be improved if a smaller contact area for the transmitting transducer were used, and if the intervals between ultrasonic measurement locations were smaller. Physical properties of the tested potatoes were also recorded for consideration of their relationships with ultrasonic parameters. Physical properties of tested potatoes such as modulus of elasticity, tuber length, diameter, and weight, were found to have poor correlation with ultrasonic parameters such as ultrasonic velocity, attenuation coefficient, and root mean square voltage of transmitted signal. This study showed that if all potatoes with weights of 300 g or less were eliminated from a mass of incoming potatoes, only 80 percent of the total mass would have to be examined for hollow heart. / Master of Science

Indiana University-Purdue University Indianapolis (IUPUI) / Heart failure is a terminal disease with an unpredictable trajectory. Family members of patients with heart failure are often called upon to make decisions about treatment and end of life care, sometimes with little guidance as to the patients’ wishes. Advance care planning (ACP) is an ongoing process by which patients make decisions about their future healthcare. Only about one-third of patients with heart failure have participated in ACP, which is a similar percentage to the overall population. Despite increased focus on ACP and interventions to improve it, the rates of ACP in the population remain relatively unchanged. There is a need to develop interventions that are targeted based on patient engagement in the process rather than the existing broad-based interventions. The purpose of this dissertation study is to examine the relationship between the American Heart Association stage of heart failure and readiness to engage in advance care planning. The study consisted of mailed surveys that consisted of demographic questionnaires and the Advance Care Planning Engagement Survey. Engagement was analyzed in relation to heart failure stage, heart failure class, comorbidities, perception of health status, recent hospitalizations, making healthcare decisions for others, and demographic variables. The results demonstrated that although there was no significant association between heart failure stage or class and engagement in advance care planning, there were significant associations between medical comorbidities and advance care planning engagement. Other significantly associated participant characteristics included age, gender, education, ethnicity, and income. Findings suggest that people with multiple comorbid conditions will be more likely to be ready to engage in ACP than those with fewer health conditions. The results from this study will contribute to the development of strategies to improve advance care planning that are targeted based on engagement level.

Self-care is a central concept in heart failure management and nursing practice. Yet, the uptake of heart failure self-care has been uncritical and detached from broader contexts. Therefore, heart failure self-care was explored using Rodger’s evolutionary concept analysis approach to identify antecedents, attributes, and consequences with attention to context, time, application, and meaning. The analysis suggests that heart failure self-care tends to focus on individual behaviours to the detriment of social and structural determinants of health. It also shifts responsibility away from the healthcare system and onto the individual. Moving forward, a more robust conceptualization of heart failure self-care is needed or possibly, the development of a new concept that focuses beyond the self. / Graduate / 2022-12-15

To determine differences in A1- and A2-selective adenosine effects on coronary endothelium, isolated rabbit hearts (n = 18) were perfused with erythrocyte-enriched buffer at constant left ventricular volume and physiologic flow rates. After 10-20 minutes of stabilization, the perfusate was changed to contain an A1-selective agonist (N6-cyclopentyladenosine, CPA; high dose, 4.26 X 10-7M or low dose, 10-8M), or an A2-selective agonist ((5'-(N-cyclopropyl) carboxaminoadenosine, CPCA; high dose, 4.45 X 10-6M or low dose 10-7 M). Before and during each treatment period of 1-15 minutes aortic and left ventricular pressures and rates of change were recorded. Hearts were then perfused intravascularly with ruthenium red stain (RR) dissolved in filtered 2.5% glutaraldehyde, and processed by routine electron microscopic methods for ultrastructural examination. Of the hemodynamic parameters measured only aortic pressure increased with CPA, and decreased with CPCA, indicating the expected pharmacologic efficacy at the doses used. However, no observable differences in RR uptake was noted between hearts that received no adenosine agonist and either low- or high-dose CPA. CPCA-treated hearts had noticeable RR uptake into endothelium with both low and high dose levels, with a marked uptake in hearts receiving high doses of this A2 agonist. These results provide direct morphological evidence that supports the concept that endothelial macromolecular uptake is an adenosine A2-mediated process.

Graphene is a 2D material well known for its high intrinsic strength of 100 GPa and Young’s modulus of 1 TPa. Because of its 2D nature, the most promising avenues to utilize graphene as a mechanical material include incorporating it as reinforcement in a nanocomposite and creating free-standing foams and aerogels. However, the current techniques are not well-controlled – the reinforcing graphene particles are often discontinuous and randomly dispersed – making it difficult to accurately model and predict the resulting material properties. Here we aim to develop a framework for a new class of nanocomposites reinforced not by discrete nanoparticles, but by a continuous 3D graphene network. These 3D graphene networks were formed by chemical vapor deposition of graphene on periodic metallic microlattices, thereby providing mechanical reinforcement for the lattices. To assist in the lattice design, analytical models were derived for the mechanical properties of core/shell composite lattices and experimentally validated through compression testing of polymer lattices coated with electroless Ni-P. The models and experiments showed good agreement at lower shell thicknesses, while there was divergence at higher thicknesses, likely due to fabrication imperfections. The analytical models were also applied to hollow metallic lattices coated with graphene and compared to experimental data. The results showed that the models are plausible and suggest that graphene has a significant strengthening effect on the microlattices. These studies represent a paradigm shift in the design and fabrication of nanocomposites as one may now precisely prescribe the placement of the reinforcing nanomaterials. On a broader scale, this work also lays the framework for using a 2D material to span 3D space, enabling further exploration of 2D material properties and applications. One potential application area for a graphene-reinforced polymer composite is in prosthetic heart valves. The tissue of a human heart valve leaflet is heavily reinforced with networks of collagen and elastin fibers. One could similarly incorporate a graphene network as reinforcement within the polymeric leaflets of a prosthetic valve. One promising application of polymeric valves is in growth-accommodating implants for pediatric patients. Here we aim to develop a polymeric valved conduit that can be expanded by transcatheter balloon dilation to match a child’s growth. We designed the valve, characterized and selected materials, fabricated the devices and performed benchtop in vitro testing. The first generation of an expandable biostable valved conduit displayed excellent hydrodynamic performance before and after permanent balloon dilation from 22 to 25 mm. The second generation has shown the potential for a greater dilation from 12 to 24 mm. These results demonstrate concept feasibility and motivate further development of a polymeric balloon-expandable device to replace valves in children and avoid reoperations.