Objective: Fontan circulatory inefficiency can be addressed by replacing the missing subpulmonary power source to reverse the Fontan paradox. An implantable cavopulmonary assist device is described that will simultaneously reduce systemic venous pressure and increase pulmonary arterial pressure, thereby improving preload and cardiac output, in a univentricular Fontan circulation on a long-term basis. Methods: A rotary blood pump based on the von Karman viscous pump was designed for implantation into the total cavopulmonary connection (TCPC). It will impart modest pressure energy to augment Fontan flow without risk of obstruction. In the event of rotational failure, it is designed to default to a passive flow diverter. Pressure-flow (H-Q) performance was characterized in vitro in a Fontan mock circulatory loop using blood analog. Results: The pump performed through the fully specified operating range, augmenting flow in all 4 directions of the TCPC. Pressure rise of 6-8 mmHg was readily achieved, ranging up to 14 mmHg at highest speed (5600 RPM). Performance was consistent over a wide range of cardiac output. In the stalled condition (0 RPM), there was no discernible pressure loss across the TCPC. Conclusions: A blood pump technology is described that can reverse the Fontan paradox and may permit a surgical strategy of long-term biventricular maintenance of a univentricular Fontan circulation. The technology is intended for Fontan failure in which right-sided circulatory inefficiencies predominate and ventricular systolic function is preserved. It may also apply prior to clinical Fontan failure as health maintenance to preempt the progression of Fontan disease.
This paper presents an analysis of the ways in which UK higher education (HE) has become increasingly commercialised and commodified in the post-1980s. It critiques the strategies adopted by successive UK governments to reinvigorate the relationship between educational and economic life, and to facilitate a more corporate and entrepreneurial spirit within the academy in line with the pressures of a 'knowledge-based economy'. Arguing for a more critical exploration of teaching and learning within HE, the paper presents evidence from work carried out by the Reinvention Centre for Undergraduate Research, a Centre for Excellence in Teaching in Learning (CETL) which adopts a research-based learning approach to teaching and learning at undergraduate level.1 Within the context of ongoing debates surrounding the relationship between teaching, learning and research in UK HE, the paper advocates a reinvention of curriculum design through an engagement with the broader principles of critical pedagogy, and in so doing, presents a critical engagement with the commercialisation of H
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