Using a Vermicomposting Curriculum to Grow Students’ Advocacy Towards the Environment

The use of food waste in a vermicomposting bin is a positive solution to the growing problem in the United States. Integrating a vermicomposting container into a classroom exposes students to the environment creatively, allowing them to explore the worm’s habitat in a controlled setting. Using a worm bin to explore how worms decompose organic food waste and observing the process of vermicomposting brings the natural world into a classroom environment. This is crucial when many people are distancing themselves from the natural world around them. This capstone project uses a variety of research to develop a curriculum that answers the question: How can using a vermicomposting curriculum grow students’ advocacy toward the environment? The research concludes that incorporating a vermicomposting bin into a classroom environment can have a positive effect on students’ advocacy toward the environment

Local adaptation drives the diversification of effectors in the fungal wheat pathogen Parastagonospora nodorum in the United States

Filamentous fungi rapidly evolve in response to environmental selection pressures in part due to their genomic plasticity. Parastagonospora nodorum, a fungal pathogen of wheat and causal agent of septoria nodorum blotch, responds to selection pressure exerted by its host, influencing the gain, loss, or functional diversification of virulence determinants, known as effector genes. Whole genome resequencing of 197 P. nodorum isolates collected from spring, durum, and winter wheat production regions of the United States enabled the examination of effector diversity and genomic regions under selection specific to geographically discrete populations. 1,026,859 SNPs/InDels were used to identify novel loci, as well as SnToxA and SnTox3 as factors in disease. Genes displaying presence/absence variation, predicted effector genes, and genes localized on an accessory chromosome had significantly higher pN/pS ratios, indicating a higher rate of sequence evolution. Population structure analyses indicated two P. nodorum populations corresponding to the Upper Midwest (Population 1) and Southern/Eastern United States (Population 2). Prevalence of SnToxA varied greatly between the two populations which correlated with presence of the host sensitivity gene Tsn1 in the most prevalent cultivars in the corresponding regions. Additionally, 12 and 5 candidate effector genes were observed to be under diversifying selection among isolates from Population 1 and 2, respectively, but under purifying selection or neutrally evolving in the opposite population. Selective sweep analysis revealed 10 and 19 regions that had recently undergone positive selection in Population 1 and 2, respectively, involving 92 genes in total. When comparing genes with and without presence/absence variation, those genes exhibiting this variation were significantly closer to transposable elements. Taken together, these results indicate that P. nodorum is rapidly adapting to distinct selection pressures unique to spring and winter wheat production regions by rapid adaptive evolution and various routes of genomic diversification, potentially facilitated through transposable element activity

Power, Pathological Worldviews, and the Strengths Perspective in Social Work

This article takes up Blundo’s (2001) assertion in this journal that in order to practice from the strengths perspective, social workers need to alter their “frames.” Expanding on this assertion, we specify a particular frame that requires change: a pathological worldview. Examining the strengths perspective with regard to a Foucauldian analysis of power, we argue that to thoroughly implement the strengths perspective, we need to consider the dividing practices that allow us to maintain power and that reflect a pathological worldview. This article provides considerations for social work practice that will be of interest to practicing social workers and social work educators interested in continuing to develop their strengths-based practice

What If the Destination Is Transplant? Outcomes of Destination Therapy Patients Who Were Transplanted

We sought to characterize patients who underwent heart transplant (HTx) following destination therapy (DT) implant in the combined ENDURANCE/ENDURANCE Supplemental Trials (DT/DT2). A post hoc analysis of the DT/DT2 trials was performed. Baseline characteristics and adverse events between the HTx and no-HTx cohorts were analyzed. Reasons for transplant were examined. Time to HTx was compared with contemporaneous HVAD BTT trial patients. Of the 604 DT/DT2 HVAD patients, 80 (13%) underwent HTx. The HTx cohort was younger (53.6 ± 11.1 vs. 65.2 ± 10.8, P \u3c 0.0001) with fewer Caucasians (60.0% vs. 76.5%, P = 0.002), less ischemic cardiomyopathy (42.5% vs. 58.8%, P = 0.01), and atrial fibrillation (38.8% vs. 54.4%, P = 0.01). The HTx cohort had longer 6-minute walk distances (183.6 vs. 38.0 m, P = 0.02). Most HTx in DT/DT2 were categorized as elective (n = 63, 79%) and, of these, 70% were due to modification of behavioral issues and weight loss. Adverse events were the main indication for urgent HTx (n = 17, 21%). Median times to HTx were longer in DT/DT2 (550.0 days) versus BTT/lateral (285.2 days). In this post hoc analysis of the DT/DT2 trials, over 1 in 10 underwent heart transplantation within 3 years of HVAD support. In DT therapy patients, consideration for transplant following DT VAD implant may be feasible

Characterizing Outflow Graft Narrowing over Time

Purpose: Cases of pump dysfunction due to outflow graft (OG) anastomosis obstruction related to serous fluid accumulation have been reported but the rate of occlusion and actual frequency of asymptomatic OG diminution is not known. Methods: This was a multicenter retrospective analysis of patients on HeartMate II (HMII) or HeartMate 3 (HM3) support surviving at least 180 days with at least one chest computed tomography (CT) scan at 6 months, 1, 2, and/or 3 years postoperative. Patients with OG obstruction due to torsion were excluded. The outflow graft (OG) diameter was measured at its narrowest region; region was categorized as external outflow graft (EOG), mid-graft, or within 2 cm of the aortic anastomosis. Mixed models with repeated measure linear regression was used to assess OG diameter change over time, with 14 mm as reference. Using the narrowest measure, OG diameter was modelled for freedom from death, admission for HF and low flow alarms with hazard ratio [95% CI presented]. Results: Of 71 patients included herein, 25% and 75% were on HMII and HM3 support for a median [25th, 75th] 1230 [703,1592] days. The median CT count was 2 [1,2] per patient. At follow-up, small (1-3 mm, table), but statistically significant reductions in OG diameter were noted (Figure). The median OG narrowing was 7% [0%, 20%]. Time from device implant was the most significant contributing factor (p\u3c0.001) while wrapping of the outflow was nonsignificantly correlated with OG narrowing (p=0.071). Device model was not correlative (p=0.16). OG diameter was not correlated with survival (HR 1.04 [0.81-1.3]), stroke (HR 0.94 [0.78-1.1]) or admissions for heart failure (HR 1.06 [0.88-1.3]), or VAD alarms (HR 0.93 [0.79-1.1]). Conclusion: Minor narrowing of the OG was noted over time, irrespective of LVAD model. The observed degrees of non-twist related-OG narrowing herein did not lead to increase mortality or events. OG wrapping may be associated with OG narrowing over time. Larger sample analyses aim to define degrees of narrowing that elicit device dysfunction

Characterizing Outflow Graft Narrowing over Time

Purpose: Cases of pump dysfunction due to outflow graft (OG) anastomosis obstruction related to serous fluid accumulation have been reported but the rate of occlusion and actual frequency of asymptomatic OG diminution is not known. Methods: This was a multicenter retrospective analysis of patients on HeartMate II (HMII) or HeartMate 3 (HM3) support surviving at least 180 days with at least one chest computed tomography (CT) scan at 6 months, 1, 2, and/or 3 years postoperative. Patients with OG obstruction due to torsion were excluded. The outflow graft (OG) diameter was measured at its narrowest region; region was categorized as external outflow graft (EOG), mid-graft, or within 2 cm of the aortic anastomosis. Mixed models with repeated measure linear regression was used to assess OG diameter change over time, with 14 mm as reference. Using the narrowest measure, OG diameter was modelled for freedom from death, admission for HF and low flow alarms with hazard ratio [95% CI presented]. Results: Of 71 patients included herein, 25% and 75% were on HMII and HM3 support for a median [25th, 75th] 1230 [703,1592] days. The median CT count was 2 [1,2] per patient. At follow-up, small (1-3 mm, table), but statistically significant reductions in OG diameter were noted (Figure). The median OG narrowing was 7% [0%, 20%]. Time from device implant was the most significant contributing factor (p\u3c0.001) while wrapping of the outflow was nonsignificantly correlated with OG narrowing (p=0.071). Device model was not correlative (p=0.16). OG diameter was not correlated with survival (HR 1.04 [0.81-1.3]), stroke (HR 0.94 [0.78-1.1]) or admissions for heart failure (HR 1.06 [0.88-1.3]), or VAD alarms (HR 0.93 [0.79-1.1]). Conclusion: Minor narrowing of the OG was noted over time, irrespective of LVAD model. The observed degrees of non-twist related-OG narrowing herein did not lead to increase mortality or events. OG wrapping may be associated with OG narrowing over time. Larger sample analyses aim to define degrees of narrowing that elicit device dysfunction

2-year outcomes for transcatheter repair in patients with functional mitral regurgitation from the CLASP study

Background: Transcatheter mitral valve repair has emerged as a favourable option in patient care for treating functional mitral regurgitation (FMR) with a need for longer term data. We herein report two-year outcomes from the FMR group of the multicentre, prospective, single arm CLASP study with the PASCAL transcatheter valve repair system. Methods: Patients with symptomatic, clinically significant FMR ≥3+ as evaluated by the core laboratory and deemed candidates for transcatheter repair by the local heart team were eligible for the study. Follow-up was conducted at 30 days, one year, and two years with echocardiographic outcomes evaluated by the core laboratory at all timepoints and major adverse events (MAEs) evaluated by an independent clinical events committee to one year (site-reported thereafter). Results: Eighty-five FMR patients were treated with mean age 72 years, 55% male, 65% in NYHA Class III-IVa, 37% LVEF, and 100% MR grade ≥3+. Successful implantation was achieved in 96% of patients. MAEs included one cardiovascular mortality (1.2%) and one conversion tomitral valve replacement surgery (1.2%) at 30 days, and two reinterventions between 30 days and two years. Kaplan-Meier (KM) estimates for survival were 88% at one year and 72% at two years. Freedom from heart failure (HF) rehospitalization KM estimates were 81% at one year and 78% for two years. The reduction in annualized HF hospitalization rate was 81% at two years (p\u3c0.001). MR ≤1+ was achieved in 73% of patients at 30 days, 75% at one year, and 84% at two years; MR ≤2+ was achieved in 96% of patients at 30 days, 100% at one year, and 95% two years (all p\u3c0.001). Mean LVEDV of 199 mL at baseline decreased by 9 mL at 30 days (p=0.039), 29 mL at one year (p\u3c0.001), and 31 mL at two years (p\u3c0.001). NYHA class I/II was achieved in 87% of patients at 30 days, 86% at one year, and 88% at two years (all p\u3c0.001). Six-minute walk distance (6MWD) improved by 22 m at 30 days (p=0.004) and 40 m at one year (p=0.003). Kansas City Cardiomyopathy Questionnaire (KCCQ) score improved by 16 points at 30 days and one year (all p\u3c0.001). Conclusions: In the CLASP study, the PASCAL transcatheter valve repair system demonstrated sustained favourable outcomes at two years in patients with FMR. Results showed a high survival rate of 72% and freedom from HF rehospitalization of 78% at two years. An 81% reduction in annualized HF hospitalization rate was observed. At two years, sustained MR reduction of MR ≤2+ was achieved in 95% andMR ≤1+ in 84% of patients, with evidence of left ventricular reverse remodelling. Improvements in functional status were significant and sustained at two years. The CLASP IIF randomized pivotal trial is ongoing

Predicting Survival in Patients Receiving Continuous Flow Left Ventricular Assist Devices The HeartMate II Risk Score

ObjectivesThe aim of this study was to derive and validate a model to predict survival in candidates for HeartMate II (HMII) (Thoratec, Pleasanton, California) left ventricular assist device (LVAD) support.BackgroundLVAD mortality risk prediction is important for candidate selection and communicating expectations to patients and clinicians. With the evolution of LVAD support, prior risk prediction models have become less valid.MethodsPatients enrolled into the HMII bridge to transplantation and destination therapy trials (N = 1,122) were randomly divided into derivation (DC) (n = 583) and validation cohorts (VC) (n = 539). Pre-operative candidate predictors of 90-day mortality were examined in the DC with logistic regression, from which the HMII Risk Score (HMRS) was derived. The HMRS was then applied to the VC.ResultsThere were 149 (13%) deaths within 90 days. In the DC, mortality (n = 80) was higher in older patients (odds ratio [OR]: 1.3, 95% confidence interval [CI]: 1.1 to 1.7 per 10 years), those with greater hypoalbuminemia (OR: 0.49, 95% CI: 0.31 to 0.76 per mg/dl of albumin), renal dysfunction (OR: 2.1, 95% CI: 1.4 to 3.2 per mg/dl creatinine), coagulopathy (OR: 3.1, 95% CI: 1.7 to 5.8 per international normalized ratio unit), and in those receiving LVAD support at less experienced centers (OR: 2.2, 95% CI: 1.2 to 4.4 for <15 trial patients). Mortality in the DC low, medium, and high HMRS groups was 4%, 16%, and 29%, respectively (p < 0.001). In the VC, corresponding mortality was 8%, 11%, and 25%, respectively (p < 0.001). HMRS discrimination was good (area under the receiver-operating characteristic curve: 0.71, 95% CI: 0.66 to 0.75).ConclusionsThe HMRS might be useful for mortality risk stratification in HMII candidates and may serve as an additional tool in the patient selection process

Variability Across Implanting Centers in Short and Long-Term Mortality and Adverse Events in Patients on HeartMate 3 Support: A Momentum 3 Secondary Analysis

Purpose: We aimed to characterize center-specific variability in HeartMate 3 (HM3) patient survival within the MOMENTUM 3 studies and to examine the correlation between implanting center survival and major adverse events (AEs). Methods: Center HM3 implant volume during the MOMENTUM 3 pivotal (n=515) and continued access protocol (n=1685) trials were tallied. Centers implanting ≤16 HM3 patients (25th percentile) were excluded. De-identified center variability in mortality was assessed at 90 days and 2 years using direct adjusted survival while accounting for key baseline risk factors. The 90-day frequency and 2-year rates of stroke, bleeding, and infection were compared across centers and correlations between survival and event rate variability were assessed. Results: Among 48 centers, 1957 HM3 patients were included in this analysis with site implants ranging between 17 to 103 patients. Patient cohorts differed across the sites by age (average 52-68 years), sex (60-95% male), destination therapy intent (25-100%), and %INTERMACS profile 1-2 (2-81%). At 90 days, center adjusted median mortality was 6.5%, nadiring at ≤3.2% (25th percentile) and peaking at ≥10.5% (75th percentile). Median 2-year center adjusted mortality was 18.6%, nadiring at ≤14.0% and peaking at ≥25.2% (figure A). AEs were also highly variable across centers; centers with low mortality tended to have lower AE rates at 2 years (figure B). Conclusion: Patient characteristics and outcomes were highly variable across MOMENTUM 3 centers despite trial preoperative inclusion/exclusion criteria. Many centers had exemplary risk-adjusted HM3 patient outcomes. Studies are needed to improve our understanding of top performing centers’ best practices as they relate to HM3 care in the pre, interoperative, and chronic support stages in an effort to further improve HM3 LVAD-associated clinical outcomes