Two Different Approaches To Successful Capstones

Many universities offer capstone projects as an integrating, experiential learning device for diverse theories that students might otherwise not be able to practice. This research describes two variations on capstones as exemplifying the diversity of such courses. This research develops a conceptual mapping of types of capstones, discussing two variations in real-world capstones in depth. The risks and oversight requirements of professors for the two variants differ considerably. Prescriptions for managing the risks with each type of project are offered

A Strategy of Underexpansion and Ad Hoc Post-Dilation of Balloon-Expandable Transcatheter Aortic Valves in Patients at Risk of Annular Injury Favorable Mid-Term Outcomes

AbstractObjectivesThe aim of this study was to evaluate a strategy of intentional underexpansion of excessively oversized balloon-expandable transcatheter heart valves (THVs) in terms of clinical outcomes, valve function, and frame durability at 1 year.BackgroundTranscatheter aortic valve replacement requires the selection of an optimally sized THV to ensure paravalvular sealing and fixation without risking annular injury. However, some patients have “borderline” annular dimensions that require choosing between a THV that may be too small or another that may be too large.MethodsWe evaluated 47 patients at risk of annular injury who underwent transcatheter aortic valve replacement (TAVR) with an oversized, but deliberately underexpanded, THV followed by post-dilation if required. Clinical evaluation, echocardiography, and cardiac computed tomography were performed pre-TAVR, post-TAVR, and at 1 year.ResultsDeployment of oversized THVs with modest underfilling of the deployment balloon (<10% by volume) was not associated with significant annular injury. Paravalvular regurgitation was mild or less in 95.7% of patients, with post-dilation required in 10.7%. THV hemodynamic function was excellent and remained stable at 1 year. Computed tomography documented stent frame circularity in 87.5%. Underexpansion was greatest within the intra-annular THV inflow (stent frame area 85.8% of nominal). There was no evidence of stent frame recoil, deformation, or fracture at 1 year.ConclusionsIn carefully selected patients with borderline annulus dimensions and in whom excessive oversizing of a balloon-expandable SAPIEN XT valve (Edwards Lifesciences, Inc., Irvine, California) is a concern, a strategy of deliberate underexpansion, with ad hoc post-dilation, if necessary, may reduce the risk of annular injury without compromising valve performance

A Study of the Contributions of Attitude, Computer Security Policy Awareness, and Computer Self-Efficacy to the Employees\u27 Computer Abuse Intention in Business Environments

While computer technology is generally intended to increase employee productivity and effectiveness that same computer technology may be used in negative ways that reduces productivity and increases cost in the business environment. Computer abuse has occurred in the past 12 months in more than half of the business environments surveyed by the Computer Security Institute. To date, research results still indicate that employee computer abuse is problematic and continues to significantly increase. It is estimated American businesses will lose $63 billion each year due to employees\u27 computer abuse on the Internet. This study was a predictive study that attempted to predict employees\u27 computer abuse intention (CAI) in the business environment based on the contribution of attitude (ATT), computer security policy awareness (CSPA), and computer self-efficacy (CSE). Working professionals from the south central United States were surveyed to determine their ATT toward computer abuse, CSPA, and CSE, as well as their intention to commit computer abuse in the business environment. A theoretical model was proposed, and two statistical methods were used to formulate models and test predictive power: Multiple Linear Regression (MLR) and Ordinal Logistic Regression (OLR). It was predicted that ATT, CSPA, and CSE will have a significant impact on employee\u27s CAI. Results demonstrated that ATT was a significant predictor in predicting employee CAI on both the MLR and OLR regression models. CSE was a significant predictor on the MLR model only. CSPA was not found to be a significant predictor of CAI on either regression models. There are two main contributions of this study. First, to develop and empirically validate models for predicting employee\u27s CAI in the business environment. Second, to investigate the most significant construct of the three constructs studied that contribute to the employee\u27s CAI in the business environment

Long-Term Outcomes of the FORMA Transcatheter Tricuspid Valve Repair System for the Treatment of Severe Tricuspid Regurgitation: Insights From the First-in-Human Experience.

OBJECTIVES To evaluate the long-term (≥2 years) outcomes following transcatheter tricuspid valve repair (TTVr) with the FORMA Transcatheter Tricuspid Valve Repair System (Edwards Lifesciences, Irvine, California). BACKGROUND Scarce data exist on long-term outcomes following TTVr. METHODS This multicenter experience included patients with severe tricuspid regurgitation (TR) who underwent TTVr with the FORMA system at 4 centers under a compassionate clinical use program. Data were collected at baseline, 30 days, and 1 year, and yearly thereafter. RESULTS Nineteen patients (76 ± 9 years of age, 74% women, mean EuroSCORE II [European System for Cardiac Operative Risk Evaluation] 9.2 ± 5.6%) with functional TR were included. Procedural success was achieved in 17 (89%) patients and there were no cases of 30-day mortality. At a median follow-up of 32 (interquartile range: 24 to 36) months, 4 (24%) patients had died (3 from terminal heart failure, 1 from sepsis) and 3 (18%) patients required rehospitalization for heart failure. There was 1 device-related thrombosis and 1 pulmonary embolism, both in the setting of subtherapeutic oral anticoagulation. Less than severe TR was observed at echocardiography in 67% of patients at the 2- to 3-year follow-up. Among 15 successfully implanted patients with at least 24-month follow-up, significant improvements in New York Heart Association functional class (p < 0.001), 6-min walk test (+54 m; p = 0.016) and Kansas City Cardiomyopathy Questionnaire score (+16 points; p = 0.016) were observed, compared with baseline. CONCLUSIONS TTVr using the FORMA system showed favorable long-term safety profile in high-surgical-risk patients, with sustained functional improvement and acceptable TR reduction up to 3 years

Transcatheter Tricuspid Valve Repair With a New Transcatheter Coaptation System for the Treatment of Severe Tricuspid Regurgitation: 1-Year Clinical and Echocardiographic Results.

OBJECTIVES This study sought to describe the 1-year experience with the transcatheter FORMA system for severe tricuspid regurgitation (TR). BACKGROUND Severe TR is associated with significant morbidity and mortality. Novel transcatheter therapies have been recently developed. METHODS Eighteen patients underwent device implantation at 3 centers in Canada and Switzerland. Baseline characteristics, procedural, 30-day, and 1-year outcomes were prospectively evaluated using multimodality imaging and hemodynamic and clinical assessments. RESULTS Procedural success was achieved in 16 (89%) patients. Unsuccessful procedures were because of right ventricular perforation requiring open surgery and device dislocation. At 1 year there were no deaths, significant arrhythmias, device infections, or dislocations. Thrombus was observed on 1 device at 4 months and there was 1 rehospitalization for heart failure. Among the 14 patients with successful device implantation and 1-year follow-up, 79% were in New York Heart Association functional class I/II (p < 0.001), the average 6-min-walk test increased by 84 m (p = 0.03), and the Kansas City Cardiomyopathy Questionaire heart failure score improved by 18 points (p = 0.02) compared with baseline. Echocardiography showed a reduction of TR from severe in 17 of 18 (94%) patients at baseline to moderate-severe or less in 11 of 16 patients (69%) by 30 days (p = 0.001) and 6 of 13 patients (46%) by 1 year (p = 0.01). The diameters of the tricuspid annulus and the right ventricle were reduced at 1 year (45.7 ± 4.8 mm to 42.1 ± 4.4 mm, p = 0.004; 54 ± 5.3 mm to 49.9 ± 4.3 mm, p = 0.02, respectively). CONCLUSIONS Implantation of the FORMA system in high-risk patients with severe TR shows feasibility with a good mid-term safety profile. At 1 year, despite variable success in reducing echocardiographic TR grade, there were significant clinical improvements and reductions in right ventricular dimensions