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To evaluate the impact of the new donor heart allocation system implemented in the United States in October 2018 on development of early cardiac allograft vasculopathy (CAV).Retrospective cohort study.Adult (≥ 18 years) heart transplant recipients registered in the United Network for Organ Sharing database between October 18, 2015 and October 17, 2018 (old system) and October 18, 2018 and May 31, 2020 (new system).Incidence of angiographic CAV at 1 year (accelerated CAV) in the overall transplant population and among the highest acuity subgroup-Status 1A (old) and Status 1 or 2 (new). We included recipient and donor demographic, cardiovascular, and transplant factors in multivariable logistic regression models to identify predictors of accelerated CAV.Of 10,375 transplant recipients, 6,660 (64%) and 3,715 (36%) were listed in the old and new allocation cohorts, respectively. The incidence of accelerated CAV was 521 (8%) in the old period compared with 272 (7%) in the new period (P = .36). Similar incidence rates were observed in the highest acuity subgroup-363 (8%) compared with 143 (7%), respectively (P = .13). In adjusted analyses of the high-acuity cohort, the new allocation system was not associated with a higher likelihood of accelerated CAV (odds ratio = 0.87, 95% confidence interval: 0.70-1.08, P = .20).The new donor heart allocation system is not associated with development of accelerated angiographic CAV at 1 year, including among recipients requiring the most urgent transplants.

Background The use of telehealth in the management of care and care delivery has been increasing significantly during the COVID-19 pandemic. Telehealth is an emerging technology used to manage care for patients with cardiovascular diseases (CVDs) in Jordan. However, implementing this approach in Jordan faces many challenges that need to be explored to identify practical solutions. Purpose To explore the perceived challenges and barriers to using telehealth in managing acute and chronic CVDs among healthcare professionals. Methods A qualitative, exploratory study was conducted by interviewing 24 health professionals at two hospitals in different clinical areas in Jordan. Results Several barriers were reported by participants that affected the utilization of telehealth services. The barriers were categorized into the following four themes: Drawbacks related to patients, Health providers’ concerns, Procedural faults, and telehealth To complement the service only. Conclusions The study suggests that telehealth can be instrumental in supporting care management for patients with CVD. It means that understanding the advantages and barriers to implementing telehealth by the healthcare providers in Jordan can improve many aspects of the healthcare services for patients with CVD within the healthcare settings in Jordan.

It is common practice in healthcare systems in the Arabic region to exclude relatives when patients receive treatment for critical emergent incidents or illnesses. This exclusion is despite family members' wishes for proximity and cultural and religious values that mean being with unwell people is considered a form of worship or religious act. The marked lack of implementation of relatives' wishes in this regard is coupled with a paucity of relevant policies, guidelines, and research, despite patient populations in these countries being traditional in nature, religious, and having strong connections within their families and extended social units. The present authors reflected on this concern and advocated for increased attention to the needs and rights of critically ill patients and their families to support better quality, holistic care, especially during critical illness incidents. Healthcare professionals should consider allowing families to be present with their patients in such circumstances and appreciate the importance of family presence, despite the acknowledged challenges. The recommendations presented in this reflection may support the implementation of effective, holistic healthcare services in these countries. This reflection is also relevant to any context where care for Arabic or Muslim patients is provided.

The new United Network for Organ Sharing (UNOS) heart allocation policy prioritizes temporary percutaneous over durable left ventricular assist devices (LVAD) as bridge to transplant. We sought to examine one-year outcomes of heart transplant recipients bridged with Impella versus durable LVADs.All primary adult orthotopic heart transplant recipients registered in UNOS between January 2016 to June 2021 were analyzed. Recipients were identified as being bridged with isolated durable or percutaneous LVAD at the time of transplant. Baseline characteristics were compared and one-year survival was examined using the Kaplan Meier method and multivariable Cox proportional hazards regression.During our study period, heart transplant recipients bridged with LVADs were divided between 5,422(94%) durable and 324(6%) percutaneous options. Impella-bridged recipients were more likely to be status 1A under the old allocation system (98% vs 70%, p0.01) and status 2 or higher under the new allocation system (99% vs 24%, p0.01). Impella-bridged recipients were less likely to be obese (27% vs 42%, p0.01), have ischemic cardiomyopathy (27% vs 34%, p0.01), and were more likely to be on inotropic agents at the time of transplant (68% vs 6%, p0.01). One-year post-transplant survival was not significantly different between the two groups on univariable (HR 0.87, 95% CI 0.56-1.37) or multivariable analysis (aHR 0.63, 95% CI 0.37-1.07).Following the UNOS allocation policy change, Impella utilization has increased with no significant difference in one-year survival compared to bridge with durable LVADs. Impella may be a reasonable alternative to durable LVADs in select patients. This article is protected by copyright. All rights reserved.

ObjectivesTo evaluate characteristics and outcomes of patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) during the coronavirus disease 2019 (COVID-19) pandemic.BackgroundThe COVID-19 pandemic has created challenges in delivering acute cardiovascular care. Quality measures and outcomes of patients presenting with AMICS during COVID-19 in the United States have not been well described.MethodsWe identified 406 patients from the National Cardiogenic Shock Initiative (NCSI) with AMICS and divided them into those presenting before (N = 346, 5/9/2016-2/29/2020) and those presenting during the COVID-19 pandemic (N = 60, 3/1/2020-11/10/2020). We compared baseline clinical data, admission characteristics, and outcomes.ResultsThe median age of the cohort was 64 years, and 23.7% of the group was female. There were no significant differences in age, sex, and medical comorbidities between the two groups. Patients presenting during the pandemic were less likely to be Black compared to those presenting prior. Median door to balloon (90 vs. 88 min, p = 0.38), door to support (88 vs. 78 min, p = 0.13), and the onset of shock to support (74 vs. 62 min, p = 0.15) times were not significantly different between the two groups. Patients presented with ST-elevation myocardial infarction more often during the COVID-19 period (95.0% vs. 80.0%, p = 0.005). In adjusted logistic regression models, COVID-19 period did not significantly associate with survival to discharge (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.54-2.19, p = 0.81) or with 1-month survival (OR 0.82, 95% CI 0.42-1.61, p = 0.56).ConclusionsCare of patients presenting with AMICS has remained robust among hospitals participating in the NCSI during the COVID-19 pandemic.

Heyam F Dalky,1,2 Nariman Ghader,3 Muna Al Kuwari,4 Malek Alnajar,5 Samantha Ismaile,5 Mona Almalik,5,6 Raed Shudifat,5 Sarah Sanad,5 Nezam Al-Nsair,7 Fatima Al Matrooshi8 1Psychiatric Mental Health, Faculty of Health Sciences/Nursing Department, Higher Colleges of Technology, Sharjah, United Arab Emirates; 2Psychiatric Mental Health, Faculty of Nursing, Jordan University of Science & Technology, Irbid 22110, Jordan; 3Specialized Care Department, Strategic Planning and Institutional Performance, Ministry of Health and Prevention-HQ, Dubai, United Arab Emirates; 4Specialized Care Department, Specialized Care Management, Hospitals Sector, Ministry of Health and Prevention-HQ, Dubai, United Arab Emirates; 5Faculty of Health Science/Nursing Department, Higher Colleges of Technology, Sharjah, United Arab Emirates; 6Maternal and Child Health Nursing Department, Faculty of Nursing, University of Mutah, Mu’tah, Jordan; 7Higher Colleges of Technology, Faculty of Health Sciences, Sharjah, United Arab Emirates; 8Specialized Care Department, Hospitals Sector, Ministry of Health and Prevention-HQ, Dubai, United Arab EmiratesCorrespondence: Heyam F DalkyPsychiatric Mental Health, Faculty of Health Sciences/Nursing Department, Higher Colleges of Technology, PO Box 9747, Sharjah, United Arab EmiratesEmail hdalky@hct.ac.aeBackground: Since COVID-19 surfaced in December 2019, health-care organizations across the globe have struggled to maintain the safety and well-being of health-care professionals (HCPs).Purpose: This study investigates the HCPs’ general understanding of the health risks of COVID-19 and to what extent they are equipped with the knowledge to protect themselves and others against this contagion.Methods: This cross-sectional study used a web-based structured questionnaire posted on the UAE government electronic survey portal. A collection of 941 HCPs from diverse general and specialty hospitals in the UAE responded to an electronic participation invite.Results: Our analysis showed that the majority of HCPs (97.6%) had updated information about COVID-19 modes of transmission, risks of contamination, high-risk groups, and the potential consequences of testing positive. Furthermore, the results of the chi-squared testing revealed that the HCPs’ confidence and vigilance of the COVID-19 threats were significantly increased (p< 0.01) by being experienced, having had infection control training, or/and having undergone COVID-19 education.Conclusion: We conclude that HCPs have an evidence-based understanding of the ways their own health is at risk while they are performing their duties in hospital setups. Further, the study found that HCPs who undergo special infection control training and who are kept posted on the official updates on COVID-19 are more likely to remain vigilant at all times to minimize the risks to themselves and their patients. Although the generalizability of the study findings should be considered with caution, the results could be generalizable to health-care professionals who received similar COVID-19 related training in the UAE or other regional countries.Keywords: vigilance, pandemic, attitude, COVID-19, infection control, health-care professionals

The hemodynamic effects of pre-transplant vaccination against COVID-19 among heart transplant candidates hospitalized for advanced heart failure remains unknown.A retrospective chart review was conducted at a high-volume transplant center from January through December 2021. 22 COVID-19 vaccination events occurred among patients hospitalized for decompensated heart failure while awaiting transplantation. Primary outcomes included inotrope and vasopressor dosages. Secondary outcomes included vital signs, pulmonary artery catheter measurements, diuretic dosages, and renal function. Data were extracted 24 h before through 72 h after vaccination.One of 22 vaccination events was associated with hemodynamic changes requiring increased inotropic and vasopressor support post-vaccination. In all other cases, transient hemodynamic changes occurred without need for escalated therapy.COVID-19 vaccination can be administered safely to most critically ill patients with advanced heart failure including those awaiting transplantation. All patients should be monitored closely as some may be susceptible to significant hemodynamic changes.

ObjectiveAlthough extracorporeal life support (ECLS) has been increasingly adopted as rescue therapy for cardiac and pulmonary failure, it remains limited to specialized centers. The present study reports our institutional experience with mobile ECLS across broad indications, including postcardiotomy syndrome, cardiogenic shock, and COVID-19 acute respiratory failure.MethodsWe performed a retrospective review of all patients transported to our institution through our mobile ECLS program from January 1, 2018, to January 15, 2021.ResultsOf 110 patients transported to our institution on ECLS, 65.5% required venovenous, 30.9% peripheral venoarterial, and 3.6% central venoarterial support. The most common indications for mobile ECLS were acute respiratory failure (46.4%), COVID-19-associated respiratory failure (19.1%), cardiogenic shock (18.2%) and postcardiotomy syndrome (11.8%). The median pre-ECLS Pao2:Fio2 for venovenous-ECLS was 64 mm Hg (interquartile range [IQR], 53-75 mm Hg) and 95.8 mm Hg (IQR, 55-227 mm Hg) for venoarterial-ECLS, whereas median pH and base deficit were 7.25 (IQR, 7.16-7.33) and 7 mmol/L (IQR, 4-11 mmol/L) for those requiring venoarterial-ECLS. Patients were transported using a ground ambulance from 50 institutions with a median distance of 27.5 miles (IQR, 18.7-48.0 miles). Extracorporeal circulation was established within a median of 45minutes (IQR, 30-55minutes) after team arrival. Survival to discharge was 67.3% for those requiring venovenous-ECLS for non-COVID-19 respiratory failure, 52.4% for those with COVID-19%, and 54.1% for those requiring venoarterial-ECLS.ConclusionsPatients can be safely and expeditiously placed on ECLS across broad indications, utilizing ground transportation in an urban setting. Clinical outcomes are promising and comparable to institutional non-transfers and those reported by Extracorporeal Life Support Organization.

Background Heart transplant selection committee meetings have transitioned from in-person to remote video meetings during the COVID-19 pandemic, but how this impacts committee members and patient outcomes is unknown. Objective The aim of this study is to determine the perceived impact of remote video transplant selection meetings on usability and patient care and to measure patient selection outcomes during the transition period from in-person to virtual meetings. Methods A 35-item anonymous survey was developed and distributed electronically to the heart transplant selection committee. We reviewed medical records to compare the outcomes of patients presented at in-person meetings (January-March 2020) to those presented during video meetings (March-June 2020). Results Among 83 committee members queried, 50 were regular attendees. Of the 50 regular attendees, 24 (48%) were physicians and 26 (52%) were nonphysicians, including nurses, social workers, and coordinators; 46 responses were received, 23 (50%) from physicians and 23 (50%) from nonphysicians, with 41 responses fully completed. Overall, respondents were satisfied with the videoconference format and felt that video meetings did not impact patient care and were an acceptable alternative to in-person meetings. However, 54% (22/41) preferred in-person meetings, with 71% (15/21) of nonphysicians preferring in-person meetings compared to only 35% (7/20) of physicians (P=.02). Of the 46 new patient evaluations presented, there was a statistically nonsignificant trend toward fewer patients initially declined at video meetings compared with in-person meetings (6/24, 25% compared to 10/22, 45%; P=.32). Conclusions The transition from in-person to video heart transplant selection committee meetings was well-received and did not appear to affect committee members’ perceived ability to deliver patient care. Patient selection outcomes were similar between meeting modalities.

A 32-year-old man with a history of relapsing polychondritis presented with acute coronary syndrome due to aortitis with ostial coronary artery involvement from his underlying autoimmune condition. Concomitant aortic insufficiency with ostial coronary lesions is a rare complication of relapsing polychondritis, requiring a multidisciplinary team approach for management. (Level of Difficulty: Advanced.), Graphical abstract, A 32-year-old man with a history of relapsing polychondritis presented with acute coronary syndrome due to aortitis with ostial coronary artery involvement…

Temperature management is one of the primary considerations of biogas plant operation, and influences physical and biochemical processes. An increase in the temperature leads to an increase in the hydrolysis rate of the feedstock, while it can inhibit microorganisms taking part in different stages of anaerobic digestion. Because of the complexity of the biochemical processes within the anaerobic digestion process, there is a lack of knowledge about the effects of temperature and temperature change on efficiency. Moreover, the impact of stirring directly affects the temperature distribution in the anaerobic digestion reactors. In this study, the temperature management in an industrial-scale biogas plant was examined, and the effect of small temperature changes (from the operation temperature 42 °C) on the efficiency was studied in a laboratory under two different conditions: with stirring (at 40 and 44 °C) and without stirring (at 40 and 44 °C). The examination results from the biogas plant showed that heat transfer in the reactor was not sufficient at the bottom of the digester. Adaptation of the post-digester samples to the temperature changes was more challenging than that of the digester samples. From digestate samples, higher biomethane generation could be obtained, resulting from sufficient contact between microorganisms, enzymes, and substrates. Overall, differences between these changing conditions (approx. 6 NmL CH4 g VS−1) were not significant and could be adapted by the process.

Temperature management is one of the primary considerations of biogas plant operation, and influences physical and biochemical processes. An increase in the temperature leads to an increase in the hydrolysis rate of the feedstock, while it can inhibit microorganisms taking part in different stages of anaerobic digestion. Because of the complexity of the biochemical processes within the anaerobic digestion process, there is a lack of knowledge about the effects of temperature and temperature change on efficiency. Moreover, the impact of stirring directly affects the temperature distribution in the anaerobic digestion reactors. In this study, the temperature management in an industrial-scale biogas plant was examined, and the effect of small temperature changes (from the operation temperature 42 °C) on the efficiency was studied in a laboratory under two different conditions: with stirring (at 40 and 44 °C) and without stirring (at 40 and 44 °C). The examination results from the biogas plant showed that heat transfer in the reactor was not sufficient at the bottom of the digester. Adaptation of the post-digester samples to the temperature changes was more challenging than that of the digester samples. From digestate samples, higher biomethane generation could be obtained, resulting from sufficient contact between microorganisms, enzymes, and substrates. Overall, differences between these changing conditions (approx. 6 NmL CH4 g VS−1) were not significant and could be adapted by the process., Temperature management is one of the primary considerations of biogas plant operation, and influences physical and biochemical processes. An increase in the temperature leads to an increase in the hydrolysis rate of the feedstock, while it can inhibit microorganisms taking part in different stages of anaerobic digestion. Because of the complexity of the biochemical processes within the anaerobic digestion process, there is a lack of knowledge about the effects of temperature and temperature change on efficiency. Moreover, the impact of stirring directly affects the temperature distribution in the anaerobic digestion reactors. In this study, the temperature management in an industrial-scale biogas plant was examined, and the effect of small temperature changes (from the operation temperature 42 °C) on the efficiency was studied in a laboratory under two different conditions: with stirring (at 40 and 44 °C) and without stirring (at 40 and 44 °C). The examination results from the biogas plant showed that heat transfer in the reactor was not sufficient at the bottom of the digester. Adaptation of the post-digester samples to the temperature changes was more challenging than that of the digester samples. From digestate samples, higher biomethane generation could be obtained, resulting from sufficient contact between microorganisms, enzymes, and substrates. Overall, differences between these changing conditions (approx. 6 NmL CH4 g VS−1) were not significant and could be adapted by the process.

We explore the stability of floating objects through mathematical modeling and experimentation. Our models are based on standard ideas of center of gravity, center of buoyancy, and Archimedes' Principle. We investigate a variety of floating shapes with two-dimensional cross sections and identify analytically and/or computationally a potential energy landscape that helps identify stable and unstable floating orientations. We compare our analyses and computations to experiments on floating objects designed and created through 3D printing. In addition to our results, we provide code for testing the floating configurations for new shapes, as well as giving details of the methods for 3D printing the objects. The paper includes conjectures and open problems for further study., Comment: 31 pages, 17 figures

BACKGROUND Heart transplant selection committee meetings have transitioned from in-person to remote video meetings during the COVID-19 pandemic, but how this impacts committee members and patient outcomes is unknown. OBJECTIVE The aim of this study is to determine the perceived impact of remote video transplant selection meetings on usability and patient care and to measure patient selection outcomes during the transition period from in-person to virtual meetings. METHODS A 35-item anonymous survey was developed and distributed electronically to the heart transplant selection committee. We reviewed medical records to compare the outcomes of patients presented at in-person meetings (January-March 2020) to those presented during video meetings (March-June 2020). RESULTS Among 83 committee members queried, 50 were regular attendees. Of the 50 regular attendees, 24 (48%) were physicians and 26 (52%) were nonphysicians, including nurses, social workers, and coordinators; 46 responses were received, 23 (50%) from physicians and 23 (50%) from nonphysicians, with 41 responses fully completed. Overall, respondents were satisfied with the videoconference format and felt that video meetings did not impact patient care and were an acceptable alternative to in-person meetings. However, 54% (22/41) preferred in-person meetings, with 71% (15/21) of nonphysicians preferring in-person meetings compared to only 35% (7/20) of physicians (P=.02). Of the 46 new patient evaluations presented, there was a statistically nonsignificant trend toward fewer patients initially declined at video meetings compared with in-person meetings (6/24, 25% compared to 10/22, 45%; P=.32). CONCLUSIONS The transition from in-person to video heart transplant selection committee meetings was well-received and did not appear to affect committee members’ perceived ability to deliver patient care. Patient selection outcomes were similar between meeting modalities.

IntroductionFrailty status affects outcomes after heart transplantation, but the optimal way to assess frailty prior to transplant remains unknown.MethodsThissingle-center,observationalstudy assessed 44 heart transplant candidates for frailty using three methods. The Short Physical Performance Battery (SPPB) and Fried Frailty Phenotype (FFP) were used as two physical assessments of frailty. The Frailty Risk Score (FRS) was used as a chart-review based assessment measuring 20 different biopsychosocial and functional components, including biomarkers, depression, cognitive impairment, and sleep.ResultsWe determined the correlation between FRS, SPPB, and FFP and how each correlated with clinical outcomes. Of 44 participants, mean age was 60 years. FRS correlated with SPPB and FFP (P=.043, P&nbsp

A 71 year-old man with heart failure, porcelain aorta, and mitral regurgitation presented for heart transplant evaluation. He was in cardiogenic shock requiring inotropic support. An echocardiogram showed a dilated left ventricle, severely reduced systolic function, restricted mitral valve leaflet motion, an elevated mean transmitral gradient, and severe mitral regurgitation. The differential of mixed stenotic and regurgitant mitral valve pathology included rheumatic heart disease and congenital mitral valve anomaly. Hemodynamic management of cardiogenic shock in the setting of mixed mitral valve disease presented unique challenges due to a narrow therapeutic window of optimal preload, afterload reduction, inotropic support, and chronotropic control. He was not a candidate for percutaneous mitral valve interventions or surgery. A porcelain aorta made him high risk for vascular complications with mechanical circulatory support. His course was complicated by worsening shock requiring escalation of inotropes, rapid atrial fibrillation, and recurrent episodes of acute pulmonary edema. Ultimately, he underwent an orthotropic heart transplant. A transesophageal echocardiogram at the time of transplant suggested a parachute mitral valve, where all chordae appeared be originating from one papillary muscle. However, additional views revealed the presence of two papillary muscles with asymmetric, shortened anterior chordae and a hypertrophied anterior papillary muscle. Findings were consistent with a rare parachute-like asymmetric mitral valve complicated by mild mitral stenosis and severe mitral regurgitation. Examination of the explanted native heart confirmed these findings.This case highlights: 1) complex management of mixed valvular disease in the setting of cardiogenic shock, 2) echocardiographic evaluation of mixed valvular heart disease, and 3) a rare congenital malformation of a parachute-like mitral valve presenting in adulthood.

Background: The impact of telehealth on cardiovascular care during the COVID-19 pandemic on patient satisfaction and factors associated with satisfaction are not well characterized. Methods: We conducted a nonrandomized, prospective cross-sectional survey study for outpatient telehealth cardiovascular visits over a 169-day period utilizing a validated telehealth usability questionnaire. For each variable, patients were divided into 2 groups—1 with scores above the median, labeled “greater satisfaction,” and the other with scores below the median, labeled “less satisfaction.” Results: A total of 13,913 outpatient telehealth encounters were successfully completed during the study period. A total of 7327 unique patients were identified and received a survey invitation; 5993 (81.8%) patients opened the invitation, and 1034 (14.1%) patients consented and completed the survey. Overall mean and median scores were 3.15 (standard deviation 0.74) and 3.37 (interquartile range 2.73–3.68) (maximum score 4.00). Greater satisfaction was noted among younger patients (mean age 63.3 ± 14.0 years, P = .005), female gender (46.3%, P = .007), non-White ethnicity (24.2% P = .006), self-identified early adopters and innovators of new technology (49.8%, P < .001), 1-way travel time greater than 1 hour (22.3%, P < .001), 1-way travel distance greater than 10 miles (49.0%, P < .001), patients needing child care arrangement (16.4%, P < .001), and history of orthotopic heart transplant (OHT) (5.1%, P = .04). Conclusion: Patients reported overall satisfaction with telehealth during the COVID-19 pandemic. Factors associated with patient convenience, along with female gender, younger age, and non-White ethnicity, correlated with greater satisfaction. Cardiovascular comorbidities did not correlate with greater satisfaction except for OHT. Further research into the impact of telehealth on patient satisfaction, safety, and clinical outcomes is needed.

Telemedicine is one of the new technological solutions used to facilitate treatment and intervention in patients with Cardiovascular Diseases (CVD). Nevertheless, the utilization of telehealth in Jordan is under-researched.To explore the perspectives and experiences of patients with cardiovascular disease (CVD) and healthcare providers on how telehealth can help manage critical and long-term CVD health problems.A qualitative, descriptive approach was employed, whereby individual interviews were conducted with 12 healthcare providers and 12 cardiac patients from Abdali and Prince Hamzah Hospitals in Jordan. The derived data were analyzed using thematic analysis, according to the method expounded by Braun and Clarke (2014).The analysis of collected data revealed that telehealth deployment exhibited several advantages from the participants' perspectives, these can be divided into the following six themes: mitigating associated risks, qualified and friendly staff, streamlined work processes, effective and structured services, accessibility and privacy of patient information, affordable and convenient services.The current study suggests that telehealth can be helpful and convenient in many aspects of the health care services for patients with CVD, mainly during the crucial times of the COVID pandemic. With this study, stakeholders and Jordanian managers can better understand the telehealth advantages. This will enable them to improve the quality of care in their health organizations in the future.

The use of living cells as a therapeutic option presents several challenges including identification of a suitable source, development of adequate derivation, maintenance and differentiation methods, and very importantly proof of safety and efficacy. One of the major issues for cardiovascular tissue engineering is determining the ideal cell type for use in regenerative therapies.Many clinical trials have used bone marrow derived mononuclear cells (BM-MNC) (Schächinger V 2006). These clinical trials have not shown any significant cardiomyocyte regeneration and the results have been mixed at best with no robust improvement in cardiac function (Coombs 2008). However, this trial and others have provided a proof of concept that intracoronary or intramyocardial transplant of autologous adult stem cells is safe with out any evidence of increased mortality in the treated patients. The next generation of clinical studies will need to demonstrate robust cardiomyocyte regeneration, definite improvement of cardiac pump function, and ultimately improved patient survival as the ultimate goal. The availability of the proposed cell type for regenerative medicine and tissue engineering in sufficient and relatively easily derivable quantities is also critical. To date, engineered tissue constructs containing adult and stem cells have exhibited problems with physical properties, maintenance of cell phenotypes and the host immune response to the engrafted construct. Ideally, the cells used for tissue engineering should have the capacity to proliferate and differentiate in vivo in a manner that can be reproducibly controlled and predicted (Atala A 2002). Due to the high number of cells that is needed for culturing, isolation and expansion require invasive procedures it remains a challenge to generate sufficient numbers of a single cell type, to assemble the needed mixture of multiple cell phenotypes, and to maintain stable phenotypes as needed (Atala A 2002). Furthermore, this process will need to be automated to mass produce sufficient amounts of cells and tissue constructs for clinical therapies on a wide scale. This discussion also highlights the ushering in of a new era of personalized medicine. One of the possibilities for cell therapies is patient-specific iPS cells generated from his/her own somatic cells to be used to treat that person. These designer iPS cells will be differentiated into the desired tissue types and transplanted in an autologous manner to avoid immune rejection. Although pluripotent hESCs or hiPS cells are non-immunogenic, they loose this characteristic as they become more differentiated with increased risk of immune mediated rejection if transplanted into a non-compatible patient. ASCs derived from patients may be a potential source to use to either differentiate into desired cells and re-transplant into the patient or develop and differentiate iPS cells that would be used in an autologous manner to ensure immunocompatibility as it has been shown that ASCs are much more easily induced into hiPS cells compared to fibroblasts (Sun N 2009).

The authors report a case of fulminant myocarditis from an influenza A (H3N2) infection in a healthy individual who experienced cardiac arrest…, The authors report a case of fulminant myocarditis from an influenza A (H3N2) infection in a healthy individual who experienced cardiac arrest requiring extracorporeal membrane oxygenation (ECMO). The case highlights the management of complications arising from the use of ECMO including differential hypoxia and left ventricular overload requiring left ventricular venting. (Level of Difficulty: Beginner.), Central Illustration

Ventricular arrhythmias are challenging to manage in athletes with concern for an elevated risk of sudden cardiac death (SCD) during sports competition. Monomorphic ventricular arrhythmias (MMVA), while often benign in athletes with a structurally normal heart, are also associated with a unique subset of idiopathic and malignant substrates that must be clearly defined. A comprehensive evaluation for structural and/or electrical heart disease is required in order to exclude cardiac conditions that increase risk of SCD with exercise, such as hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. Unique issues for physicians who manage this population include navigating athletes through the decision of whether they can safely continue their chosen sport. In the absence of structural heart disease, therapies such as radiofrequency catheter ablation are very effective for certain arrhythmias and may allow for return to competitive sports participation. In this comprehensive review, we summarise the recommendations for evaluating and managing athletes with MMVA.

Finding the optimum operational conditions (mainly temperature and stirring) inside the fermenters is crucial in the field of anaerobic digestion. This study was conducted to contribute to the research area of anaerobic digestion process optimization and is an example for other biogas plants to improve efficiency. The research aimed at finding the optimum operational conditions in a large-scale biogas plant located in Lower Saxony, Germany, which started operation in 2011. The optimization activities were performed by operating the fermenters under different operational conditions: the temperature inside the fermenters ranged between 40°C and 43°C, while applying several stirring scenarios. These changes led to an increase in specific electricity yield of 11.7% and a decrease in internal energy consumption of 10.4%.The total internal energy consumption of the biogas plant was in the range of 6.3–7.2% (the average monthly internal energy consumption was 6.7% in 2013 and 6.0% in 2014) from their own production, and 28% of this energy consumption was used by the stirrers before optimization. Therefore, finding the optimum operational conditions leads to high energy harvesting and lower internal energy consumption.

Heyam F Dalky,1,2 Nariman Ghader,3 Muna Al Kuwari,4 Malek Alnajar,5 Samantha Ismaile,5 Mona Almalik,5,6 Raed Shudifat,5 Sarah Sanad,5 Nezam Al-Nsair,7 Fatima Al Matrooshi8 1Psychiatric Mental Health, Faculty of Health Sciences/Nursing Department, Higher Colleges of Technology, Sharjah, United Arab Emirates; 2Psychiatric Mental Health, Faculty of Nursing, Jordan University of Science & Technology, Irbid 22110, Jordan; 3Specialized Care Department, Strategic Planning and Institutional Performance, Ministry of Health and Prevention-HQ, Dubai, United Arab Emirates; 4Specialized Care Department, Specialized Care Management, Hospitals Sector, Ministry of Health and Prevention-HQ, Dubai, United Arab Emirates; 5Faculty of Health Science/Nursing Department, Higher Colleges of Technology, Sharjah, United Arab Emirates; 6Maternal and Child Health Nursing Department, Faculty of Nursing, University of Mutah, Mu’tah, Jordan; 7Higher Colleges of Technology, Faculty of Health Sciences, Sharjah, United Arab Emirates; 8Specialized Care Department, Hospitals Sector, Ministry of Health and Prevention-HQ, Dubai, United Arab EmiratesCorrespondence: Heyam F DalkyPsychiatric Mental Health, Faculty of Health Sciences/Nursing Department, Higher Colleges of Technology, PO Box 9747, Sharjah, United Arab EmiratesEmail hdalky@hct.ac.aeBackground: Since COVID-19 surfaced in December 2019, health-care organizations across the globe have struggled to maintain the safety and well-being of health-care professionals (HCPs).Purpose: This study investigates the HCPs’ general understanding of the health risks of COVID-19 and to what extent they are equipped with the knowledge to protect themselves and others against this contagion.Methods: This cross-sectional study used a web-based structured questionnaire posted on the UAE government electronic survey portal. A collection of 941 HCPs from diverse general and specialty hospitals in the UAE responded to an electronic participation invite.Results: Our analysis showed that the majority of HCPs (97.6%) had updated information about COVID-19 modes of transmission, risks of contamination, high-risk groups, and the potential consequences of testing positive. Furthermore, the results of the chi-squared testing revealed that the HCPs’ confidence and vigilance of the COVID-19 threats were significantly increased (p< 0.01) by being experienced, having had infection control training, or/and having undergone COVID-19 education.Conclusion: We conclude that HCPs have an evidence-based understanding of the ways their own health is at risk while they are performing their duties in hospital setups. Further, the study found that HCPs who undergo special infection control training and who are kept posted on the official updates on COVID-19 are more likely to remain vigilant at all times to minimize the risks to themselves and their patients. Although the generalizability of the study findings should be considered with caution, the results could be generalizable to health-care professionals who received similar COVID-19 related training in the UAE or other regional countries.Keywords: vigilance, pandemic, attitude, COVID-19, infection control, health-care professionals

Purpose of the Review This is a comprehensive update on failing Fontan physiology and the role of heart and combined heart and liver transplantation in the current era. Recent Findings Single ventricle physiology encompasses a series of rare congenital cardiac abnormalities that are characterized by absence of or hypoplasia of one ventricle. This effectively results in a single ventricular pumping chamber. These abnormalities are rarely compatible with long-term survival if left without surgical palliation in the first few years of life. Surgical treatment of single ventricle physiology has evolved over the past 60 years and is characterized by numerous creative innovations. These include the development of arteriopulmonary shunts, the evolution of partial cavopulmonary connections, and the eventual development of the “Fontan” operation. Regardless of the type of Fontan modification, the long-term consequences of the Fontan operation are predominantly related to chronic central venous hypertension and the multi-organ consequences thereof. Atrial arrhythmias can further compromise this circulation.Patients with single ventricle physiology represent a special sub-segment of congenital cardiac transplants and are arguably the most challenging patients considered for transplantation. Summary This review describes in detail the challenges and opportunities of heart and liver transplantation in Fontan patients, as viewed and managed by the experienced team at the Ahmanson/UCLA Adult Congenital Heart Center.

Coronavirus disease 2019 (COVID-19) is a viral pandemic precipitated by the severe acute respiratory syndrome coronavirus 2. Since previous reports suggested that viral entry into cells may involve angiotensin converting enzyme 2, there has been growing concern that angiotensin converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ARB) use may exacerbate the disease severity. In this retrospective, single-center US study of adult patients diagnosed with COVID-19, we evaluated the association of ACEI/ARB use with hospital admission. Secondary outcomes included: ICU admission, mechanical ventilation, length of hospital stay, use of inotropes, and all-cause mortality. Propensity score matching was performed to account for potential confounders. Among 590 unmatched patients diagnosed with COVID-19, 78 patients were receiving ACEI/ARB (median age 63 years and 59.7% male) and 512 patients were non-users (median age 42 years and 47.1% male). In the propensity matched population, multivariate logistic regression analysis adjusting for age, gender and comorbidities demonstrated that ACEI/ARB use was not associated with hospital admission (OR 1.2, 95%CI 0.5 to 2.7, p = 0.652). CAD and CKD/end stage renal disease [ESRD] remained independently associated with admission to hospital. All-cause mortality, ICU stay, need for ventilation, and inotrope use was not significantly different between the 2 study groups. In conclusion, among patients who were diagnosed with COVID-19, ACEI/ARB use was not associated with increased risk of hospital admission.

Background The COVID-19 pandemic has introduced numerous changes to clinical and administrative practices in heart transplantation. One change is the transition of transplant selection committee meetings from in-person to remote video conference in order to maintain social distancing requirements. The impact of this transition on committee members and patient care is unknown. Methods A 35-item anonymous survey, adapted from the validated Telehealth Usability Questionnaire, was developed and distributed electronically to the UCLA heart transplant selection committee. Quantitative and qualitative descriptive analyses were performed. Results Of 83 committee members queried, 46 (55%) responded. 50% were non-physician members and 50% were physician members, including 48% cardiologists, 13% anesthesiologists, and 9% surgeons. Over a 6 week period, there was a 5% increase in the average number of attendees from in-person to video meetings. Respondents were satisfied with the ease of use, interface quality, and interaction quality of the video conference system, except for the ability to see meeting attendees. Overall, respondents were satisfied with video meetings, agreeing that they could contribute effectively and achieve their goals over video. However, if given the choice, 54% still preferred the in-person format. Respondents did not feel that video meetings impacted patient care, such as ability to clarify clinical questions, create management plans, and determine and/or update transplant listing status. Multitasking, technology integration, and location convenience were the predominant positive aspects of video meetings, while communication was the main negative, including inability to see attendees, audio interruptions and barriers to communication flow. Communication and clinical decision-making were the predominant positive aspects of in-person meetings (Figure). Conclusions The transition from in-person to remote video conference heart transplantation selection committee meetings during the COVID-19 era has been well-received and does not appear to affect committee members’ perception of their ability to deliver patient care. Future, longer-term studies are needed to evaluate the impact of video meetings on transplant-related outcomes.

The infectious disease coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization in March 2020. The impact of COVID-19 on solid organ transplantations, including heart transplantation, is currently unclear. Many transplant programs have been forced to swiftly re-evaluate and adapt their practices, leading to a marked decrease in transplants performed. This trend has been due to various factors, including increased donor COVID-19 screening scrutiny and recipient waiting list management in anticipation of COVID-19 critical care surge capacity planning. In the face of these unknown variables, determining when and how to proceed with transplantation in our population of patients with end-stage cardiomyopathies is challenging. Here, we describe our center's experience with orthotopic heart transplantation (OHT) in one of the country's pandemic epicenters, where we performed eight OHTs in the first 2months after community spread began in late February 2020.

The infectious disease Coronavirus Disease 2019 (COVID‐19) was declared a pandemic by the World Health Organization in March 2020. The impact of COVID‐19 on solid organ transplantations, including heart transplantation, is currently unclear. Many transplant programs have been forced to swiftly re‐evaluate and adapt their practices, leading to a marked decrease in transplants performed. This trend has been due to various factors, including increased donor COVID‐19 screening scrutiny and recipient waiting list management in anticipation of COVID‐19 critical care surge capacity planning. In the face of these unknown variables, determining when and how to proceed with transplantation in our population of patients with end‐stage cardiomyopathies is challenging. Here, we describe our center’s experience with orthotopic heart transplantation (OHT) in one of the country’s pandemic epicenters, where we performed eight OHTs in the first two months after community spread began in late February 2020.

The biogas production technology has improved over the last years for the aim of reducing the costs of the process, increasing the biogas yields, and minimizing the greenhouse gas emissions. To obtain a stable and efficient biogas production, there are several design considerations and operational parameters to be taken into account. Besides, adapting the process to unanticipated conditions can be achieved by adequate monitoring of various operational parameters. This paper reviews the research that has been conducted over the last years. This review paper summarizes the developments in biogas design and operation, while highlighting the main factors that affect the efficiency of the anaerobic digestion process. The study’s outcomes revealed that the optimum operational values of the main parameters may vary from one biogas plant to another. Additionally, the negative conditions that should be avoided while operating a biogas plant were identified.