Background The use of a left ventricular assist device (LVAD) is becoming increasingly common in patients with end-stage heart failure. Many LVAD programs require patients to have a caregiver prior to receiving a device. There are few studies exploring the experience, burden, and impacts on caregivers of patients with LVADs. Objectives The aim of this study was to synthesize the qualitative literature regarding what caregiver’s perceptions about caring for an adult LVAD patient. Methods We searched Medline, CINAHL, PsychInfo and Web of Science to find English articles on the topic of LVAD caregiver’s perceptions. The articles were then synthesized using a formal process of qualitative meta-synthesis. Results Eight articles met criteria for inclusion. The meta-synthesis across the articles resulted in eight themes categorized under three domains. Many of the articles suggested a longitudinal process of caregiving with perceptions largely dependent upon the time of interview in relation to the LVAD. The first domain of caregiving is the “early” stage covering life before the LVAD through the procedure. This phase is characterized by the pre-LVAD “emotional rollercoaster,” the decision seen as “no option,” and the thought of “leave it [the LVAD] at the hospital.” The second domain is the “middle” stage covering the timeframe following discharge from the hospital. This phase is characterized by fragility of the patient, recognition of a need to adapt, and a transformed life. The final domain is “late LVAD” and describes how late in the LVAD process, the LVAD indication (bridge to transplant or destination therapy) brings in to focus what is important to caregivers. Conclusions Existing literature indicates that the LVAD caregiver experience is intense, burdensome, and the need to adapt to a new life. Given the burdens caregivers experience, clinicians and future research should explore strategies to support these important individuals.

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Do hotspots of plant biodiversity translate into hotspots in the abundance and diversity of large mammalian herbivores? A common expectation in community ecology is that the diversity of plants and animals should be positively correlated in space, as with the latitudinal diversity gradient and the geographic mosaic of biodiversity. Whether this pattern ‘scales down’ to landscape-level linkages between the diversity of plants or the activities of highly mobile megafauna has received less attention. We investigated spatial associations between plants and large herbivores by integrating data from a plant-DNA-barcode phylogeny, camera traps, and a comprehensive map of woody plants across the 1.2-km2 Mpala Forest Global Earth Observatory (ForestGEO) plot, Kenya. Plant and large herbivore communities were strongly associated with an underlying soil gradient, but the richness of large herbivore species was negatively correlated with the richness of woody plants. Results suggest thickets and steep terrain create associational refuges for plants by deterring megaherbivores from browsing on otherwise palatable species. Recent work using dietary DNA metabarcoding has demonstrated that large herbivores often directly control populations of the plant species they prefer to eat, and our results reinforce the important role of megaherbivores in shaping vegetation across landscapes.