Ellisonclayton6904

Although use of mechanical circulatory support is increasing, it is unclear how providing such care affects clinicians' moral distress.

To measure moral distress among intensive care unit clinicians who commonly care for patients receiving mechanical circulatory support.

In this prospective study, the Moral Distress Scale-Revised was administered to physicians, nurses, and advanced practice providers from 2 intensive care units in an academic medical center. Linear regression was used to assess whether moral distress was associated with clinician type, burnout, or desire to leave one's job. Clinicians' likelihood of reporting frequent moral distress when caring for patients receiving mechanical circulatory support vs other critically ill patients also was assessed.

The sample comprised 102 clinicians who had a mean (SD) score of 100.5 (51.6) on the Moral Distress Scale- Revised. After adjustment for clinician characteristics, moral distress was significantly higher in registered nurses than physicians/advanced practice providers (115.9 vs 71.0, P < .001), clinicians reporting burnout vs those who did not (114.7 vs 83.1, P = .003), and those considering leaving vs those who were not (121.1 vs 89.2, P = .001). Clinicians were more likely to report experiencing frequent moral distress when caring for patients receiving mechanical circulatory support (26.5%) than when caring for patients needing routine care (10.8%; P = .004), but less likely than when caring for patients with either chronic critical illness (57.8%) or multisystem organ failure (56.9%; both P < .001).

Moral distress was high among clinicians who commonly care for patients receiving mechanical circulatory support, suggesting that use of this therapy may affect well-being among intensive care unit clinicians.

Moral distress was high among clinicians who commonly care for patients receiving mechanical circulatory support, suggesting that use of this therapy may affect well-being among intensive care unit clinicians.Pediatric traumatic brain injury (TBI) protocols vary widely among institutions, despite the existence of published guidelines. This study seeks to identify significant differences in management of pediatric TBI across several institutions. Severe pediatric TBI protocols were collected from major US pediatric hospitals through direct communication with trauma staff. Of 24 institutions identified and contacted, 10 did not respond and 5 did not have a pediatric TBI protocol. Pediatric TBI protocols were successfully collected from 9 institutions. These 9 protocols were separated into treatment tiers analogous to those in the 2019 Society of Critical Care Medicine and World Federation of Pediatric Intensive and Critical Care Societies guidelines, and the intervention variables were identified and compared across the 9 institutions. First-line therapies were similar between institutions, including seizure prophylaxis, maintenance of normoglycemia and normothermia, and avoidance of hypoxia, hyponatremia, and hypotension. However, significant variation across institutions was found regarding timing of cerebrospinal fluid drainage, hyperventilation, and neuromuscular blockade. When included in institutional protocols, most therapies are in line with the 2019 guidelines, except for diversion of cerebrospinal fluid, hyperventilation, maintenance of cerebral perfusion pressure, and use of neuromuscular blocking agents. Although these variations may represent differences in style or preference, the optimal timing of these specific treatment variations should be studied to determine the impact of each protocol on clinical outcomes.

Health care professionals working in intensive care units report a high degree of burnout, but this topic has not been extensively studied from an interdisciplinary perspective.

To characterize experiences of burnout among members of interprofessional intensive care unit teams and identify possible contributing factors.

This qualitative study involved interviews of registered nurses, respiratory therapists, physicians, pharmacists, and a personal care assistant working in multiple intensive care units of a single academic medical center to assess work stressors.

Team composition was a factor in burnout, particularly when nonphysician team members felt that their opinions were not valued despite the institution's emphasis on a multidisciplinary team-based model of care. This was especially true when roles were not well defined at the outset of a code situation. Members of nearly all disciplines stated that there was not enough time in a day to complete all the required tasks.

Multiple factors contribute to work-related stress and burnout across different professions in the intensive care unit. Improved communication and increased receptivity to diverse opinions among members of the multidisciplinary team may help reduce stress.

Multiple factors contribute to work-related stress and burnout across different professions in the intensive care unit. HDAC inhibitor Improved communication and increased receptivity to diverse opinions among members of the multidisciplinary team may help reduce stress.

The Glasgow Coma Scale was developed in 1974 as an injury severity score to assess and predict outcome after traumatic brain injury. The tool is now used to score depth of impaired consciousness in patients with and without traumatic brain injury. However, evidence supporting the use of the Glasgow Coma Scale in the latter group is limited.

To assess Glasgow Coma Scale score on hospital admission as a predictor of outcome in patients without traumatic brain injury.

This was a secondary analysis of prospectively collected data from 3507 patients admitted to 4 hospitals between October 2015 and October 2019. Patients with a primary diagnosis of traumatic brain injury were excluded from this study.

The mean age of the 3507 participants in the study was 57 years. Participants were primarily female (52%), White (77%), and non-Hispanic (89%). On admission, 90% of patients had a modified Rankin Scale score of 0 to 3 and 72% had a Glasgow Coma Scale score of 13 to 15 (mild injury). Generalized estimating equation modeling indicated that admission Glasgow Coma Scale score did not predict modified Rankin Scale score at discharge in patients not diagnosed with traumatic brain injury (Glasgow Coma Scale score <8 z = -7.89, P < .001; Glasgow Coma Scale score 8-12 z = -4.17, P < .001).

The Glasgow Coma Scale is not recommended for use in patients without traumatic brain injury; clinicians should use a more appropriate and validated clinical assessment instrument for this patient population.

The Glasgow Coma Scale is not recommended for use in patients without traumatic brain injury; clinicians should use a more appropriate and validated clinical assessment instrument for this patient population.Using high-energy photon beams is one of the most practical methods in radiotherapy treatment of cases in deep site located tumors. In such treatments, neutron contamination induced through photoneutron interaction of high energy photons (>8 MeV) with high Z materials of LINAC structures is the most crucial issue which should be considered. Generated neutrons will affect shielding calculations and cause extra doses to the patient and the probability of increase induced secondary cancer risks. In this study, different parameters of neutron production in radiotherapy processes will be reviewed.Homozygous mutations in the gene encoding the scavenger mRNA-decapping enzyme, DcpS, have been shown to underlie developmental delay and intellectual disability. Intellectual disability is associated with both abnormal neocortical development and mRNA metabolism. However, the role of DcpS and its scavenger decapping activity in neuronal development is unknown. Here, we show that human neurons derived from patients with a DcpS mutation have compromised differentiation and neurite outgrowth. Moreover, in the developing mouse neocortex, DcpS is required for the radial migration, polarity, neurite outgrowth, and identity of developing glutamatergic neurons. Collectively, these findings demonstrate that the scavenger mRNA decapping activity contributes to multiple pivotal roles in neural development and further corroborate that mRNA metabolism and neocortical pathologies are associated with intellectual disability.High-dimensional biological data collection across heterogeneous groups of samples has become increasingly common, creating high demand for dimensionality reduction techniques that capture underlying structure of the data. Discovering low-dimensional embeddings that describe the separation of any underlying discrete latent structure in data is an important motivation for applying these techniques since these latent classes can represent important sources of unwanted variability, such as batch effects, or interesting sources of signal such as unknown cell types. The features that define this discrete latent structure are often hard to identify in high-dimensional data. Principal component analysis (PCA) is one of the most widely used methods as an unsupervised step for dimensionality reduction. This reduction technique finds linear transformations of the data which explain total variance. When the goal is detecting discrete structure, PCA is applied with the assumption that classes will be separated in directia dimensionality reduction technique designed to mitigate these limitations. iDA produces an embedding that carries discriminatory information which optimally separates latent clusters using linear transformations that permit post hoc analysis to determine features that define these latent structures.In this work, consideration is given to an aerodynamic concept to boost the filtration in face masks of airborne hygroscopic particles such as those caused by an infected person when coughs or sneezes. Nowadays, increasing the filtration efficiency of face masks implies either increasing the number of crisscrossing fiber layers or decreasing the equivalent hydraulic diameter of the pore, however, both measures are in clear detriment of its breathability. Here, a novel strategy is proposed in which the filtration of an airborne particle is boosted by increasing its diameter. We called properly this concept as the aerodynamic barrier layer. In this concept, a traditional crisscrossing fiber layer is replaced by a parallel rearranged of the fibers in the direction of the flow. This rearrangement will promote central lift forces which will push the particles toward the center of the channel where after clustering they will coalesce resulting in a bigger particle that can be now easily captured by a conventional fiber crisscrossing layer. Utilizing a simplified geometrical model, an expression for the required length of the aerodynamic barrier layer was derived. It is shown that an aerodynamic barrier layer with a length of only a few millimeters can aerodynamically focus water droplets around 1 μm-diameter and the penetration of airborne particles can be reduced up to 55%.

We previously reported on COVID-19 vaccination intent among HCP before emergency use authorization. We found widespread hesitancy and a substantial proportion of HCP did not intend to vaccinate.

We conducted a cross-sectional survey of HCP, including clinical and non-clinical staff, researchers, and trainees between February 21 and March 19, 2021. The survey evaluated vaccine attitudes, beliefs, intent and acceptance.

Overall, 3,981 (87.7%) of respondents had already received a COVID-19 vaccine or planned to get vaccinated. There were significant differences in vaccine acceptance by gender, age, race, and hospital role. Males (93.7%) were more likely than females (89.8%) to report vaccine acceptance (p<0.001). Mean age was higher among those reporting vaccine acceptance (p<0.001). Physicians and scientists showed the highest acceptance rate (97.3%), while staff in ancillary services showed the lowest acceptance rate (79.9%). Unvaccinated respondents were more likely to be females, to have refused vaccines in the past due to reasons other than illness or allergy, to care for COVID-19 patients, or to rely on themselves when making vaccination decision.