Wellness and coping of physicians who worked in ICUs during the pandemic: A multicenter cross-sectional North American survey

OBJECTIVES: Few surveys have focused on physician moral distress, burnout, and professional fulfilment. We assessed physician wellness and coping during the COVID-19 pandemic. DESIGN: Cross-sectional survey using four validated instruments. SETTING: Sixty-two sites in Canada and the United States. SUBJECTS: Attending physicians (adult, pediatric; intensivist, nonintensivist) who worked in North American ICUs. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: We analysed 431 questionnaires (43.3% response rate) from 25 states and eight provinces. Respondents were predominantly male (229 [55.6%]) and in practice for 11.8 ± 9.8 years. Compared with prepandemic, respondents reported significant intrapandemic increases in days worked/mo, ICU bed occupancy, and self-reported moral distress (240 [56.9%]) and burnout (259 [63.8%]). Of the 10 top-ranked items that incited moral distress, most pertained to regulatory/organizational ( n = 6) or local/institutional ( n = 2) issues or both ( n = 2). Average moral distress (95.6 ± 66.9), professional fulfilment (6.5 ± 2.1), and burnout scores (3.6 ± 2.0) were moderate with 227 physicians (54.6%) meeting burnout criteria. A significant dose-response existed between COVID-19 patient volume and moral distress scores. Physicians who worked more days/mo and more scheduled in-house nightshifts, especially combined with more unscheduled in-house nightshifts, experienced significantly more moral distress. One in five physicians used at least one maladaptive coping strategy. We identified four coping profiles (active/social, avoidant, mixed/ambivalent, infrequent) that were associated with significant differences across all wellness measures. CONCLUSIONS: Despite moderate intrapandemic moral distress and burnout, physicians experienced moderate professional fulfilment. However, one in five physicians used at least one maladaptive coping strategy. We highlight potentially modifiable factors at individual, institutional, and regulatory levels to enhance physician wellness

Analyzing the Impacts of Natural Environments on Launch and Landing Availability for NASA's Eploration Systems Development Programs

NASA is developing new capabilities for human and scientific exploration beyond Earth orbit. Natural environments information is an important asset for NASA's development of the next generation space transportation system as part of the Exploration Systems Development Program, which includes the Space Launch System (SLS) and MultiPurpose Crew Vehicle (MPCV) Programs. Natural terrestrial environment conditions - such as wind, lightning and sea states - can affect vehicle safety and performance during multiple mission phases ranging from prelaunch ground processing to landing and recovery operations, including all potential abort scenarios. Space vehicles are particularly sensitive to these environments during the launch/ascent and the entry/landing phases of mission operations. The Marshall Space Flight Center (MSFC) Natural Environments Branch provides engineering design support for NASA space vehicle projects and programs by providing design engineers and mission planners with natural environments definitions as well as performing custom analyses to help characterize the impacts the natural environment may have on vehicle performance. One such analysis involves assessing the impact of natural environments to operational availability. Climatological time series of operational surface weather observations are used to calculate probabilities of meeting or exceeding various sets of hypothetical vehicle-specific parametric constraint thresholds

Analyzing the Impacts of Natural Environments on Launch and Landing Availability for NASA's Exploration Systems Development Programs

The National Aeronautics and Space Administration (NASA) is developing new capabilities for human and scientific exploration beyond Earth orbit. Natural environments information is an important asset for NASA's development of the next generation space transportation system as part of the Exploration Systems Development (ESD) Programs, which includes the Space Launch System (SLS) and Multi-Purpose Crew Vehicle (MPCV) Programs. Natural terrestrial environment conditions - such as wind, lightning and sea states - can affect vehicle safety and performance during multiple mission phases ranging from pre-launch ground processing to landing and recovery operations, including all potential abort scenarios. Space vehicles are particularly sensitive to these environments during the launch/ascent and the entry/landing phases of mission operations. The Marshall Space Flight Center (MSFC) Natural Environments Branch provides engineering design support for NASA space vehicle projects and programs by providing design engineers and mission planners with natural environments definitions as well as performing custom analyses to help characterize the impacts the natural environment may have on vehicle performance. One such analysis involves assessing the impact of natural environments to operational availability. Climatological time series of operational surface weather observations are used to calculate probabilities of meeting/exceeding various sets of hypothetical vehicle-specific parametric constraint thresholds. Outputs are tabulated by month and hour of day to show both seasonal and diurnal variation. This paper will discuss how climate analyses are performed by the MSFC Natural Environments Branch to support the ESD Launch Availability (LA) Technical Performance Measure (TPM), the SLS Launch Availability due to Natural Environments TPM, and several MPCV (Orion) launch and landing availability analyses - including the 2014 Orion Exploration Flight Test 1 (EFT-1) mission

Pressure and Volume Limited Ventilation for the Ventilatory Management of Patients with Acute Lung Injury: A Systematic Review and Meta-Analysis

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are life threatening clinical conditions seen in critically ill patients with diverse underlying illnesses. Lung injury may be perpetuated by ventilation strategies that do not limit lung volumes and airway pressures. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing pressure and volume-limited (PVL) ventilation strategies with more traditional mechanical ventilation in adults with ALI and ARDS.We searched Medline, EMBASE, HEALTHSTAR and CENTRAL, related articles on PubMed™, conference proceedings and bibliographies of identified articles for randomized trials comparing PVL ventilation with traditional approaches to ventilation in critically ill adults with ALI and ARDS. Two reviewers independently selected trials, assessed trial quality, and abstracted data. We identified ten trials (n = 1,749) meeting study inclusion criteria. Tidal volumes achieved in control groups were at the lower end of the traditional range of 10-15 mL/kg. We found a clinically important but borderline statistically significant reduction in hospital mortality with PVL [relative risk (RR) 0.84; 95% CI 0.70, 1.00; p = 0.05]. This reduction in risk was attenuated (RR 0.90; 95% CI 0.74, 1.09, p = 0.27) in a sensitivity analysis which excluded 2 trials that combined PVL with open-lung strategies and stopped early for benefit. We found no effect of PVL on barotrauma; however, use of paralytic agents increased significantly with PVL (RR 1.37; 95% CI, 1.04, 1.82; p = 0.03).This systematic review suggests that PVL strategies for mechanical ventilation in ALI and ARDS reduce mortality and are associated with increased use of paralytic agents

Comparisons Between NO PLIF Imaging and CFD Simulations of Mixing Flowfields for High-Speed Fuel Injectors

The current work compares experimentally and computationally obtained nitric oxide (NO) planar laser-induced fluorescence (PLIF) images of the mixing flowfields for three types of high-speed fuel injectors: a strut, a ramp, and a rectangular flush-wall. These injection devices, which exhibited promising mixing performance at lower flight Mach numbers, are currently being studied as a part of the Enhanced Injection and Mixing Project (EIMP) at the NASA Langley Research Center. The EIMP aims to investigate scramjet fuel injection and mixing physics, and improve the understanding of underlying physical processes relevant to flight Mach numbers greater than eight. In the experiments, conducted in the NASA Langley Arc-Heated Scramjet Test Facility (AHSTF), the injectors are placed downstream of a Mach 6 facility nozzle, which simulates the high Mach number air flow at the entrance of a scramjet combustor. Helium is used as an inert substitute for hydrogen fuel. The PLIF is obtained by using a tunable laser to excite the NO, which is present in the AHSTF air as a direct result of arc-heating. Consequently, the absence of signal is an indication of pure helium (fuel). The PLIF images computed from the computational fluid dynamics (CFD) simulations are obtained by combining a fluorescence model for NO with the Reynolds-Averaged Simulation results carried out using the VULCAN-CFD solver to obtain a computational equivalent of the experimentally measured PLIF signal. The measured NO PLIF signal is mainly a function of NO concentration allowing for semi-quantitative comparisons between the CFD and the experiments. The PLIF signal intensity is also sensitive to pressure and temperature variations in the flow, allowing additional flow features to be identified and compared with the CFD. Good agreement between the PLIF and the CFD results provides increased confidence in the CFD simulations for investigations of injector performance

Learning hand in hand: Engaging in research-practice partnerships to advance developmental science.

Developmental science research often involves research questions developed by academic teams, which are tested within community or educational settings. In this piece, we outline the importance of research-practice partnerships, which involve both research and practice-based partners collaborating at each stage of the research process. We articulate challenges and benefits of these partnerships for developmental science research, identify relevant research frameworks that may inform these partnerships, and provide an example of an ongoing research-practice partnership

Francisella tularensis Transmission by Solid Organ Transplantation, 20171.

In July 2017, fever and sepsis developed in 3 recipients of solid organs (1 heart and 2 kidneys) from a common donor in the United States; 1 of the kidney recipients died. Tularemia was suspected only after blood cultures from the surviving kidney recipient grew Francisella species. The organ donor, a middle-aged man from the southwestern United States, had been hospitalized for acute alcohol withdrawal syndrome, pneumonia, and multiorgan failure. F. tularensis subsp. tularensis (clade A2) was cultured from archived spleen tissue from the donor and blood from both kidney recipients. Whole-genome multilocus sequence typing indicated that the isolated strains were indistinguishable. The heart recipient remained seronegative with negative blood cultures but had been receiving antimicrobial drugs for a medical device infection before transplant. Two lagomorph carcasses collected near the donor's residence were positive by PCR for F. tularensis subsp. tularensis (clade A2). This investigation documents F. tularensis transmission by solid organ transplantation

Multicentre pilot randomised clinical trial of early in-bed cycle ergometry with ventilated patients.

Introduction: Acute rehabilitation in critically ill patients can improve post-intensive care unit (post-ICU) physical function. In-bed cycling early in a patient\u27s ICU stay is a promising intervention. The objective of this study was to determine the feasibility of recruitment, intervention delivery and retention in a multi centre randomised clinical trial (RCT) of early in-bed cycling with mechanically ventilated (MV) patients. Methods: We conducted a pilot RCT conducted in seven Canadian medical-surgical ICUs. We enrolled adults who could ambulate independently before ICU admission, within the first 4 days of invasive MV and first 7 days of ICU admission. Following informed consent, patients underwent concealed randomisation to either 30 min/day of in-bed cycling and routine physiotherapy (Cycling) or routine physiotherapy alone (Routine) for 5 days/week, until ICU discharge. Our feasibility outcome targets included: accrual of 1-2 patients/month/site; \u3e80% cycling protocol delivery; \u3e80% outcomes measured and \u3e80% blinded outcome measures at hospital discharge. We report ascertainment rates for our primary outcome for the main trial (Physical Function ICU Test-scored (PFIT-s) at hospital discharge). Results: Between 3/2015 and 6/2016, we randomised 66 patients (36 Cycling, 30 Routine). Our consent rate was 84.6 % (66/78). Patient accrual was (mean (SD)) 1.1 (0.3) patients/month/site. Cycling occurred in 79.3% (146/184) of eligible sessions, with a median (IQR) session duration of 30.5 (30.0, 30.7) min. We recorded 43 (97.7%) PFIT-s scores at hospital discharge and 37 (86.0%) of these assessments were blinded. Discussion: Our pilot RCT suggests that a future multicentre RCT of early in-bed cycling for MV patients in the ICU is feasible. Trial registration number: NCT02377830