Effectiveness of radiation protection systems in the cardiac catheterization laboratory: a comparative study

BACKGROUND As numbers and complexity of percutaneous coronary interventions are constantly increasing, optimal radiation protection is required to ensure operator safety. Suspended radiation protection systems (SRPS) and protective scatter-radiation absorbing drapes (PAD) are novel methods to mitigate fluoroscopic scattered radiation exposure. The aim of the study was to investigate the effectiveness regarding radiation protection of a SRPS and a PAD in comparison with conventional protection. METHODS A total of 229 cardiac catheterization procedures with SRPS (N = 73), PAD (N = 82) and standard radiation protection (N = 74) were prospectively included. Real-time dosimeter data were collected from the first operator and the assistant. Endpoints were the cumulative operator exposure relative to the dose area product [standardized operator exposure (SOE)] for the first operator and the assistant. RESULTS For the first operator, the SRPS and the PAD significantly decreased the overall SOE compared to conventional shielding by 93.9% and 66.4%, respectively (P < 0.001). The protective effect of the SRPS was significantly higher compared to the PAD (P < 0.001). For the assistant, the SRPS and the PAD provided a not statistically significant reduction compared to conventional shielding in the overall SOE by 38.0% and 30.6%, respectively. CONCLUSIONS The SRPS and the PAD enhance radiation protection significantly compared to conventional protection. In most clinical scenarios, the protective effect of SRPS is significantly higher than the additional protection provided by the PAD. Comparison of the additional radiation protection provided by protective scatter-radiation absorbing drapes (PAD) and the suspended radiation protection system (SRPS) system over standard protection with lead aprons

Salve Regina University Act on Climate: Strategic Plan for the University to Reach State Carbon Neutrality Goals

In order to become more sustainable and meet the mandate set by the 2021 Rhode Island Act on Climate law (RI General Law §42-6.2), Salve Regina University must work to reach net-zero greenhouse gas emissions by the year 2050. Action to meet these standards begins now and must be continually built upon to ensure that Salve Regina University, as leader in Rhode Island, is always working for a more sustainable future. Throughout the Spring 2022 semester, students of the BIO-140: Humans and Their Environment course instructed by Dr. Jameson Chace have researched ways in which Salve Regina can begin on the path to zero greenhouse gas emissions today. By focusing on change in the areas of energy, transportation, food, financial investments, and sequestration, Salve Regina can reduce the greenhouse gas emissions of today for a more sustainable tomorrow. Recommendations are broken into three time periods. Action for today to achieve by 2030 include improving energy efficiency, installing the first electric vehicle (EV) parking/charging stations, increasing carbon sequestration, reducing beef in the campus diet, and assessing the carbon impact of university financial holdings. Actions to be initiated soon and to be achieved by 2040 include shifting away from natural gas heating when system renewals take place, increasing EV parking to meet rising demand, during turnover replace current university vehicles with electric or hybrid, continuing with sequestration efforts on campus, begin phasing out high carbon diet items, and by 2040 the university investment portfolio should be carbon neutral. If carbon neutrality can be reached by 2050 the most challenging aspects of campus life that need to change will require planning now and thoughtful implementation. The class in 2022 envisions a campus in 2050 where solar lights illuminate campus and buildings through the night, all university vehicles and most faculty and staff vehicles are electric and are found charging during the day at solar powered charging stations, dining services in Miley supports community agriculture and includes incentives for meatless and low carbon meal plans, the university has become a leader in low carbon/green market investing demonstrating how careful planning can reap high returns, and carbon sequestration on campus grounds has maximized such that off campus carbon offsets are established with local land trusts to complete the carbon neutrality goals. In doing so no only will the university be recognized as a state-wide leader in climate action, but will also be a global leader in working towards a world that is more harmonious, just, and merciful.https://digitalcommons.salve.edu/bio140_arboretum/1033/thumbnail.jp

Implementation of a Virtual Interprofessional ICU Learning Collaborative: Successes, Challenges, and Initial Reactions From the Structured Team- Based Optimal Patient-Centered Care for Virus COVID-19 Collaborators

IMPORTANCE: Initial Society of Critical Care Medicine Discovery Viral Infection and Respiratory illness Universal Study (VIRUS) Registry analysis suggested that improvements in critical care processes offered the greatest modifiable opportunity to improve critically ill COVID-19 patient outcomes. OBJECTIVES: The Structured Team-based Optimal Patient-Centered Care for Virus COVID-19 ICU Collaborative was created to identify and speed implementation of best evidence based COVID-19 practices. DESIGN, SETTING, AND PARTICIPANTS: This 6-month project included volunteer interprofessional teams from VIRUS Registry sites, who received online training on the Checklist for Early Recognition and Treatment of Acute Illness and iNjury approach, a structured and systematic method for delivering evidence based critical care. Collaborators participated in weekly 1-hour videoconference sessions on high impact topics, monthly quality improvement (QI) coaching sessions, and received extensive additional resources for asynchronous learning. MAIN OUTCOMES AND MEASURES: Outcomes included learner engagement, satisfaction, and number of QI projects initiated by participating teams. RESULTS: Eleven of 13 initial sites participated in the Collaborative from March 2, 2021, to September 29, 2021. A total of 67 learners participated in the Collaborative, including 23 nurses, 22 physicians, 10 pharmacists, nine respiratory therapists, and three nonclinicians. Site attendance among the 11 sites in the 25 videoconference sessions ranged between 82% and 100%, with three sites providing at least one team member for 100% of sessions. The majority reported that topics matched their scope of practice (69%) and would highly recommend the program to colleagues (77%). A total of nine QI projects were initiated across three clinical domains and focused on improving adherence to established critical care practice bundles, reducing nosocomial complications, and strengthening patient- and family-centered care in the ICU. Major factors impacting successful Collaborative engagement included an engaged interprofessional team; an established culture of engagement; opportunities to benchmark performance and accelerate institutional innovation, networking, and acclaim; and ready access to data that could be leveraged for QI purposes. CONCLUSIONS AND RELEVANCE: Use of a virtual platform to establish a learning collaborative to accelerate the identification, dissemination, and implementation of critical care best practices for COVID-19 is feasible. Our experience offers important lessons for future collaborative efforts focused on improving ICU processes of care

Racemic and Meso Crystal Structures of an Axial-Chiral Spirobi-(dinaphthoazepin)ium Salt: Emergence of an S4-Symmetric Molecule

To date, only a few instances of S4-symmetric organic molecules exist. In principle, spirobi-(dinaphthoazepin)ium cations can achieve this highly symmetric point group. Heating racemic 2,2′-bis(bromomethyl)-1,1′binaphthyl with aqueous ammonia afforded a mixture of rac- and meso-3,3′,5,5′-tetrahydro-4,4′-spirobi[dinaphtho[2,1-c:1′,2′-e]azepin]-4-ium bromide which was separated by fractional crystallisation. Both stereoisomers were characterised spectroscopically, and their crystal structures were determined and compared. The rac crystal structure differs significantly from the known enantiopure one. The meso molecules display a near-perfect S4 symmetry. Upon treatment with KOtBu, both isomers undergo Stevens rearrangement

Reliability and Validity of the Checklist for Early Recognition and Treatment of Acute Illness and Injury as a Charting Tool in the Medical Intensive Care Unit.

BACKGROUND: Resuscitation of critically ill patients is complex and potentially prone to diagnostic errors and therapeutic harm. The Checklist for early recognition and treatment of acute illness and injury (CERTAIN) is an electronic tool that aims to provide decision-support, charting, and prompting for standardization. This study sought to evaluate the validity and reliability of CERTAIN in a real-time Intensive Care Unit (ICU). MATERIALS AND METHODS: This was a prospective pilot study in the medical ICU of a tertiary care medical center. A total of thirty patient encounters over 2 months period were charted independently by two CERTAIN investigators. The inter-observer recordings and comparison to the electronic medical records (EMR) were used to evaluate reliability and validity, respectively. The primary outcome was reliability and validity measured using Cohen\u27s Kappa statistic. Secondary outcomes included time to completion, user satisfaction, and learning curve. RESULTS: A total of 30 patients with a median age of 59 (42-78) years and median acute physiology and chronic health evaluation III score of 38 (23-50) were included in this study. Inter-observer agreement was very good (κ = 0.79) in this study and agreement between CERTAIN and the EMR was good (κ = 0.5). CERTAIN charting was completed in real-time that was 121 (92-150) min before completion of EMR charting. The subjective learning curve was 3.5 patients without differences in providers with different levels of training. CONCLUSIONS: CERTAIN provides a reliable and valid method to evaluate resuscitation events in real time. CERTAIN provided the ability to complete data in real-time

Rapid, multimodal, critical care knowledge-sharing platform for COVID-19 pandemics

In many areas of the world, critical care providers caring for COVID-19 patients lacked specific knowledge and were exposed to the abundance of new and unfiltered information. With support from the World Health Organization, we created a multimodal tele-education intervention to rapidly share critical care knowledge related to COVID-19 targeting providers in a region of Southeastern Europe. We delivered 60-minute weekly interactive tele-education sessions over YouTube TM between March and May 2020, supplemented by a dedicated webpage. The intervention was reinforced using a secure social media platform (Viber TM) providing continuous rapid knowledge exchange among faculty and learners. A high level of engagement was observed with over 2,000 clinicians participating and actively interacting over a six-week period. Surveyed participants were highly satisfied with the intervention. Tele-education interventions using social media platforms are feasible, low-cost, and effective methods to share knowledge during the COVID-19 pandemic

Data_Sheet_1_Development and usability testing of a patient digital twin for critical care education: a mixed methods study.DOCX

BackgroundDigital twins are computerized patient replicas that allow clinical interventions testing in silico to minimize preventable patient harm. Our group has developed a novel application software utilizing a digital twin patient model based on electronic health record (EHR) variables to simulate clinical trajectories during the initial 6 h of critical illness. This study aimed to assess the usability, workload, and acceptance of the digital twin application as an educational tool in critical care.MethodsA mixed methods study was conducted during seven user testing sessions of the digital twin application with thirty-five first-year internal medicine residents. Qualitative data were collected using a think-aloud and semi-structured interview format, while quantitative measurements included the System Usability Scale (SUS), NASA Task Load Index (NASA-TLX), and a short survey.ResultsMedian SUS scores and NASA-TLX were 70 (IQR 62.5–82.5) and 29.2 (IQR 22.5–34.2), consistent with good software usability and low to moderate workload, respectively. Residents expressed interest in using the digital twin application for ICU rotations and identified five themes for software improvement: clinical fidelity, interface organization, learning experience, serious gaming, and implementation strategies.ConclusionA digital twin application based on EHR clinical variables showed good usability and high acceptance for critical care education.</p