The Use of High-Fidelity Simulation in Training Nurses on the Delivery of Targeted Temperature Management After Cardiac Arrest

The delivery of targeted temperature management (TTM) is recommended for cardiac arrest patients with specific initial rhythms after the return of spontaneous circulation. Some hospitals have established institutional TTM protocols based on national guidelines. Yet, successful implementation of an institutional TTM protocol depends on the nurses’ knowledge and skills. The study’s purpose was to compare the level of post-training knowledge, psychomotor skills, confidence and satisfaction among nurses taught the delivery of TTM with video lecture versus high fidelity simulation. The effectiveness of the two different training programs was compared with multiple choice and psychomotor skills testing prior to, immediately after, and 6 weeks after training. Confidence and satisfaction were assessed using a questionnaire immediately after training and 6 weeks later. Mixed effects model and independent t-tests were used to investigate the study aims. The results from the mixed effects model, repeated measures analysis of variance, simple regressions and paired t-tests were all consistent. Fifty-two nurses were recruited; all completed baseline and immediate post-intervention testing, while 48/52 (92.3%) completed follow-up evaluation at 6 weeks. The knowledge test scores did not differ between the groups immediately after the training (beta = 3.80, SE = 3.47, p = .27), but there was a strong trend 6 weeks after training, with higher scores in the simulation group (beta = 7.93, SE = 3.88, p = .04). In the simulation group, skills were significantly better immediately after the training, however, there was no significant difference between the groups 6 weeks later. No difference in confidence was found between the groups at either post-test point. Training satisfaction was significantly higher in the simulation group at both post-testing points. Nurses trained with high-fidelity simulation may benefit from such training by maintaining their TTM knowledge longer. Frequent “booster” sessions may help to maintain their competency in the use of cooling equipment. Further research should focus on the assessment of the effect of different TTM education interventions on the transfer of the knowledge/skills to bedside and subsequent patient outcomes

Stabilization of Pancake Bonding in (TCNQ)₂.⁻ Dimers in the Radical‐Anionic Salt (N−CH₃−2‐NH₂−5Cl−Py)(TCNQ)(CH₃CN) Solvate and Antiferromagnetism Induction

We report a new antiferromagnetic radical‐anion salt (RAS) formed from 7,7,8,8‐tetracyanquinonedimethane (TCNQ) anion and 2‐amino‐5‐chloro‐pyridine cation with the composition of (N−CH3−2‐NH2−5Cl−Py)(TCNQ)(CH3CN). The crystallographic data indicates the formation of (TCNQ)2.− radical‐anion π‐dimers in the synthesized RAS. Unrestricted density functional theory calculations show that the formed π‐dimers characterize with strong π‐stacking “pancake” interactions, resulting in high electronic coupling, enabling efficient charge transfer properties, but π‐dimers cannot be stable in the isolated conditions as a result of strong Coulomb repulsions. In a crystal, where (TCNQ)2.− π‐dimers bound in the endless chainlets via supramolecular bonds with (N−CH3−2‐NH2−5‐Cl−Py)+ cations, the repulsion forces are screened, allowing for specific parallel π‐stacking interactions and stable radical‐anion dimers formation. Measurements of magnetic susceptibility and magnetization confirm antiferromagnetic properties of RAS, what is in line with the higher stability of ground singlet state of the radical‐anion pair, calculated by means of the DFT. Therefore, the reported radical‐anion (N−CH3−2‐NH2−5Cl−Py)(TCNQ)(CH3CN) solvate has promising applications in novel magnetics with supramolecular structures

In-plane orientation effects on the electronic structure, stability and Raman scattering of monolayer graphene on Ir(111)

We employ angle-resolved photoemission spectroscopy (ARPES) to investigate the electronic structures of two rotational variants of epitaxial, single-layer graphene on Ir(111). As grown, the more-abundant R0 variant is nearly charge-neutral, with strong hybridization between graphene and Ir bands near the Fermi level. The graphene Fermi surface and its replicas exactly coincide with Van Hove singularities in the Ir Fermi surface. Sublattice symmetry breaking introduces a small gap-inducing potential at the Dirac crossing, which is revealed by n-doping the graphene using K atoms. The energy gaps between main and replica bands (originating from the moir\'e interference pattern between graphene and Ir lattices) is shown to be non-uniform along the mini- zone boundary due to hybridization with Ir bands. An electronically mediated interaction is proposed to account for the stability of the R0 variant. The variant rotated 30{\deg} in-plane, R30, is p-doped as grown and K doping reveals no band gap at the Dirac crossing. No replica bands are found in ARPES measurements. Raman spectra from the R30 variant exhibit the characteristic phonon modes of graphene, while R0 spectra are featureless. These results show that the film/substrate interaction changes from chemisorption (R0) to physisorption (R30) with in-plane orientation. Finally, graphene-covered Ir has a work function lower than the clean substrate but higher than graphite.Comment: Manuscript plus 7 figure