Nurses' Perceptions of Intensive Care Unit Orientation Patient Education Pamphlet.

Background: Critical illness is a stressful time for patients and their support networks. Although patient-directed educational material to improve the understanding of critical illness exists, both patients and staff members are often unaware of these resources or how to find them. Objectives: We aimed to evaluate the impact of the implementation of the American Thoracic Society's (ATS) "Managing the Intensive Care Unity (ICU) Experience: A Proactive Guide for Patients and Families", an ICU orientation pamphlet, on nurses' perceptions of the availability and effectiveness of patient and family educational resources. Methods: In a safety-net urban institution, we surveyed medical ICU (MICU) nurses in February 2021 regarding their perceptions of the availability of patient and family educational materials and the time and quality of communication with families of critically ill patients. We then introduced the MICU nurses to the ATS ICU orientation pamphlet to complement patient and family education. Quick response (QR) codes were created, linking to the online versions of the ICU pamphlet, and made available in waiting rooms. Printed copies of the pamphlet were provided to families in the ICU introductory packet upon patient MICU admission. We informed nurses regarding the pamphlet content, website, and QR codes. A postintervention survey was administered 11 months after the initial survey. Changes between pre and postintervention responses were analyzed for significant differences. Debriefing sessions with the MICU nurses were conducted, and subsequent discussions identified opportunities to improve the available educational resources. Results: At baseline, 28 of 67 (42%) MICU nurses responded to the survey. Although all nurses provided verbal education to patients and families, only 18% reported knowing about and using additional resources to supplement this education. The postintervention survey was completed by 39% of nurses; 39% of them reported using additional materials to supplement patient and family education. Reported awareness of the ATS ICU pamphlet increased from 4% before implementation to 23% after implementation (P = 0.04). MICU nurses offered suggestions to improve the pamphlet, which thematically fell into three categories: 1) opportunities to alter the ICU pamphlet, 2) opportunities to provide the pamphlet in varied formats, and 3) opportunities to add additional education topics. Conclusions: Informing nurses about the ICU pamphlet improved the acceptance and use of the materials, but it was still not accepted by many nurses. Barriers to ICU nurses using patient education resources should be explored to facilitate quality materials reaching patients and complementing patient communication. QR codes may have offered a way to disseminate educational materials to patients and families in a manner not previously considered. The process of evaluating the ICU pamphlet for our institution led to a broader discussion of additional needs for patient and family educational materials for our patient population. We encourage institutions to evaluate the sufficiency of their patient and family educational materials for similar local benefits.

Modeling Ecological Constraints on a CO2 Pipeline Network.

Carbon capture, utilization, and storage (CCUS) are a critical set of strategies to decarbonize the industrial and power sectors and to mitigate global climate change. Pipeline infrastructure connecting CO2 sources and sinks, if not planned strategically, can cause environmental and social impacts by disturbing local landscapes. We investigated the impacts of these considerations on optimal CO2 pipeline routing and sink locations by modifying and leveraging an open-source CCUS infrastructure model, SimCCS. We expanded SimCCS from a cost-minimizing to a multiobjective framework, explicitly incorporating environmental protection objectives. We estimated trade-offs between private costs and environmental and social impacts. Using a version of the model focused on the southeastern United States, we modeled seven scenarios with varying weights given to environmental impacts to evaluate how the pipeline network responds to the multiobjective optimization. We found that the optimal path is sensitive to environmental and social impact considerations in that a small increase in pipeline length (and cost) significantly avoids large environmental and social impacts. We hope such a tool can be used to improve the pipeline permitting and siting processes and contribute to the achievement of decarbonization goals with minimal environmental impacts.

Year two of virtual interviews: longitudinal changes and diverse perspectives.

BACKGROUND: The coronavirus disease (COVID-19) pandemic brought the virtual interview (VI) format to graduate medical education (GME) and the trainee recruitment process. It is unclear if applicants' VI experience is consistent across all demographic groups. Our group collected 2 years of survey data to assess longitudinal changes in applicants' attitudes towards the VI format. In addition, demographic data were collected, and analyses were performed to identify if between-group differences were present amongst a diverse applicant population. METHODS: We distributed an anonymous electronic survey to applicants to the pulmonary disease and critical care medicine fellowship programs at Case Western Reserve University/University Hospitals Cleveland Medical Center and MetroHealth Medical Center for the 2021 and 2022 appointment years. RESULTS: We received 112 responses (20% response rate) for our surveys. Although there was an overall stability of responses between the first 2 years, there were significant gender differences with applicants identifying as female more likely to recommend VI as a future model. Similarly, there were a significant difference in factor importance based on underrepresented minority (URM) status with applicants identifying as URM placing more emphasis on programs' social media presence. CONCLUSIONS: There were no significant change in the responses of applicants between the first 2 years of VI. However, subset analyses revealed multiple significant findings. These differences have implications for future iterations of the VI format.

Virtual Interviews: Challenges and Opportunities for Pulmonary Disease and Critical Care Medicine Fellowship Programs.

The coronavirus disease (COVID-19) pandemic brought profound change to the medical education system, and residency and fellowship recruitment was not spared. Many of the activities required for recruitment of new fellows (e.g., airline travel and face-to-face meetings) were not able to be safely done. The rapid shift to all-virtual interviewing brought logistical challenges but, as the season concluded, called into question the value and validity of prior protocols. Our institutions (University Hospitals Cleveland Medical Center and MetroHealth Medical Center in Cleveland, Ohio) designed surveys to collect both applicants' and interviewers' perspectives on the virtual interview process for the 2020-2021 recruitment season to identify the challenges virtual interviews may bring to the current paradigm and what that may mean for the value of the traditional in-person model. Our results show that the absence of certain aspects of in-person interviews (e.g., travel costs and time required off-service) were welcome changes to both applicants and interviewers. However, there were new challenges identified, such as lack of formal training for virtual interviews and a shift in applicants' attention to fellowship program websites. We discuss how these observations could inform best practices for programs and applicants in the future.

Cellular defibrillation: interaction of micro-scale electric fields with voltage-gated ion channels.

We study the effect of micro-scale electric fields on voltage-gated ion channels in mammalian cell membranes. Such micro- and nano-scale electric fields mimic the effects of multiferroic nanoparticles that were recently proposed [1] as a novel way of controlling the function of voltage-sensing biomolecules such as ion channels. This article describes experimental procedures and initial results that reveal the effect of the electric field, in close proximity of cells, on the ion transport through voltage-gated ion channels. We present two configurations of the whole-cell patch-clamping apparatus that were used to detect the effect of external stimulation on ionic currents and discuss preliminary results that indicate modulation of the ionic currents consistent with the applied stimulus.