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June 19, 2014

Concise Critical Appraisal

Benefits of the ABCDE Bundle in ICU Patients
Red Blood Cell Transfusion and Associated Outcomes
Nitric Oxide Synthase: Key Factor for Vascular Dysfunction in Sepsis

Education

No Cost, Online CME Activities from the 43rd Critical Care Congress
On-Site Registration: 2014 Adult and Pediatric Board Review Courses
On-Site Registration: Advanced Critical Care Ultrasound
Upcoming Webcasts on Corticosteroids and Pet and Music Therapy
Webcast: Palliative Sedation in the ICU
Webcast: Collaborating with Families to Improve Patient Care and Transitions
Educational Series to Discuss Advanced Practice Providers in the ICU

SCCM News

Help Further the Mission of Project Dispatch
New CDC Website Features Surviving Sepsis Campaign
New Surviving Sepsis Campaign Facebook Page
Proposal Will Assign New Designated Seats to Two SCCM Specialty Sections
New Award Recognizes Excellence in Pediatric Critical Care Medicine
ASHP Foundation Seeking Applicants for Critical Care Traineeship
Sandra Swoboda Wins Nursing Excellence Award
Red Blood Cell Transfusion and Associated Outcomes

Many studies have detailed increasing risks of morbidity and mortality associated with anemia in critically ill patients.  Despite these findings, transfusion of red blood cells (RBCs) to optimize oxygen delivery has been shown to carry its own inherent risks, ranging from the development of acute lung injury to immunomodulation to problems with the storage lesion and oxygen delivery. A study by Hassan et al adds to the mounting evidence regarding the deleterious effects of RBC transfusion by retrospectively looking at the impact of transfusion on pediatric trauma patients. The authors compared the outcomes of 81 children with trauma who were transfused with RBCs to 282 who did not receive any blood products.

They found that transfusion of packed RBCs is associated with higher risk of adverse outcomes independent of injury severity. Due to its retrospective nature, this study does not provide any new evidence proving that transfusion of RBCs can be harmful to critically ill patients, but it adds to the evidence of the effects in pediatric trauma patients.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

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Benefits of the ABCDE Bundle in ICU Patients

The Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility (ABCDE) bundle has been proposed as a strategy to reduce delirium, liberate patients from the ventilator and improve outcomes for intensive care unit (ICU) patients. Balas and colleagues conducted a prospective before-after study at a tertiary medical center to determine the safety and impact of the ABCDE bundle implementation for ICU patients.

They found that critically ill patients managed with the ABCDE bundle spent more days breathing without assistance and experienced less delirium than patients treated with usual care. Some of the limitations of this study are the small sample size and the inclusion of nonventilated and oncology/hematology patients. Although the patient population was small, it represented a heterogeneous population, with more than 40% of patients having had surgery.  Ultimately, multicomponent ventilator liberation and “animation” strategies such as the ABCDE bundle are likely to become an integral component of ICU care if the safety and effectiveness demonstrated in this study can be reproduced.

To learn more about reducing delirium and improving care for ICU patients, visit www.iculiberation.org.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

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On-Site Registration: 2014 Adult and Pediatric Board Review Courses

Join your colleagues August 12 to 16, 2014, in Chicago, Illinois, USA, for the Society of Critical Care Medicine’s (SCCM) Adult and Pediatric Multiprofessional Critical Care Board Review Courses (MCCBRC).

MCCBRC is the premier source for any critical care professional seeking the most comprehensive review in the diagnosis, monitoring and management of critically ill patients. Led by internationally recognized faculty, Adult and Pediatric MCCBRC each offer 4.5 days of expert guidance on the core areas of critical care medicine. Whether you need to certify, recertify or simply review, MCCBRC provides an excellent update and thorough overview of the field.

Registration will be accepted on site at the Fairmont Chicago, Millennium Park. An SCCM staff member will be available to assist you at the registration desk.

Adult MCCBRC
The SCCM registration desk will be open during the following hours in the Imperial Ballroom Foyer:

Monday, August 11            4:00 p.m. – 7:00 p.m.
Tuesday, August 12            6:45 a.m. – 6:00 p.m.
Wednesday, August 13      6:15 a.m. – 6:15 p.m.
Thursday, August 14           6:15 a.m. – 6:15 p.m.
Friday, August 15                 6:15 a.m. – 6:15 p.m.
Saturday, August 16            6:15 a.m. – 12:00 p.m.

Pediatric MCCBRC
The SCCM registration desk will be open during the following hours in the International Ballroom Foyer:

Monday, August 11            4:00 p.m. – 7:00 p.m.
Tuesday, August 12            7:15 a.m. – 5:15 p.m.
Wednesday, August 13      7:15 a.m. – 5:30 p.m.
Thursday, August 14           7:15 a.m. – 5:30 p.m.
Friday, August 15                 7:15 a.m. – 5:15 p.m.
Saturday, August 16            7:15 a.m. – 12:00 p.m.

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Nitric Oxide Synthase: Key Factor for Vascular Dysfunction in Sepsis

Previous experimental work has demonstrated that excessive nitric oxide (NO) is produced during sepsis and is a key mechanism for vascular dysfunction. The amount of NO produced appears to be directly related to hypotension and decreased responsiveness to vasoconstrictors. Three nitric oxide synthase (NOS) isoforms may contribute to hypotension during sepsis, but most studies suggest that the majority of NO is produced by nitric oxide synthase 2 (NOS-2). Nardi and colleagues sought to define the contribution of nitric oxide synthase 1 (NOS-1) and its relationship with the main vascular effector of NO, soluble guanylate cyclase (sGC), in an animal model of sepsis.

The investigators found that NO production by NOS-1 has an important role in sepsis-induced vascular dysfunction. Limitations of this study include the nature of the sepsis model and the fact that the NOS-1 and sGC association was established only in smooth muscle.  This work may some day be clinically relevant for septic patients with refractory hypotension if the results can be replicated in humans.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

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No Cost, Online CME Activities from the 43rd Critical Care Congress

Several videos featuring the industry-supported sessions from the Society of Critical Care Medicine’s (SCCM) 2014 Critical Care Congress in San Francisco, California, USA, are available in the SCCM Store. Whether you missed the 2014 Congress or couldn’t make it to all the sessions of interest, you can still participate in the most popular events online at your convenience. Earn free continuing medical education (CME) credits by viewing any of the following webcasts and then applying for credit.

Can We Feed? Ensuring Optimal Early Enteral NutritionSupported by educational grants from Abbott Nutrition and Nestlé HealthCare Nutrition, Inc.

This offering identifies the development and initiation of early enteral nutrition therapy in the intensive care unit (ICU), compensatory enteral nutrition administration techniques, and strategies to reduce the incidence of aspiration and aspiration-related pneumonia in critically ill, tube-fed patients.

Feed Your Brain: It’s Not Just About Calories!Supported by an educational grant from Abbott Nutrition

In this session, expert faculty identify the basic concepts for optimal ICU nutritional support, examine pros and cons of pre- and probiotic use in the ICU and translate research findings into ICU management protocols.

Hemostatic Resuscitation and Acute Coagulopathy in the ICU – Supported by an educational grant from CSL Behring

This discussion focuses on the issues surrounding plasma and factor concentrates, as well as management of bleeding with the new anticoagulants.

Malnutrition: New International Etiology-Based DiagnosisSupported by an educational grant from Abbott Nutrition

The presenters discuss the integration of a cutting edge, international, etiology-based malnutrition diagnosis in the ICU, and outline characteristics of the diagnosis in the critically ill patient.

Noninvasive VentilationSupported by an educational grant from Covidien Puritan Bennett

This offering reviews the latest techniques in providing noninvasive ventilation and explores the efficacy of noninvasive ventilation in treating primary respiratory failure.

Pulmonary HypertensionSupported by an educational grant from Actelion Pharmaceuticals US, Inc.

Expert faculty describe basic management principles of patients with pulmonary hypertension, and look at developing a medication treatment plan for pulmonary hypertension.

Translation Research in Cardiopulmonary Resuscitation – Supported by an educational grant from ZOLL Medical Corporation

This offering details how outcomes of sudden death have not changed since the introduction of cardiopulmonary resuscitation, and examines how many established standards of medical care are wrong or less than perfect.

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On-Site Registration: Advanced Critical Care Ultrasound

On-site registration will take place Tuesday, August 19, 2014, for the Society of Critical Care Medicine’s (SCCM)  popular Advanced Critical Care Ultrasound course, which will be held at the Fairmont Chicago, Millennium Park, in Chicago, Illinois, USA. A staff member will be available to assist you at the SCCM registration desk in the International Ballroom Foyer beginning at 6:45 a.m. on August 19.

This course is intended for those who have previously attended an ultrasound course or are experienced in basic skills and procedures. It will focus on the specialty-specific use of echocardiography in the management of the critically ill patient. Participants will expand on their fundamental skills and knowledge while learning to gather important cardiovascular information for the noninvasive management of the hemodynamically unstable patient.

Course Learning Objectives

  • Describe the use of echocardiography in the assessment of hemodynamic parameters
  • Perform the quantitative assessment of left ventricular systolic function
  • Recognize the regional wall motion abnormalities
  • Describe the basic assessment of valvular pathology
  • Describe the limitations of echocardiography in intensive care unit settings
  • Describe the use of ultrasonography for evaluation of pulmonary edema

Please contact SCCM Customer Service at +1 847 827-6888 with any questions.

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Webcast: Palliative Sedation in the ICU

Use of palliative sedation in patient care is widely debated among intensive care unit (ICU) clinicians. In the webcast, Palliative Sedation in the ICU, the latest offering from the Society of Critical Care Medicine’s (SCCM) Controversies in Critical Care series, Douglas B. White, MD, will begin the discussion by introducing the topic of palliative sedation. Expert faculty will then debate about when and under what conditions such treatment is warranted and what types of sedation regimens are included under this rubric. Margaret L. Campbell, PhD, RN, FPCN, will discuss clinical considerations for use of palliative sedation in the ICU, and Mark Siegel, MD, will review the ethical foundations and potential pitfalls with this form of sedation.

Learning Objectives

  • Distinguish palliative sedation from the use of opioids/sedatives for symptom management
  • Identify clinical reasons to continue ICU care with palliative sedation using case examples
  • Explain ethical arguments for and against palliative sedation and its use in the ICU
  • Contrast palliative sedation to euthanasia and decisions to forgo life-sustaining treatment

This webcast will take place on Wednesday, August 13, 2014, at 1:00 p.m. Central Time. Participants will receive 1 hour of continuing education credit.

Register online today using your customer ID and password. The registration fee for this 60-minute webcast is $30 ($40 for nonmembers). For institutions seeking unlimited participation at a single location, a $200 group rate is available. Please contact SCCM Customer Service at +1 847 827-6888 to inquire about the group rate.

The Controversies in Critical Care webcast series is a joint project of the SCCM Scientific Review Committee and the American College of Critical Care Medicine’s Ethics Committee. This series is intended to provide insight into topics in critical care medicine for which there is no clear consensus or unequivocal evidence for guiding practice decisions.

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Upcoming Webcasts on Corticosteroids and Pet and Music Therapy

The Society of Critical Care Medicine (SCCM) will feature two webcasts in the month of June, covering critical care topics pertinent to quality patient care.

Use of Corticosteroids in Septic Shock
Tuesday, June 24, 2014
1:00 p.m. Central Time
Register online today

The mortality rate for septic shock can climb to 50% in the sickest patients. In this webcast from SCCM’s Controversies in Critical Care series, the rationale for use or avoidance of corticosteroids in critically ill patients with septic shock will be discussed. Djillali Annane, MD, and Greet Van den Berghe, MD, PhD, will highlight the controversies surrounding the use of low-dose corticosteroids and the association with clinical outcomes. The registration fee for this 60-minute webcast is $30 for SCCM members ($40 for nonmembers). For institutions seeking unlimited participation, a $200 group rate is available. Participants will receive 1 hour of continuing education credit.

Learning Objectives

  • List the rationales for the use of low-dose steroids in septic shock
  • Explain the controversies surrounding steroid use and clinical outcomes
  • Describe the context in which steroids should be used (e.g., dose, duration, severe sepsis versus septic shock)
  • Outline the end points for use of steroids (e.g., mortality versus shock reversal)
  • Categorize the adverse effects expected for steroid use in the critically ill
  • Review the 2012 Surviving Sepsis Campaign guidelines regarding recommendations for steroid use

The Controversies in Critical Care webcast series is a joint project of the SCCM Scientific Review Committee and the American College of Critical Care Medicine’s Ethics Committee. This series is intended to provide insight into topics in critical care medicine for which no clear consensus or unequivocal evidence is available to guide practice decisions.

The Impact of Pet and Music Therapy on the Critically Ill
Wednesday, June 25, 2014
12:00 p.m. Central Time
Register online today

Pet and music therapy have been in use for centuries. In this webcast from SCCM’s Project Dispatch series, these two integrative approaches and their ability to alleviate patient anxiety and reduce sedation frequency and intensity will be discussed. Linda Chlan, PhD, RN, FAAN, and Erika Gonzalez, MSN, RN, CCRN, will share their unique experiences with integrative therapies for patients and families in the intensive care unit. Complimentary registration is made possible by a grant from the Agency for Healthcare Research and Quality (AHRQ).

Learning Objectives

  • Understand the key obstacles and challenges to establishing such programs
  • Apply similar strategies in your institution
  • Evaluate your program’s success

This webcast was organized by SCCM’s Project Dispatch.  Project Dispatch aims to improve the quality, efficacy, accessibility, and cost-effectiveness of healthcare in the United States by developing and distributing resources for critical care clinicians focused on patient-centered research. This project is supported by grant number R18HS21940 from AHRQ. The content is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ.

If you have any questions regarding either webcast, please contact SCCM Customer Service at +1 847 827-6888.

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Webcast: Collaborating with Families to Improve Patient Care and Transitions

Registration is now open for Collaborating with Families to Improve Patient Care and Transitions, the latest webcast from the Society of Critical Care Medicine’s (SCCM) Project Dispatch series. This session will discuss patient transfers out of the intensive care unit (ICU), one of the most stressful times for patients and their families. Common concerns include what to expect and how to help the patient upon departure from the ICU. Furthermore, patients are being transferred with higher acuities after shorter lengths of stay, adding to “relocation stress” and contributing to slower recovery and discharge from the hospital.

Through patient satisfaction data and feedback from a formal rounding survey, the medical ICU at the Medical University of South Carolina developed a patient- and family-centered transfer brochure to help reduce the psychological and physiological problems that can materialize after an ICU stay. These problems include posttraumatic stress disorder, which can affect a patient’s recovery and quality of life.

Andrea Meaburn, RN, MSN, ANP-BC, CCRN, from the Medical University of South Carolina, will share the medical ICU staff’s experience in creating a comprehensive transfer brochure. She will discuss how the brochure supports patients and families and how it fits into their broader patient-centered care approach. Ms. Meaburn’s presentation will be followed by an opportunity for audience questions. Complimentary registration is made possible by a grant from the Agency for Healthcare Research and Quality (AHRQ).

Learning Objectives

  • Define the concerns patients and families have about transfer from the ICU
  • Identify ways to alleviate patient and family stress to improve outcomes
  • Deploy strategies that lead to a less stressful experience
  • Evaluate the effectiveness of these efforts

This 60-minute webcast will take place on Wednesday, August 27, 2014, at 12:00 p.m. Central Time.

Register online today using your Customer ID and password.

If you have any questions, please contact SCCM Customer Service at +1 847 827-6888.

This webcast was organized by the Society of Critical Care Medicine’s Project Dispatch.  Project Dispatch aims to improve the quality, efficacy, accessibility, and cost-effectiveness of healthcare in the United States by developing and distributing resources for critical care clinicians focused on patient-centered research. This project is supported by grant number R18HS21940 from AHRQ. The content is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ.

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Educational Series to Discuss Advanced Practice Providers in the ICU

The demand for and implementation of advanced practice providers (APPs)  — such as nurse practitioners (NPs) and physician assistants (PAs)  — in the intensive care unit (ICU) has generated great interest in the healthcare community in general and the medical community in particular. In the new Advanced Practice Providers: Administration, Leadership and Outcomes series from the Society of Critical Care Medicine (SCCM), speakers will bring their local and national expertise to a variety of subject areas, providing participants with the comprehensive view needed to establish a multiprofessional ICU provider team.

This four-part educational series sponsored by SCCM’s eLearning NP/PA Task Force will feature three webcasts and a live, half-day course and is designed to provide information on building an APP service model.

Webcasts
The webcasts cover a spectrum of topics on designing, initiating and maintaining a skilled APP program.

Financial and Administrative Considerations for the Development of an ICU NP/PA Practice
Thursday, August 21, 2014
12:00 p.m. – 1:00 p.m. Central Time

Developing Formal Orientation and Onboarding for Advanced Practice Providers
Tuesday, September 30, 2014
11:00 a.m. – 12:00 p.m. Central Time

Ensuring Initial and Ongoing Competency of Advanced Practice Providers in the ICU
Wednesday, October 8, 2014
12:00 p.m. – 1:30 p.m. Central Time

Live Event
The half-day course will be held at SCCM’s 2015 Critical Care Congress and will focus on identifying care models that integrate APPs in the ICU, national trends in NP and PA practice, fiscal approaches, and benchmarking to assess  program value.

Advanced Practice Providers: Administration, Leadership and Outcomes
Saturday, January 17, 2015
8:00 a.m. – 12:00 p.m.  Mountain Standard Time
Phoenix Convention Center
Phoenix, Arizona, USA

Register online today using your customer ID and password. The registration fee is $295 ($348 for nonmembers) and includes all three webcasts, On Demand access to content after the webcasts and the live event. Attendees of the live event are eligible to receive continuing education credit. Components of the series are not available to purchase separately. Please contact SCCM Customer Service at +1 847 827-6888 for details.

If you plan to attend this course in conjunction with Congress, register at www.sccm.org/Congress.

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Help Further the Mission of Project Dispatch

The most recent issue of Critical Connections focused on the Society of Critical Care Medicine’s (SCCM) Project Dispatch initiative, which aims to put a spotlight on efforts to improve patient- and family-centered care by disseminating the latest research in this exciting field. Be sure to check out the articles from our contributors:

The Value and Future of Patient-Centered Outcomes Research

Transforming Care: Developing a Patient- and Family-Centered ICU

Team Training to Enhance Communication with Families in the ICU

Have an Interest in Patient- and Family-Centered Care?

If you have a passion for patient-centered initiatives, an interest to learn more or are looking for an opportunity to be a leader in this field, SCCM and Project Dispatch want to hear from you. Whether you have started a successful program related to family presence during procedures or rounds, have outcomes-related research or are exploring new ideas, we want to hear from you! Contact Project Dispatch staff partner Stephen Davidow and get involved.

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New CDC Website Features Surviving Sepsis Campaign

SSC LogoThe U.S. Centers for Disease Control and Prevention (CDC) recently launched a new website to increase sepsis awareness and improve early recognition, diagnosis and treatment of patients.

The Surviving Sepsis Campaign, a joint collaboration of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine, features heavily on the new website. Throughout, readers are directed to the Campaign’s website for additional information regarding sepsis. They are also specifically encouraged to examine and review Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012.

The CDC website houses the following resources:

  • Basic Information: Fact sheets and questions and answers for patients
  • Clinical Guidelines and Tools: Guidelines, bundles, education resources, and tools
  • Information on Improving Survival:  A look at quality improvement efforts undertaken by healthcare facilities to improve survival in sepsis
  • Medical Bibliography: Selected sepsis chapters from medical textbooks
  • Data Reports: Recent reports on the incidence of sepsis
  • Related Links: Links to websites that provide additional information about sepsis
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New Surviving Sepsis Campaign Facebook Page

The Surviving Sepsis Campaign (SSC), a joint collaboration of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine, just launched its own Facebook page.

The new page will feature regular updates on the Campaign and provide pertinent information related to the 2012 SSC guidelines and the recommendations contained therein. It will also provide a forum for interested parties to connect and exchange meaningful ideas about the management of sepsis in critically ill patients.

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New Award Recognizes Excellence in Pediatric Critical Care Medicine

The Dharmapuri Vidyasagar Award for Excellence in Pediatric Critical Care Medicine, sponsored by Dr. Vidyasagar and the Society of Critical Care Medicine (SCCM), recognizes an individual for sustained exemplary and pioneering achievement in the care of critically ill and injured infants and children.

Nominees for this award should have distinguished themselves by achieving national and international professional prominence due to personal character, leadership, eminence in clinical practice, and outstanding contributions to research, education, program development, and advocacy for pediatric critical care medicine. All SCCM members are eligible for this award.

Candidates will be selected and evaluated according to the following criteria (not all criteria need apply, though it is expected that recipients will have demonstrated excellence in several of the areas):

  • Personal attributes that distinguish the recipient as a pediatric critical care medicine pioneer and exemplar
  • Leadership in pediatric critical care medicine, as evidenced by current and past academic and organizational accomplishments
  • Contributions that further the mission, vision and values of the Society, specifically pertaining to the care of critically ill and injured infants and children
  • Scientific publications, specifically related to the care of critically ill and injured infants and children
  • Research grants and projects that have advanced the care of critically ill and injured infants and children
  • Teaching accomplishments, especially those that have impacted the training of healthcare professionals in pediatric critical care medicine
  • Contributions to pediatric critical care medicine through other medical societies and organizations
  • Contributions to the community and volunteerism, specifically related to pediatric medical and/or educational programs
  • Awards and honors

The recipient will receive a $500 cash award, a plaque and complimentary registration to SCCM’s Critical Care Congress.

Nominations for this award must be submitted by August 1, 2014. Submit nominations and questions related to this award to SCCM staff member Carol Prendergast.

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Proposal Will Assign New Designated Seats to Two SCCM Specialty Sections

The Society of Critical Care Medicine (SCCM) is pleased to announce that SCCM Council supported and approved the Emergency Medicine Section and the Neuroscience Section each being considered for a designated seat on SCCM Council. As a result, an amendment to the SCCM bylaws will be drafted and presented to the SCCM membership for a vote prior to SCCM’s 2015 Critical Care Congress. If the bylaw revision is accepted by the SCCM membership, the Emergency Medicine Section and the Neuroscience Section will each have a Designated Seat on SCCM Council beginning in 2016.

The Society strongly urges all members to participate in the election this fall. A strong turnout by the sections will be essential for an electoral victory.

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12th Annual NCS Meeting