Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: “My life changed forever”: A nurse’s account of her own PICS Author(s): Jessica (no last name listed) Publisher or Source: Not listed Type of Media: Testimonial Media Originally for: Former ICU Patients or Their Caregivers, General Public Country of Origin: United States Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: No Description: Jessica, a nurse, is a survivor of post-intensive care syndrome (PICS). Below, she recounts her experiences in the ICU and after discharge. As you read her story, think about how you and your peers provide care to critically ill patients—and how you might be able to prevent some of the negative effects experienced by ICU patients. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Over 100 Inflammatory Syndrome Cases Among Children In North India As Post-Covid Reaction Author(s): ANI Publisher or Source: NDTV Type of Media: Newspaper Article Media Originally for: General Public Country of Origin: India Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: Yes Description: New Delhi: More than 100 cases of multi-organ inflammatory syndrome in children (MIS-C) have been reported in northern India in the last five days as post-Covid reaction, Indian Academy of Pediatric Intensive Care said citing its data. According to the academy, the sudden spurt in MIS-C cases has been observed typically in post-Covid patients mostly between 4 to 18 years. However, there are rare cases of MIS-C affecting babies six months old. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: After the ICU: Caregiver Well-Being Author(s): Greg Martin, MD (December 21, 2016). After the ICU: Caregiver Well-Being. Medscape. https://www.medscape.com/viewarticle/873260 Publisher or Source: Medscope Type of Media: One-Pager Media Originally for: Former ICU Patients, Former ICU Patients' Family Members, Friends or Caregivers, General Public, General Medical Professionals Country of Origin: United States Primary Focus of Media: Post Intensive Care Syndrome for Families (PICS-F) COVID-19 Related: No Description: Patients who survive long stays in the intensive care unit (ICU), such as those who receive prolonged mechanical ventilation, will most often require continued assistance from a caregiver more than a year after ICU discharge. The effects of this responsibility on the family caregivers are not well known but may include such negative consequences as poor health-related quality of life, emotional distress, a subjective sense of burden, and symptoms of posttraumatic stress disorder. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Coronavirus: 'Long COVID' could be four syndromes affecting body at the same time - study Author(s): Sky News Publisher or Source: Sky News Type of Media: Newspaper Article Media Originally for: General Public Country of Origin: United Kingdom of Great Britain and Northern Ireland (the) Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: Yes Description: Coronavirus patients still suffering debilitating symptoms after seven months may be experiencing a mixture of post-viral fatigue syndrome, post-intensive care syndrome, permanent organ damage and long-term COVID syndrome, researchers claim. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Defining Patient and Family Engagement in the Intensive Care Unit Author(s): Barbara Sarnoff Lee, L.I.C.S.W.; Kathleen Turner, R.N.; Dominick L. Frosch, Ph.D. Publisher or Source: the American Thoracic Society Type of Media: Medical Journal Media Originally for: Critical Care Physicians, General Medical Professionals, Nurses and/or Other Critical Care Medical Professionals Country of Origin: United States Primary Focus of Media: Post Intensive Care Syndrome for Families (PICS-F) COVID-19 Related: No Description: Patient and family* engagement in the ICU is an active partnership between health professionals and patients and families working at every level of the healthcare system to improve health and the quality, safety, and delivery of healthcare. Arenas for such engagement include but are not limited to participation in direct care, communication of patient values and goals, and transformation of care processes to promote and protect individual respect and dignity. PFE comprises five core concepts: Collaboration, Respect and Dignity, Activation and Participation, Information Sharing, and Decision Making To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Rationing critical care beds: a systematic review Author(s): Sinuff T, Kahnamoui K, Cook DJ, Luce JM, Levy MM Publisher or Source: University of York- the Centre for Reviews and Dissemination Type of Media: Medical Journal Media Originally for: Critical Care Physicians Country of Origin: United Kingdom of Great Britain and Northern Ireland (the) Primary Focus of Media: Pre-Use of PICS Designation COVID-19 Related: No Description: CRD summary The authors assessed the impact of rationing intensive care unit beds on the process and outcomes of care and concluded that the observational nature, heterogeneity, moderate to poor methodological quality and lack of succinct conclusions of the individual studies precluded strong conclusions. The authors' conclusions reflect the evidence presented and appear reliable. Authors' objectives To assess the impact of rationing intensive care unit beds on the process and outcomes of care. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Post-intensive Care Syndrome – The Paediatric Perspective Author(s): Karen Choong Publisher or Source: ICU Management & Practice Type of Media: Medical Journal Media Originally for: Critical Care Physicians,Nurses and/or Other Critical Care Medical Professionals Country of Origin: Canada Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: No Description: Persistent critical illness acquired morbidities have been well known to affect adults since our attention was drawn to this in the landmark publication by Herridge et al. in 2003. What was first labelled as intensive care unit-acquired weakness, was broadened as we began to understand the physical, neurocognitive, and psychological sequelae that can affect not only patients, but their caregivers. The Post-Intensive Care Syndrome (PICS) was coined in a 2012 publication, to capture the three key affected domains of mental health, cognitive function and physical sequalae that adult survivors experience (Needham et al. 2012). This understanding of long-term impact of critical illness on patients has prompted clinicians and researchers to expand our focus beyond acute care and survival, to optimising survivorship and longer-term functional and health-related quality of life (HRQL) outcomes in our patients and families. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: For Each Critically Ill COVID Patient, a Family Is Suffering, Too Author(s): Charlotte Huff Publisher or Source: KNH Type of Media: Newspaper Article Media Originally for: General Public Country of Origin: United States Primary Focus of Media: Post Intensive Care Syndrome for Families (PICS-F) COVID-19 Related: Yes Description: The number of Americans hospitalized with the virus is increasing again, reaching 41,000 late last week, many with a circle of loved ones holding vigil in their minds, even if they can’t sit at the bedside. A decade ago, critical care clinicians coined the term post-intensive care syndrome, or PICS. It describes the muscle weakness, cognitive changes, anxiety and other physical and mental symptoms that some ICU patients cope with after leaving the hospital. Those complications are fallout from the medications, immobility and other possible components of being critically ill. Now they worry that some family members of critically ill COVID patients may develop a related syndrome, PICS-Family. Studies show that about one-fourth of family members, and sometimes more, experience at least one symptom of PICS-Family, including anxiety, depression, post-traumatic stress disorder or “complicated grief” — grief that is persistent and disabling — when their loved one has been hospitalized, according to a 2012 review article published in the journal Critical Care Medicine. Dr. Daniela Lamas, a critical care physician at Boston’s Brigham and Women’s Hospital, believes relatives and friends of coronavirus patients may be particularly vulnerable. Hospital rules designed to prevent the spread of the virus have robbed them of the opportunity to sit with their loved ones, watching clinicians provide medical care and gradually processing what’s happening between physician updates, Lamas said. In pre-pandemic times, a nurse “would explain what they had heard [from the doctor] and help them come to terms with unacceptable realities,” she said. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Antibiotics for exacerbations of chronic obstructive pulmonary disease Author(s): Vollenweider DJ, Frei A, Steurer‐Stey CA, Garcia‐Aymerich J, Puhan MA Publisher or Source: Cochrane Database of Systematic Reviews Type of Media: Medical Research Media Originally for: Critical Care Physicians Country of Origin: Switzerland Primary Focus of Media: Pre-Use of PICS Designation COVID-19 Related: No Description: Background Many patients with an exacerbation of chronic obstructive pulmonary disease (COPD) are treated with antibiotics. However, the value of antibiotics remains uncertain, as systematic reviews and clinical trials have shown conflicting results. Objectives To assess effects of antibiotics on treatment failure as observed between seven days and one month after treatment initiation (primary outcome) for management of acute COPD exacerbations, as well as their effects on other patient‐important outcomes (mortality, adverse events, length of hospital stay, time to next exacerbation). Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library, MEDLINE, Embase, and other electronically available databases up to 26 September 2018. Selection criteria We sought to find randomised controlled trials (RCTs) including people with acute COPD exacerbations comparing antibiotic therapy and placebo and providing follow‐up of at least seven days. Data collection and analysis Two review authors independently screened references and extracted data from trial reports. We kept the three groups of outpatients, inpatients, and patients admitted to the intensive care unit (ICU) separate for benefit outcomes and mortality because we considered them to be clinically too different to be summarised as a single group. We considered outpatients to have a mild to moderate exacerbation, inpatients to have a severe exacerbation, and ICU patients to have a very severe exacerbation. When authors of primary studies did not report outcomes or study details, we contacted them to request missing data. We calculated pooled risk ratios (RRs) for treatment failure, Peto odds ratios (ORs) for rare events (mortality and adverse events), and mean differences (MDs) for continuous outcomes using random‐effects models. We used GRADE to assess the quality of the evidence. The primary outcome was treatment failure as observed between seven days and one month after treatment initiation. Main results We included 19 trials with 2663 participants (11 with outpatients, seven with inpatients, and one with ICU patients). For outpatients (with mild to moderate exacerbations), evidence of low quality suggests that currently available antibiotics statistically significantly reduced the risk for treatment failure between seven days and one month after treatment initiation (RR 0.72, 95% confidence interval (CI) 0.56 to 0.94; I² = 31%; in absolute terms, reduction in treatment failures from 295 to 212 per 1000 treated participants, 95% CI 165 to 277). Studies providing older antibiotics not in use anymore yielded an RR of 0.69 (95% CI 0.53 to 0.90; I² = 31%). Evidence of low quality from one trial in outpatients suggested no effects of antibiotics on mortality (Peto OR 1.27, 95% CI 0.49 to 3.30). One trial reported no effects of antibiotics on re‐exacerbations between two and six weeks after treatment initiation. Only one trial (N = 35) reported health‐related quality of life but did not show a statistically significant difference between treatment and control groups. Evidence of moderate quality does not show that currently used antibiotics statistically significantly reduced the risk of treatment failure among inpatients with severe exacerbations (i.e. for inpatients excluding ICU patients) (RR 0.65, 95% CI 0.38 to 1.12; I² = 50%), but trial results remain uncertain. In turn, the effect was statistically significant when trials included older antibiotics no longer in clinical use (RR 0.76, 95% CI 0.58 to 1.00; I² = 39%). Evidence of moderate quality from two trials including inpatients shows no beneficial effects of antibiotics on mortality (Peto OR 2.48, 95% CI 0.94 to 6.55). Length of hospital stay (in days) was similar in antibiotic and placebo groups. The only trial with 93 patients admitted to the ICU showed a large and statistically significant effect on treatment failure (RR 0.19, 95% CI 0.08 to 0.45; moderate‐quality evidence; in absolute terms, reduction in treatment failures from 565 to 107 per 1000 treated participants, 95% CI 45 to 254). Results of this trial show a statistically significant effect on mortality (Peto OR 0.21, 95% CI 0.06 to 0.72; moderate‐quality evidence) and on length of hospital stay (MD ‐9.60 days, 95% CI ‐12.84 to ‐6.36; low‐quality evidence). Evidence of moderate quality gathered from trials conducted in all settings shows no statistically significant effect on overall incidence of adverse events (Peto OR 1.20, 95% CI 0.89 to 1.63; moderate‐quality evidence) nor on diarrhoea (Peto OR 1.68, 95% CI 0.92 to 3.07; moderate‐quality evidence). Authors' conclusions Researchers have found that antibiotics have some effect on inpatients and outpatients, but these effects are small, and they are inconsistent for some outcomes (treatment failure) and absent for other outcomes (mortality, length of hospital stay). Analyses show a strong beneficial effect of antibiotics among ICU patients. Few data are available on the effects of antibiotics on health‐related quality of life or on other patient‐reported symptoms, and data show no statistically significant increase in the risk of adverse events with antibiotics compared to placebo. These inconsistent effects call for research into clinical signs and biomarkers that can help identify patients who would benefit from antibiotics, while sparing antibiotics for patients who are unlikely to experience benefit and for whom downsides of antibiotics (side effects, costs, and multi‐resistance) should be avoided. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Post-Intensive Care Syndrome: Surviving the Pediatric ICU Author(s): Dyana Mejia, BSN,RN,CCRN Publisher or Source: CHOC Children’s Hospital Type of Media: Medical Journal Media Originally for: Critical Care Physicians, Nurses and/or Other Critical Care Medical Professionals Country of Origin: United States Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: No Description: Medical advances over the past few decades have led to an overall decrease in patient mortality for those experiencing a traumatic health challenge. Research on long-term health out comes post-traumatic illness has shown there is an increase and worsening of functional morbidity resulting from the critical illnesses and associated therapies and treatments experienced by patients.Pollack et al.(2014) estimates morbidity (the rate of ongoing clinical health challenges) to be as high as4.8%, twice the rate of mortality. Preventing or reducing mortality is no longer the sole outcome measure for effectiveness of critical care interventions(Herrup et al.,2017). Rather, ensuring optimal long-term health outcomes post-trauma are a major focus of current healthcare interventions in the intensive care unit (ICU). To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Guidelines for family-centered care in the neonatal, pediatric, and adult ICU Author(s): Davidson, Judy E. DNP, RN, FCCM, FAAN; Aslakson, Rebecca A. MD, PhD, FAAHPM; Long, Ann C. MD, MS; Puntillo, Kathleen A. PhD, RN, FAAN, FCCM; Kross, Erin K. MD; Hart, Joanna MD, MS; Cox, Christopher E. MD, MPH; Wunsch, Hannah MD, MSc; Wickline, Mary A. MLIS, MEd; Nunnally, Mark E. MD, FCCM; Netzer, Giora MD, MSCE; Kentish-Barnes, Nancy PhD; Sprung, Charles L. MD, MCCM, JD; Hartog, Christiane S. MD; Coombs, Maureen PhD, RN; Gerritsen, Rik T. MD, FCCM; Hopkins, Ramona O. PhD; Franck, Linda S. PhD, RN, FRCPCH, FAAN; Skrobik, Yoanna MD, FRCP(c); Kon, Alexander A. MD, FCCM; Scruth, Elizabeth A. PhD, MPH, RN, CCRN, CCNS, FCCM; Harvey, Maurene A. MPH, MCCM; Lewis-Newby, Mithya MD, MPH; White, Douglas B. MD, MAS; Swoboda, Sandra M. MS, RN, FCCM; Cooke, Colin R. MD, MS; Levy, Mitchell M. MD, MCCM, FCCM; Azoulay, Elie MD, PhD; Curtis, J. Randall MD, MPH Publisher or Source: Critical Care Medicine Type of Media: Medical Journal Media Originally for: Critical Care Physicians, General Medical Professionals, Nurses and/or Other Critical Care Medical Professionals Country of Origin: United States Primary Focus of Media: Pre-Use of PICS Designation COVID-19 Related: No Description: Objective: To provide clinicians with evidence-based strategies to optimize the support of the family of critically ill patients in the ICU. Methods: We used the Council of Medical Specialty Societies principles for the development of clinical guidelines as the framework for guideline development. We assembled an international multidisciplinary team of 29 members with expertise in guideline development, evidence analysis, and family-centered care to revise the 2007 Clinical Practice Guidelines for support of the family in the patient-centered ICU. We conducted a scoping review of qualitative research that explored family-centered care in the ICU. Thematic analyses were conducted to support Population, Intervention, Comparison, Outcome question development. Patients and families validated the importance of interventions and outcomes. We then conducted a systematic review using the Grading of Recommendations, Assessment, Development and Evaluations methodology to make recommendations for practice. Recommendations were subjected to electronic voting with pre established voting thresholds. No industry funding was associated with the guideline development. Results: The scoping review yielded 683 qualitative studies; 228 were used for thematic analysis and Population, Intervention, Comparison, Outcome question development. The systematic review search yielded 4,158 reports after deduplication and 76 additional studies were added from alerts and hand searches; 238 studies met inclusion criteria. We made 23 recommendations from moderate, low, and very low level of evidence on the topics of: communication with family members, family presence, family support, consultations and ICU team members, and operational and environmental issues. We provide recommendations for future research and work-tools to support translation of the recommendations into practice. Conclusions: These guidelines identify the evidence base for best practices for family-centered care in the ICU. All recommendations were weak, highlighting the relative nascency of this field of research and the importance of future research to identify the most effective interventions to improve this important aspect of ICU care. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Physical Therapy for Post-Intensive Care Syndrome Author(s): Brett Sears, PT Publisher or Source: verywell health Type of Media: Magazine Article Media Originally for: Critical Care Physicians, Former ICU Patients or Their Caregivers, Nurses and/or Other Critical Care Medical Professionals Country of Origin: United States Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: No Description: Post-intensive care syndrome (PICS) is a collection of symptoms, limitations, and impairments that are present in people who have recently been treated in a hospital’s intensive care unit (ICU). These impairments may be chronic and may limit your full participation in your normal activities upon discharge from the ICU. If you have been recently discharged from the intensive care unit, you may benefit from the care of a physical therapist to help you recover fully and return to your previous level of work and recreational activity. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.