Investigating the Effects of Lubricant Infusion Methods on Polymer SLIPS.

Slippery lubricant infused porous surfaces (SLIPSs) are promising bioinspired surfaces with self-healing and droplet wetting properties, among many others, that are desirable due to their range of applications. Recently, there have been many developments in the SLIPS field regarding the creation of textured surfaces and lubricant selection. However, there is a lack of knowledge regarding the method of lubricant infusion. In this study, we aim to fill this void by investigating different infusion methods that impose external forces on the lubricant. We developed our SLIPS by hot embossing nanostructures onto polypropylene by using molds that were laser micromachined. These textured surfaces were then infused with silicone oil using three different infusion methods: ultrasonication, vacuum, and hydrostatic pressure. We analyzed the wettability and slipperiness of the SLIPS by evaluating the critical tilt angle and comparing the sliding velocities of water droplets on each sample at a tilt angle of 20°. Additionally, the durability of the SLIPS was tested by dropping 50 successive water drops onto the samples and evaluating the droplet-surface interactions throughout. The sonicated infusion method yielded SLIPS that performed the best with a contact angle hysteresis of 13°, a critical tilt angle of 18.3°, a sliding velocity of 1.66 mm/s, and the least accumulation of droplets over time with use. These values are greatly improved when compared to the control sample where lubricant was simply dripped on, which resulted in a contact angle hysteresis of 20°, a critical tilt angle of 26.3°, and a sliding velocity of 0.23 mm/s. The sonicated and drip infusion methods were also compared with different materials (stainless steel) and different textures (microstructures). It was found that the improvement in slipperiness using the sonicated infusion method is prominent for nanoscale textures on both stainless steel and polypropylene. In this study, we discuss the challenges with oil depletion in SLIPS (cloaking and wetting ridges) and with the selection of contact angle measurement methods. While further investigation as to why certain applied forces during infusion yield better SLIPS is warranted, these forces greatly affect the outcome. This work suggests that researchers should consider using sonication or other methods of lubricant infusion that apply external forces as infusion techniques to yield better SLIPS on the nanoscale.

Safety gaps in medical team communication: Closing the loop on quality improvement efforts in the cardiac catheterization lab.

Closed-loop communication (CLC) is a fundamental aspect of effective communication, critical in the cardiac catheterization laboratory (cath lab) where physician orders are verbal. Complete CLC is typically a hospital and national mandate. Deficiencies in CLC have been shown to impair quality of care. Single center observational study, CLC for physician verbal orders in the cath lab were assessed by direct observation during a 5-year quality improvement effort. Performance feedback and educational efforts were used over this time frame to improve CLC, and the effects of each intervention assessed. Responses to verbal orders were characterized as complete (all important parameters of the order repeated, the mandated response), partial, acknowledgment only, or no response. During the first observational period of 101 cases, complete CLC occurred in 195 of 515 (38%) medication orders and 136 of 235 (50%) equipment orders. Complete CLC improved over time with various educational efforts, (p < 0.001) but in the final observation period of 117 cases, complete CLC occurred in just 259 of 328 (79%) medication orders and 439 of 581 (76%) equipment orders. Incomplete CLC was associated with medication and equipment errors. CLC of physician verbal orders was used suboptimally in this medical team setting. Baseline data indicate that physicians and staff have normalized weak, unreliable communication methods. Such lapses were associated with errors in order implementation. A subsequent 5-year quality improvement program resulted in improvement but a sizable minority of unacceptable responses. This represents an opportunity to improve patient safety in cath labs.

Comparison of Student Pharmacists' Clinical Interventions by Semester During APPE Internal Medicine and Critical Care Rotations.

BACKGROUND: Students contribute to health care through clinical interventions made during rotations. Previous studies assessed student interventions through cost savings instead of student progression throughout the year. OBJECTIVE: The purpose of this project is to assess clinical interventions made by student pharmacists completing internal medicine and critical care rotations during their Advanced Pharmacy Practice Experiences (APPE) year to determine whether there is a difference in the number and type of interventions between three 3-block rotations, rotation type, and participation in a concentrated learning experience. METHODS: Student clinical interventions from 2013 to 2018 were collected. Interventions were organized into categories and subcategories. The primary end point was the difference in the number of interventions between rotation blocks 1 to 3, 4 to 6, and 7 to 9. Secondary objectives compared interventions based on rotation type and participation in a concentrated learning experience. Descriptive statistics and Fisher's exact tests were conducted. RESULTS: A total of 848 interventions were analyzed. Average student interventions were 39 in blocks 1 to 3, 18 in blocks 4 to 6, and 62 in blocks 7 to 9. Interventions were significantly above the median for students in blocks 1 to 3 and blocks 7 to 9 compared to blocks 4 to 6 (P = .048 and P = .036), respectively. Interventions were significantly above the median for students completing critical care rotations (P = .03). No significant difference was noted in the number of interventions above the median based on participation in a concentrated learning experience (P = .34). CONCLUSIONS: Although a difference exists in the number of interventions made during 3 semesters, more research is needed to assess the relationship of rotation block, student program, and rotation type to intervention number.