Implementation and Mixed-Methods Assessment of an Early Mobility Interprofessional Education Simulation.

INTRODUCTION: Extended periods of bed rest and mechanical ventilation (MV) have devastating effects on the body. BACKGROUND: Early mobility (EM) for patients in respiratory failure is safe and feasible, and an interprofessional team is recommended. Using simulation to train EM skills improves student confidence. The purpose of this study was to enable health care student collaboration as an interprofessional team in providing safe management and monitoring during an EM simulation for a patient requiring MV. METHODS: Nursing (n = 33), respiratory (n = 7), occupational (n = 24), and physical therapist students (n = 55) participated in an EM interprofessional education (IPE) simulation experience. A mixed-methods analytic approach was used with pre/post quantitative analysis of the Student Perceptions of Interprofessional Clinical Education-Revised, Version 2 instrument and qualitative analysis of students' guided reflection papers. RESULTS: Pre/post surveys completion rate was 39.5% (n = 47). The Student Perceptions of Interprofessional Clinical Education-Revised, Version 2 instrument indicated a significant improvement (P = .037) in students' perceptions of interprofessional collaborative practice. Qualitative data showed a positive response to the EM simulation IPE. Themes reflected all 4 Interprofessional Education Collaborative competencies. DISCUSSION: This study demonstrated improved perception of interprofessional collaborative practice and better understanding of the Interprofessional Education Collaborative competencies. CONCLUSION: Students collaborated in the simulation-based IPE to provide EM for a patient requiring MV and reported perceived benefits of the experience.

Cycle-to-cycle flow variations in a square duct with a symmetrically oscillating constriction.

Spatially and temporally resolved Digital Particle Image Velocimetry (DPIV) measurements are presented of flow complexities in a nominally two-dimensional, symmetric, duct with an oscillating constriction. The motivation for this research lies in advancing the state-of-the-art in applying integral control volume analysis to modeling unsteady internal flows. The specific target is acoustic modeling of human phonation. The integral mass and momentum equations are directly coupled to the acoustic equations and provide quantitative insight into acoustic source strengths in addition to the dynamics of the fluid-structure interactions in the glottis. In this study, a square cross-section duct was constructed with symmetric, computer controlled, oscillating constrictions that incorporate both rocking as well as oscillatory open/close motions. Experiments were run in a free-surface water tunnel over a Strouhal number range, based on maximum jet speed and model length, of 0.012 - 0.048, for a fixed Reynolds number, based on maximum gap opening and maximum jet speed, of 8000. In this study, the constriction motions were continuous with one open-close cycle immediately following another. While the model and its motions were nominally two-dimensional and symmetric, flow asymmetries and oscillation frequency dependent cycle-to-cycle variations were observed. These are examined in the context of terms in the integral conservation equations.

Observations of Shear Stress Effects on Staphylococcus aureus Biofilm Formation.

Staphylococcus aureus bacteria form biofilms and distinctive microcolony or "tower" structures that facilitate their ability to tolerate antibiotic treatment and to spread within the human body. The formation of microcolonies, which break off, get carried downstream, and serve to initiate biofilms in other parts of the body, is of particular interest here. It is known that flow conditions play a role in the development, dispersion, and propagation of biofilms in general. The influence of flow on microcolony formation and, ultimately, what factors lead to microcolony development are, however, not well understood. The hypothesis being examined is that microcolony structures form within a specific range of levels of shear stress. In this study, laminar shear flow over a range of 0.15 to 1.5 dynes/cm2 was examined. It was found that microcolony structures form in a narrow range of shear stresses around 0.6 dynes/cm2 Further, measurements of cell density as a function of space and time showed that shear dependence can be observed hours before microcolonies form. This is significant because, among other physiologic flows, this is the same shear stress found in large veins in the human vasculature, which, along with catheters of similar diameters and flow rates, may therefore play a critical role in biofilm development and subsequent spreading of infections throughout the body.IMPORTANCE It is well known that flow plays an important role in the formation, transportation, and dispersion of Staphylococcus aureus biofilms. What was heretofore not known was that the formation of tower structures in these biofilms is strongly shear stress dependent; there is, in fact, a narrow range of shear stresses in which the phenomenon occurs. This work quantifies the observed shear dependence in terms of cell growth, distribution, and fluid mechanics. It represents an important first step in opening up a line of questioning as to the interaction of fluid forces and their influence on the dynamics of tower formation, break-off, and transportation in biofilms by identifying the parameter space in which this phenomenon occurs. We have also introduced state-of-the-art flow measurement techniques to address this problem.