B. Braun (United States)

To address the challenges related to the interconnectivity between vial container closure systems and vial transfer devices, pharmaceutical, elastomer, and transfer device manufacturers have formed a working group under the Product Quality Research Institute (PQRI) to establish best practices for the evaluation of the assembly of vial transfer devices and vial systems. As part of the project, the first activity was to quantify the nature and frequency of issues (complaints). To this end, the working group conducted a survey with questionnaires related to categories and numbers of complaints, regions/countries where complaints were received, and the nature of the manufacturers who received the complaints. The survey was distributed to the 16 companies participating in the working group, and 11 companies submitted a response. Besides quantifying and ranking the frequency of issues, the survey determined what issues are common across all companies and what issues may be product-specific or specific by manufacturer. In this article, the analysis and outcomes of the survey will be presented, and the next steps will be discussed.

Vascular access device decision-making for pediatric patients remains a complex, highly variable process. To date, evidence-based criteria to inform these choices do not exist. The objective of the Michigan Appropriateness Guide for Intravenous Catheters in pediatrics (miniMAGIC) was to provide guidance on device selection, device characteristics, and insertion technique for clinicians, balancing and contextualizing evidence with current practice through a multidisciplinary panel of experts. The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop miniMAGIC, which included the following sequential phases: definition of scope and key terms, information synthesis and literature review, expert multidisciplinary panel selection and engagement, case scenario development, and appropriateness ratings by an expert panel via 2 rounds. The appropriateness of the selection, characteristics, and insertion technique of intravenous catheters commonly used in pediatric health care across age populations (neonates, infants, children, and adolescents), settings, diagnoses, clinical indications, insertion locations, and vessel visualization devices and techniques was defined. Core concepts including vessel preservation, insertion and postinsertion harm minimization (eg, infection, thrombosis), undisrupted treatment provision, and inclusion of patient preferences were emphasized. In this study, we provide evidence-based criteria for intravenous catheter selection (from umbilical catheters to totally implanted venous devices) in pediatric patients across a range of clinical indications. miniMAGIC also highlights core vascular access practices in need of collaborative research and innovation.

Orthopedic implants benefit from a surface that encourages direct bony ongrowth (contact osteogenesis). This process is initiated as osteoprogenitor cells attach to the implant surface and deposit a calcium-enriched, collagen-deficient interfacial layer known as the cement line, which provides an anchoring foundation for the subsequent production of collagenous bone matrix from differentiated osteoblasts. Despite the importance of the cement line, the conditions affecting its deposition are incompletely understood. The current study aimed to examine cement line formation from human osteoprogenitor cells (hFOB 1.19) on a titanium plasma-sprayed PEEK (termed Ti-PEEK) surface exhibiting hierarchical roughness, compared to two relatively flat implant materials, PEEK and Ti-6Al-4 V (Ti). The hierarchical roughness of Ti-PEEK surfaces created more surface area (40% increase at the microscale) for greater cellular proliferation and stimulated significantly increased calcium deposition, which was produced by osteoprogenitor cells in their undifferentiated state. The absence of increases in alkaline phosphatase confirmed that cells remained undifferentiated, and the lack of variation in collagen measurements supported the non-collagenous composition of the cement line. Impressively, after just 24 h, the calcium deposition measured on Ti-PEEK surfaces was 305% and 470% higher than on Ti and PEEK, respectively, providing evidence that Ti-PEEK surfaces may enhance contact osteogenesis by stimulating accelerated cement line formation from undifferentiated osteoprogenitor cells.

Virtual reality simulation may significantly benefit a geographically dispersed learner demographic in the medical outpatient setting. Our research used an immersive virtual reality platform as a novel way to recreate high-risk medical scenarios targeted for office-based emergencies. Using a design-based research approach we designed virtual-reality-based simulation scenarios to prepare interprofessional office personnel for emergencies. Learners were connected using laptop computers, via a browser interface, with learner controlled team member avatars and educator controlled patient avatars. The virtual environment was modeled after a multi-provider healthcare office setting in a large suburban health network. Evaluation occurred via post-event surveys and feedback transcribed from video recordings and debriefings. Three office-based emergency scenarios were created (chest pain, respiratory distress/allergic reaction, and suicidal risk), with progressively smaller changes to the virtual environment with each iterative improvement. In total, 18 individuals representative of a typical outpatient office interprofessional care team participated in the pilot study. Qualitative design-related feedback from participants and faculty improved the educational environment, artifacts, and scenarios. Participant feedback was overwhelmingly positive and enthusiastic about the use of virtual reality-based simulations to explore teamwork, build scope of practice, and rehearse infrequently used clinical skills. We successfully created novel outpatient virtual reality simulations in a first-person-perspective virtual environment. Pilot testing revealed successful rapid development, implementation, and participant orientation, with the ability to present learning opportunities. Future efforts will include assessments and attempt to overcome development barriers by switching to a more versatile platform.

The main focus of this paper is on two-dimensional (2-D) analog filtering. The development of the bivariate and bifrequency theory for autonomous dynamic systems and circuits are reviewed. The two-...

Properties of double (or two-dimensional) Laplace transform (2DLT) for analysis of linear time-varying (LTV) systems are explored. The one-dimensional to two-dimensional expansion formulas, as well as the two-dimensional to one-dimensional reduction formulas, are outlined. The merit of the proposed technique for frequency analysis of LTV systems is demonstrated.

Q Are there any guidelines for withdrawing fluid through a filter straw?A Paula Lusardi, RN, PhD, CCRN, CCNS, and Alex Smith, MS, RD, reply:There are a number of variables that factor into aspiration pressure (the size of the syringe used and the aggressiveness of the person aspirating the fluid through the filter being the most noteworthy). Therefore, an exact pressure cannot be stated for each occasion. The filter straws do meet the required product specifications, namely, 20 mL of distilled water must be aspirated at a vacuum pressure of 26 inches of Hg in 5 to 40 seconds. The recommendation on using these, or any filter device, is that an effort should be made not to create an excessive vacuum within the syringe, that is, between the plunger and the fluid.

Those of us who drill wells in carbonate sequences and those who have to provide postmortem explanations for success or failure are (or should be) interested in the basic lithofacies pattern, the 3-D distribution, of potential carbonate reservoir facies. From a depositional standpoint, these rock bodies are comprised mainly of tidal flat deposits, reefs of various types, and sand shoals. Once diagenetically altered, porosity in carbonates may be created/destroyed in a number of ways that are not clearly understood. The first article in our series (March 1998) dealt mainly with the types and distribution of reef facies. Now we will look at the other important carbonate reservoir types and summarize their occurrences. No new data are reported here. Instead, this is a review of ideas off the shelf—the bookshelf in this case.