Background Design thinking is a problem-solving framework that has been used to enhance patient experiences, improve clinical outcomes, and refine medical curricula. This study reviewed the use of design thinking in health professions education. Methods A search yielded 169 articles, which were excluded if they were: (1) not related to education; (2) lacking an application of design thinking; or (3) not associated with healthcare. The final review yielded 15 articles, which were analyzed using qualitative methods. Results All articles were published in 2009 or later and were diverse in their context, participants, and approach. Six studies emphasized the early stages of design thinking, with inspiration and ideation stages fostered through a variety of activities, such as lectures, small group discussions, and workshops. Studies examined a range of outcomes, including self-efficacy, perceptions, and solutions to a specific problem. Conclusions Our findings raise important considerations for health professions education, including the extent to which we should: 1) teach design thinking to students as a skill-based tool to prepare students for problem solving in complex healthcare environments; and 2) use design thinking to create, implement, and refine health professions curricula and educational programs. Despite the apparent benefits of design thinking, many questions for health professions education remain. Electronic supplementary material The online version of this article (10.1186/s12909-019-1528-8) contains supplementary material, which is available to authorized users.

We describe direct measurements of ozone concentration achievable in small enclosed containers (plastic storage boxes) for use as improvised decontamination systems for small articles such as disposable PPE (N95 masks, nitrile gloves, etc.), clothing, mail and small packages, food, and other miscellaneous articles. The emphasis is on the reliable and sustained generation of ozone gas concentrations of sufficient concentration and duration to create an effective virucidal environment to achieve more than 95% to 99% viral inactivation, based upon the data already published in the peer-review literature on this topic. The suggestion that ozone be used to inactivate virus is certainly not a new idea. Our objective in this report is to make clear that the necessary levels of ozone can be improvised using simple, easy-to-use, inexpensive, and widely available supplies, and that there is every theoretical and experimental reason to believe that this approach is as highly effective in viral inactivation by ozone as are the far more expensive, complex, cumbersome, and less available equivalent ozone (and other) disinfectant systems that have themselves become unavailable during times of pandemic crisis. Using multiple types of readily available commercial ozone generators, concentration in the tested improvised enclosure is tracked over time to assess ozone charging and decay rates, and the ozone quenching effects of items placed in the box. Generator performance is compared against published ozone dosage values for virucidal and antimicrobial activity. Bubbler and box-fan-type ozone generators were found to be effective at achieving and maintaining target concentrations of 10ppm ozone or higher, whereas automotive cigarette lighter and universal serial bus type plug in “air freshener” ozone generators could not achieve the target concentrations in these experiments. Calculations and practical guidelines for assembly and effective use of an ozone box for improvised decontamination are offered. The majority of this report is directed toward the scientific justification and rationale for this approach. The end of the document summarizes the findings and offers simplified designs for the construction and use of ozone boxes as an improvised method of disinfection.

The principle finding of this report is that both commercial and a novel material used for N95 mask filters can endure many cycles of disinfection by ozone gas (20 ppm for 30 minutes) without detectable degradation or loss of filtration efficiency.  N95 masks and surgical masks (hereafter referred to as masks) typically use a filtration material fabricated from meltblown polypropylene.  To achieve maximum filtration efficiency while maintaining a reasonable pressure drop, these nonwoven fabrics are also electrostatically charged (corona discharge is the most common method used), to maximize attraction and capture of aerosols and solid particulates.  Under normal circumstances, the reuse of masks is generally discouraged, but in times of crisis has become a necessity, making disinfection after each use a necessity.  To be acceptable, any disinfection procedure must cause minimal degradation to the performance of the filter material.  Possible performance degradation mechanisms include mechanical damage, loss of electrostatic charge, or both.  One of the most practical and direct ways to measure combined mechanical and electrostatic integrity, and the subsequent ability to reuse mask filter material, is by the direct measurement of filtration efficiency. In this paper, we report that small numbers of disinfection cycles at reasonable virucidal doses of ozone do not significantly degrade the filtration efficiency of meltblown polypropylene filter material. By comparison, laundering quickly results in a significant loss of filtration efficiency and requires subsequent recharging to restore the electrostatic charge and filtration efficiency. A common assumption among biomedical scientists that ozone is far too destructive for this application.  However, these direct measurements show that mask materials, specifically the filtration material, can withstand dozens of ozone disinfection cycles without any measurable degradation of filtration efficiency, nor any visible discoloration or loss of fiber integrity.  The data are clear: when subjected to a virucidal dose of ozone for a much longer duration than is required for viral inactivation, there was no degradation of N95 filtration efficiency.  The specific dosages of ozone needed for ~99% viral inactivation are thought to be at least 10 ppm for up to 30 minutes based upon an extensive literature review, but to standardize our testing, we consider a dose of 20 ppm for 30 minutes to be a reasonable and conservatively high ozone disinfection cycle.  The material tested in this study withstood dosages of up to 200 ppm for 90 minutes, or alternatively 20 ppm for up to 36 hours, without detectable degradation, and further testing suggests that up to 30 or more disinfection cycles (at 20 ppm for 30 minutes) would result in less than a 5% loss of filtration efficiency. This report does not address the effect of ozone cycling on other mask components, such as elastics.