Search results for: medical advantage

Authors: K. V. Venugopalan

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Micro, Small and Medium Enterprises (MSMEs) have been accepted as the engine of economic growth and for promoting equitable development. The major advantage of the sector is its employment potential at low capital cost. The labour intensity of the MSME sector is much higher than that of the large enterprises. The MSMEs constitute over 90% of total enterprises in most of the economies and are credited with generating the highest rates of employment growth and account for a major share of industrial production and exports. Kerala is a small state in India with the limited land area with high potential in educated human resources need micro, small and medium enterprises for development. Kerala has the highest Physical Quality of Life Index (PQLI) in India and the highest Human Development Index (HDI) at par with the developed countries SME play an important role in alleviating poverty and contribute significantly towards the growth of developing economies. Financial institutions can play a vital role for the promotion of micro, small and medium enterprises in Kerala. The study entitled “Financial Institutions and its role in the promotion of Small and Medium Enterprises in Kerala “examine the progress of MSME in Kerala and India and also the role of financial institutions and the problems faced by entrepreneurs for getting advances with reference to ‘Kerala Financial Corporation’-an agency set up by the government for promoting small and medium enterprises in the state. This study is based on both secondary and primary data. Primary data for the study was collected from those entrepreneurs who availed advances from financial institutions. The secondary data include the investment made, goods and services provided, the employment generated and the number of units registered in MSME sector for the last 10 years in Kerala. The study concluded that financial institutions providing finance with simple procedures and charging smaller interest rates will increase the number of MSME's and also contribute gross state domestic product and reduce the unemployment problem and poverty in the economy.

Keywords: gross state domestic product, human development index, micro, small and medium enterprises

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Authors: Chi-Chang Lin, Jian-Rong Wu, Jiun-Yan Chiu

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Myopia, ubiquitous symptom that is necessary to correct the eyesight by optical lens struggles many people for their daily life. Recent years, younger people raise interesting on using contact lens because of its convenience and aesthetics. In clinical, the risk of eye infections increases owing to the behavior of incorrectly using contact lens unsupervised cleaning which raising the infection risk of cornea, named ocular keratitis. In order to overcome the identification needs, new detection or analysis method with rapid and more accurate identification for clinical microorganism is importantly needed. In our study, we take advantage of Raman spectroscopy having unique fingerprint for different functional groups as the distinct and fast examination tool on microorganism. As we know, Raman scatting signals are normally too weak for the detection, especially in biological field. Here, we applied special SERS enhancement substrates to generate higher Raman signals. SERS filter we designed in this article that prepared by deposition of silver nanoparticles directly onto cellulose filter surface and suspension nanoparticles - gold nanostars (AuNSs) also be introduced together to achieve better enhancement for lower concentration analyte (i.e., various bacteria). Research targets also focusing on studying the shape effect of synthetic AuNSs, needle-like surface morphology may possible creates more hot-spot for getting higher SERS enhance ability. We utilized new designed SERS technology to distinguish the bacteria from ocular keratitis under strain level, and specific Raman and SERS fingerprint were grouped under pattern recognition process. We reported a new method combined different SERS substrates can be applied for clinical microorganism detection under strain level with simple, rapid preparation and low cost. Our presenting SERS technology not only shows the great potential for clinical bacteria detection but also can be used for environmental pollution and food safety analysis.

Keywords: bacteria, gold nanostars, Raman spectroscopy surface-enhanced Raman scattering filter

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Authors: Denise Levy, Anna Lucia C. H. Villavicencio

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In a rapid-changing world, science teachers face considerable challenges. In addition to the basic curriculum, there must be included several transversal themes, which demand creative and innovative strategies to be arranged and integrated to traditional disciplines. In Brazil, nuclear science is still a controversial theme, and teachers themselves seem to be unaware of the issue, most often perpetuating prejudice, errors and misconceptions. This article presents the authors’ experience in the development of an interdisciplinary pedagogical proposal to include nuclear science in the basic curriculum, in a transversal and integrating way. The methodology applied was based on the analysis of several normative documents that define the requirements of essential learning, competences and skills of basic education for all schools in Brazil. The didactic materials and resources were developed according to the best practices to improve learning processes privileging constructivist educational techniques, with emphasis on active learning process, collaborative learning and learning through research. The material consists of an illustrated book for students, a book for teachers and a manual with activities that can articulate nuclear science to different disciplines: Portuguese, mathematics, science, art, English, history and geography. The content counts on high scientific rigor and articulate nuclear technology with topics of interest to society in the most diverse spheres, such as food supply, public health, food safety and foreign trade. Moreover, this pedagogical proposal takes advantage of the potential value of digital technologies, implementing QR codes that excite and challenge students of all ages, improving interaction and engagement. The expected results include the education of the educators for nuclear science communication in a transversal and integrating way, demystifying nuclear technology in a contextualized and significant approach. It is expected that the interdisciplinary pedagogical proposal contributes to improving attitudes towards knowledge construction, privileging reconstructive questioning, fostering a culture of systematic curiosity and encouraging critical thinking skills.

Keywords: science education, interdisciplinary learning, nuclear science, scientific literacy

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Authors: Shang-Sin Shiu, Shu-I Chin, Hsiu-Ju Chen, Ru-Yu Lien

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The Hospice and Palliative Care Act has undergone three revisions, making it less challenging for terminal patients to withdraw life support systems. However, the adequacy of care before withdraw is a crucial factor in end-of-life medical treatment. The author observed that intensive care unit (ICU) nursing staff often rely on simple flowcharts or word of mouth, leading to inadequate preparation and failure to meet patient needs before withdraw. This results in confusion or hesitation among those executing the process. Therefore, there is a motivation to improve the withdraw of patient care processes, establish standardized procedures, ensure the accuracy of removal execution, enhance end-of-life care self-efficacy for nursing staff, and improve the overall quality of care. The investigation identified key issues: the lack of applicable guidelines for ICU care for withdraw from life-sustaining, insufficient education and training on withdraw and end-of-life care, scattered locations of withdraw-related tools, and inadequate self-efficacy in withdraw from life-sustaining care. Solutions proposed include revising withdraw care processes and guidelines, integrating tools and locations, conducting educational courses, and forming support groups. After the project implementation, the accuracy of removal cognition improved from 78% to 96.5%, self-efficacy in end-of-life care after removal increased from 54.7% to 93.1%, and the correctness of care behavior progressed from 27.7% to 97.8%. It is recommended to regularly conduct courses on removing life support system care and grief consolation to enhance the quality of end-of-life care.

Keywords: the intensive care unit (ICU) patients, nursing staff, withdraw life support systems, self-efficacy

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Authors: Cassey Younghans

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Background: Current health care trends demonstrate that there is an increasing number of patients being hospitalized with complex comorbidities. These complex needs require advanced therapies, and treatment goals often focus on doing everything possible to prolong life rather than focusing on the individual patient’s quality of life which is the goal of palliative care efforts. Patients benefit from palliative care in the early stages of the illness rather than after the disease progressed or the state of acuity has advanced. The clinical problem identified was that palliative care was not being implemented early enough in the disease process with patients who had complex medical conditions and who would benefit from the philosophy and skills of palliative care professionals. Purpose: The purpose of this quality improvement study was to increase the number of palliative care screenings and consults completed on adults after being admitted to one Non-ICU and Non-COVID hospital unit. Methods: A retrospective chart review assessing for possible missed opportunities to introduce palliation was performed for patients with six primary diagnoses, including heart failure, liver failure, end stage renal disease, chronic obstructive pulmonary disease, cerebrovascular accident, and cancer in a population of adults over the ago of 19 on one medical-surgical unit over a three-month period prior to the intervention. An educational session with the nurses on the benefits of palliative care was conducted by the researcher, and a screening tool was implemented. The expected outcome was to have an increase in early palliative care consultation with patients with complex comorbid conditions and a decrease in missed opportunities for the implementation of palliative care. Another retrospective chart review was completed following completion of the three month piloting of the tool. Results: During the retrospective chart review, 46 patients were admitted to the medical-surgical floor with the primary diagnoses identified in the inclusion criteria. Six patients had palliative care consults completed during that time. Twenty-two palliative care screening tools were completed during the intervention period. Of those, 15 of the patients scored a 7 or higher, suggesting that a palliative care consultation was warranted. The final retrospective chart review identified that 4 palliative consults were implemented during that time of the 31 patients who were admitted over the three month time frame. Conclusion: Educating nurses and implementing a palliative care screening upon admission can be of great value in providing early identification of patients who might benefit from palliative care. Recommendations – It is recommended that this screening tool should be used to help identify the patents of whom would benefit from a palliative care consult, and nurses would be able to initiated a palliative care consultation themselves.

Keywords: palliative care, screening, early, palliative care consult

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Authors: Arun C. Gulani, Aaishwariya A. Gulani, Amanda Southall

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Background: Laser Corneoplastique™ as a least interventional, visually promising technique for patients with vision disability from corneal scars of varied causes has been retrospectively reviewed and proves to cause a paradigm shift in mindset and approach towards corneal scars as a Refractive surgery aiming for emmetropic, unaided vision of 20;/20 in most cases. Three decades of work on this technique has been compiled in this 15-year study. Subject and Methods: The objective of this study was to determine the success of Laser Corneoplastique™ surgery as a treatment of corneal scar cases. A survey of corneal scar cases caused by various medical histories that had undergone Laser Corneoplastique™ surgery over the past twenty years by a single surgeon Arun C. Gulani, M.D. were retrospectively reviewed. The details of each of the cases were retrieved from their medical records and analyzed. Each patient had been examined thoroughly at their preoperative appointments for stability of refraction and vision, depth of scar, pachymetry, topography, pattern of the scar and uncorrected and best corrected vision potential, which were all taken into account in the patients' treatment plans. Results: 64 eyes of 53 patients were investigated for scar etiology, keratometry, visual acuity, and complications. There were 25 different etiologies seen, with the most common being a Herpetic scar. The average visual acuity post-op was, on average, 20/23.55 (±7.05). Laser parameters used were depth and pulses. Overall, the mean Laser ablation depth was 30.67 (±19.05), ranging from 2 to 73 µm. Number of Laser pulses averaged 191.85 (±112.02). Conclusion: Refractive Laser Corneoplastique™ surgery, when practiced as an art, can address all levels of ametropia while reversing complex corneas and scars from refractive surgery complications back to 20/20 vision.

Keywords: corneal scar, refractive surgery, corneal transplant, laser corneoplastique

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Authors: Md. Shakhawat Hossain, Jimma Hossain, Md. Naushad Ali

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Acute pancreatitis is a dangerous medical emergency in the practice of gastroenterology. Management of acute pancreatitis needs multidisciplinary approach with support starts from emergency to ICU. So, there is a chance of mismanagement in every steps, especially in low resource settings. Other factors such as patient’s financial condition, education, social custom, transport facility, referral system from periphery may also challenge the current guidelines for management. The present study is intended to determine the clinico-pathological profile, severity assessment and challenges of management of acute pancreatitis in a government laid tertiary care hospital to image the real scenario of management in a low resource place. A total 100 patients of acute pancreatitis were studied in this prospective study, held in the Department of Gastroenterology, Rangpur medical college hospital, Bangladesh from July 2017 to July 2018 within one year. Regarding severity, 85 % of the patients were mild, whereas 13 were moderately severe, and 2 had severe acute pancreatitis according to the revised Atlanta criteria. The most common etiologies of acute pancreatitis in our study were gall stone (15%) and biliary sludge (15%), whereas 54% were idiopathic. The most common challenges we faced were delay in hospital admission (59%) and delay in hospital diagnosis (20%). Others are non-adherence of patient party, and lack of investigation facility, physician’s poor knowledge about current guidelines. We were able to give early aggressive fluid to only 18% of patients as per current guideline. Conclusion: Management of acute pancreatitis as per guideline is challenging when optimum facility is lacking. So, modified guidelines for assessment and management of acute pancreatitis should be prepared for low resource setting.

Keywords: acute pancreatitis, challenges of management, severity, prognosis

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Authors: Zh. Saffari, A. Naeimi, M. S. Ekrami-Kakhki, Kh. Khandan-Barani

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The textile industries are becoming a major source of environmental contamination because an alarming amount of dye pollutants are generated during the dyeing processes. Organic dyes are one of the largest pollutants released into wastewater from textile and other industrial processes, which have shown severe impacts on human physiology. Nano-structure compounds have gained importance in this category due their anticipated high surface area and improved reactive sites. In recent years several novel adsorbents have been reported to possess great adsorption potential due to their enhanced adsorptive capacity. Nano-MnO2 has great potential applications in environment protection field and has gained importance in this category because it has a wide variety of structure with large surface area. The diverse structures, chemical properties of manganese oxides are taken advantage of in potential applications such as adsorbents, sensor catalysis and it is also used for wide catalytic applications, such as degradation of dyes. In this study, adsorption of Methyl Violet (MV) dye from aqueous solutions onto MnO2 nanoparticles (MNP) has been investigated. The surface characterization of these nano particles was examined by Particle size analysis, Scanning Electron Microscopy (SEM), Fourier Transform Infrared (FTIR) spectroscopy and X-Ray Diffraction (XRD). The effects of process parameters such as initial concentration, pH, temperature and contact duration on the adsorption capacities have been evaluated, in which pH has been found to be most effective parameter among all. The data were analyzed using the Langmuir and Freundlich for explaining the equilibrium characteristics of adsorption. And kinetic models like pseudo first- order, second-order model and Elovich equation were utilized to describe the kinetic data. The experimental data were well fitted with Langmuir adsorption isotherm model and pseudo second order kinetic model. The thermodynamic parameters, such as Free energy of adsorption (ΔG°), enthalpy change (ΔH°) and entropy change (ΔS°) were also determined and evaluated.

Keywords: MnO2 nanoparticles, adsorption, methyl violet, isotherm models, kinetic models, surface chemistry

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Authors: Faiz Khan Mohammad, Saumya Ray Chaudhari, Raghunathan Rengaswamy, Swagatika Sahoo

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Cholera caused by pathogenic gut bacteria Vibrio Cholerae (VC), is a major health problem in developing countries. Different strains of VC exhibit variable responses subject to different extracellular medium (Nag et al, Infect Immun, 2018). In this study, we present a new approach to model the variable VC responses in mono- and co-cultures, subject to continuously changing growth medium, which is otherwise difficult via simple FBA model. Nine VC strain and seven E. coli (EC) models were assembled and considered. A continuously changing medium is modelled using a new iterative-based controlled medium technique (ITC). The medium is appropriately prefixed with the VC model secretome. As the flux through the bacteria biomass increases secretes certain by-products. These products shall add-on to the medium, either deviating the nutrient potential or block certain metabolic components of the model, effectively forming a controlled feed-back loop. Different VC models were setup as monoculture of VC in glucose enriched medium, and in co-culture with VC strains and EC. Constrained to glucose enriched medium, (i) VC_Classical model resulted in higher flux through acidic secretome suggesting a pH change of the medium, leading to lowering of its biomass. This is in consonance with the literature reports. (ii) When compared for neutral secretome, flux through acetoin exchange was higher in VC_El tor than the classical models, suggesting El tor requires an acidic partner to lower its biomass. (iii) Seven of nine VC models predicted 3-methyl-2-Oxovaleric acid, mysirtic acid, folic acid, and acetate significantly affect corresponding biomass reactions. (iv) V. parhemolyticus and vulnificus were found to be phenotypically similar to VC Classical strain, across the nine VC strains. The work addresses the advantage of the ITC over regular flux balance analysis for modelling varying growth medium. Future expansion to co-cultures, potentiates the identification of novel interacting partners as effective cholera therapeutics.

Keywords: cholera, vibrio cholera El. tor, vibrio cholera classical, acetate

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Authors: Kenneth D. Aiello, M. Simeone, Manfred Laubichler

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It is increasingly difficult to analyze emerging scientific fields as contemporary scientific fields are more dynamic, their boundaries are more porous, and the relational possibilities have increased due to Big Data and new information sources. In biomedicine, where funding, medical categories, and medical jurisdiction are determined by distinct boundaries on biomedical research fields and definitions of concepts, ambiguity persists between the microbiome, metabolome, and metagenome research fields. This ambiguity continues despite efforts by institutions and organizations to establish parameters on the core concepts and research discourses. Further, the explosive growth of microbiome, metabolome, and metagenomic research has led to unknown variation and covariation making application of findings across subfields or coming to a consensus difficult. This study explores the evolution and variation of knowledge within the microbiome, metabolome, and metagenome research fields related to ambiguous scholarly language and commensurable theoretical frameworks via a semantic analysis of key concepts and narratives. A computational historical framework of cultural evolution and large-scale publication data highlight the boundaries and overlaps between the competing scientific discourses surrounding the three research areas. The results of this study highlight how discourse and language distribute power within scholarly and scientific networks, specifically the power to set and define norms, central questions, methods, and knowledge.

Keywords: biomedicine, conceptual change, history of science, philosophy of science, science of science, sociolinguistics, sociology of knowledge

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Authors: Sana Fatima, Paul Sadler, Jon Cooper, David Mendel, Ayesha Jameel

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Background: Neurodiversity refers to intrinsic differences between human minds and encompasses dyspraxia, dyslexia, attention deficit hyperactivity disorder, dyscalculia, autism spectrum disorder, and Tourette syndrome. There is increasing recognition of neurodiversity in relation to disability/diversity in medical education and the associated impact on training, career progression, and personal and professional wellbeing. In addition, documented and anecdotal evidence suggests that medical educators and training providers in all four nations (UK) are increasingly concerned about understanding neurodiversity and identifying and providing support for neurodivergent trainees. Summary of Work: A national Neurodiversity Task and Finish group were established to survey Health Education England local office Professional Support teams about insights into infrastructure, training for educators, triggers for assessment, resources, and intervention protocols. This group drew from educational leadership, professional and personal neurodiverse expertise, occupational medicine, employer human resource, and trainees. An online, exploratory survey was conducted to gather insights from supervisors and trainers across England using the Professional Support Units' platform. Summary of Results: This survey highlighted marked heterogeneity in the identification, assessment, and approaches to support and management of neurodivergent trainees and highlighted a 'deficit' approach to neurodiversity. It also demonstrated a paucity of educational and protocol resources for educators and supervisors in supporting neurodivergent trainees. Discussions and Conclusions: In phase one, we focused on faculty development. An educational repository for all supervising trainees using a thematic approach was formalised. This was guided by our survey findings specific for neurodiversity and took a triple 'A' approach: awareness, assessment, and action. This is further supported by video material incorporating stories in training as well as mobile workshops for trainers for more immersive learning. The subtle theme from both the survey and Task and finish group suggested a move away from deficit-focused methods toward a positive holistic, interdisciplinary approach within a biopsychosocial framework. Contributions: 1. Faculty Knowledge and basic understanding of neurodiversity are key to supporting trainees with known or underlying Neurodiverse conditions. This is further complicated by challenges around non-disclosure, varied presentations, stigma, and intersectionality. 2. There is national (and international) inconsistency in the approach to how trainees are managed once a neurodiverse condition is suspected or diagnosed. 3. A carefully constituted and focussed Task and Finish group can rapidly identify national inconsistencies in neurodiversity and implement rapid educational interventions. 4. Nuanced findings from surveys and discussion can reframe the approach to neurodiversity; from a medical model to a more comprehensive, asset-based, biopsychosocial model of support, fostering a cultural shift, accepting 'diversity' in all its manifestations, visible and hidden.

Keywords: neurodiversity, professional support, human considerations, workplace wellbeing

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Authors: Huda Alyami

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The present study aims to measure the effectiveness of an "Interactive eBook" in order to develop skills of designing and employing webquests for female intern teachers. The study uses descriptive analytical methodology as well as quasi-experimental methodology. The sample of the study consists of (30) female intern teachers from the Department of Special Education (in the tracks of Gifted Education and Learning Difficulties), during the first semester of the academic year 2015, at King Abdul-Aziz University in Jeddah city. The sample is divided into (15) female intern teachers for the experimental group, and (15) female intern teachers for the control group. A set of qualitative and quantitative tools have been prepared and verified for the study, embodied in: a list of the designing webquests' skills, a list of the employing webquests' skills, a webquests' knowledge achievement test, a product rating card, an observation card, and an interactive ebook. The study concludes the following results: 1. After pre-control, there are statistically significant differences, at the significance level of (α ≤ 0.05), between the mean scores of the experimental and the control groups in the post measurement of the webquests' knowledge achievement test, in favor of the experimental group. 2. There are statistically significant differences, at the significance level of (α ≤ 0.05), between the mean scores of experimental and control groups in the post measurement of the product rating card in favor of the experimental group. 3. There are statistically significant differences, at the significance level of (α ≤ 0.05), between the mean scores of experimental and control groups in the post measurement of the observation card for the experimental group. In the light of the previous findings, the study recommends the following: taking advantage of interactive ebooks when teaching all educational courses for various disciplines at the university level, creating educational participative platforms to share educational interactive ebooks for various disciplines at the local and regional levels. The study suggests conducting further qualitative studies on the effectiveness of interactive ebooks, in addition to conducting studies on the use of (Web 2.0) in webquests.

Keywords: interactive eBook, webquest, design, employing, develop skills

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Authors: Rezaul K. Sk., Mohammad Ashiq, Avinash K. Srivastava

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The use of radiation shielding technology ranging from EMI to high energy gamma rays in various areas such as devices, medical science, defense, nuclear power plants, medical diagnostics etc. is increasing all over the world. However, exposure to different radiations such as X-ray, gamma ray, neutrons and EMI above the permissible limits is harmful to living beings, the environment and sensitive laboratory equipment. In order to solve this problem, there is a need to develop effective radiation shielding materials. Conventionally, lead and lead-based materials are used in making shielding materials, as lead is cheap, dense and provides very effective shielding to radiation. However, the problem associated with the use of lead is its toxic nature and carcinogenic. So, to overcome these drawbacks, there is a great need for lead-free radiation shielding materials and that should also be economically sustainable. Therefore, it is necessary to look for the synthesis of radiation-shielding glass by using other heavy metal oxides (HMO) instead of lead. The lead-free BaO-doped TeZnCaB glass systems have been synthesized by the traditional melt-quenching method. X-ray diffraction analysis confirmed the glassy nature of the synthesized samples. The densities of the developed glass samples were increased by doping the BaO concentration, ranging from 4.292 to 4.725 g/cm3. The vibrational and bending modes of the BaO-doped glass samples were analyzed by Raman spectroscopy, and FTIR (Fourier-transform infrared spectroscopy) was performed to study the functional group present in the samples. UV-visible characterization revealed the significance of optical parameters such as Urbach’s energy, refractive index and optical energy band gap. The indirect and direct energy band gaps were decreased with the BaO concentration whereas the refractive index was increased. X-ray attenuation measurements were performed to determine the radiation shielding parameters such as linear attenuation coefficient (LAC), mass attenuation coefficient (MAC), half value layer (HVL), tenth value layer (TVL), mean free path (MFP), attenuation factor (Att%) and lead equivalent thickness of the lead-free BaO-doped TeZnCaB glass system. It was observed that the radiation shielding characteristics were enhanced with the addition of BaO content in the TeZnCaB glass samples. The glass samples with higher contents of BaO have the best attenuation performance. So, it could be concluded that the addition of BaO into TeZnCaB glass samples is a significant technique to improve the radiation shielding performance of the glass samples. The best lead equivalent thickness was 2.626 mm, and these glasses could be good materials for medical diagnostics applications.

Keywords: heavy metal oxides, lead-free, melt-quenching method, x-ray attenuation

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Authors: Jacklyn Yek, Clara Tong, Shin Yuet Chong, Yee Yian Ong

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Background: While emergency manuals and cognitive aids (CA) have been used in high-hazard industries for decades, this has been a nascent field in healthcare. CAs can potentially offset the large cognitive load involved in crisis resource management and possibly facilitate the efficient performance of key steps in treatment. A crisis manual was developed based on local guidelines and the latest evidence-based information and introduced to a tertiary hospital setting in Singapore. Hence, the objective of this study is to evaluate the effectiveness of the crisis manual in guiding response and management of critical events. Methods: 7 surgical teams were recruited to participate in a series of simulated emergencies in high-fidelity operating room simulator over the period of April to June 2018. All teams consisted of a surgical consultant and medical officer/registrar, anesthesia consultant and medical officer/registrar; as well as a circulating, scrub and anesthetic nurse. Each team performed a simulated operation in which 1 or more of the crisis events occurred. The teams were randomly assigned to a scenario of the crisis manual and all teams were deemed to be equal in experience and knowledge. Before the simulation, teams were instructed on proper checklist use but the use of the checklist was optional. Results: 7 simulation sessions were performed, consisting of the following scenarios: Airway fire, Massive Transfusion Protocol, Malignant Hyperthermia, Eclampsia, and Difficult Airway. Out of the 7 surgical teams, 2 teams made use of the crisis manual – of which both teams had encountered a ‘Malignant Hyperthermia’ scenario. These team members reflected that the crisis manual assisted allowed them to work in a team, especially being able to involve the surgical doctors who were unfamiliar with the condition and management. A run chart plotted showed a possible upward trend, suggesting that with increasing awareness and training, staff would become more likely to initiate the use of the crisis manual. Conclusion: Despite the high volume load in this tertiary hospital, certain crises remain rare and clinicians are often caught unprepared. A crisis manual is an effective tool and easy-to-use repository that can improve patient outcome and encourage teamwork. With training, familiarity would allow clinicians to be increasingly comfortable with reaching out for the crisis manual. More simulation training would need to be conducted to determine its effectiveness.

Keywords: crisis resource management, high fidelity simulation training, medical errors, visual aids

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Authors: Suwapitch Chalongkulasak, Teerasak E-Kobon, Pramote Chumnanpuen

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Acne vulgaris is a common skin disease mainly caused by the Gram–positive pathogenic bacterium, Propionibacterium acnes. This bacterium stimulates inflammation process in human sebaceous glands. Giant African snail (Achatina fulica) is alien species that rapidly reproduces and seriously damages agricultural products in Thailand. There were several research reports on the medical and pharmaceutical benefits of this snail mucus peptides and proteins. This study aimed to in silico predict multifunctional bioactive peptides from A. fulica mucus peptidome using several bioinformatic tools for determination of antimicrobial (iAMPpred), anti–biofilm (dPABBs), cytotoxic (Toxinpred), cell membrane penetrating (CPPpred) and anti–quorum sensing (QSPpred) peptides. Three candidate peptides with the highest predictive score were selected and re-designed/modified to improve the required activities. Structural and physicochemical properties of six anti–P. acnes (APA) peptide candidates were performed by PEP–FOLD3 program and the five aforementioned tools. All candidates had random coiled structure and were named as APA1–ori, APA2–ori, APA3–ori, APA1–mod, APA2–mod and APA3–mod. To validate the APA activity, these peptide candidates were synthesized and tested against six isolates of P. acnes. The modified APA peptides showed high APA activity on some isolates. Therefore, our biomimetic mucus peptides could be useful for preventing acne vulgaris and further examined on other activities important to medical and pharmaceutical applications.

Keywords: Propionibacterium acnes, Achatina fulica, peptidomes, antibacterial peptides, snail mucus

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Authors: G. Calleja-Rodriguez, N. Jimenez-Redondo, J. J. Peralta Escalante

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This research work aims at developing a solution to take advantage of the potential energy saving related to occupants behaviour estimated in between 5-30 % according to existing studies. For that purpose, the following methodology has been followed: 1) literature review and gap analysis, 2) define concept and functional requirements, 3) evaluation and feedback by experts. As result, the concept for a tool-box that implements continuous behavior change interventions named as engagement methods and based on increasing energy literacy, increasing energy visibility, using bonus system, etc. has been defined. These engagement methods are deployed through a set of ICT tools: Building Automation and Control System (BACS) add-ons services installed in buildings and Users Apps installed in smartphones, smart-TVs or dashboards. The tool-box called eTEACHER identifies energy conservation measures (ECM) based on energy behavioral change through a what-if analysis that collects information about the building and its users (comfort feedback, behavior, etc.) and carry out cost-effective calculations to provide outputs such us efficient control settings of building systems. This information is processed and showed in an attractive way as tailored advice to the energy end-users. Therefore, eTEACHER goal is to change the behavior of building´s energy users towards energy efficiency, comfort and better health conditions by deploying customized ICT-based interventions taking into account building typology (schools, residential, offices, health care centres, etc.), users profile (occupants, owners, facility managers, employers, etc.) as well as cultural and demographic factors. One of the main findings of this work is the common failure when technological interventions on behavioural change are done to not consult, train and support users regarding technological changes leading to poor performance in practices. As conclusion, a strong need to carry out social studies to identify relevant behavioural issues and to identify effective pro-evironmental behavioral change strategies has been identified.

Keywords: energy saving, behavioral bhange, building users, engagement methods, energy conservation measures

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Authors: Saman Naqvi

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Introduction: Telemedicine is the practise of providing remote healthcare to patients via the utilisation of communication technologies. Its application has become increasingly important since the Coronavirus Disease 2019 (COVID-19) pandemic. It is essential to determine the knowledge and attitudes of healthcare professionals concerning its use in order to maximise its application. Purpose: We aim to examine and evaluate the current understanding and perceptions of medical staff toward the use of telemedicine. Methods: In this cross-sectional study, we surveyed 1091 healthcare professionals worldwide. Following an extensive review of the literature, data were gathered using a questionnaire. To depict the participant profile, frequency, percentages, and cumulative percentages were determined. Results: The majority of respondents had either heard of (90.9%), seen (65.3%), or were familiar with (74.6%) how telemedicine is implemented in practice. 72.2% of people were familiar with the tools that could be applied to this technology. Those with a medical degree and experience of under five years were found to be more familiar with telemedicine. Additionally, opinions on providing healthcare remotely were largely favorable, with 80% of respondents stating that it reduced staff burden and 80.6% thinking that it eliminated unnecessary transportation costs. Furthermore, 83% expressed that it saves clinicians' time. However, 20% of participants believed telemedicine adds to staff workload and 40% of healthcare professionals felt it compromises patient privacy and information confidentiality. Conclusion: Despite being a new and developing practice in many countries, telemedicine appears to have a bright future. This is crucial during a pandemic as it provides effective healthcare while maintaining social isolation measures. Moreover, the majority of the participants in this study demonstrated a good understanding and a favorable attitude toward telemedicine.

Keywords: healthcare system, global survey, knowledge, attitude, covid 19, telemedicine

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Authors: Badryah Alshehri, Kevin Gormley, Gillian Prue, Karen McCutcheon

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In a disaster event, sharing patient information between the pre-hospital Emergency Medical Services (EMS) and Emergency Department (ED) hospitals is a complex process during which important information may be altered or lost due to poor communication. The aim of this study was to critically discuss the current evidence base in relation to communication between pre- EMS hospital and ED hospital professionals by the use of Information and Communication Systems (ICT). This study followed the systematic approach; six electronic databases were searched: CINAHL, Medline, Embase, PubMed, Web of Science, and IEEE Xplore Digital Library were comprehensively searched in January 2018 and a second search was completed in April 2020 to capture more recent publications. The study selection process was undertaken independently by the study authors. Both qualitative and quantitative studies were chosen that focused on factors that are positively or negatively associated with coordinated communication between pre-hospital EMS and ED teams in a disaster event. These studies were assessed for quality, and the data were analyzed according to the key screening themes which emerged from the literature search. Twenty-two studies were included. Eleven studies employed quantitative methods, seven studies used qualitative methods, and four studies used mixed methods. Four themes emerged on communication between EMTs (pre-hospital EMS and ED staff) in a disaster event using the ICT. (1) Disaster preparedness plans and coordination. This theme reported that disaster plans are in place in hospitals, and in some cases, there are interagency agreements with pre-hospital and relevant stakeholders. However, the findings showed that the disaster plans highlighted in these studies lacked information regarding coordinated communications within and between the pre-hospital and hospital. (2) Communication systems used in the disaster. This theme highlighted that although various communication systems are used between and within hospitals and pre-hospitals, technical issues have influenced communication between teams during disasters. (3) Integrated information management systems. This theme suggested the need for an integrated health information system that can help pre-hospital and hospital staff to record patient data and ensure the data is shared. (4) Disaster training and drills. While some studies analyzed disaster drills and training, the majority of these studies were focused on hospital departments other than EMTs. These studies suggest the need for simulation disaster training and drills, including EMTs. This review demonstrates that considerable gaps remain in the understanding of the communication between the EMS and ED hospital staff in relation to response in disasters. The review shows that although different types of ICTs are used, various issues remain which affect coordinated communication among the relevant professionals.

Keywords: emergency medical teams, communication, information and communication technologies, disaster

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Authors: Mrinal Kanti Bhowmik, Kakali Das Jr., Barin Kumar De, Debotosh Bhattacharjee

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Breast cancer is the most common cancer and a leading cause of death for women in the 35 to 55 age group. Early detection of breast cancer can decrease the mortality rate of breast cancer. Mammography is considered as a ‘Gold Standard’ for breast cancer detection and a very popular modality, presently used for breast cancer screening and detection. The screening of digital mammograms often leads to over diagnosis and a consequence to unnecessary traumatic & painful biopsies. For that reason recent studies involving the use of thermal imaging as a screening technique have generated a growing interest especially in cases where the mammography is limited, as in young patients who have dense breast tissue. Tumor is a significant sign of breast cancer in both mammography and thermography. The tumors are complex in structure and they also exhibit a different statistical and textural features compared to the breast background tissue. Fractal geometry is a geometry which is used to describe this type of complex structure as per their main characteristic, where traditional Euclidean geometry fails. Over the last few years, fractal geometrics have been applied mostly in many medical image (1D, 2D, or 3D) analysis applications. In breast cancer detection using digital mammogram images, also it plays a significant role. Fractal is also used in thermography for early detection of the masses using the thermal texture. This paper presents an overview of the recent aspects and initiatives of fractals in breast cancer detection in both mammography and thermography. The scope of fractal geometry in automatic breast cancer detection using digital mammogram and thermogram images are analysed, which forms a foundation for further study on application of fractal geometry in medical imaging for improving the efficiency of automatic detection.

Keywords: fractal, tumor, thermography, mammography

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Authors: Muhammad Saleem Ullah Khan Sumbal, Eric Tsui, Ricky Cheong, Eric See To

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Organizations are posed to a threat of valuable knowledge loss when employees leave either due to retirement, resignation, job change or because of disabilities e.g. death, etc. Due to changing economic conditions, globalization, and aging workforce, organizations are facing challenges regarding retention of valuable knowledge. On the one hand, large number of employees are going to retire in the organizations whereas on the other hand, younger generation does not want to work in a company for a long time and there is an increasing trend of frequent job change among the new generation. Because of these factors, organizations need to make sure that they capture the knowledge of employee before (s)he walks out of the door. The first step in this process is to know what type of knowledge employee possesses and whether this knowledge is important for the organization. Researchers reveal in the literature that despite the serious consequences of knowledge loss in terms of organizational productivity and competitive advantage, there has not been much work done in the area of knowledge loss assessment of departing employees. An important step in the knowledge retention process is to determine the critical ‘at risk’ knowledge. Thus, knowledge loss risk assessment is a process by which organizations can gauge the importance of knowledge of the departing employee. The purpose of this study is to explore this topic of knowledge loss risk assessment by conducting a qualitative study in oil and gas sector. By engaging in dialogues with managers and executives of the organizations through in-depth interviews and adopting a grounded methodology approach, the research will explore; i) Are there any measures adopted by organizations to assess the risk of knowledge loss from departing employees? ii) Which factors are crucial for knowledge loss assessment in the organizations? iii) How can we prioritize the employees for knowledge retention according to their criticality? Grounded theory approach is used when there is not much knowledge available in the area under research and thus new knowledge is generated about the topic through an in-depth exploration of the topic by using methods such as interviews and using a systematic approach to analyze the data. The outcome of the study will generate a model for the risk of knowledge loss through factors such as the likelihood of knowledge loss, the consequence/impact of knowledge loss and quality of the knowledge loss of departing employees. Initial results show that knowledge loss assessment is quite crucial for the organizations and it helps in determining what types of knowledge employees possess e.g. organizations knowledge, subject matter expertise or relationships knowledge. Based on that, it can be assessed which employee is more important for the organizations and how to prioritize the knowledge retention process for departing employees.

Keywords: knowledge loss, risk assessment, departing employees, Hong Kong organizations

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Authors: Priyal Chikhaliwala, Sudeshna Chandra

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Liver cancer is one of the most common malignant tumors with poor prognosis. This is because liver cancer does not exhibit any symptoms in early stage of disease. Increased serum level of AFP is clinically considered as a diagnostic marker for liver malignancy. The present diagnostic modalities include various types of immunoassays, radiological studies, and biopsy. However, these tests undergo slow response times, require significant sample volumes, achieve limited sensitivity and ultimately become expensive and burdensome to patients. Considering all these aspects, electrochemical biosensors based on dendrimer-magnetic nanoparticles (MNPs) was designed. Dendrimers are novel nano-sized, three-dimensional molecules with monodispersed structures. Poly-amidoamine (PAMAM) dendrimers with eight –NH₂ groups using ethylenediamine as a core molecule were synthesized using Michael addition reaction. Dendrimers provide added the advantage of not only stabilizing Fe₃O₄ NPs but also displays capability of performing multiple electron redox events and binding multiple biological ligands to its dendritic end-surface. Fe₃O₄ NPs due to its superparamagnetic behavior can be exploited for magneto-separation process. Fe₃O₄ NPs were stabilized with PAMAM dendrimer by in situ co-precipitation method. The surface coating was examined by FT-IR, XRD, VSM, and TGA analysis. Electrochemical behavior and kinetic studies were evaluated using CV which revealed that the dendrimer-Fe₃O₄ NPs can be looked upon as electrochemically active materials. Electrochemical immunosensor was designed by immobilizing anti-AFP onto dendrimer-MNPs by gluteraldehyde conjugation reaction. The bioconjugates were then incubated with AFP antigen. The immunosensor was characterized electrochemically indicating successful immuno-binding events. The binding events were also further studied using magnetic particle imaging (MPI) which is a novel imaging modality in which Fe₃O₄ NPs are used as tracer molecules with positive contrast. Multicolor MPI was able to clearly localize AFP antigen and antibody and its binding successfully. Results demonstrate immense potential in terms of biosensing and enabling MPI of AFP in clinical diagnosis.

Keywords: alpha-fetoprotein, dendrimers, electrochemical biosensors, magnetic nanoparticles

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Authors: Long Zhang, Ian Hampson, Loretta O' Donnell

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Practitioners in various industries, especially in the finance industry that conventionally benefit from financial capital and resources, appear to be increasingly aware of the importance of human capital resources (HCR) after the 2008 Global Financial Crisis. Scholars from diverse fields have conducted extensive and fruitful research on HCR within their own disciplines. This review suggests that the mainstream of pure quantitative research alone is insufficient to provide precise or comprehensive understanding of HCR. The complex relationships and interactions in HCR call for more integrative and cross-disciplinary research to more holistically understand complex and intricate HCRs. The complex nature of HCR requires deep qualitative exploration based on in-depth data to capture the everydayness of organizational activities and to register its individuality and variety. Despite previous efforts, a systematic and holistic integration of HCR research among multiple disciplines is lacking. Using a retrospective analysis of articles published in the field of economics, finance and management, including psychology, human resources management (HRM), organizational behaviour (OB), industrial and organizational psychology (I-O psychology), organizational theory, and strategy literatures, this study summaries and compares the major perspectives, theories, and findings on HCR research. A careful examination of the progress of the debates of HCR definitions and measurements in distinct disciplines enables an identification of the limitations and gaps in existing research. It enables an analysis of the interplay of these concepts, as well as that of the related concepts of intellectual capital, social capital, and Chinese guanxi, and how they provide a broader perspective on the HCR-related influences on firms’ competitive advantage. The study also introduces the themes of Environmental, Social and Governance, or ESG based investing, as the burgeoning body of ESG studies illustrates the rising importance of human and non-financial capital in investment process. The ESG literature locates HCR into a broader research context of the value of non-financial capital in explaining firm performance. The study concludes with a discussion of new directions for future research that may help advance our knowledge of HCR.

Keywords: human capital resources, social capital, Chinese guanxi, human resources management

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Authors: Kym Drady

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This paper considers whether creativity is the missing link which would allow the evolution of organisational behaviour and profitability if it was ‘released’. It suggests that although many organisations try to engage their workforce and expect innovation they fail to provide the means for its achievement. The paper suggests that creative thinking is the ‘glue’ which links organisational performance to profitability. A key role of a university today, is to produce skilled and capable graduates. Increasing competition and internationalisation has meant that the employability agenda has never been more prominent within the field of education. As such it should be a key consideration when designing and developing a curriculum. It has been suggested that creativity is a valuable personal skill and perhaps should be the focus of an organisations business strategy in order for them to increase their competitive advantage in the twenty first century. Flexible and agile graduates are now required to become creative in their use of skills and resources in an increasingly complex and sophisticated global market. The paper, therefore, questions that if this is the case why then does creativity fail to appear as a key curriculum subject in many business schools. It also considers why policy makers continue to neglect this critical issue when it could offer the ‘key’ to economic prosperity. Recent literature does go some way to addressing by suggesting that small clusters of UK Universities have started including some creativity in their PDP work. However, this paper builds on this work and proposes that that creativity should become a central component of the curriculum. The paper suggests that creativity should appear in every area of the curriculum and that it should act as the link that connects productivity to profitability rather than being marginalised as an additional part of the curriculum. A range of data gathering methods have been used but each has been drawn from a qualitative base as it was felt that due to nature of the study individual’s thoughts and feelings needed to be examined and reflection was important. The author also recognises the importance of her own reflection both on the experiences of the students and their later working experiences as well as on the creative elements within the programme that she delivered. This paper has been drawn from research undertaken by the author in relation to her PhD study which explores the potential benefits of including creativity in the curriculum within business schools and the added value this could make to their employability. To conclude, creativity is, in the opinion of the author, the missing link to organisational profitability and as such should be prioritised especially by higher education providers.

Keywords: business curriculum, business curriculum, higher education, creative thinking and problem-solving, creativity

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Authors: Ling-Lang Huang

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Research Background: Historically, the evolution of medicine has not only aimed to extend life but has also inadvertently introduced suffering in the process of maintaining life, presenting a contemporary challenge. We must carefully assess the conflict between the length of life and the quality of living. Evidence-Based Medicine (EBM) exists primarily to ensure the quality of cures. However, EBM alone does not fulfill our ultimate medical goals; we must also evaluate Value-Based Medicine (VBM) to find the best treatment for patients. Research Methodology: We can attempt to integrate EBM with VBM. Within the five steps of EBM, the first three steps (Ask—Acquire—Appraise) focus on the physical aspect of humans. However, in the fourth and fifth steps (Apply—Assess), the focus shifts from the physical to applying evidence-based treatment to the patient and assessing its effectiveness, considering a holistic approach to the individual. To consider VBM for patients, we can divide the process into three steps: The first step is "awareness," recognizing that each patient inhabits a different life-world and possesses unique differences. The second step is "integration," akin to the hermeneutic concept of the Fusion of Horizons. This means being aware of differences and also understanding the origins of these patient differences. The third step is "respect," which involves setting aside our adherence to medical objectivity and scientific rigor to respect the ultimate healthcare decisions made by individuals regarding their lives. Discussion and Conclusion: After completing these three steps of VBM, we can return to the fifth step of EBM: Assess. Our assessment can now transcend the physical treatment focus of the initial steps to align with a holistic care philosophy.

Keywords: shared decision-making, evidence-based medicine, values-based medicine, holistic healthcare

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Authors: Yanjun Chen, Chuanping Hu, Jie Shao, Lin Mei, Chongyang Zhang

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Traditional image classification is based on encoding scheme (e.g. Fisher Vector, Vector of Locally Aggregated Descriptor) with low-level image features (e.g. SIFT, HoG). Compared to these low-level local features, deep convolutional features obtained at the mid-level layer of convolutional neural networks (CNN) have richer information but lack of geometric invariance. For scene classification, there are scattered objects with different size, category, layout, number and so on. It is crucial to find the distinctive objects in scene as well as their co-occurrence relationship. In this paper, we propose a method to take advantage of both deep convolutional features and the traditional encoding scheme while taking object-centric and scene-centric information into consideration. First, to exploit the object-centric and scene-centric information, two CNNs that trained on ImageNet and Places dataset separately are used as the pre-trained models to extract deep convolutional features at multiple scales. This produces dense local activations. By analyzing the performance of different CNNs at multiple scales, it is found that each CNN works better in different scale ranges. A scale-wise CNN adaption is reasonable since objects in scene are at its own specific scale. Second, a fisher kernel is applied to aggregate a global representation at each scale and then to merge into a single vector by using a post-processing method called scale-wise normalization. The essence of Fisher Vector lies on the accumulation of the first and second order differences. Hence, the scale-wise normalization followed by average pooling would balance the influence of each scale since different amount of features are extracted. Third, the Fisher vector representation based on the deep convolutional features is followed by a linear Supported Vector Machine, which is a simple yet efficient way to classify the scene categories. Experimental results show that the scale-specific feature extraction and normalization with CNNs trained on object-centric and scene-centric datasets can boost the results from 74.03% up to 79.43% on MIT Indoor67 when only two scales are used (compared to results at single scale). The result is comparable to state-of-art performance which proves that the representation can be applied to other visual recognition tasks.

Keywords: deep convolutional features, Fisher Vector, multiple scales, scale-specific normalization

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Authors: Nan Hu, Chao Wang, Xi Li, Xuehai Zhou

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The field-programmable gate array (FPGA) has been widely adopted in the high-performance computing domain. In recent years, the embedded system-on-a-chip (SoC) contains coarse granularity multi-core CPU (central processing unit) and mobile GPU (graphics processing unit) that can be used as general-purpose accelerators. The motivation is that algorithms of various parallel characteristics can be efficiently mapped to the heterogeneous architecture coupled with these three processors. The CPU and GPU offload partial computationally intensive tasks from the FPGA to reduce the resource consumption and lower the overall cost of the system. However, in present common scenarios, the applications always utilize only one type of accelerator because the development approach supporting the collaboration of the heterogeneous processors faces challenges. Therefore, a systematic approach takes advantage of write-once-run-anywhere portability, high execution performance of the modules mapped to various architectures and facilitates the exploration of design space. In this paper, A servant-execution-flow model is proposed for the abstraction of the cooperation of the heterogeneous processors, which supports task partition, communication and synchronization. At its first run, the intermediate language represented by the data flow diagram can generate the executable code of the target processor or can be converted into high-level programming languages. The instantiation parameters efficiently control the relationship between the modules and computational units, including two hierarchical processing units mapping and adjustment of data-level parallelism. An embedded system of a three-dimensional waveform oscilloscope is selected as a case study. The performance of algorithms such as contrast stretching, etc., are analyzed with implementations on various combinations of these processors. The experimental results show that the heterogeneous computing system with less than 35% resources achieves similar performance to the pure FPGA and approximate energy efficiency.

Keywords: FPGA-CPU-GPU collaboration, design space exploration, heterogeneous computing, intermediate language, parameterized instantiation

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Authors: Zachary Huffman, Joana Rocha

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Wall-pressure fluctuations induced by the turbulent boundary layer (TBL) developed over aircraft are a significant source of aircraft cabin noise. Since the power spectral density (PSD) of these pressure fluctuations is directly correlated with the amount of sound radiated into the cabin, the development of accurate empirical models that predict the PSD has been an important ongoing research topic. The sound emitted can be represented from the pressure fluctuations term in the Reynoldsaveraged Navier-Stokes equations (RANS). Therefore, early TBL empirical models (including those from Lowson, Robertson, Chase, and Howe) were primarily derived by simplifying and solving the RANS for pressure fluctuation and adding appropriate scales. Most subsequent models (including Goody, Efimtsov, Laganelli, Smol’yakov, and Rackl and Weston models) were derived by making modifications to these early models or by physical principles. Overall, these models have had varying levels of accuracy, but, in general, they are most accurate under the specific Reynolds and Mach numbers they were developed for, while being less accurate under other flow conditions. Despite this, recent research into the possibility of using alternative methods for deriving the models has been rather limited. More recent studies have demonstrated that an artificial neural network model was more accurate than traditional models and could be applied more generally, but the accuracy of other machine learning techniques has not been explored. In the current study, an original model is derived using a stepwise regression algorithm in the statistical programming language R, and TBL wall-pressure fluctuations PSD data gathered at the Carleton University wind tunnel. The theoretical advantage of a stepwise regression approach is that it will automatically filter out redundant or uncorrelated input variables (through the process of feature selection), and it is computationally faster than machine learning. The main disadvantage is the potential risk of overfitting. The accuracy of the developed model is assessed by comparing it to independently sourced datasets.

Keywords: aircraft noise, machine learning, power spectral density models, regression models, turbulent boundary layer wall-pressure fluctuations

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Authors: Xiuguo Zhao, Xudong Ren, Chen Su, Xinxi Xu, Fu Niu, Lingshuai Meng

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The respiratory diseases such as asthma, emphysema and bronchitis are connected with the air pollution and the number of these diseases tends to increase, which may attribute to the toxic aerosol deposition in human upper respiratory tract or in the bifurcation of human lung. The therapy of these diseases mostly uses pharmaceuticals in the form of aerosol delivered into the human upper respiratory tract or the lung. Understanding of airflow structures in human upper respiratory tract plays a very important role in the analysis of the “filtering” effect in the pharynx/larynx and for obtaining correct air-particle inlet conditions to the lung. However, numerical simulation based CFD (Computational Fluid Dynamics) technology has its own advantage on studying airflow structure in human upper respiratory tract. In this paper, a representative human upper respiratory tract is built and the CFD technology was used to investigate the air movement characteristic in the human upper respiratory tract. The airflow movement characteristic, the effect of the airflow movement on the shear stress distribution and the probability of the wall injury caused by the shear stress are discussed. Experimentally validated computational fluid-aerosol dynamics results showed the following: the phenomenon of airflow separation appears near the outer wall of the pharynx and the trachea. The high velocity zone is created near the inner wall of the trachea. The airflow splits at the divider and a new boundary layer is generated at the inner wall of the downstream from the bifurcation with the high velocity near the inner wall of the trachea. The maximum velocity appears at the exterior of the boundary layer. The secondary swirls and axial velocity distribution result in the high shear stress acting on the inner wall of the trachea and bifurcation, finally lead to the inner wall injury. The enhancement of breathing intensity enhances the intensity of the shear stress acting on the inner wall of the trachea and the bifurcation. If human keep the high breathing intensity for long time, not only the ability for the transportation and regulation of the gas through the trachea and the bifurcation fall, but also result in the increase of the probability of the wall strain and tissue injury.

Keywords: airflow structure, computational fluid dynamics, human upper respiratory tract, wall shear stress, numerical simulation

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Authors: Jolanta Jonak, Sylvia Tolczyk

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Students demonstrate various learning preferences and learning styles that range from visual, auditory to kinesthetic preferences. These learning preferences are further impacted by individual cognitive make up that characterizes itself in linguistic strengths, logical- special, inter-or intra- personal, just to name a few. Students from culturally and linguistically diverse backgrounds (CLD) have an increased risk of being misunderstood by many school systems and even medical personnel. CLD students are influenced by many factors (like acculturation and experience) that may impact their achievements and functioning levels. CLD students who develop initial or basic interpersonal communication proficiency skills in the target language are even at a higher risk for being suspected of learning disability when they are underachieving academically. Research indicates that large numbers of students arenot provided the type of education and types of supports they need in order to be successful in an academicenvironment. Multiple research findings indicate that significant numbers of school staff self-reports that they do not feel adequately prepared to work with CLD students. It is extremely important for the school staff, especially school psychologists, who often are the first experts that are consulted, to be educated about overlapping symptoms and settle differences between learning difference and disability. It is equally important for medical personnel, mainly pediatricians, psychologists, and psychiatrists, to understand the subtle differences to avoid inaccurate opinions. Having the knowledge, school staff can avoid unnecessary referrals for special education evaluations and avoid inaccurate decisions about the presence of a disability. This presentation will illustrate distinctions based on research between learning differences and disabilities, how to recognize them, and how to assess for them.

Keywords: special education, learning disability, differentiation, differences

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Authors: Hsiao-Lin Fang

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The Patient Self-Determination Act is based on the belief that each life is unique. The act regards each patient as an autonomous entity and explicitly protects the patient’s rights to know and make decisions and choices while ensuring that the patient’s wish for a peaceful end is granted. Even when the patient is unconscious and unable to express himself/herself, the patient’s self-determination and its exercise are still protected under the law. The act also ensures that healthcare professionals (HCPs) have a specific set of rules to follow and complete legal protection when their patients are unable to express themselves clearly. This report is about a 55-year-old female patient who weighed 110 kg and was diagnosed with acute type A aortic dissection. The case was that the patient suddenly felt backache and nausea during sleep before daybreak and was therefore transferred to this hospital from the original one. After the doctor explained the patient’s conditions, it was concluded that surgery was necessary. However, the patient’s family was immediately against the surgery after having heard its possible complications. Nevertheless, the patient was still willing to receive the surgery. Being at odds with her family, the patient decided to sign the surgery agreement herself and agreed to receive the two surgical procedures: (1) ascending aorta replacement and (2) innominate artery debranching. After the surgery, the patient did not regain consciousness and therefore received computed tomography scanning of the brain, which revealed false lumen involving proximal left common carotid artery, left subclavian artery and innominate artery, and severe compression of the true lumen with total/subtotal occlusion in the left common carotid artery. On the following day, the doctor discussed two further surgical procedures: (1) endografting for descending aorta and (2) endografting for left common carotid artery and subclavian artery with the family. However, as the patient’s postoperative recovery of consciousness only reached the level of stupor and her family had no intention of subsequent healthcare for the patient, the family made the joint decision three days later to have the endotracheal tube removed from the patient and let her die a natural death. Suggestion: An advance directive (AD) can be created beforehand. Once the patient is in a special clinical state (e.g., terminal illness, permanent vegetative state, etc.), the AD can determine whether to sustain the patient’s life through ‘medical intervention’ or to respect the patient’s rights to choose a peaceful end and receive palliative care. Through the expression of self-determination, it is possible to respect the patient’s medical practice autonomy and protect the patient’s dignity and right to a peaceful end, thereby respecting and supporting the patient’s decision. This also allows the three sides: the patient, the family and the medical team to understand the patient’s true wish in the process of advance care planning (ACP) and thereby promote harmony in the HCP-patient relationship.

Keywords: intensive care unit patient, cardiovascular surgery, self-determination, advance directive

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