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The sensitivity of pneumothorax diagnosis via handheld ultrasound is low, and there is no equipment suitable for use with life-threatening tension pneumothorax in a prehospital setting. This study proposes a novel technology involving optical fibers and near-infrared spectroscopy to assist in needle thoracostomy decompression. The proposed system via the optical fibers emitted dual wavelengths of 690 and 850 nm, allowing distinction among different layers of tissue in vivo. The fundamental principle is the modified Beer–Lambert law (MBLL) which is the basis of near-infrared tissue spectroscopy. Changes in optical density corresponding to different wavelengths (690 and 850 nm) and hemoglobin parameters (levels of Hb and HbO2) were examined. The Kruskal–Wallis H test was used to compare the differences in parameter estimates among tissue layers; all p-values were 2 levels relative to those observed in the vein and artery, all p-values were also

Hotel A served the boutique hotel segment. Rather than focusing on market segments in Singapore’s hotel chain scale system, the management decided to offer guests an affordable luxury experience via excellent personalized service while capitalizing on the rich and authentic cultural heritage that the hotel offered in terms of history and design. Although Hotel A had won the Best Hotel Service award three years consecutively, it was getting harder to distinguish itself from other boutique hotels and to align itself with the parent company’s (Company A) strategic long-term goals. Mr. Lim had been the manager of Hotel A for five years. He worked up the ranks, learning the ropes and garnering accolades for best service, and management skills. He had earned the respect of his staff as he empowered his staff, empathized with them and walked the talk. Since December 2019, the world had been reeling from the impact of a global pandemic caused by the coronavirus (COVID-19) which was primarily spread through physical contact and respiratory droplets. Most countries implemented very stringent measures to prevent the disease from spreading within its borders. The luxury boutique hotel category in particular had been negatively affected as the hospitality industry focused on people, personalized services and face to face interactions. One prominent change seen as a result of COVID-19 was a change in consumer behavior, influenced by risk perception (Gössling et al., 2020; Kirk & Rifkin, 2020). Guests became more cautious and concerned about safety and hygiene, preferring less human touch during registration and food delivery, and practiced safe distancing from others (Rittichainuwat & Chakraborty, 2009). Millennials had increasingly become an attractive market segment for the luxury hotel industry as they were not price conscious, preferring to “spend tomorrow’s money” and “spend ahead of income” (Wang, Sun & Song, 2011). Furthermore, as they were digital natives, products and experiences which could satisfy their luxury consumptions could be promoted easily via social media marketing. In August 2020, the Singapore government rolled out a S$45 million SingapoRediscovers campaign where Singaporeans were given S$320 million in tourism credits to drive local spending (Straits Times, August 2020). Mr. Lim is in a dilemma. How can he promote Hotel A as the preferred staycation destination to local Millennials without alienating its more traditional clientele and brand image as a heritage hotel catering to foreigners? How should Hotel A provide personalized service and maintain service quality and satisfaction with safe management measures in place in sync with Millennials’ lifestyle?

The traditional needle cricothyroidotomy procedure is performed blindly without any medical equipment. Complications including posterior tracheal wall perforation, accidental vessel puncture, and missed tracheal puncture are reported. Therefore, we proposed a dual-wavelength fiber-optic technique based on the technique of near-infrared spectroscopy to assist operators performing needle cricothyroidotomy in a swine model. We embedded optical fibers in a 16-gauge intravenous needle catheter. Real-time data were displayed on an oscilloscope, and we used the program to analyze the data immediately. The change of optical density corresponding to 690-nm and 850-nm wavelengths and hemoglobin parameters (HbO2 and Hb concentrations) was analyzed immediately using the program in the laptop. Unique and significant optical differences were presented in this experiment. We could easily identify every different tissue by the change of optical density corresponding to 690-nm and 850-nm wavelengths and hemoglobin parameters (HbO2 and Hb concentrations). Statistical method (Kruskal-Wallis H test) was used to compare differences in tissues at each time-point, respectively. The p values in every tissue in optical density change corresponding to 690 nm and 850 nm were all p values in every tissue in Hb and HbO2 were also all

A novel aptamer-based competitive drug screening platform for osteoporosis was devised in which fluorescence-labeled, sclerostin-specific aptamers compete with compounds from selected chemical libraries for the binding of immobilized recombinant human sclerostin to achieve high-throughput screening for potential small-molecule sclerostin inhibitors and to facilitate drug repurposing and drug discovery. Of the 96 selected inhibitors and FDA-approved drugs, six were shown to result in a significant decrease in the fluorescence intensity of the aptamer, suggesting a higher affinity toward sclerostin compared with that of the aptamer. The targets of these potential sclerostin inhibitors were correlated to lipid or bone metabolism, and several of the compounds have already been shown to be potential osteogenic activators, indicating that the aptamer-based competitive drug screening assay offered a potentially reliable strategy for the discovery of target-specific new drugs. The six potential sclerostin inhibitors suppressed the level of both intracellular and/or extracellular sclerostin in mouse osteocyte IDG-SW3 and increased alkaline phosphatase activity in IDG-SW3 cells, human bone marrow-derived mesenchymal stem cells and human fetal osteoblasts hFOB1.19. Potential small-molecule drug candidates obtained in this study are expected to provide new therapeutics for osteoporosis as well as insights into the structure–activity relationship of sclerostin inhibitors for rational drug design.

This study aimed to provide insights on the perceptions of engineering students from two educational paths in Singapore of desired graduate attributes by employers. Research questions: (1) Do graduates from the polytechnic and junior college paths have similar perceptions with regard to the ranking of desirable graduate attributes? (2) If not, in what ways are their perceptions different? Literature review: A review of literature on employers’ ranking of desirable graduate attributes revealed mismatches in employers’ and graduates’ rankings. There has not been any published study on student awareness of employability skills in Singapore in particular. Hence, this study investigated the perceptions of final-year engineering students from two different educational paths of their ranking of graduate attributes. Methodology: The students were asked to rank eight attributes and explain their ranking from an employer’s perspective. Results: The findings show that communication, teamwork, and problem-solving were ranked the top three desirable attributes by both groups of students. However, polytechnic students seem to reflect greater familiarity and confidence in tackling workplace requirements compared to junior college students. The implications of the findings are presented. Accepted version

We read with interest the article regarding 97 patients who underwent thyroidectomy for Graves’ disease (1). In the retrospective study, 49 patients received open thyroidectomy (OT) and 46 patients received transoral endoscopic thyroidectomy vestibular approach (TOETVA). The outcomes of patients with TOETVA were compared to those of patients with OT. The authors discovered and concluded that patients receiving TOETVA had better cosmetic results (scare-free) than patients with OT. Also, they reported that patients receiving TOETVA experienced significantly less pain than that in patients with OT. The finding has drawn the attention of anesthesiologists who are involved in the pain management perioperatively.

Chia-Chun Chuang,1 Chien-Ching Lee,1,2 Li-Kai Wang,1 Bor-Shyh Lin,2 Wen-Ju Wu,1 Chung-Han Ho,3 Jen-Yin Chen1,4 1Department of Anesthesiology, ChiMei Medical Center, 2Department of Imaging and Biomedical Photonics, National Chiao Tung University, 3Department of Medical Research, Chi Mei Medical Center, 4Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan, Republic of China Purpose: This study aimed to evaluate whether a nonpharmacological approach through implementation of a communication improvement program (named CICARE for Connect, Introduce, Communicate, Ask, Respond and Exit) into standard operating procedure (SOP) in acute pain service (APS) improved satisfaction in patients receiving intravenous patient-controlled analgesia (IV-PCA).Patients and methods: This was a nonrandomized before–after study. Adult patients (aged between 20 and 80years) who received IV-PCA after major surgery were included. Implementing CICARE into SOP was conducted in APS. Anonymous questionnaires were used to measure outcomes in this prospective two-part survey. The first part completed by APS nurses contained patients’ characteristics, morphine dosage, delivery/demand ratios, IV-PCA side effects and pain at rest measured with an 11-point numeric rating scale (NRS, 0–10). A score of NRS ≥4 was defined as inadequately treated pain. The ten-question second part was completed by patients voluntarily after IV-PCA was discontinued. Each question was assessed with a 5-point Likert scale (1: extremely poor; 5: excellent). Patients were separated into “before” and “after” CICARE groups. Primary outcomes were patient global impression of improvement in pain (PGI-Improvement) and patient satisfaction. Secondary outcomes included quality of communication skills, instrument proficiency and accessibility/availability of IV-PCA.Results: The response rate was 55.3%, with 187 usable questionnaires. CICARE effectively improved patient global impression of improvement in pain, patient satisfaction, communication skills and accessibility/availability of IV-PCA. No significant differences were noted in instrument proficiency, morphine dosage, delivery/demand ratios, rates of inadequately treated pain at rest and side effects of IV-PCA between groups. Paradoxical findings were noted between the rates of inadequately treated pain/side effects and PGI-Improvement in pain/patient satisfaction, which were affected by psychological factors.Conclusion: Nonpharmacological interventions carried out by implementing CICARE into SOP for APS effectively improved patient satisfaction and postoperative pain management quality, but this did not affect actual pain. Keywords: acute pain service, patient–physician communication, nonpharmacological approach, patient-controlled analgesia, patient satisfaction

Medical institutions are eager to introduce new information technology to improve patient safety and clinical efficiency. However, the acceptance of new information technology by medical personnel plays a key role in its adoption and application. This study aims to investigate whether perceived organizational learning capability (OLC) is associated with user acceptance of information technology among operating room nurse staff.Nurse anesthetists and operating room nurses were recruited in this questionnaire survey. A pilot study was performed to ensure the reliability and validity of the translated questionnaire, which consisted of 14 items from the four dimensions of OLC, and 16 items from the four constructs of user acceptance of information technology, including performance expectancy, effort expectancy, social influence, and behavioral intention. Confirmatory factor analysis was applied in the main survey to evaluate the construct validity of the questionnaire. Structural equation modeling was used to test the hypothetical relationships between the four dimensions of user acceptance of information technology and the second-ordered OLC. Goodness of fit of the hypothetic model was also assessed.Performance expectancy, effort expectancy, and social influence positively influenced behavioral intention of users of the clinical information system (all p0.001) and accounted for 75% of its variation. The second-ordered OLC was positively associated with performance expectancy, effort expectancy, and social influence (all p0.001). However, the hypothetic relationship between perceived OLC and behavioral intention was not significant (p = 0.87). The fit statistical analysis indicated reasonable model fit to data (root mean square error of approximation = 0.07 and comparative fit index = 0.91).Perceived OLC indirectly affects user behavioral intention through the mediation of performance expectancy, effort expectancy, and social influence in the operating room setting.

The left ventricular assist device (LVAD) is a battery-operated, mechanical pump-type device that helps in maintaining the pumping ability of a failing heart. Thromboembolism poses a significant risk during and after LVAD implantation. It occurs in up to 35% of patients with adverse sequelae. We present the case of a 75-year-old man who underwent coronary artery bypass graft surgery and LVAD implantation for acute myocardial ischemia and severe left ventricular dysfunction. However, subsequent transthoracic echocardiographic examination revealed an LVAD thrombus, and LVAD removal was suggested following the failure of thrombolytic therapy. After the LVAD cannula was removed, transesophageal echocardiography (TEE) revealed a residual thrombus in the left atrium. Thrombectomy was successfully performed by opening the left atrium with cardiopulmonary bypass. We believe that TEE monitoring aided the implantation and removal of the LVAD device. In this case, we found that TEE not only helped in monitoring the ventricular function but also in detecting other problems such as the residual thrombus. We strongly recommend TEE monitoring during the entire LVAD-removal procedure, particularly for patients who need to undergo LVAD removal because of thrombosis formation.

Patients with Hallervorden-Spatz disease may be confronted by invasive procedure, like gastrostomy and thalamotomy for care of the status of extreme dystonia and rigidity. This rare disorder possesses potential perioperative risks, such as difficult airway management, aspiration pneumonia, hyperpyrexia, dehydration, acute renal failure, and postoperative pulmonary insufficiency. As patients were usually in the state of uncontrollable dystonia and rigidity, delayed endotracheal extubation had been suggested by several previous case reports. We report the anesthetic management of a 34-year-old Hallervorden-Spatz disease woman scheduled for intrathecal baclofen pump implantation under general anesthesia. Preoperatively she had suffered from severe dystonia, confusion and repeated attacks of respiratory insufficiency and pneumonia requiring mechanical ventilation and critical care. Anesthesia was induced uneventfully and the catheter of the pump reached the CSF via T2 interspace. Intraoperative intrathecal baclofen injection mildly relieved her severe dystonia and rigidity. Hemodynamics and arterial blood gas were improved than preoperative. She was extubated after consciousness was regained. Postanesthetic visit demonstrated a fair outcome. Whether this treatment applies to every case confronted by general anesthesia needs to be elucidated. Nevertheless, we suggest intrathecal baclofen may help postanesthetic pulmonary care by attenuating dystonia and rigidity and can be an adjuvant for anesthesia care in patients with Hallervorden-Spatz disease.

We describe the successful management of extravasation injury to the left hand by contrast medium with stellate ganglion block and intra-arterial nitroglycerin in a patient which befell during contrast-enhanced imaging. The incidence of contrast-medium extravasation injury is increasing because of the convenience and availability of contrast-enhanced imaging and ease of injection access. Extravasation of contrast medium may results in severe pain, erythema, cyanosis, and edema or even skin necrosis, which is largely related to the ionization, osmolarity, and volume of the contrast medium. The conservative treatment is often adequate in small amount extravasation, but if the extravasation is overwhelming further energetic management is mandatory. A 29-year-old man was brought to our emergency because of diffuse abdominal pain and he was arranged to receive intravenous contrast media enhanced abdominal computed tomography for diagnosis. Ruptured appendicitis with abscess formation was suspected; then the patient underwent emergent appendectomy and drainage of the abscess. However, severe swelling and cyanotic change that radiated from the intravenous catheter insertion site in every direction over the entire dorsum of the left hand were noted after the surgery. Contrast-medium extravasation injury was highly contemplated and a left stellate ganglion block was performed immediately for relief of symptoms. The consulting surgeon ruled out compartment syndrome, but advised emergent left upper limb arteriography, which revealed signs of vasospasm with high intravascular pressure of the left distal ulnar and radial arteries; thus nitroglycerin was injected into left distal ulnar and radial arteries for relief of vasospasm. The clinical symptoms were improved after the above managements and the patient was discharged 7 days later without any sequela.

Teaching problem: Students’ written assignments show that they tend to list ideas rather than provide evidence-based arguments. This might be because they do not have a framework to base their arguments on. Research question: Does the communication model framework help students to write evidence-based arguments when evaluating the communicative effectiveness in corporate blogs? Situating the case: The ability to engage in argument from evidence is one of the Next Generation Science Standards for scientific and engineering practices. Thus, it is important for engineering students to know how to present evidence-based arguments. The communication model framework was introduced to provide students with a framework to base their arguments on. This framework builds on the genre-based and academic literacies approaches to teaching writing. More companies are now using corporate blogs (an open, participatory and globally networked social media tool) to engage stakeholders directly across multiple contexts. The framework is useful in analyzing evolving genres like corporate blogs because it is not only structured but also flexible. About the case: This teaching case describes the use of the communication model framework as the basis for students’ arguments. The framework was used in a general writing course for engineering students. Working in groups, the students used the framework for their oral practice critique and also their critique assignment on a given piece of academic writing or corporate blog. They also had to write a reflection paper individually at the end of the course. Results: Overall, the mixed groups and international students groups made a stronger attempt to apply the framework compared to the Singaporean students groups. The students’ educational backgrounds, the group dynamics within the group and the nature of the discussions affected the level of adoption of the framework in their writing. Conclusions: This teaching case reflects the value of mixed group, face-to-face discussions, and personal reflection in teaching students evidence-based writing, and calls for more research on flexible frameworks as genres evolve. Accepted version

This paper presented the use of the dialogic communication model to teach students how to write a report introduction. In the case study presented, the students engaged in discussions and reflections regarding the contextual complexities in the writers’ and readers’ organizational environments, which helped them adapt their writing to their readers’ needs and flow of thought. The thinking process that students go through in making their writing more reader-centered using this model could be a useful springboard to help students adopt the thinking processes of professional engineers. Accepted version