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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?

For steady state visually evoked potential (SSVEP) based brain computer interfaces (BCIs), the elicited SSVEP signals always contain noises and then the performance of SSVEP-based BCIs would be greatly degraded in practical applications. Therefore, to develop an SSVEP signal enhancement would be able to increase the accuracy of SSVEP-based BCIs. In this study, a convolutional denoising autoencoder based SSVEP signal enhancement is proposed to suppress the noise components. The convolutional denoising autoencoder is applied to estimate and suppress the noise components. To effectively estimate the noise components, a sinusoid wave is designed as an ideal SSVEP signal. To ignore the effects of phase, cross correlation is adopted to estimate the phase in the training stage. The experimental results evaluated by using signal-to-noise ratio and canonical correspondence analysis showed that the proposed approaches can effectively suppress the noises components. Therefore, the proposed approach can be applied to develop robust SSVEP-based BCIs.

The communication of a patient with amyotrophic lateral sclerosis is limited and then the quality of lives would be greatly reduced. The patients still maintain the cognitive ability, thus developing an assistive communication interface would greatly help them in daily live. Recently, steady state visually evoked potential (SSVEP) based brain computer interfaces (BCIs) had been successfully developed to help patients. Increasing the accuracy of SSVEP-based BCIs is able to realize the assistive communication interfaces in practical applications. In this study, a modular continuous restricted Boltzmann machine (MCRBM) is proposed to improve the performance of SSVEP-based BCIs. To precisely represent the characteristics of elicited signals of SSVEP, the frequency magnitude, the coefficients of canonical correlation analysis, and the correlations of magnitude square coherence are selected as the features. In the first layer of MCRBM, the continuous restricted Boltzmann machine based neural networks are used as the basic units and applied to accurately estimate by using different types of features. In the second layer of MCRBM, a CRBM is then designed to fuse the decisions and find the final results. The experimental results showed that MCRBM produce higher accuracy compared to CRBM. Therefore, the proposed approach can be adopted in practical applications and then help patients in communicating with others.

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

Tracheobronchomegaly (also called Mounier–Kuhn syndrome) is a rare disease characterized by flaccid and markedly dilated trachea and main bronchi on inspiration with narrowing or collapse on expiration or cough. It is associated with recurrent lower respiratory tract infection. A 75-year-old man with unexpected giant tracheomegaly had a significant peritubal air leak which impeded an operation. Lumbar epidural anesthesia was performed for a subsequent operation without any sequela. Careful evaluation with chest radiography is basic to exclude a large airway. Chest computed tomography and fiber-optic bronchoscopy provided the diagnosis of a large airway. If a large airway is suspected, these examinations help to evaluate and manage the airway.

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.

In previous research about thermally and laterally driven microactuators, Guckel et al. proposed a microactuator based on the variable cross sections but the same length of two adjacent beams. Pan and Hsu presented another type of microactuator based on different lengths but the same cross sections of two adjacent beams. Here, a microactuator that combines the traits of those two designs is proposed, optimized, and fabricated. Finite element analysis is performed to obtain the optimal dimensions of the structures when the maximum lateral displacement is achieved. When the air gap is 2 μm, the optimal performance of current design is similar to Guckel's design with optimal dimensions, but it has 65% larger displacement than Pan and Hsu's design at optimal dimensions. For the case of the large air gap beneath the structure (300 μm), the microactuator of current design has more than 25% tip displacement improvement compared to Guckel's or Pan and Hsu's designs. It is also found that the proposed structure is less sensitive to the beam length variations around optimal point no matter in small or large air gap case. Experimental results also verify that the dimension of the air gap affects the thermal boundary condition, so does the performance and optimal architecture of the microactuators.

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.

Recent years, with the development of multi-core processor architecture, multi-core software development is also being gradually recognized. Therefore, how to quickly develop reliable multi-core software will be a challenge. In our approach, we use Model-driven architecture (MDA) technology to achieve this challenge. First, we extract the experience of designing multi-core software and model the experience as a reusable pattern by using UML meta-modeling techniques. Then, we specify a set of constraints using the Object Constraint Language (OCL) to verify the model with profile. Finally, we provide a tool to specify the operation definition for connecting the design and implementation, so that the model transformation process can be more efficient. Furthermore, we demonstrate our approach by a case study on a real-world multi-core embedded system called PVE (Parallel Video Encoder), where a pattern CommandPipeline is designed for the development convenience.