Video consultation in healthcare:Receiving surgical medical specialist care at home

This thesis describes the implementation and scale up of video consultation at a tertiary referral center. Before video consultation can be implemented and used sustainably in healthcare, it is vital to involve patients and address their needs and requirements of receiving care over a video connection. Therefore the aim of this thesis was to provide the most optimal implementation strategy for video consultation in healthcare based on scientific research. We have researched patient- and provider needs in order to understand their preferences when it comes to digital care. Next, patient- and provider satisfaction with video consultation was evaluated when compared to both physical as telephone consultation. Based on this strategy video consultation was implemented at the surgical outpatient clinic. During the COVID-19 pandemic we were able to scale-up to all outpatient departments. Again, patient and provider satisfaction and willingness to use video consultation was evaluated. Both technical as workflow aspects of the scale up are described in detail. This thesis indicates that the use of video consultation for outpatient care appointments is feasible, and accepted by both patients as well as providers without a detriment to the quality of care provided. There are still a few difficulties that hamper the structural use of video consultation in clinical practice today. But as soon as “Why?” becomes, “Why did we not do this before?”, we can work towards a climate in which receiving care at the right moment, at the right place can be supported by the convenience of digital care

Emergency upscaling of video consultation during the COVID-19 pandemic:Contrasting user experience with data insights from the electronic health record in a large academic hospital

BackgroundVideo consultation (VC) has been scaled up at our academic centre attempting to facilitate and accommodate patient-provider interaction in times of social distancing during the recent and ongoing COVID-19 pandemic.ObjectivesThis study evaluates qualitative outcomes with data insights from the electronic health record, to contrast satisfaction outcomes with the actual use of VC.MethodsHealthcare providers and patients using VC during the COVID-19 pandemic at a large academic centre in the Netherlands were surveyed for user satisfaction and experiences with VC. In addition, quantitative technical assessment was performed using data related to VC from the EHR record.ResultsIn total, 1,027/4,443 patients and 87/166 healthcare providers completed their online questionnaire. Users rated the use of VC during a pandemic with an average score of 8.3/10 and 7.6/10 respectively. Both groups believed the use of VC was a good solution to continue the provision of healthcare during this pandemic. The use of VC increased from 92 in March 2020 to 837 in April 2020.ConclusionThis study strongly signals that VC is an important modality in futureproofing outpatient care during and beyond pandemic times. Further development in end-user technology is needed for EHR integrated VC solutions. Guidelines needs to be developed advising both patients and healthcare providers. Such guidelines should not solely focus on technical implementation and troubleshooting, but must also consider important aspects such as digital health literacy, patient and provider authentication, privacy and ethics

Reduction of low-order harmonics and new topologies of current source converters

Two CSCs related issues are investigated. The first is the reductions of Low Order Harmonics (LOH) in Low Switching Frequency (LSF) CSCs. High power CSCs operate with LSF. This is not an ideal scenario for Space Vector Modulation (SVM), resulting in non-characteristics LOH, 5 th and 7 th (HD 5-7 ). Researchers have attempted to reduce these harmonics by creating new sequences of space vectors (states) or different sampling techniques. New approaches based on the fact that HD 5-7 is affected by states ON times calculation process are proposed. Results show that by using a new technique called Record Middle (RM), one can obtain a smaller HD 5-7 . Also, results for calculating states ON times as the reference vector rotates by new SVM equations show that one can get a significant reduction in HD 5-7 . Another alternative effective with large overlap periods is minimizing LOHs in LSF-SVM-CSCs with Minimum Harmonic Tracking (MHT) technique. Fuzzy logic dependent states ON times calculation give fixed states ON times adjustment during steady state and fast response. Those techniques allowed the usage of reduced size ac-side filters with high cut-off frequencies. The second issue is on new hybrid current source converters (HCSCs). Three SCRs and four IGBTs HCSC has similar characteristics, less capital cost and less power losses compared to the 6-switches CSC. Two types of modulation are proposed. The first is Hard Switching Space Vector Modulation technique (HS-SVM). HS-SVM is presenting low maximum modulation index (m a.max ), resulting in LOH distortion and requiring multiple mandatory switching inside a cycle. The second modulation technique achieves line-commutation or soft switching (SS) of the SCRs whenever possible, thus being called Soft Switching Space Vector Modulation technique (SS-SVM). SS-SVM increases the m a.max while reducing LOH, the switching frequency and switching losses. Comparisons between the 6-switches CSC and the HCSCs are provided. Cost analysis showing the importance of HCSCs is carried out. A case study is presented to show that the HCSC is economically viable in medium and high power ranges. Besides having lower capital cost, the HCSC can operate with lower power losses than 6-switches CSC

Fatigue life of an anchored blind-bolt loaded in tension

This paper investigates and reports on the fatigue behaviour of a novel blind-bolt system termed the Extended Hollo-bolt (EHB). The new blind-bolt is a modified version of the standard Lindapter Hollo-bolt, and its application relates to the construction of bolted, moment-resisting connections between open profile beams and concrete-filled tubular columns. The fatigue behaviour of the system is studied on the basis of constant amplitude loading tests, with a total of 56 experiments being reported. The specimens were subjected to tensile loading for various stress ranges, with the repeated load being selected relative to the design yield stress of the blind-bolt's internal shank. The influence of testing frequency and strength of concrete infill is also examined. An analysis of the results indicates that an increase in the concrete strength can increase the fatigue life of the EHB system. Within the tested range, the failure mode of the EHB under repeated loading was found to be due to internal bolt shank fracture, a mode which is consistent with its monotonic behaviour and also comparable with standard bolt–nut–washer system behaviour. The experimental results (S–N data) were further compared with the Eurocode 3 Part 1-9 guidelines. The fatigue design strength of the anchored EHB blind-bolt is found to be adequately represented by the current specification detail Category 50 that is provided for standard bolting systems

The Effectiveness of a Program Based on Electronic Interactive Activities in Developing the Tourism Awareness of Kindergarten Children

This study aimed to reveal the effectiveness of a program based on electronic interactive activities in developing the tourism awareness of kindergarten children. To achieve the objectives of the study, the descriptive approach and the quasi-experimental approach were used, on a random sample of (62) boys and girls from the kindergarten stage, they were divided into (32) children for the experimental sample and (30) children for the control sample, all from the Eastern Province in the Kingdom of Saudi Arabia. The researchers designed several tools that included a list of the most important concepts of tourism awareness appropriate for a kindergarten child, prepared a program based on electronic interactive activities, and presented it to the children to develop tourism awareness concepts. An electronic scale was used to measure tourism awareness in children in the study sample before and after the application of the program. After validating the psychometric properties of the tools, the pre-test for tourism awareness was performed, then the program was applied to the experimental sample, and finally the post-test was performed. Data was statistically analyzed using the SPSS program to calculate the significance of the differences between the mean scores of the experimental sample and the control sample (T -test) and measuring the effectiveness of the program by calculating Plaque’s Gain Ratio. The results showed the effectiveness of the program based on electronic interactive activities in developing tourism awareness in kindergarten children .Considering the results of the study, the researchers recommend expanding the integration of electronic interactive programs into the kindergarten curricula to develop the kindergarten child’s tourism awareness and prepare them for the future

G_13 is an essential mediator of platelet activation in hemostasis and thrombosis

Platelet activation at sites of vascular injury is essential for primary hemostasis, but also underlies arterial thrombosis leading to myocardial infarction or stroke. Platelet activators such as adenosine diphosphate, thrombin or thromboxane A_2 (TXA_2) activate receptors that are coupled to heterotrimeric G proteins. Activation of platelets through these receptors involves signaling through G_q, G_i and G_z (refs. 4, 5, 6). However, the role and relative importance of G12 and G13, which are activated by various platelet stimuli, are unclear. Here we show that lack of Galpha_13, but not Galpha_12, severely reduced the potency of thrombin, TXA2 and collagen to induce platelet shape changes and aggregation in vitro. These defects were accompanied by reduced activation of RhoA and inability to form stable platelet thrombi under high shear stress ex vivo. Galpha_13 deficiency in platelets resulted in a severe defect in primary hemostasis and complete protection against arterial thrombosis in vivo. We conclude that G_13-mediated signaling processes are required for normal hemostasis and thrombosis and may serve as a new target for antiplatelet drugs

Crack growth in a naturally corroded bridge steel

This paper summarises the findings of an international collaborative programme that focuses on the problem of the growth of cracks that arise from natural corrosion in bridge steels. The experimental data presented in this paper confirm that the bridge steel da/dN versus ΔK relationship is similar to that seen by the high-strength aerospace steels D6ac and 4340. It is then shown that the methodology developed to predict the growth of small naturally occurring cracks in aerospace materials can also be used to compute the growth of cracks that arise because of natural corrosion in bridge steels

Augmented Reality For Education

Reimagining our future engagement with learners through an augmented reality (AR) lens offers a range of possibilities, on a continuum from rigid materials, created with generic learning outcomes, to learner-centred, personalised and emancipatory practice. Educational paradigms are shifting to include alternatives to physical classrooms and the controlled virtual learning spaces that support traditional content delivery. Augmented reality is part of a broader mixed reality where varying degrees of virtual enhancement to the real world can be integrated into traditional delivery practice but also allow learning spaces to be explored more imaginatively and collaboratively. For educators, there are significant challenges to utilise the potential of technology to meet the increasing demands of students, institutions, industry and the expectations of society. By carefully scaffolding educators into reframing their curricula to encourage, inspire and motivate a diverse student body, technology can act as a mediator – a proxy for what Vygotsky termed the ‘more capable peer’ (Cook 2010). AR applications in education, training, marketing, medicine and other industries demonstrate both the capability of the technology and the need for designers to be aware of the possibilities. Karakus et al (2019), in their bibliometric study of augmented reality in education, identify the work by Wu et al (2013) as the most influential across the sector. This paper suggests that AR not only bridges virtual and real worlds but alsocreates an enhanced reality through a creative process. They argue that the educational values of AR are not solely based on the use of technologies but are closely related to how AR is designed, implemented and integrated into formal and informal learning settings. The recent McKinsey report (Bughin et al, 2018) modelled skills shifts in automation and artificial intelligence going forward to 2020 and found a sharp acceleration in demand for these technologies that will transform the workplace, as humans work with ever smarter machines. Transferring technology for educational use, re-use and re-purpose are key emergent themes in research as employers demand ever more technology enabled graduates, with high-level cognitive skills