Tools for creating interactive teaching environments

Although learning-by-doing is one of the most effective teaching and learning methodology, its application to some disciplines, such as history, is difficult even when using complex simulation environments. One possible solution is to combine learning-by-doing principles with gaming elements to create immersive and interesting virtual environments. Unfortunately, the level of programming required to create such environments makes it prohibitive for most educators. We describe the Graphical Interactive Fiction Toolkit, GIFT, system we have created that allows educators and writers to easily create interactive stories. While programmers will still be required for complex interactive environments, we believe GIFT can lower the entry bar and allow much richer set of interactive environments to be produced

Concordance between side-stream end-tidal carbon dioxide and arterial carbon dioxide partial pressure in respiratory service setting

OBJECTIVE: To explore the correlation and concordance between end-tidal carbon dioxide and arterial carbon dioxide partial pressure, and confirm the experience of the general consensus among service environments. DESIGN: A prospective cross-sectional analysis. SETTING: Two respiratory service units in Hong Kong. PARTICIPANTS: Two hundred respiratory patients were recruited, in whom 219 sets of observations were recorded. Patients deemed to require arterial blood gas determination also had their end-tidal carbon dioxide partial pressure measured at that time, using two LifeSense LS1-9R Capnometers. MAIN OUTCOME MEASURES: The agreement of end-tidal carbon dioxide partial pressure and arterial carbon dioxide partial pressure was studied by correlation coefficients, mean and standard deviation of their difference, and the Bland-Altman plot. RESULTS: Overall, the correlation was low and insignificant (r=0.1185, P=0.0801). The mean of the difference was 7.2 torr (95% confidence interval, 5.5-8.9) and significant (P<0.001). The limits of agreement by Bland-Altman analysis were -18.1 to 32.5 torr, which were too large to be acceptable. In the sub-group on room air, the mean difference was reduced to 2.26 torr, the correlation between end-tidal carbon dioxide partial pressure and arterial carbon dioxide partial pressure was 0.2194 (P=0.0068), though statistically significant, the extent of correlation was still low. CONCLUSION: End-tidal carbon dioxide partial pressure did not show significant correlation or concordance with arterial carbon dioxide partial pressure, especially when supplemental oxygen was used. End-tidal carbon dioxide partial pressure currently cannot replace arterial blood gas measurement as a tool for monitoring arterial carbon dioxide partial pressure. Possible reasons for the discrepancy with previous studies include small sample size in previous studies, lack of research facilities in service settings, and publication bias against negative studies.published_or_final_versio

Tri-Level Bit-Stream Signal Processing Circuits and Applications

We present signal processing building blocks for trilevel bit-stream signal processing (BSSP). These architectures are the 2-bit extensions from the existing 1-bit BSSP circuit modules. It is shown that the 2-bit designs offer better performance than their 1-bit counterparts. FPGA implementation results of both 1-bit and 2-bit designs are compared in terms of their hardware complexity. Finally, a digital phase locked loop (DPLL) and a quadrature phase-shift keying (QPSK) demodulator are presented as application examples of the proposed circuits.published_or_final_versio

Bit-stream adders and multipliers for tri-level sigma-delta modulators

We propose both adder and multiplier circuits for bit-stream signal processing customized for tri-level sigma-delta modulated signals. These architectures are the 2-bit extensions from the existing 1-bit bit-stream adders and multipliers, and are shown to offer better signal-to-noise performance. Field-programmable gate array implementations then confirm their efficacy. © 2007 IEEE.published_or_final_versio

Gene panel analysis for nonsyndromic cryptogenic neonatal/infantile epileptic encephalopathy

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Spinal cord stimulation for chronic non-cancer pain: a review of current evidence and practice

Spinal cord stimulation provides analgesia through electrical stimulation of the dorsal column of the spinal cord via electrode leads placed into the epidural space. In traditional tonic stimulation, a painful sensation is replaced with paraesthesia. Spinal cord stimulation is effective in reducing neuropathic pain, enhancing function, and improving quality of life in different chronic pain conditions. Currently, there is most evidence to support its use for failed back surgery syndrome when multidisciplinary conventional management is unsuccessful. Temporary trial leads are inserted in carefully selected patients to test their responsiveness prior to permanent implantation. Newer neuromodulation modalities are now available. These include burst stimulation, high-frequency stimulation, and dorsal root ganglion stimulation. Results are encouraging to date, and they may provide superior analgesia and cover for deficiencies of traditional tonic stimulation. Although complications are not uncommon, they are rarely life threatening or permanently disabling. Nonetheless, device removal is occasionally needed.link_to_OA_fulltex

Evolving frontiers in severe polytrauma management: refining the essential principles

This editorial aims to refine the severe polytrauma management principles. While keeping ABCDE priorities, the termination of futile resuscitation and the early use of tourniquet to stop exsanguinating limb bleeding are crucial. Difficult-airway-management (DAM) is by a structured 5-level approach. The computerised tomography (CT) scanner is the tunnel to death for hemodynamically unstable patients. Focused Abdominal Sonography for Trauma-Ultrasonography (FAST USG) has replaced diagnostic peritoneal lavage (DPL) and is expanding to USG life support. Direct whole-body multidetector-row computed tomography (MDCT) expedites diagnosis & treatment. Non-operative management is a viable option in rapid responders in shock. Damage control resuscitation comprising of permissive hypotension, hemostatic resuscitation & damage control surgery (DCS) help prevent the lethal triad of trauma. Massive transfusion protocol reduces mortality and decreases the blood requirement. DCS attains rapid correction of the deranged physiology. Mortality reduction in major pelvic disruption requires a multi-disciplinary protocol, the novel pre-peritoneal pelvic packing and the angio-embolization. When operation is the definitive treatment for injury, prevention is best therapy. © Penerbit Universiti Sains Malaysia, 2013.published_or_final_versio

Application of Equity Sensitivity Theory to Problem-Solving Approaches in Construction Dispute Negotiation

This material may be downloaded for personal use only. Any other use requires prior permission of the American Society of Civil Engineers. This material may be found at https://ascelibrary.org/doi/10.1061/%28ASCE%29ME.1943-5479.0000031Publishe

Pixel-to-pixel fiber-coupled emissive micro-light-emitting diode arrays

We report on an integrated fiber-coupled bi-linear micro-light-emitting diode array, serving as a portable microdisplay system. The fiber bundle transforms the bi-linearly arranged optical signals from the emissive array into a 6-by-8 pixel microdisplay, offering a crisp and clear optical output. The pixel-to-pixel coupling arrangement ensures optical coupling efficiency. Due to the narrow acceptance cones of optical fibers, individual pixels can be well resolved with minimal crosstalk. The performance and functionality of this optical system is fully evaluated. A model to determine the fiber-coupling efficiency was constructed; it was found that the simulated results compare well with the measured data.published_or_final_versio

Persistent hypocalcaemia in a Chinese girl due to a novel de-novo activating mutation of the calciumsensing receptor gene

A significant proportion of patients formerly diagnosed with idiopathic hypoparathyroidism actually have activating mutation of the calcium-sensing receptor (CaSR) gene. Awareness of the possibility of activating mutation of CaSR gene in patients with sporadic idiopathic hypoparathyroidism is important because of its relevance to clinical management. This report is of a novel activating mutation of the CaSR gene identified in a 10-year-old Chinese girl who was initially diagnosed as having idiopathic hypoparathyroidism at 6 years of age after presenting with seizures. Her serum calcium level was difficult to maintain near the lower limit of normal despite treatment with high-dose calcitriol. Treatment with calcitriol produced significantly elevated urinary calcium-to-creatinine ratio. Direct sequencing of the CaSR gene showed a novel heterozygous mutation (p.Q735P (c.2204A>C)). Molecular genetic analysis of her parents demonstrated that both parents did not harbour the child's mutation, indicating that her mutation had arisen de novo. © 1995-2011 HKAM.published_or_final_versio