650 research outputs found
An evaluation of the development of clinical reasoning skills in a cohort of occupational therapy students in Hong Kong: implications of curriculum design
No full textThe aim of the study was to evaluate how Hong Kong Occupational Therapy students develop their clinical reasoning abilities and progress through the stages of their undergraduate curriculum. The study examines a range of factors that may affect their development of clinical reasoning. The student cohort was composed of a class of 80 BSc (Honours) occupational therapy students at the Hong Kong Polytechnic University. The study was predominantly quantitative; however, focus group interviews were included among a range of methodologies. Validated test instruments were administered during the four instances of pre- and post-clinical education intervention. The Study Process Questionnaire (Biggs, 1987c) assessed approaches to learning. The Moore & Fitch Inventory of Learning Preferences (cited in Woods, 1994) was administered to determine whether or not changes in students’ learning preferences and attitudes affected clinical reasoning skills. The Self-Assessment of Clinical Reflection and Reasoning (Royeen et al, 1994) was administered as a pre- and post-clinical education intervention to evaluate students’ level of clinical reflection and reasoning skills. A focus group interview was designed to probe students’ understanding and application of clinical reasoning processes. The study’s findings enhance our understanding of the progressive development of students’ clinical reasoning skills through novice to expert continuum. Extrapolating into the undergraduate domain, this study highlighted the difficulties students face when trying to reason through, integrate and synthesize their theoretical learning in both academic and clinical education settings. An outcome of this study identified that clinical reasoning is multifaceted and complex in its application.The major conclusions suggest ways in which the development of Hong Kong students’ clinical reasoning skills could be enhanced by taking account of their culturally influenced learning styles. As clinical reasoning does not occur in isolation, students need to develop these skills, establish the connection between theory and practice, and apply these skills in client intervention.<br/
Optimal Design of a Canopy Using Parametric Structural Design and a Genetic Algorithm
No full textThe structural performance of any building design is often dependent on the geometrical shape, which affects its behavior and stability. Structural consideration and optimization in the conceptual stage of the design process can lead to better solutions and design exploration. In this paper, a design approach for generating and structurally optimizing the geometrical form in the conceptual design phase is presented. The method is applied to a canopy of an ecological island (waste collection center in Rome, Italy). We demonstrate how parametric structural design can facilitate the decision-maker to generate and analyze the optimal design solutions rapidly in the conceptual stage of the design process. Fully parametric models are created in a Rhinoceros3D® environment and interfaced with in-house built algorithms, and Finite Element simulations are performed in DubalRFEM. An ecological island’s canopy has been completely redesigned with a Genetic Algorithm and a Dynamic Relaxation Algorithm, resulting in a free-form shape-resistant structure. Finally, the shape-optimized canopy meets various requirements (structural, functional, formal) that improve structural efficiency and design collaboration, such as in the role of the architect and engineer in the design process and in the relationship between the designer and design tools
The utility of MASS-FIX to detect and monitor monoclonal proteins in the clinic
No full textThe detection and quantification of monoclonal-proteins (M-proteins) are necessary for the diagnosis and evaluation of response in plasma cell dyscrasias. Immunoglobulin enrichment-coupled with matrix-assisted laser desorption ionization time-of-flight mass-spectrometry (MASS-FIX) is a simple and inexpensive method to identify M-proteins, but its clinical generalizability has not yet been elucidated. We compared MASS-FIX to protein electrophoresis (PEL), serum/urine immunofixation-electrophoresis (IFE), and quantitative serum free-light chain (FLC) for the identification of M-proteins in different clinical diagnoses. Paired serum and urine samples from 257 patients were tested. There were six patients for whom s-IFE and FLC ratio were positive and serum MASS-FIX was negative, but when serum and urine MASS-FIX results were combined, only one patient with light chain-MGUS was missed. Serum/urine-MASS-FIX detected M-proteins in 18 patients with negative serum/urine-PEL/IFE and serum-FLC, 10 of whom had multiple myeloma or AL amyloidosis, who were mistakenly thought to have complete hematologic response by serum/urine-PEL/IFE and serum-FLC. Nearly half of the AL amyloidosis patients had atypical spectra, which may prove to be a clue to the diagnosis and pathogenesis of the disease. In conclusion, MASS-FIX has a comparable sensitivity with PEL/IFE/FLC methods and can help inform the clinical diagnosis
System Performance Modelling of Heterogeneous HW Platforms: An Automated Driving Case Study
No full textThe push towards automated and connected driving functionalities mandates the use of heterogeneous HW platforms in order to provide the required computational resources. For these platforms, the established methods for performance modelling in industry are no longer effective. In this paper, we propose an initial modelling concept for heterogeneous platforms which can then be fed into appropriate tools to derive effective performance predictions. The approach is demonstrated for a prototypical automated driving application on the Nvidia Tegra X2 platform
Impact of task oriented physical activity to improve hand motor control in stroke patients: an interventional comparative motor learning strategy
No full textBackground: The objective of this study was to compare the impact of task oriented physical activity to
improve hand motor control in stroke patients by comparing with motor learning and motor strategy.
Methods: A total of 20 patients who are post-stroke patients suffered a left brain hemisphere were
recruited for the study. The patients were divided into 2 groups: the experimental group consisted of 10
patients who underwent occupational therapy 5 times per week along with occupational therapy based on
differential training 5 times per week and control group consisted of 10 patients without any occupational
therapy. Results: In the experimental group the mean performance time of all tasks for wrist, hand and lift
of toys improved significantly (p<5) and no decline in quality of arm function was observed. In control
group, the mean performance time of five patients is not improved significantly (p<5) and the lift of toys
and the quality of arm function was not significantly improved. Conclusions: In the both groups, the
experimental group with interventional and occupational therapy sessions improved arm function and
differential training based occupational therapy and counseling on joint movements exercise,inter-locking
blocks therapy, using extension and flexion along with enhancing fingers dexterity. this approach is
inexpensive and more effectively
Performance modeling of heterogeneous HW platforms
No full textThe push towards automated and connected driving functionalities mandates the use of heterogeneous hardware platforms in order to provide the required computational resources. For these platforms, established methods for performance modeling in industry are no longer effective or adequate. In this paper, we explore the detailed problem of mapping a prototypical autonomous driving application on a Nvidia Tegra X2 platform while considering different constraints of the application, including end-to-end latencies of event chains spanning CPU and GPU boundaries. With the given use-case and platform, we propose modeling concepts in Amalthea, capturing the architectural aspects of heterogeneous platforms and also the execution structure of the application. These models can be fed into appropriate tools to predict performance properties. We proposed the above problem in the Workshop on Analysis Tools and Methodologies for Embedded and Real-time Systems (WATERS) Industrial Challenge 2019 and in response, academicians came up with different solutions. In this paper, we evaluate these different solutions and summarize all approaches. The lesson learned from this challenge is then used to improve on the simplifying assumptions we made in our original formulation and discuss future modeling extensions
Risk adjusted assessment of individual surgeon's pancreatic fistula outcomes
No full textBackground: Post-operative pancreatic fistula (POPF) is a major cause of morbidity following pancreatoduodenectomy. The risk of POPF varies between individuals and thus assessment without risk adjustment is crude. However, despite the availability of numerous scores to determine risk, no study has provided a risk adjusted assessment of POPF outcomes. Methods: The observed and risk adjusted occurrence of POPF from consecutive patients operated upon by eight surgeons were recorded. Surgeons varied in experience from newly appointed (n = 5) to established (n = 3). CUSUM (cumulative sum) analysis was used to assess performance. Results: 104 POPF occurred among 519 patients (20.0%). The occurrence of POPF was significantly lower among experienced surgeons (20/186, 10.7% vs 84/333, 25.2%; p < 0.001). Following risk adjustment surgeons observed 16.6 fewer to 6.5 excess POPF per 100 patients than predicted. Analysis of the CUSUM plots demonstrated the experienced surgeons performed steadily with a gradual reduction in observed POPF compared to what was predicted. The new surgeon's performance was less consistent and evidence of a learning curve was observed with steady improvement occurring after 50–70 patients. Conclusions: Risk adjusted assessment of POPF demonstrates differences between experienced and less experienced surgeons. This method could be used to audit practice and observe effects of changes to technique
Sustainable Spatial Structures: A Design Approach Using Shape and Topology Optimization to Minimize Environmental Impact and Improve Buildability
No full textThe construction industry has a massive impact on climate change, and reducing its environmental impact is a critical challenge that requires innovative solutions. Shape and topology optimization methods can play a crucial role in addressing this issue by optimizing the structural geometry and material distribution. In this paper, we present a novel design approach for optimizing shape, topology, global warming potential and buildability. The proposed approach optimizes the shape and layout of structural elements to minimize the overall embodied energy and carbon emissions of the structure while ensuring that the structure is constructible. The methodology is demonstrated through case studies, the optimized design is evaluated based on the performance criteria and constraints that resulting in significant reduction of design cycle time as well as environmental impact while improving buildability. The research presented in this paper provides valuable insights for designers and engineers seeking to create environmentally sustainable yet elegant spatial structures with optimal buildability
Developing and validating a pre-operative risk score to predict post-hepatectomy liver failure
No full textBackground: Post hepatectomy liver failure (PHLF) is a serious complication in patients undergoing liver resection. This study hypothesized that a new pre-operative risk score developed through statistical modeling to predict PHLF could be used to stratify patients at higher risk of PHLF. Methods: Patients who underwent hepatectomy between 2008 and 2016 were included in the derivation and validation cohorts. A multivariable binary logistic regression model was performed to identify predictors of PHLF, and a prognostic score was derived. Results: A total of 1269 patients were included in the derivation cohort. PHLF was encountered in 13.1% and was associated with significantly increased 90-day mortality and prolonged post-operative hospital stay (both p < 0.001). Multivariable analysis identified the extent of surgery (p < 0.001) and pre-operative bilirubin (p = 0.015), INR (p < 0.001), and creatinine (p = 0.048) to be independent predictors of PHLF. A risk score derived from these factors returned an area under the ROC curve (AUROC) of 0.816 (p < 0.001) for an internal validation cohort (N = 453), significantly outperforming the MELD score (AUROC: 0.643). Conclusion: The PHLF risk score could be used to stratify the risk of PHLF among patients planned for hepatectomy
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