The Advanced Modular Manikin Open Source Platform for Healthcare Simulation

ABSTRACT Introduction Current thinking in healthcare education stipulates a holistic approach with a focus on patient management, bringing together technical skills, decision-making, and team performance. In parallel, training opportunities with actual patients have diminished, and the number of different interventions to master has increased. Training on simulators has become broadly accepted; however, requirements for such training devices have outpaced the development of new simulators. The Department of Defense (DoD) targeted this gap with a development challenge. This article introduces the Advanced Modular Manikin (AMM) platform and describes the path followed to address the challenge. Materials and Methods Under Contract # W81XWH-14-C-0101, our interdisciplinary team of healthcare providers, educators, engineers, and scientists, together with partners in industry and the government collaborated to establish a set of comprehensive requirements and develop an overarching system architecture and specifications to meet healthcare simulation needs. In order to instantiate the architecture and investigate usability of the platform, a demonstration modular manikin was created that incorporated physical and digital peripherals. Results The system architecture and corresponding data models have been completed and published as open source. A developer’s tool kit has been created, including instructional materials and required hardware and software for interested parties to develop AMM-compatible modules. A reference manikin was created based on the platform specifications and successfully supported a usability study that was performed by the American College of Surgeons, Education Division at the Naval Medical Center San Diego. Conclusions The formal release of a functional modular, interoperable open-source healthcare simulation platform is complete. Next steps involve a strategy for maintaining the open standards and verification of AMM-compatibility for modules. Increasing awareness of this powerful tool and prioritization of module-development to address the wide range of healthcare education needs could lead to a renaissance in military and civilian healthcare simulation-based training.

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Survey of opioid tapering practices of pediatric healthcare providers: A national perspective

Journal of Opioid Management ◽

10.5055/jom.2017.0368 ◽

2017 ◽

Vol 13 (1) ◽

pp. 59 ◽

Cited By ~ 3

Author(s):

Deborah Fisher, PhD, RN, PPCNP-BC ◽

Suzanne W. Ameringer, PhD, RN

Keyword(s):

Nurse Practitioners ◽

Online Survey ◽

Medical Center ◽

Pediatric Population ◽

Healthcare Providers ◽

Physician Assistants ◽

Pediatric Pain ◽

Wide Range ◽

Opioid Tapering ◽

Pediatric Healthcare

Objective: The purpose of this study was to describe the current opioid tapering practice.Design: Cross-sectional, online, survey research.Participants: Pediatric healthcare providers from a national sample of practicing nurse practitioners, physician assistants, and physicians who participate in five different pediatric pain and/or palliative care list serves.Results: One hundred four participants responded to the survey. The respondents were predominantly physicians (n = 58, 62 percent). The majority of respondents worked in an academic children's medical center (n = 50, 52 percent). The average number of years in pediatric practice was 16 (mean = 16.33, range of 0-45 years). Of the 104 respondents, only 22 (27 percent) had a written protocol for opioid tapering. Use of expert consultants such as pharmacists or pediatric pain management teams varied. The majority of respondents (n = 46, 44 percent) seldom or never consult a pharmacist. Only 22 percent (n = 17) almost always or always consult a pediatric pain team. There was a wide range of personal tapering rate preferences. Conclusions: This study provided a baseline assessment of pediatric opioid tapering practices by pediatric healthcare providers. Results revealed a marked variation in practice patterns that may indicate deficits in the assessment and management of opioid withdrawal in children. The need for the development of assessment-based opioid tapering guidelines for the pediatric population is long overdue.

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Distributed Manufacturing of Open Source Medical Hardware for Pandemics

Journal of Manufacturing and Materials Processing ◽

10.3390/jmmp4020049 ◽

2020 ◽

Vol 4 (2) ◽

pp. 49 ◽

Cited By ~ 7

Author(s):

Joshua M. Pearce

Keyword(s):

Open Source ◽

Future Research ◽

Open Hardware ◽

Medical Supplies ◽

Considerable Research ◽

Wide Range ◽

Core Areas ◽

The Government ◽

Hardware Designs ◽

Good Samaritan Laws

Distributed digital manufacturing offers a solution to medical supply and technology shortages during pandemics. To prepare for the next pandemic, this study reviews the state-of-the-art of open hardware designs needed in a COVID-19-like pandemic. It evaluates the readiness of the top twenty technologies requested by the Government of India. The results show that the majority of the actual medical products have some open source development, however, only 15% of the supporting technologies required to produce them are freely available. The results show there is still considerable research needed to provide open source paths for the development of all the medical hardware needed during pandemics. Five core areas of future research are discussed, which include (i) technical development of a wide-range of open source solutions for all medical supplies and devices, (ii) policies that protect the productivity of laboratories, makerspaces, and fabrication facilities during a pandemic, as well as (iii) streamlining the regulatory process, (iv) developing Good-Samaritan laws to protect makers and designers of open medical hardware, as well as to compel those with knowledge that will save lives to share it, and (v) requiring all citizen-funded research to be released with free and open source licenses.

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Distributed Manufacturing of Open-Source Medical Hardware for Pandemics

10.20944/preprints202004.0054.v1 ◽

2020 ◽

Cited By ~ 5

Author(s):

Joshua Pearce

Keyword(s):

Open Source ◽

Open Hardware ◽

Medical Supplies ◽

Wide Range ◽

Core Areas ◽

The Government ◽

Considerable Work ◽

Hardware Designs ◽

Future Work ◽

Good Samaritan Laws

Distributed digital manufacturing offers a solution to medical supply and technology shortages during pandemics. To prepare for the next pandemic, this study reviews the state-of-the-art for open hardware designs needed in a COVID-19-like pandemic. It evaluates the readiness of the top twenty technologies requested by the Government of India. The results show that the majority of the actual medical products have had some open source development, however, only 15% of the supporting technologies that make the open source device possible are freely available. The results show there is still considerable work needed to provide open source paths for the development of all the medical hardware needed during pandemics. Five core areas of future work are discussed that include: i) technical development of a wide-range of open source solutions for all medical supplies and devices, ii) policies that protect the productivity of laboratories, makerspaces and fabrication facilities during a pandemic, as well as iii) streamlining the regulatory process, iv) developing Good-Samaritan laws to protect makers and designers of open medical hardware, as well as to compel those with knowledge that will save lives to share it, and v) requiring all citizen-funded research to be released with free and open source licenses.

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THE VALUE OF LOVE IN THE SYSTEM OF FORMATION OF THE PROFESSIONAL MATURITY OF THE EDUCATOR

EurasianUnionScientists ◽

10.31618/esu.2413-9335.2020.1.79.1032 ◽

2020 ◽

Vol 1 (10(79)) ◽

pp. 12-18

Author(s):

G. Bubyreva

Keyword(s):

Russian Federation ◽

The State ◽

Educational Process ◽

Wide Range ◽

The Family ◽

The Russian Federation ◽

The Government ◽

The Individual ◽

The Right

The existing legislation determines the education as "an integral and focused process of teaching and upbringing, which represents a socially important value and shall be implemented so as to meet the interests of the individual, the family, the society and the state". However, even in this part, the meaning of the notion ‘socially significant benefit is not specified and allows for a wide range of interpretation [2]. Yet the more inconcrete is the answer to the question – "who and how should determine the interests of the individual, the family and even the state?" The national doctrine of education in the Russian Federation, which determined the goals of teaching and upbringing, the ways to attain them by means of the state policy regulating the field of education, the target achievements of the development of the educational system for the period up to 2025, approved by the Decree of the Government of the Russian Federation of October 4, 2000 #751, was abrogated by the Decree of the Government of the Russian Federation of March 29, 2014 #245 [7]. The new doctrine has not been developed so far. The RAE Academician A.B. Khutorsky believes that the absence of the national doctrine of education presents a threat to national security and a violation of the right of citizens to quality education. Accordingly, the teacher has to solve the problem of achieving the harmony of interests of the individual, the family, the society and the government on their own, which, however, judging by the officially published results, is the task that exceeds the abilities of the participants of the educational process. The particular concern about the results of the patriotic upbringing served as a basis for the legislative initiative of the RF President V. V. Putin, who introduced the project of an amendment to the Law of RF "About Education of the Russian Federation" to the State Duma in 2020, regarding the quality of patriotic upbringing [3]. Patriotism, considered by the President of RF V. V. Putin as the only possible idea to unite the nation is "THE FEELING OF LOVE OF THE MOTHERLAND" and the readiness for every sacrifice and heroic deed for the sake of the interests of your Motherland. However, the practicing educators experience shortfalls in efficient methodologies of patriotic upbringing, which should let them bring up citizens, loving their Motherland more than themselves. The article is dedicated to solution to this problem based on the Value-sense paradigm of upbringing educational dynasty of the Kurbatovs [15].

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Jordanian EFL Teachers' Perceptions of the Appropriateness of Action Pack Textbooks

ITL - International Journal of Applied Linguistics ◽

10.2143/itl.151.0.2015221 ◽

2006 ◽

Vol 151 ◽

pp. 33-56

Author(s):

Ali Ahmad Al-Barakat ◽

Ruba Fahmi Bataineh ◽

Samih Mahmoud Al-Karasneh ◽

Rula Fahmi Bataineh

Keyword(s):

Public Schools ◽

Developmentally Appropriate ◽

Structured Interview ◽

Instructional Materials ◽

Teachers Perceptions ◽

Textbook Series ◽

Assessment Tasks ◽

Wide Range ◽

Efl Teachers ◽

Age Appropriate

This study investigates the appropriateness of the Action Pack Textbook Series (APTS) currently taught in the first four primary stage classes in Jordanian public schools. An evaluation checklist, compiled from the literature, and a semi-structured interview were used to evaluate the content, layout, assessment tasks, teacher's book and the availability of supplementary materials. The findings support the following conclusions: Poor ratings were minimal; APTS is adaptable to the needs of both teachers and pupils and provides a broad range of resources that can be selectively integrated into the curriculum; APTS contains modes of instruction that are developmentally appropriate for a wide range of learners; APTS instructional materials are interesting, engaging and effective for the target learners; the format of the teacher's book is easy to follow, the directions for implementing activities are clear, and the teacher's book itself is flexible and allows teachers to choose from a variety of activities to use with their pupils; for the most part, non-text materials are used appropriately to promote learning; and, overall, the materials for the pupils are well written, age-appropriate and compelling in content.

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Healthcare Providers’ Perceptions of Challenges with Frequent Users of Emergency Department Care in Switzerland: A Qualitative Study

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/00469580211028173 ◽

2021 ◽

Vol 58 ◽

pp. 004695802110281

Author(s):

Patrick Bodenmann ◽

Miriam Kasztura ◽

Madison Graells ◽

Elodie Schmutz ◽

Oriane Chastonay ◽

...

Keyword(s):

Online Survey ◽

Emergency Services ◽

Healthcare Providers ◽

Negative Consequences ◽

Emergency Department Care ◽

Frequent Users ◽

Complex Needs ◽

Wide Range ◽

Ed Overcrowding ◽

Ed Visits

Frequent users of emergency departments (FUED; ≥ 5 ED visits/year) commonly cumulate medical, social, and substance use problems requiring complex and sustained care coordination often unavailable in ED. This study aimed to explore ED healthcare providers’ challenges related to FUED care to gain insight into the support and resources required to address FUED complex needs. An online survey was sent to all general adult emergency services within Switzerland (N = 106). Participants were asked to indicate the extent to which they perceived that FUED represented a problem and to describe the main challenges encountered. In total, 208 physicians and nurses from 75 EDs (70.7%) completed the survey. Among the 208 participants, 134 (64%) reported that FUED represented a challenge and 133 described 1 to 5 challenges encountered. A conventional content analysis yielded 4 main categories of perceived challenges. Negative consequences in the ED secondary to FUED’s presence (eg, ED overcrowding, staff helplessness, and fatigue) was the most frequently reported challenge, followed by challenges related to FUEDs’ characteristics (eg, mental health and social problems) leading to healthcare complexity. The third most frequently encountered challenge was related to the ED inappropriateness and inefficiency to address FUEDs’ needs. Finally, challenges related to the lack of FUED healthcare network were the least often mentioned. ED healthcare providers experience a wide range of challenges related to FUED care. These findings suggest that currently EDs nor their staff are equipped to address FUEDs’ complex needs.

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Alcohol Hand Rub Significantly Reduces Overall Bacterial Bioburden on Stethoscopes in a Real-World Clinical Setting

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.620 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s114-s115

Author(s):

Alexandra Johnson ◽

Bobby Warren ◽

Deverick John Anderson ◽

Melissa Johnson ◽

Isabella Gamez ◽

...

Keyword(s):

Real World ◽

Medical Center ◽

Academic Medical Center ◽

Randomized Study ◽

Healthcare Providers ◽

Clinical Workflow ◽

Provider Type ◽

Academic Medical ◽

Rn Students ◽

The Impact

Background: Stethoscopes are a known vector for microbial transmission; however, common strategies used to clean stethoscopes pose certain barriers that prevent routine cleaning after every use. We aimed to determine whether using readily available alcohol-based hand rub (ABHR) would effectively reduce bacterial bioburden on stethoscopes in a real-world setting. Methods: We performed a randomized study on inpatient wards of an academic medical center to assess the impact of using ABHR (AlcareExtra; ethyl alcohol, 80%) on the bacterial bioburden of stethoscopes. Stethoscopes were obtained from healthcare providers after routine use during an inpatient examination and were randomized to control (no intervention) or ABHR disinfection (2 pumps applied to tubing and bell or diaphragm by study personnel, then allowed to dry). Cultures of the tubing and bell or diaphragm were obtained with premoistened cellulose sponges. Sponges were combined with 1% Tween20-PBS and mixed in the Seward Stomacher. The homogenate was centrifuged and all but ~5 mL of the supernatant was discarded. Samples were plated on sheep’s blood agar and selective media for clinically important pathogens (CIPs) including S. aureus, Enterococcus spp, and gram-negative bacteria (GNB). CFU count was determined by counting the number of colonies on each plate and using dilution calculations to calculate the CFU of the original ~5 mL homogenate. Results: In total, 80 stethoscopes (40 disinfection, 40 control) were sampled from 46 physicians (MDs) and MD students (57.5%), 13 advanced practice providers (16.3%), and 21 nurses (RNs) and RN students (26.3%). The median CFU count was ~30-fold lower in the disinfection arm compared to control (106 [IQR, 50–381] vs 3,320 [986–4,834]; P < .0001). The effect was consistent across provider type, frequency of recent usual stethoscope cleaning, age, and status of pet ownership (Fig. 1). Overall, 26 of 80 (33%) of stethoscopes harbored CIP. The presence of CIP was lower but not significantly different for stethoscopes that underwent disinfection versus controls: S. aureus (25% vs 32.5%), Enterococcus (2.5% vs 10%), and GNB (2.5% vs 5%). Conclusions: Stethoscopes may serve as vectors for clean hands to become recontaminated immediately prior to performing patient care activities. Using ABHR to clean stethoscopes after every use is a practical and effective strategy to reduce overall bacterial contamination that can be easily incorporated into clinical workflow. Larger studies are needed to determine the efficacy of ABHR at removing CIP from stethoscopes as stethoscopes in both arms were frequently contaminated with CIP. Prior cleaning of stethoscopes on the study day did not seem to impact contamination rates, suggesting the impact of alcohol foam disinfection is short-lived and may need to be repeated frequently (ie, after each use).Funding: NoneDisclosures: NoneDisclosures: NoneFunding: None

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Holistic Approach to Design, Test, and Optimize Stand-Alone SOFC-Reformer Systems

Processes ◽

10.3390/pr9020348 ◽

2021 ◽

Vol 9 (2) ◽

pp. 348

Author(s):

Michael Höber ◽

Benjamin Königshofer ◽

Philipp Wachter ◽

Gjorgji Nusev ◽

Pavle Boskoski ◽

...

Keyword(s):

Rural Communities ◽

High Efficiency ◽

Diffusion Processes ◽

Holistic Approach ◽

Maximum Error ◽

Gas Diffusion ◽

Electrochemical Analysis ◽

Internal Reforming ◽

Operation Conditions ◽

Wide Range

Reliable electrical and thermal energy supplies are basic requirements for modern societies and their food supply. Stand-alone stationary power generators based on solid oxide fuel cells (SOFC) represent an attractive solution to the problems of providing the energy required in both rural communities and in rurally-based industries such as those of the agricultural industry. The great advantages of SOFC-based systems are high efficiency and high fuel flexibility. A wide range of commercially available fuels can be used with no or low-effort pre-treatment. In this study, a design process for stand-alone system consisting of a reformer unit and an SOFC-based power generator is presented and tested. An adequate agreement between the measured and simulated values for the gas compositions after a reformer unit is observed with a maximum error of 3 vol% (volume percent). Theoretical degradation free operation conditions determined by employing equilibrium calculations are identified to be steam to carbon ratio (H2O/C) higher 0.6 for auto-thermal reformation and H2O/C higher 1 for internal reforming. The produced gas mixtures are used to fuel large planar electrolyte supported cells (ESC). Current densities up to 500 mA/cm2 at 0.75 V are reached under internal reforming conditions without degradation of the cells anode during the more than 500 h long-term test run. More detailed electrochemical analysis of SOFCs fed with different fuel mixtures showed that major losses are caused by gas diffusion processes.

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Biodiesel Renewable Energy and Transportation Consumption

11th GLOBAL CONFERENCE ON BUSINESS AND SOCIAL SCIENCES - Global Conference on Business and Social Sciences Proceeding ◽

10.35609/gcbssproceeding.2021.12(77) ◽

2021 ◽

Vol 12 (1) ◽

pp. 77-77

Author(s):

Suppanunta Romprasert ◽

Korakot Kataboonyaruk ◽

Natthacha Tangnititham ◽

Tanyaluk Suwanthaijaroen ◽

Maytavee Soonthornwattanachai ◽

...

Keyword(s):

Renewable Energy ◽

Environmental Sustainability ◽

Swot Analysis ◽

Development Theory ◽

Pm 2.5 ◽

Quality Practices ◽

Current Consumption ◽

Wide Range ◽

The Government ◽

Set Up

Paper focuses on the renewable energy in Thailand. Objective is to compare risk on renewable energy and transportation consumption on biodiesel. It is using SWOT analysis and sustainable development theory as the tools. Besides, collecting data via questionnaire to investigate behaviors of people in having the ideas relating to biodiesel. The 52 responses from survey launching have returned. According to the results, the current consumption of biodiesel is still low because insufficient is on awareness of the consumers' trusts about biodiesel. Moreover, government's policy is not in good quality control. Biodiesel price has not been confirmed or set up in a clear standard that shows confidence in biodiesel to consumers. Remains adherence to diesel as it has been used for a longer period of time. Therefore, the risk of renewable energy in biodiesel is a relatively high risk. At the same time, in terms of environmental sustainability development, research results show that the use of biodiesel can help reducing air pollution at either PM 2.5 or global warming. Also, it would distribute an income to palm farmers. The results can be implemented for making improvements and suggesting recommendations to the government. A strengthening policy on renewable energy security and implement strategies is for solving various energy problems. With the concept of supporting research and development, it can create a wide range of knowledges, and the production of biodiesel as renewable energy. There should control the price structure, and the well quality practices to be fairly suitable in the nearly future. Keywords: Biodiesel, Consumption, Renewable Energy, Risk, Transportation

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An open-source R-package and web application for high-quality probabilistic predictions in hydrology

10.5194/egusphere-egu21-8549 ◽

2021 ◽

Author(s):

Jason Hunter ◽

Mark Thyer ◽

Dmitri Kavetski ◽

David McInerney

Keyword(s):

Open Source ◽

Web Application ◽

R Package ◽

Error Model ◽

Objective Functions ◽

High Quality ◽

Wide Range ◽

Probabilistic Error

Probabilistic predictions provide crucial information regarding the uncertainty of hydrological predictions, which are a key input for risk-based decision-making. However, they are often excluded from hydrological modelling applications because suitable probabilistic error models can be both challenging to construct and interpret, and the quality of results are often reliant on the objective function used to calibrate the hydrological model.We present an open-source R-package and an online web application that achieves the following two aims. Firstly, these resources are easy-to-use and accessible, so that users need not have specialised knowledge in probabilistic modelling to apply them. Secondly, the probabilistic error model that we describe provides high-quality probabilistic predictions for a wide range of commonly-used hydrological objective functions, which it is only able to do by including a new innovation that resolves a long-standing issue relating to model assumptions that previously prevented this broad application. &#160;We demonstrate our methods by comparing our new probabilistic error model with an existing reference error model in an empirical case study that uses 54 perennial Australian catchments, the hydrological model GR4J, 8 common objective functions and 4 performance metrics (reliability, precision, volumetric bias and errors in the flow duration curve). The existing reference error model introduces additional flow dependencies into the residual error structure when it is used with most of the study objective functions, which in turn leads to poor-quality probabilistic predictions. In contrast, the new probabilistic error model achieves high-quality probabilistic predictions for all objective functions used in this case study.The new probabilistic error model and the open-source software and web application aims to facilitate the adoption of probabilistic predictions in the hydrological modelling community, and to improve the quality of predictions and decisions that are made using those predictions. In particular, our methods can be used to achieve high-quality probabilistic predictions from hydrological models that are calibrated with a wide range of common objective functions.

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