scholarly journals Complexity and Simplicity in Doctor–Patient Email Consultations

Author(s):  
Jane Ege Møller ◽  
Antoinette Fage-Butler ◽  
Mathilde Nisbeth Brøgger

New technologies have facilitated doctor–patient email consultations (e-consultations). Guidelines for e-consultation use in Denmark state that they should be used for simple, concrete and non-urgent queries; however, a small-scale Danish study suggested that doctors encounter e-consultations that do not match the guidelines. The purpose of this article is to explore whether e-consultations in Denmark reflect recommendations that they should be simple, short, concrete and well defined, and if not, what forms of complexity are evident. We inductively analysed 1,671 e-consultations from 38 patients aged 21–91 years communicating with 28 doctors, 6 nurses, 1 medical student and 8 secretaries. Results showed both quantitative complexity in terms of number of interaction turns, communicative participants, and questions asked, and qualitative complexity relating to patients’ psychosocial contexts and GPs’ biomedical disease perspective. Thus, despite existing guidelines and the leanness associated with the email medium, multiple forms of complexity were evident. This mismatch highlights the need for theoretical development as well as the value of re-examining existing policies and guidelines regarding expectations for e-consultation use.

Processes ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 575
Author(s):  
Jelena Ochs ◽  
Ferdinand Biermann ◽  
Tobias Piotrowski ◽  
Frederik Erkens ◽  
Bastian Nießing ◽  
...  

Laboratory automation is a key driver in biotechnology and an enabler for powerful new technologies and applications. In particular, in the field of personalized therapies, automation in research and production is a prerequisite for achieving cost efficiency and broad availability of tailored treatments. For this reason, we present the StemCellDiscovery, a fully automated robotic laboratory for the cultivation of human mesenchymal stem cells (hMSCs) in small scale and in parallel. While the system can handle different kinds of adherent cells, here, we focus on the cultivation of adipose-derived hMSCs. The StemCellDiscovery provides an in-line visual quality control for automated confluence estimation, which is realized by combining high-speed microscopy with deep learning-based image processing. We demonstrate the feasibility of the algorithm to detect hMSCs in culture at different densities and calculate confluences based on the resulting image. Furthermore, we show that the StemCellDiscovery is capable of expanding adipose-derived hMSCs in a fully automated manner using the confluence estimation algorithm. In order to estimate the system capacity under high-throughput conditions, we modeled the production environment in a simulation software. The simulations of the production process indicate that the robotic laboratory is capable of handling more than 95 cell culture plates per day.


2016 ◽  
Vol 53 (5) ◽  
pp. 43-53
Author(s):  
G. Klāvs ◽  
A. Kundziņa ◽  
I. Kudrenickis

Abstract Use of renewable energy sources (RES) might be one of the key factors for the triple win-win: improving energy supply security, promoting local economic development, and reducing greenhouse gas emissions. The authors ex-post evaluate the impact of two main support instruments applied in 2010-2014 – the investment support (IS) and the feed-in tariff (FIT) – on the economic viability of small scale (up to 2MWel) biogas unit. The results indicate that the electricity production cost in biogas utility roughly corresponds to the historical FIT regarding electricity production using RES. However, if in addition to the FIT the IS is provided, the analysis shows that the practice of combining both the above-mentioned instruments is not optimal because too high total support (overcompensation) is provided for a biogas utility developer. In a long-term perspective, the latter gives wrong signals for investments in new technologies and also creates unequal competition in the RES electricity market. To provide optimal biogas utilisation, it is necessary to consider several options. Both on-site production of electricity and upgrading to biomethane for use in a low pressure gas distribution network are simulated by the cost estimation model. The authors’ estimates show that upgrading for use in a gas distribution network should be particularly considered taking into account the already existing infrastructure and technologies. This option requires lower support compared to support for electricity production in small-scale biogas utilities.


2021 ◽  
Author(s):  
◽  
Tabitha Gaylyn Kura McKenzie

<p>What are the effects of using mobile devices as part of teacher professional development focused on teaching and learning the Māori language for Māori immersion educational settings? Answers to this question are explored by researching the extent to which electronic devices could be an effective strategy to address the crisis of the continuing decline of the Māori language. Another issue explored in the research is whether learners make expected gains in language proficiency through the use of mobile devices in comparison to standard face-to-face methods of language instruction.  An indigenous framework, Hei Korowai, was used to guide the research and ensure the practices used were culturally appropriate, particularly when entering into and negotiating the research project with participants. Kaupapa Māori and Māori centred approaches were also drawn on to gather data from semi-structured interviews, observations of mobile device use, online questionnaires, and Māori language proficiency tests results. Fifty two participants in total took part in the research, 46 from a PLD programme that used mobile devices and 6 from a separate PLD programme that used mainly face-to-face instruction.  Electronic forms of second language acquisition could be advantageous for learners to access audio and video content on the move and at a time, pace and place convenient for them. The capacity to have literally a library’s worth of resources, functions and internet connectivity all in one tool and at the touch of a button could also be of particular significance to users. Conversely, participant attitudes about technology, varied needs for initial and on-going training in how to operate the electronic devices, and interaction preferences were challenges experienced with utilising the device as part of the language learning and teaching process. Videos viewed on the device could also be seen as one-way learning with a lack of spiritual connection and no opportunities for discussion about content, potentially causing road blocks for learners who need extra support.  Face-to-face instruction was a preferred method for participants and the physical presence of the teacher highly valued to allow the space to pose and answer questions and receive an immediate response, which is not possible when learning via videos on a mobile device. However, there was acknowledgement of the complementary nature and value of utilising the mobile device followed by face-to-face meetings.  Evidence suggests that Māori have been quick to adopt and adapt new technologies since the arrival of the early settlers to the shores of Aotearoa. Could technology be the panacea, the cure-all for the revitalisation of the Māori language, a tool that provides access to language, culture and identity to the multitudes? This research tests the hypotheses in the context of two items of modern technology, the iPod Touch® and the iPad®.  The limitations of the research include potential bias in interpretation given the researcher’s insider position, the relatively small scale of the project, and the absence of a widely accepted theoretical framework for mobile learning. Critical questions that still remain are the implications of promoting ‘one Māori language’ for a large-scale programme and the risks in doing so for the preservation of tribal dialect and community identity. This study has, however, begun the conversation about the use of mobile devices in Māori medium educational settings, and it may contribute to an understanding of how to design technologies, media, and interactions to support learning within these settings towards innovative practices.</p>


Author(s):  
Dillon Mahoney

This chapter traces the development of Kenya’s tourism and handicraft industries from their roots in 20th century British colonialism to provide some of the broader history of Kenya’s tourism and co-operative development, their emergence in Mombasa, and their relationships with local governments. I draw on archival as well as ethnographic data collected just before the 2002 demolition of Mombasa’s roadside kiosks, which form the starting point for the larger longitudinal study. I focus on the array of experiences of Mombasa’s roadside traders of diverse backgrounds as they struggle with the privatization and segregation of urban residential and commercial space both before and after the demolitions. The economy was radically altered as the roadsides were “cleaned” and a new wave of economic formalization characterized the relationship between small-scale businesspeople and the state. For many entrepreneurs invested in the global crafts trade, this was the final straw that pushed them toward new technologies, jumping scales into global markets, and investing in export and wholesale businesses that were not spatially dependent upon a connection to the city center.


Author(s):  
Karen Webster

Three defining pillars spearhead the current global fashion system: speed to market, overt supply (and consumption) and low prices. This contrasts with a juxtaposing position, through the evolution of slow fashion constructs, embracing artisan techniques with bespoke methodologies. Additional to this is an emerging paradigm integrating new technologies including the strengthening of online retail, virtual interfaces for communication with end-users including customised manufacturing and small scale production runs plus the capacity to communicate and market to anyone, anywhere at anytime across the globe. When these two potentially disparate cultural positions in fashion are considered in tandem, it can facilitate opportunities for small-scale operations to use their size as a platform for flexibility, responsiveness and growth. This model provides for customised and personalised options for a discerning and socially responsible fashion customer. The blurring of bespoke and virtual sees the rise of the digital fashion artisans.


2020 ◽  
Vol 12 (23) ◽  
pp. 9848
Author(s):  
Alvin Slewion Jueseah ◽  
Dadi Mar Kristofersson ◽  
Tumi Tómasson ◽  
Ogmundur Knutsson

Many coastal fisheries are subject to harvesting externalities due to inadequate regulations compounded by limited enforcement. Coastal fisheries in Liberia consist of a fleet of dugout canoes (Kru) primarily targeting demersal finfish, larger open wooden boats propelled with outboard engines targeting small inshore pelagics (Fanti), and a small number of industrial trawlers employing midwater and bottom trawls targeting finfish and shrimp. This paper develops a bio-economic model for the coastal fisheries in Liberia and employs the model to identify economic optimal fishing effort and harvesting trajectories for the different coastal fleets. The results show under harvesting and disinvestments in the coastal fisheries in Liberia. In 2010 the Government of Liberia declared a six nautical mile inshore exclusion zone accessible only to small-scale fisheries (SSF), which was accompanied by increased enforcement. The coastal fleets in 2016 were profitable but the distribution of profits was tilted to the small-scale fleets. The government needs to evaluate what policy options are available to fully utilize the fisheries potential for different species complexes while at the same time reduce the risk of conflict and overharvesting. There appears to be a need for investment in new technologies, which can only take place if fishing in Liberia will remain profitable.


2020 ◽  
Vol 81 (6) ◽  
pp. 1099-1113 ◽  
Author(s):  
Yuan Zhang ◽  
Pingping Luo ◽  
Shuangfeng Zhao ◽  
Shuxin Kang ◽  
Pengbo Wang ◽  
...  

Abstract Accelerated eutrophication, which is harmful and difficult to repair, is one of the most obvious and pervasive water pollution problems in the world. In the past three decades, the management of eutrophication has undergone a transformation from simple directed algal killing, reducing endogenous nutrient concentration to multiple technologies for the restoration of lake ecosystems. This article describes the development and revolution of three remediation methods in application, namely physical, chemical, and biological methods, and it outlines their possible improvements and future directions. Physical and chemical methods have obvious and quick effects to purify water in the short term and are more suitable for small-scale lakes. However, these two methods cannot fundamentally solve the eutrophic water phenomenon due to costly and incomplete removal results. Without a sound treatment system, the chemical method easily produces secondary pollution and residues and is usually used for emergency situations. The biological method is cost-effective and sustainable, but needs a long-term period. A combination of these three management techniques can be used to synthesize short-term and long-term management strategies that control current cyanobacterial blooms and restore the ecosystem. In addition, the development and application of new technologies, such as big data and machine learning, are promising approaches.


2019 ◽  
Vol 8 (3) ◽  
pp. e000610 ◽  
Author(s):  
Allison Brown ◽  
Seamus Sreenan ◽  
Alice McGarvey

The alarming prevalence of medical error and adverse events in the health system raises a call to action to ensure that doctors in training receive adequate training in quality improvement (QI). Training medical students in QI remains a challenge given time constraints, lack of clinical exposure, and already saturated curricula. In some instances, QI training may be delivered during clerkship through didactic, and in some instances, and experiential learning. Preclinical years of medical school remain focused on introducing students to scientific and clinical concepts, rarely do they learn about QI. The Program for Innovation in Scholarship and Medicine (PRISM) is a programme that introduces first-year medical students to the fundamentals of QI using their experience as a medical student as the context. PRISM is a condensed QI curriculum that is delivered through an international partnership, based on a previously piloted programme at a Canadian medical school. Following an introductory workshop, medical students work in teams to develop QI proposals (project charters) which detail how QI principles and tools can generate small-scale improvements within their educational programme. Project charters are assessed by a team of faculty and upper year students, who have previously participated. On completion of the programme, students demonstrated increased knowledge, skills, and attitudes towards QI. Programme participants were satisfied with the structure and expectations of PRISM and expressed a newfound interest in QI. Nearly all participants would recommend PRISM to another medical student. In conclusion, PRISM serves as a resourceful, efficient educational approach for preclerkship students that provides an introduction to the concepts of QI in order for early trainees to build on baseline knowledge and skills throughout their training.


2019 ◽  
Vol 13 (3) ◽  
pp. 433
Author(s):  
Fahrur Rozi ◽  
Quartina Pudjiastuti

Potential and opportunities for cassava development are still very broad along with development of companies in livestock, processed food, and other industries. Added value of cassava commodities resulting from development of downstream industries (processed products) is far higher than upstream industries (primary products), so that development paradigm in agriculture sector in future should be directed towards product expansion including its waste. This study aims to examine the economic value of cassava as a future crop from direct as well as by-products and their development strategies. Data was collected from small-scale tapioca flour farmers, ranchers and entrepreneurs. SWOT analysis was used to determine relevant development strategies. Analysis shows that cassava has an potential, especially as a raw material for food and feed industry. In short term, developing cassava strategy as an industrial raw material is to use new technologies i.e. varieties and cultivation techniques for planting arrangements. Cassava potential economic value is relatively high in terms of farming aspects, food raw materials, feed and industry. This potential, apart from main product, is also by-product that has been neglected at 29.7% of cassava main value. By-products potensial has not been used optimally and a bioeconomic value of biomass that can support integrated agriculture in the future.


Author(s):  
Roger Gorges ◽  
Ronald Brock

Material selection for engine internal components, e.g. bearings, is becoming increasingly more complex and demanding as the operating environments become more aggressive with the introduction of new technologies for the reduction of CO2 emissions. Historically, engine bearings contained lead, which has excellent fundamental bearing properties such as compatibility (run satisfactorily under conditions of marginal lubrication), conformability (deform and accept small scale geometrical inaccuracies of the crankshaft), and embeddablity (tolerance to dirt and other foreign materials) whilst being readily alloyed to achieve good wear and fatigue resistance. However, facing new challenges, many Original Equipment Manufacturers have started development programs to replace lead-containing with lead-free engine components in order to comply with new end-of-life vehicle directives or anticipated future directives. For more than fifteen years, MAHLE has been successfully supplying the light, medium and heavy duty market, with premium electroplated leaded composite bearings, which are designed to improve wear resistance. Some of this market now demands a switch to lead-free materials, while maintaining or exceeding its aforementioned requirements on bearing material properties. Composites of hard particles in a softer metal matrix are in this context ideally suited bearing materials as they can be tailored to obtain the optimal mix between soft and hard properties for the individual application. Typical hard particles that are commonly used comprise of metal oxides, nitrides or carbides. In addition to higher load carrying capabilities and longer service life, new engine technology trends demand that bearings also must operate under mixed or boundary lubrication conditions without having any adverse effect on the performance and integrity of the engine system. Boundary lubrication is commonly observed upon starting the engine before the elastohydrodynamic oil film is fully established. In this state, load is carried by surface asperities rather than by the lubricant. So far, the incorporation and even distribution of the hard particles into an electroplated lead-free matrix was not achievable using conventional direct current electroplating techniques. MAHLE, therefore, has developed a patented pulse plating technique in order to incorporate hard particles into the overlay metal matrix. The refined and modified crystal structure of the resulting lead-free overlay, with incorporated hard particles, yields a premium electroplated bearing with superior wear and fatigue resistance. Corresponding rig and engine test results have been completed to support the material development.


Sign in / Sign up

Export Citation Format

Share Document