Team-based learning complemented by interactive response system: Application of a strategy on the course of human growth and development for nursing students.

OBJECTIVE: Lecture-based learning (LBL) strategy cannot stimulate learners' ability to think and learn independently. Recently team-based learning (TBL), a learner-centered strategy, gained popularity in health education. An interactive response system (IRS) assists educators in providing instant feedback on classroom activities. This study was to evaluate the TBL strategy supplemented by IRS (TBL/IRS) on the learning effects of the core course, the human growth and development (HGD), in nursing education. MATERIALS AND METHODS: A quasi-experimental study design with two-group, pretests and posttests was employed with year-one students enrolled in two HGD classes in the nursing department of a university in central Taiwan. Both HGD classes employed the LBL method at the beginning of a semester. TBL/IRS strategy was introduced to the experimental class 6 weeks later. Three scales were used to measure self-directed learning, classroom engagement, and team learning. Individual and group readiness assurance tests (IRATs and GRATs) were administered. Final exams were also compared between the groups. For thematic analysis, learners' experience with TBL/IRS was collected from learner reports and a semi-structured questionnaire designed for the study. RESULTS: A total of 105 learners-48 in TBL/IRS and 55 in LBL-were recruited. Self-directed learning, classroom engagement and team learning were improved significantly in TBL/IRS whereas only self-directed learning was improved in LBL. In the TBL/IRS group, GRAT scores were significantly higher than IRAT. However, the difference in final exams between the groups was non-significant. Four themes emerged from learners' experiences with TBL/IRS: stimulate self-learning; a diverse and flexible learning method; promote high-level thinking and deepen learning results; and, cultivate teamwork and application. CONCLUSIONS: This study confirmed that TBL/IRS was effective in enhancing learners' abilities to integrate concepts and skills, thereby cultivating competence in problem-solving and teamwork. The TBL/IRS strategy was cost-effective in promoting active learning of HGD in nursing students.

Preparation and Characteristics of an Environmentally Friendly Hyperbranched Flame-Retardant Polyurethane Hybrid Containing Nitrogen, Phosphorus, and Silicon.

The NCO functional group of 3-isocyanatoproplytriethoxysilane (IPTS) and the OH functional group of 10-(2,5-dihydroxyphenyl)-10H-9-oxa-10-phospha-phenantbrene-10-oxide (DOPO-BQ) were used to conduct an addition reaction. Following completion of the reaction, triglycidyl isocyanurate (TGIC) was introduced to conduct a ring-opening reaction. Subsequently, a sol-gel method was used to initiate a hydrolysis-condensation reaction on TGIC-IPTS-DOPO-BQ to form a hyperbranched nitrogen-phosphorous-silicon (HBNPSi) flame retardant. This flame retardant was incorporated into a polyurethane (PU) matrix to prepare a hybrid material. Fourier-transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), limiting oxygen index (LOI), UV-VIS spectrophotometry, and Raman analysis were conducted to characterize the structure and analyze the transparency, thermal stability, flame retardancy, and residual char to understand the flame retardant mechanism of the prepared hybrid material. After the flame retardant was added, the maximum degradation rate decreased from -36 to -17 wt.%/min, the integral procedural decomposition temperature (IPDT) increased from 348 to 488 °C, and the char yield increased from 0.7 to 8.1 wt.%. The aforementioned results verified that the thermal stability of PU can be improved after adding HBNPSi. The LOI analysis indicated that the pristine PU was flammable because the LOI of pristine PU was only 19. When the content of added HBNPSi was 40%, the LOI value was 26; thus the PU hybrid became nonflammable.

Three-dimensional dose comparison of flattening filter (FF) and flattening filter-free (FFF) radiation therapy by using NIPAM gel dosimetry.

Intensity-modulated radiotherapy and volumetric modulated arc therapy are modern radiation therapy technologies that can create the desired dose distribution by multileaf collimator movement and dose-rate control. However, the homogeneous dose delivery of small-field irradiation techniques shows disagreement with that of treatment planning system. The removal of the flattening filter by flattening filter free (FFF) beam irradiation increases dose conformity and further reduces treatment delivery time in radiosurgery. This study aims to investigate the dose distribution of FFF and flattened beams for small-field irradiation by using the 3D gel dosimeter. The N-isopropylacrylamide (NIPAM) polymer gel dosimeter was employed to record the 3D dose distribution. In addition, flattened and FFF beams were compared using the gamma evaluation technique. The use of an FFF accelerator resulted in excellent radiation treatments with short delivery times and low doses to normal tissues and organs. Results also showed that the passing rate increased with the decrease of field size (30 × 30, 20 × 20, and 10 × 10 mm2) at post-irradiation times of 24, 48, 72, and 96 h. The passing rates for each field size were retained at the same level when gamma criteria, namely, distance-to-agreement (DTA) = 3 mm/dose difference (DD) = 3%, were used. Nevertheless, the passing rates for each field size decreased slowly after 48 h when DTA = 2 mm/DD = 2%. The Wilcoxon signed-rank test was used to determine statistical difference with a significant level of p < 0.05. The passing rates of flattened and FFF beams showed no significant difference. The edge enhancement effect in the flattened beam was more evident than in the FFF beam. The 3D NIPAM gel dosimeter can be used for dose verification of small field for radiation therapy with high dose rate.

Quantitative measurement of Parkinsonian gait from walking in monocular image sequences using a centroid tracking algorithm.

Parkinson's disease (PD) is a neurodegenerative disease of the central nervous system that results from the degeneration of dopaminergic neurons in the substantia nigra. Abnormal gait begins in the early stage and becomes severe as the disease progresses; therefore, the assessment of gait becomes an important issue in evaluating the progression of PD and the effectiveness of treatment. To provide a clinically useful gait assessment in environments with budget and space limitations, such as a small clinic or home, we propose and develop a portable method utilizing the monocular image sequences of walking to track and analyze a Parkinsonian gait pattern. In addition, a centroid tracking algorithm is developed and used here to enhance the method of quantifying kinematic gait parameters of PD in different states. Twelve healthy subjects and twelve mild patients with PD participate in this study. This method requires one digital video camera and subjects with two joint markers attached on the fibula head and the lateral malleolus of the leg. All subjects walk with a natural pace in front of a video camera during the trials. Results of our study demonstrate the stride length and walking velocity significantly decrease in PD without drug compared to PD with drug in both proposed method and simultaneous gait assessment performed by GAITRite(®) system. In gait initiation, step length and swing velocity also decrease in PD without drug compared to both PD with drug and controls. Our results showed high correlation in gait parameters between the two methods and prove the reliability of the proposed method. With the proposed method, quantitative measurement and analysis of Parkinsonian gait could be inexpensive to implement, portable within a small clinic or home, easy to administer, and simple to interpret. Although this study is assessed Parkinsonian gait, the proposed method has the potential to help clinicians and researchers assess the gait of patients with other neuromuscular diseases, such as traumatic brain injury and stroke patients.

Using K-Nearest Neighbor Classification to Diagnose Abnormal Lung Sounds.

A reported 30% of people worldwide have abnormal lung sounds, including crackles, rhonchi, and wheezes. To date, the traditional stethoscope remains the most popular tool used by physicians to diagnose such abnormal lung sounds, however, many problems arise with the use of a stethoscope, including the effects of environmental noise, the inability to record and store lung sounds for follow-up or tracking, and the physician's subjective diagnostic experience. This study has developed a digital stethoscope to help physicians overcome these problems when diagnosing abnormal lung sounds. In this digital system, mel-frequency cepstral coefficients (MFCCs) were used to extract the features of lung sounds, and then the K-means algorithm was used for feature clustering, to reduce the amount of data for computation. Finally, the K-nearest neighbor method was used to classify the lung sounds. The proposed system can also be used for home care: if the percentage of abnormal lung sound frames is > 30% of the whole test signal, the system can automatically warn the user to visit a physician for diagnosis. We also used bend sensors together with an amplification circuit, Bluetooth, and a microcontroller to implement a respiration detector. The respiratory signal extracted by the bend sensors can be transmitted to the computer via Bluetooth to calculate the respiratory cycle, for real-time assessment. If an abnormal status is detected, the device will warn the user automatically. Experimental results indicated that the error in respiratory cycles between measured and actual values was only 6.8%, illustrating the potential of our detector for home care applications.

Bidirectional and multi-user telerehabilitation system: clinical effect on balance, functional activity, and satisfaction in patients with chronic stroke living in long-term care facilities.

BACKGROUND: The application of internet technology for telerehabilitation in patients with stroke has developed rapidly. OBJECTIVE: The current study aimed to evaluate the effect of a bidirectional and multi-user telerehabilitation system on balance and satisfaction in patients with chronic stroke living in long-term care facilities (LTCFs). METHOD: This pilot study used a multi-site, blocked randomization design. Twenty-four participants from three LTCFs were recruited, and the participants were randomly assigned into the telerehabilitation (Tele) and conventional therapy (Conv) groups within each LTCF. Tele group received telerehabilitation but the Conv group received conventional therapy with two persons in each group for three sessions per week and for four weeks. The outcome measures included Berg Balance Scale (BBS), Barthel Index (BI), and the telerehabilitation satisfaction of the participants. SETTING: A telerehabilitation system included "therapist end" in a laboratory, and the "client end" in LTCFs. The conventional therapy was conducted in LTCFs. RESULTS: Training programs conducted for both the Tele and Conv groups showed significant effects within groups on the participant BBS as well as the total and self-care scores of BI. No significant difference between groups could be demonstrated. The satisfaction of participants between the Tele and the Conv groups also did not show significant difference. CONCLUSIONS: This pilot study indicated that the multi-user telerehabilitation program is feasible for improving the balance and functional activity similar to conventional therapy in patients with chronic stroke living in LTCFs.

Exquisite textiles sensors and wireless sensor network device for home health care.

In this study, we propose a wearing system with four sensors, ECG (electrocardiogram), three-axis accelerometer, temperature, and tight-switch, applied for remote monitoring system in home-care. The sensors ECG, measured with wearable electrodes made of the steel textile to generate the real-time heart-rate estimator, tight-switch, made of the steel textile to check whether wearing person dresses properly, accelerometer, and temperature parameters are received via the ZigBee receiver within an exquisite belt. Since the movable textile electrodes will cause of unfixed contacts when the wearing person is in motion, making the heart-rate estimation much a sophisticated work, the tight-switch sensor and FIR (Filter Impulse Response) filter technology are applied here to get the more satisfiable heart-rate. The other two bio-sensors can detect the whether fall-down or not and normal body-temperature of this wearing person. Moreover, the ZigBee device with small size, low-power consumption, and high-reliability characteristics is designed to transmit the detected bio-information from these four sensors. Therefore, the vital system embedded with the capability of real-time heart-rate estimation and transmission makes it highly suitable for applications of remote healthcare and wellness.

A novel design and evaluation of wearable digital sensor for monitoring posture.

In this study, we propose a novel design of the wearable digital sensor, embedded within a monitoring suit for posture monitoring. Our studies are going to solve wearable monitoring systems' drawbacks, include non-washable, uncomfortable, and high power -consumption due to complex signal processing. There are two digital sensor designs, dome shape type and clip shape type, knitted on clothes. The characteristics of these two digital sensor designs are easy implementation, small size, low power-consumption, and comfort. Our proposed system can catch up and monitor postures of the real-time information from the wearing person. Therefore, the monitoring system embedded with the capability of detecting real-time postures and transmission makes it highly suitable for applications of remote healthcare and wellness.