The study on designed gamified mobile learning model to assess students' learning outcome of accounting education.

This study constructs an innovative course for accounting teaching based on a student-centered strategy. The curriculum is designed through the effective teaching module (BOPPPS) to assist students to understand accounting knowledge. A game-based mobile learning environment is created by developing an accounting mobile game and combining it with a mobile learning system (TronClass). The private technology university students had been selected by purposive sampling. A total of 81 accounting majored students, among them, 41 students are in the experimental group, and the rest were in the control group. The quasi-experimental design was to be applied in curriculum development. Meanwhile, quantitative data were collected by questionnaires and the qualitative data were collected through interviews. The result shows that game-based mobile learning can be beneficial to teaching effectiveness. And the regression model supports that information quality and service quality have positive predictive power on use intention. In addition, use intention and user satisfaction impacted learning engagement positively. Further, user satisfaction has a mediating effect. Finally, some suggestions are put forward to provide references for accounting educators and researchers.

Needle-Probe Optical Coherence Tomography for Real-Time Visualization of Veress Peritoneal Needle Placement in a Porcine Model: A New Safety Concept for Pneumoperitoneum Establishment in Laparoscopic Surgery.

The safe establishment of pneumoperitoneum is a critical step in all laparoscopic surgeries. A closed pneumoperitoneum is usually obtained by inserting a Veress needle into the peritoneal cavity. However, there is no definite measure to visually confirm the position of the Veress needle tip inside the peritoneal cavity. This study aimed to describe a method of real-time visual detection of peritoneal placement of the Veress needle using an incorporated optical coherence tomography (OCT) probe in a porcine model. A 14-gauge Veress needle was incorporated with a miniature fiber probe to puncture the piglet's abdominal wall into the peritoneal cavity. A total of 80 peritoneal punctures were attempted in four piglets. For each puncture, continuous two-dimensional OCT images of the abdominal wall were acquired for real-time visual detection of the needle placement into the peritoneal cavity. Characteristic OCT image patterns could be observed during the puncturing process, especially a deep V-shaped concave pattern before the peritoneum puncture, which was a crucial feature. A statistical difference in the OCT signal standard deviation value also indicated the differentiability of images between the peritoneum and extra-peritoneal tissue layers. A success rate of 97.5% could be achieved with the guidance of the OCT images. OCT images translate the blind closed technique of peritoneal access into a visualized procedure, thus improving peritoneal access safety.

Fiber-Needle Swept-Source Optical Coherence Tomography for the Real-Time Visualization of the Transversus Abdominis Plane Block Procedure in a Swine Model.

BACKGROUND: Fascia blocks (eg, the transversus abdominis plane [TAP] block) target the intermuscular fascia layers. Ultrasound techniques have allowed peripheral blocks to be performed with accuracy and safety, however, with limitations. Optical coherence tomography (OCT) is based on low-coherence interferometry. In this study, we examined the ability of OCT to identify the TAP. METHODS: A swept-source OCT probe was placed in a 17-gauge needle to obtain imaging. The needle was inserted within 2 different angle ranges (0°-30° and 30°-60°) on a slice of pork belly to assess imaging characteristics. A series of real-time OCT imaging of the muscle, fascia, and interfascial space was obtained. The tissue location of the needle tip was identified using near-infrared (NIR) imaging. In vivo OCT imaging was further done on 3 female 6-month-old native Chinese Landrance Duroc pigs. Real-time images of tissue layers were obtained with needle insertion. Ultrasound imaging of the OCT needle probe was also performed at the same time for needle trajectory guidance. After imaging, the OCT probe was removed, and 5 mL of normal saline was injected via the needle to confirm correct fascia plane identification. RESULTS: In and ex vivo studies showed clear visual distinction of muscle, fascia, and interfascial layer with OCT, with limitations. Independent validation of OCT criteria for the muscle/fascia differentiation by 20 OCT readers for the in vivo data demonstrated the sensitivity = 0.91, specificity = 0.90, and accuracy = 0.89. Although the angle of needle entry affected the depth of OCT penetration in the muscle, the attenuation coefficient values of the fascia and muscle tissue were statistically different (P < .001) and with high area under the receiver operating characteristics (ROC) curve (AUC) (AUC = 0.93 in 0°-30° and AUC = 1 in 30°-60°) for fascia identification. CONCLUSIONS: This study introduced a novel needle imaging probe method to identify the transversus abdominis fascia plane in real-time. Quantitative calculation of the attenuation coefficients can further aid objective identification by providing direct confirmation of the tip position, increasing the first-pass success rate, and decreasing the need for needle repositioning. Combining OCT and ultrasound may improve the accuracy of anesthetics placement.

Intelligent epidural needle placement using fiber-probe optical coherence tomography in a piglet model.

Incorrect needle placement during an epidural block causes medical complications such as dural puncture or spinal cord injury. We propose a system combining an optical coherence tomography imaging probe with an automatic identification algorithm to objectively identify the epidural needle-tip position and thus reduce complications during epidural needle insertion. Eight quantitative features were extracted from each two-dimensional optical coherence tomography image during insertion of the needle tip from the skin surface to the epidural space. 847 in vivo optical coherence tomography images were obtained from three anesthetized piglets. The area under the receiver operating characteristic curve was used to quantify the discriminative ability of each feature. We found a combination of six image features-mean value of intensity, mean value with depth, entropy, mean absolute deviation, root mean square, and standard deviation-showed the highest differentiating performance with the shortest processing time. Finally, differentiation of the needle tip inside or outside the epidural space was automatically evaluated using five classifiers: k-nearest neighbor, linear discriminant analysis, quadratic discriminant analysis, linear support vector machines, and quadratic support vector machine. We adopted an 8-fold cross-validation strategy with five classifications. Quadratic support vector machine classification showed the highest sensitivity (97.5%), specificity (95%), and accuracy (96.2%) among the five classifiers. This study provides an intelligent method for objective identification of the epidural space that can increase the success rate of epidural needle insertion.

In vivo images of the epidural space with two- and three-dimensional optical coherence tomography in a porcine model.

BACKGROUND: No reports exist concerning in vivo optical coherence tomography visualization of the epidural space and the blood patch process in the epidural space. In this study, we produced real-time two-dimensional and reconstructed three-dimensional images of the epidural space by using optical coherence tomography in a porcine model. We also aimed to produce three-dimensional optical coherence tomography images of the dura puncture and blood patch process. METHODS: Two-dimensional and three-dimensional optical coherence tomography images were obtained using a swept source optical coherence tomography (SSOCT) system. Four laboratory pigs were intubated and ventilated after the induction of general anesthesia. An 18-gauge Tuohy needle was used as a tunnel for the optical coherence tomography probe to the epidural space. Two-dimensional and three-dimensional reconstruction optical coherence tomography images of the epidural space were acquired in four stages. RESULTS: In stage 1, real-time two-dimensional and reconstructed three-dimensional optical coherence tomography of the lumbar and thoracic epidural space were successfully acquired. In stage 2, the epidural catheter in the epidural space was successfully traced in the 3D optical coherence tomography images. In stage 3, water injection and lumbar puncture were successfully monitored in all study animals. In stage 4, 10 mL of fresh blood was injected into the epidural space and two-dimensional and three-dimensional optical coherence tomography images were successfully acquired. CONCLUSIONS: These animal experiments suggest the potential capability of using an optical coherence tomography-based imaging needle in the directed two-dimensional and three-dimensional visualization of the epidural space. More investigations involving humans are required before optical coherence tomography can be recommended for routine use. However, three-dimensional optical coherence tomography may provide a novel, minimally invasive, and safe way to observe the spinal epidural space, epidural catheter, lumbar puncture hole, and blood patch.

Miniature endoscopic optical coherence tomography for calculus detection.

The effective treatment of periodontitis involves the detection and removal of subgingival dental calculus. However, subgingival calculus is more difficult to detect than supragingival calculus because it is firmly attached to root surfaces within periodontal pockets. To achieve a smooth root surface, clinicians often remove excessive amounts of root structure because of decreased visibility. In addition, enamel pearl, a rare type of ectopic enamel formation on the root surface, can easily be confused with dental calculus in the subgingival environment. In this study, we developed a fiber-probe swept-source optical coherence tomography (SSOCT) technique and combined it with the quantitative measurement of an optical parameter [standard deviation (SD) of the optical coherence tomography (OCT) intensity] to differentiate subgingival calculus from sound enamel, including enamel pearl. Two-dimensional circumferential images were constructed by rotating the miniprobe (0.9 mm diameter) while acquiring image lines, and the adjacent lines in each rotation were stacked to generate a three-dimensional volume. In OCT images, compared to sound enamel and enamel pearls, dental calculus showed significant differences (P<0.001) in SD values. Finally, the receiver operating characteristic curve had a high capacity (area under the curve=0.934) for discriminating between healthy regions (including enamel pearl) and dental calculus.

Fiber-needle swept-source optical coherence tomography system for the identification of the epidural space in piglets.

BACKGROUND: Epidural needle insertion is traditionally a blind technique whose success depends on the experience of the operator. The authors describe a novel method using a fiber-needle-based swept-source optical coherence tomography (SSOCT) to identify epidural space. METHODS: An optical fiber probe was placed into a hollow 18-gauge Tuohy needle. It was then inserted by an experienced anesthesiologist to continuously construct a series of two-dimensional SSOCT images by mechanically rotating the optical probe. To quantify this observation, both the average SSOCT signal intensities and their diagnostic potentials were assessed. The insertions were performed three times into both the lumbar and thoracic regions of five pigs using a paramedian approach. RESULTS: A side-looking SSOCT is constructed to create a visual image of the underlying structures. The image criteria for the identification of the epidural space from the outside region were generated by the analysis of a training set (n = 100) of ex vivo data. The SSOCT image criteria for in vivo epidural space identification are high sensitivity (0.867 to 0.965) and high specificity (0.838 to 0.935). The mean value of the average signal intensities exhibits statistically significant differences (P < 0.01) and a high discriminatory capacity (area under curve = 0.88) between the epidural space and the outside tissues. CONCLUSIONS: This is the first study to introduce a SSOCT fiber probe embedded in a standard epidural needle. The authors anticipate that this technique will reduce the occurrence of failed epidural blocks and other complications such as dural punctures.

All fiber optics circular-state swept source polarization-sensitive optical coherence tomography.

A swept source (SS)-based circular-state (CS) polarization-sensitive optical coherence tomography (PS-OCT) constructed entirely with polarization-maintaining fiber optics components is proposed with the experimental verification. By means of the proposed calibration scheme, bulk quarter-wave plates can be replaced by fiber optics polarization controllers to, therefore, realize an all-fiber optics CS SSPS-OCT. We also present a numerical dispersion compensation method, which can not only enhance the axial resolution, but also improve the signal-to-noise ratio of the images. We demonstrate that this compact and portable CS SSPS-OCT system with an accuracy comparable to bulk optics systems requires less stringent lens alignment and can possibly serve as a technology to realize PS-OCT instrument for clinical applications (e.g., endoscopy). The largest deviations in the phase retardation (PR) and fast-axis (FA) angle due to sample probe in the linear scanning and a rotation angle smaller than 65 deg were of the same order as those in stationary probe setups. The influence of fiber bending on the measured PR and FA is also investigated. The largest deviations of the PR were 3.5 deg and the measured FA change by ~12 to 21 deg. Finally, in vivo imaging of the human fingertip and nail was successfully demonstrated with a linear scanning probe.