The Technology Inventory

The UAE’s flag carrier Etihad proudly introduced its “Wi-Fly” service which is a product of $1 billion agreement with one of the globe’s leading supplier of in-flight entertainment and equipment Panasonic Avionics. The first plane outfitted with the communications technology, an Airbus A330-20, flew on Monday, December 3, to Brussels. Passengers on the flight enjoy high-speed broadband access and data services, including Internet connectivity for mobile phones.

The A330-20 equipped with the Panasonic Avionics Global Communications Suite will be used for long-haul flight tos key European cities including Milan, Dublin, Manchester, and Frankfurt.

Etihad Airways’ CEO, James Hogan, expressed his excitement with the project, citing the 10-year billion dollar agreement with Panasonic a crucial investment that will reward its customers and loyal patrons with “dynamic and engaging in-flight entertainment options.” Mr Hogan said that the “Wi-Fly” will provide passengers with Internet speeds comparable to what they would enjoy at work or at home.

The airline said that it hopes to equip 10 more aircrafts with the service by the first quarter of 2013. Currently, Etihad also operate six other aircrafts with on-board connectivity through a partnership with OnAir. The Wi-Fly service will charge gues US$13.95 for one hour of service, and US$24.95 for 24 hours of use.

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In clinical practice, doctors personally assess patients in order to diagnose, which refers both to the process of attempting to determine or identify a possible disease or disorder (and diagnoses in this sense can also be termed (medical) “diagnostic procedure”), and to the opinion reached by this process (also being termed (medical) “diagnostic opinion”), treat, and prevent disease using clinical judgment.

The doctor-patient relationship, central to the practice of healthcare and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease, typically begins an interaction with an examination of the patient’s medical history, or “anamnesis” of a patient, the information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information (in this case, it is sometimes called “heteroanamnesis”), with the aim of obtaining information useful in formulating a diagnosis and providing medical care to the patient; and medical/health record/chart, the systematic documentation of a single patient’s medical history and care across time within one particular health care provider’s jurisdiction.

The second step is a medical interview and a physical/medical/clinical examination (more popularly known as a “check-up” or “medical”), the process by which a doctor investigates the body of a patient for signs of disease. Basic diagnostic medical devices, or instruments, apparatuses, implants, in vitro reagents, or similar or related articles that is used to diagnose, prevent, or treat disease or other conditions, and does not achieve its purpose through chemical action within or on the body (which would make it a medicine), are typically used; e.g. stethoscope, an acoustic medical device for auscultation, or listening to the internal sounds of an animal or human body, and tongue depressor, a device used in medical practice to depress the tongue to allow for examination of the mouth and throat.

After examination for (medical) signs—an objective indication of some medical fact or characteristic that may be detected by a physician during a physical examination or by a clinical scientist by means of an in vitro examination of a patient—and interviewing for symptoms, a departure from normal function or feeling is noticed by a patient, indicating the presence of disease or abnormality, the doctor may order medical tests, a kind of medical procedure to detect, diagnose, or monitor diseases, disease processes, susceptibility, and determine a course of treatment (e.g. blood tests, a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via finger prick); take a biopsy, a medical test commonly performed by a surgeon or an interventional radiologist involving sampling of cells or tissues for examination; or prescribe pharmaceutical drugs/medicine/medication, loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention or disease, or other therapies.

Differential diagnosis methods (sometimes abbreviated “DDx,” “ddx,” “DD,” “D/Dx,” “or “ΔΔ”), a systematic diagnostic method used to identify the presence of an entity where multiple alternatives are possible (and the process may be termed “differential diagnostic procedure”), and may also refer to any of the included candidate alternatives (which may also be termed “candidate condition”), help out to rule out conditions based on the information provided. During the encounter, properly informing the patient of all relevant facts is an important part of the relationship and the development of trust. The medical encounter is then documented in the medical record, which is a legal document in many jurisdictions. Followups may be shorter but follow the same general procedure. 

The components of the medical interview and encounter are:

• Chief complaint (cc): the reason for the current medical visit. these are the ‘symptoms.’ They are in the patient’s own words and are recorded along with the duration of each one. Also called ‘presenting complaint.’
• HPI or History of present illness/complaint (sometimes referred to as “ill-health” or “ailment”), a state of poor health: the chronological order of events of symptoms and further clarification of each symptom.
• Current activity: occupation, hobbies, what the patient actually does.
• Medications (Rx), also referred to as “pharmaceutical drug” or “medicine,” loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease: what drugs the patient takes including prescribed, over-the-counter (OTC, medicines that may be sold directly to a consumer without a prescription from a healthcare professional, as compared to prescription drugs, which may be sold only to consumers possessing a valid prescription; and home remedies (a treatment to cure a disease or ailment that employs certain spices, vegetables, or other common items), as well as alternative and herbal medicines/herbal remedies (“herbalism,” the study and use of medicinal properties of plants). Allergies, or the hypersensitivity disorder of the immune system, are also recorded.
• Past medical history (PMH/PMHx): concurrent medical problems; past hospitalizations and operations; injuries; past infectious diseases, also known as “transmissible diseases” or “communicable diseases,” comprising clinically evident illness (i.e., characteristic medical signs and/or symptoms of disease) resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism; and/or vaccinations, or the administration of antigenic material (a vaccine) to stimulate an individual’s immune system to develop adaptive immunity to a pathogen; history of known allergies.
• Social history (SH): birthplace, residences, marital history, social and economic status, habits (including diet (which in nutrition is the sum of food consumed by a person or other organism), medications, tobacco smoking (the practice of burning tobacco and inhaling the resulting smoke consisting of particle and gaseous phases), alcohol).
• Family history (FH), which in medicine consists of information about disorders from which the direct blood relatives of the patient have suffered: listing of diseases in the family that may impact the patient. A family tree, or pedigree chart, a chart representing family relationships in a conventional tree structure, is sometimes used.
• Review of systems (ROS) or “systems inquiry”: a set of additional questions to ask, which may be missed on HPI; a general enquiry (have you noticed any weight loss, change on sleep quality, fevers, lumps and bumps? etc.), followed by questions in the body’s main organ systems—the human heart, an organ that provides a continuous blood circulation through cardiac cycle and is one of the most vital organs in the human body; the human lungs, the organs of respiration in humans; the human gastrointestinal/digestive tract, the stomach and intestine, sometimes including all the structures from the mouth to the anus; the urinary tract/renal system, the organ system that produces, stores, and eliminates urine; etc.

The physical/medical/clinical examination (more popularly known as a “check-up” or “medical”) is the process by which a doctor investigates the body of a patient for signs of disease: ‘symptoms’ are what the patient volunteers, while ‘signs’ are what the healthcare provider detects by examination.

The healthcare provider uses the senses of sight, hearing, touch, and sometimes smell; e.g., in infection, uremia/uraemia (a term used to loosely describe the illness accompanying kidney failure (also called renal failure), in particular the nitrogenous waste products associated with the failure of this organ), diabetic ketoacidosis (a potentially life-threatening complication in patients with diabetes mellitus). Taste has been made redundant by the availability of modern lab tests.

Four actions are taught as the basis of physical examination: inspection, which in medicine, is the through and unhurried visualization of the client; palpation (feel), used as part of a physical examination in which an object is felt (usually with hands of a healthcare practitioner) to determine its size, shape, firmness, or location; percussion (tap to determine resonance characteristics), a method to determine the underlying structure, and is used in clinical examinations to assess the condition of the thorax or abdomen; and auscultation (listen), or the term for listening to the internal sounds of the body, usually using a stethoscope. This order may be modified depending on the main focus of the examination (e.g., a joint may be examined by simply “look, feel, move.” Having this set order is an educational tool that encourages practitioners to be systematic in their approach and refrain from using tools such as the stethoscope—an acoustic medical device for auscultation, or listening to the internal sounds of an animal or human body—before they have fully evaluated the other modalities).

The clinical examination involves study of:

• Vital signs including height, weight, body temperature, blood pressure (BP; sometimes referred to as “arterial blood pressure,” the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs), pulse (in medicine, it represents the tactile arterial palpation of the heartbeat by trained fingertips), respiration rate, hemoglobin oxygen saturation/dissolved oxygen (DO; a relative measure of the amount of oxygen that is dissolved or carried in a given medium)
• General appearance of the patient and specific indicators of disease (nutritional status, presence of jaundice, pallor or nail clubbing, which in medicine, is a deformity of the fingers and fingernails associated with a number of diseases, mostly of the heart and lungs)
• Human skin, the outer covering of the body
• Head, eye, ear (the organ that detects sound), nose, and throat—HEENT
• Cardiovascular, or the circulatory system, an organ system that passes nutrients (such as amino acids, electrolytes and lymph), gases, hormones, blood cells, etc. to and from cells in the body to help fight diseases, stabilize body temperature and pH, and to maintain homeostasis: heart, a hollow muscle that pumps blood throughout the blood vessels by repeated, rhythmic contractions; and blood vessels, the part of the circulatory system that transports blood throughout the body
• Respiratory, or the respiratory/ventilatory system, the biological system of an organism that introduces respiratory gases to the interior and performs gas exchange: large airways and lungs, the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails
• Abdomen, in vertebrates such as mammals, constitutes the part of the body between the thorax (chest) and pelvis; and rectum, the final straight portion of the large intestine in some mammals, and the gut in others
• Genitalia (and pregnancy if the patient is or could be pregnant)
• Musculoskeletal system (including spine and extremities; also known as the “locomotor system”), an organ system that gives animals (and humans) the ability to move using the muscular and skeletal systems
• Neurological, medical specialty dealing with disorders of the nervous system: consciousness; awareness; brain; vision; cranial nerves, or nerves that emerge directly from the brain, in contrast to spinal nerves, which emerge from segments of the spinal cord; spinal cord; and the “peripheral nervous system” (“PNS,” or occasionally “PeNS”), consisting of the nerves and ganglia outside of the brain and spinal cord
• Psychiatry, the medical specialty devoted to the study and treatment of mental disorders: orientation; mental status examination (USA), or “mental state examination” (rest of the world), abbreviated “MSE,” an important part of the clinical assessment process in psychiatric practice; evidence perception or thought

It is to likely focus on areas of interest highlighted in the medical history and may not include everything listed above.

A medical/clinical laboratory, a laboratory where tests are done on clinical specimens in order to get information about the health of a patient ads pertaining to the diagnosis, treatment, and prevention of disease; and imaging studies (“medical imaging”), the technique and process used to create images of the human body (or parts and function thereof) for clinical purposes (medical procedures seeking to reveal, diagnose, or examine disease) or medical science (including the study of normal anatomy and physiology), results may be obtained, if necessary.

The medical decision-making (MDM) process involves analysis and synthesis of all the above data to come up with a list of possible diagnoses (the differential diagnoses; sometimes abbreviated “DDx,” “ddx,” “DD,”” D/Dx,” or ΔΔ), a systematic diagnostic method used to identify the presence of an entity where multiple alternatives are possible (and the process may be termed “differential diagnostic procedure”), and may also refer to any of the included candidate alternatives (which may also be termed “candidate condition”); along with an idea of what needs to be done to obtain a definitive diagnosis that would explain their patient’s problem.

The treatment plan may include ordering additional laboratory tests and studies, starting therapy, referral to a specialist, or watchful observation; a laboratory is a facility that provides controlled conditions in which scientific research, experiments, and measurements may be performed. Follow-up may be advised.

This process is used by primary care providers as well as specialists. It may take only a few minutes if the problem is simple and straightforward. On the other hand, it may take weeks in a patient who has been hospitalized with bizarre symptoms or multi-system problems, with involvement by several specialists.

On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results, or specialist consultations.

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The post-18th century modernity period, typically referring to an historical era, roughly defined as a post-traditional or post-medieval period beginning Renaissance (ca. 14th-17th Centuries), characterized by a move from feudalism (or agrarianism) toward capitalism, industrialization, secularization, rationalization, the nation-state and its constituent institutions and forms of surveillance (Barker 2005, 444), brought more groundbreaking researchers from Europe. 

From Germany, a federal parliamentary republic in west-central Europe, and Austria, the following doctors made notable contributions: Rudolf Virchow, a German doctor, anthropologist, pathologist, prehistorian, biologist and politician, known for his advancement of public health; Wilhelm Conrad Röntgen, a German physicist, who, on November 8, 1895, produced and detected electromagnetic radiation in wavelength range today known as X-rays or Röntgen rays, an achievement that earned him the first Nobel Prize in Physics in 1901; Karl Landsteiner, an Austrian biologist and physician; and Otto Loewi, a German born pharmacologist whose discovery of acetylcholine helped enhance medical therapy. 

In the United Kingdom, the following are considered important: Alexander Fleming, a Scottish biologist, pharmacologist and botanist; Sir Joseph Lister, Bt., a British surgeon and a pioneer of antiseptic surgery, who promoted the idea of sterile surgery while working at their Glasgow Royal Infirmary; Francis Crick, an English molecular biologist, biophysicist, and neuroscientist, and most noted for being a co-discoverer of the structure of the DNA molecule in 1953 together with James D. Watson; and Florence Nightingale, a celebrated English social reformer and statistician, and the founder of modern nursing. 

A doctor from the country of Spain, now a sovereign state and a member of the European union located in southwestern Europe, on the Iberian peninsula, Santiago Ramón y Cajal, a pathologist, histologist, neuroscientist, and Nobel laureate, is considered the father of modern neuroscience, or the study of the nervous system. 

From New Zealand and Australia came Maurice Wilkins, a New Zealand-born English physicist and molecular biologist, and Nobel laureate whose research contributed to the scientific understanding of phosphorescence, isotope separation, optical microscopy and X-ray diffraction, and to the development of radar; Howard Florey, an Australian pharmacologist and pathologist who shared the Nobel Prize in Physiology or Medicine in 1945 with Sir Ernst Boris Chain and Sir Alexander Fleming for his role in the making of penicillin; and Frank Macfarlane Burnet, usually known as “Macfarlane” or “Mac Burnet,” an Australian virologist best known for his contributions to immunology. 

With their respective countries, the following also did significant work: 

The United States: William Williams Keen, the first brain surgeon in the United States; William Coley, an American bone surgeon and cancer researcher, pioneer of cancer immunotherapy; and James D. Watson, an American molecular biologist, geneticist, and zoologist, best known as a co-discoverer of the structure of DNA in 1953 with Francis Crick. 

Italy: Salvador Luria, an Italian microbiologist. 

Switzerland: Alexandre Yersin, a Swiss and French physician and bacteriologist. 

Japan: Kitasato Shibasaburō, a Japanese physician and bacteriologist during the prewar period. 

France: Jean-Martin Charcot, a French neurologist and professor of anatomical pathology; Claude Bernard, a French physiologist; and Paul Broca, a French physician surgeon, anatomist, and anthropologist; etc. 

And the others: Nikolai Korotkov, a Russian surgeon, a pioneer of 20th century vascular surgery, and the inventor of auscultatory technique for blood pressure measurement; Sir William Osler, a Canadian physician; and Harvey Cushing, an American neurosurgeon and a pioneer of brain surgery, and the first to describe Cushings’ syndrome.

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