Series: Casting the Light of Knowledge
A Hub that Connects the World
Series: Casting the Light of Knowledge
NCKU and NCKU Hospital’s joint epidemic prevention efforts were carried out on many different levels. Under the framework formulated by NCKU’s Emergency Response Task Force, the doctors at the Division of Infectious Diseases at NCKU Hospital played a vital role as experts in medical consultation. The Center for Infection Control at NCKU Hospital assisted NCKU in preparations for the quarantine dormitory and in planning for the various epidemic prevention projects.
NCKU and NCKU Hospital maintained a close and cooperative relationship at the highest level of decision-making and across the administrative levels. Since the presidency of Dr. Hwung-Hweng Hwung over a decade ago, the doctors at the NCKU Hospital’s Department of Psychiatry have handled counseling and mental health services, whereas the director of the Health Center has always been responsible for teaching physicians at the Department of Family Medicine and all nursing supervisors at NCKU Hospital. In addition to the invitation of doctors at NCKU Hospital to serve as executives in the NCKU administration, the College of Medicine further requires faculties to be equipped with hands-on clinical experience. The executives of both entities have been colleagues at multiple posts, which has given rise to a collaborative working culture.
A Platform for Public Participation
During the epidemic prevention process, NCKU and NCKU Hospital worked together and acted as a platform which provided an opportunity for all citizens to participate in the epidemic prevention. Since the beginnings of the epidemic prevention effort, all sectors of society including large corporations, small businesses and individuals have contributed and expressed their sincere appreciations to the medical and administrative staff by making donations in various forms, such as cash, meals, goggles etc. to NCKU and NCKU Hospital.
On the other hand, NCKU and NCKU Hospital have played the role of a liaison as well. Dr. Wen- Chien Ko, Deputy Superintendent of NCKU Hospital, was also the Deputy Commander of for the Southern Region of the Communicable Disease Control Medical Network. Therefore, he had been in close relationship with the central government even before the outbreak. Over the period of the COVID-19 pandemic, NCKU Hospital reported the first confirmed case of olfactory/ gustatory dysfunction in a timely manner which successfully contained the pandemic. Meanwhile the university’s image recognition system provided effective assistance when a confirmed case from the Fleet of Friendship (whose members paid a visit to NCKU’s stadium, a potential epidemic prevention breach which caused public consternation) was discovered. The system was linked to the Tainan City Police Department’s system, which succeeded in accurately identifying every individual who might be potentially been exposed to the virus. The system provided immediate assistance in saving the manpower of the health and police department and eliminating potential risks in the city simultaneously.
NCKU’s multifaceted body of knowledge is supporting the society during the difficult times of pandemic and responding to the country’s need in epidemic prevention, reducing the risk in the city and easing public anxiety.
Moreover, NCKU has always worked closely with eminent educational institutions and embassies around the world. During the pandemic, NCKU has not turned down a single request from the overseas embassies, and endeavored in finding teachers who were willing to respond to inquiries from the local press about the epidemic prevention. With a multilingual environment, NCKU’s international students have been able to share the latest information with their home countries and departments, so that their hometowns would get an opportunity to learn from the experiences of NCKU.
The cultural values and professional manner in the people of NCKU are all outlined within these actions. In the words of President Su, “With strong cultural values and high standards to adhere to, we should be willing to shoulder a greater burden. Nothing is impossible as long as we fulfill our responsibilities.”
Next Generation of Nursing Education
Series: Casting the Light of Knowledge
On July 9, 2020, the Association of International NCKU Nursing Alumni (AINNA) held an international online video conference to share NCKU’s experience and exchanged information on online nursing education and the pandemic.
NCKU’s Department of Nursing has always been a center for training talent in nursing and public health systems in the Southeast Asian region. The online video conference was attended by experts and scholars from India, Indonesia, Japan, Sri Lanka, Turkey, Tuvalu, Vietnam, and Thailand. It attracted as many as 6,000 viewers at the same moment.
Alumni across the world were very keen to learn about using big data to improve research, keeping clinical nursing at capacity during the emerging infectious disease pandemic, and strengthening health education in communities during the pandemic. Hence, international collaboration for higher education in nursing continued despite the pandemic.
Modular Hospital with Zero Risk of Infection Completed in Two Weeks
Series: Casting the Light of Knowledge
NCKU built the prototype for its Quarantine Units for Recovery, Emergency, and Ecology (QurE). The necessary procedure was completed in two weeks, including concept design, quarantine routes, environmental simulation, Building Information Modeling (BIM), and construction.
Pronounced similarly to the word “cure”, QurE is a testament to NCKU’s ability to complete a prototype quarantine hospital in a short time. This project was undertaken by its design and development team, which was made up of medical, architectural, and engineering experts. QurE makes the division of a clean zone and a contamination zone, and the medical waste and sewage equipment; it also provides single wards to prevent cross infection. Furthermore, computer simulation was conducted to resolve ventilation issues in negative pressure wards to reduce the risk of caretakers from aerosol pollutants from coughing, which has led to great improvements in the quality of quarantine and healthcare services.
Modularization is key to the rapid deployment of a quarantine hospital. The floor and wall materials of the QurE were all based on a 3-by-6 foot model to reduce manufacturing and construction time. Prefab housing technology adopted the technics of modular houses, which emphasizes the standardized and precast steel construction, and the insulated wall panels. A modular design also adopted the electrical equipment, so the negative pressure ward could be constructed in the shortest time. Each unit is a single room and the units are connectable. As a result, the quarantine hospital can be scaled up or down in size depending on the urgency of the project and the spatial needs of hospitals around the world.
A good design is to assist and benefit people in solving problems. Therefore, NCKU did not keep the quarantine unit design to itself. Instead, the QurE design prototype has been an open source for anyone. In the event of an emergency, countries can seek assistance immediately.
NCKU's College of Medicine Launched a VR Classroom
Series: Casting the Light of Knowledge
The pandemic gave rise to a need for remote learning. However, how would it be possible to make remote learning in medical education as effective to achieve the same or ever higher quality than traditional learning? In June 2020, the College of Medicine launched its Artificial Intelligence- Virtual Reality (AI/VR) classroom. The very first VR classroom in Southern Taiwan helped bring remote teaching to life.
The purpose of setting up the classroom was to utilize advanced technology to create a simulated environment, which improved teaching and learning effectiveness. The use of 3D organ allowed students to closely observe the organs of the body from a variety of perspectives. Even when the students were not in the classroom or operating room, everyone could put on a VR helmet and enter class virtually via remote learning.
The AI/VR classroom is located in the NCKU College of Medicine. Equipment includes 3D organ anatomical education software, a 75-inch large screen monitor, a 360-degree camera, computers, VR helmets and etc. to support online education. The College of Medicine actively encourages teachers to develop VR teaching plans. In the future, the plans to collaborate with the College of Engineering, Department of Electrical Engineering, and Department of Computer Science and Information Engineering to develop better simulation technologies, which will bring learning to the next level.
Social Medicine Balances Technology with Human Values
The pandemic raised the need for new technologies which assist medical students in gaining new knowledge and gaining depth in their training. Nonetheless, NCKU does not ignore the core value of medical education: the communication and interaction between the doctors and patients. The attitude is taught and emphasized by the professors. As Dr. Kun-Yen Huang, the founding Dean of College of Medicine, says to the students, “To be a good doctor, you must first be a good person.” The reminder has been the philosophy of the College when it comes to training students.
To cultivate students equipped with both medical profession and social value, an emphasis on technology alone is not enough. The College of Medicine plans to establish the new Medical Humanities and Social Medicine Department, which will offer integrated courses such as Medical Sociology, Medicine and Death Education, and the History of Medicine. Also, the courses in the humanities are implanted, such as Culture, Philosophy, Sociology, History, and Gender Studies. The plan will strikes a balance between emerging medical technologies and universal human values. Through the developments in medical education, the NCKU College of Medicine attempt to train the medical personnel to not only care about the medical profession but also pay more attention on the patients themselves. The value of humanity is emphasized constantly.
Accelerate Epidemic Prevention, Turn Knowledge into Action
Series: Casting the Light of Knowledge
The IT team and the IT system both played the role as accelerator in the epidemic prevention. Within 24 hours, the Information Office had set up all information and communication equipment and war room dashboards. In the Command Center, six huge displays were set up as war room dashboards that displayed the real-time epidemic information, the responses made by the hospital’s Center of Infection Control, the supply inventory, and all the personnel on duty.
All the information was updated on a minute-byminute basis, including the latest infection control measures in the hospital and updated inventories of important supplies such as N95 masks, medical masks, gloves, and protective clothing, as well as the number of personnel in every entry point and the epidemic prevention quarantine station. Everything was displayed to keep all personnel abreast of the situation so that they could act accordingly.
The displays also played a role in video conferences. For instance, Dr. Wen-Chien Ko, the Deputy Commander of the Emergency Response Center and a Deputy Superintendent of NCKU, admitted and reported the first COVID-19 patient with olfactory/gustatory dysfunction in Taiwan. Unfortunately, the patient came to the hospital without a mask. Even though Dr. Ko had worn ample protective gear, he still reported himself for 14-day isolation and quarantine. Over his quarantine period, he still attended the Emergency Response Center’s morning meetings every day via video conferencing. The displays in the Center proved the effectiveness for remote communication.
At present, NCKU Hospital is capable exporting the complete set of hospital systems that it is developed for the allied hospitals in Tainan; the systems are expected to be completed by the end of 2021. These are the secondary benefits that top-notch information fluency can bring to a national medical center. This is not just an accelerator for epidemic prevention, but a driver for turning knowledge into action.
Maintain High Morale for Frontline Nurses
Series: Casting the Light of Knowledge
The nurses at the frontlines shouldered a huge burden. The reason NCKU Hospital was able to allocate manpower smoothly was because of its high nurse-to-patient ratio. According to statistics on nurse-to-patient ratios at hospitals released in August 2020 by the National Health Insurance Administration (NHIA), NCKU Hospital ranked No. 2, with a nurse-to-patient ratio of 1:7. Additionally, the NCKU Nursing Department increased their numbers by training about 300 nurses who could be deployed immediately when needed.
NCKU Hospital worked to ease the physical and psychological burden of nurses and take care of their needs as much as possible. Dr. Meng-Ru Shen visited each frontline unit at least once a week. Nursing personnel were in close communication with the Superintendent and liaised directly whenever need arose. The personnel at the Nursing Department made sure that the lounge areas were always stocked with plenty of refreshments. Furthermore, allowances were made available to all head nurses to purchase refreshments for their colleagues at their own discretion.
Thanks to the concerted efforts of the medical and nursing teams, NCKU Hospital fulfilled the epidemic prevention mission. In addition, it came to realize that training should emphasize on the flexibility and adaptability to respond quickly and efficiently to epidemic outbreaks. Specific measures should include regular rotations of working assignments and transfers head nurses to different departments every five years, so they can familiarize themselves with the management of different departments and learn how to coordinate between them. This includes communication and coordination with the Engineering Office and the Office of General Affairs as well.
QR Code Check-Ins and Contact Tracing for Students
Series: Casting the Light of Knowledge
Contact tracing is the key to epidemic prevention. The NCKU Computer and Network Center completed the school’s Epidemic Prevention Information Website in three days after the first emergency response meeting. The Automated Epidemic Prevention Information Website was divided into two parts. The first part offered realtime information about the university’s epidemic prevention measures and the second part was a platform that featured healthcare surveys, records of daily temperature checks and symptoms, and QR Code contact tracing data.
The Information System Development Division of the Computer and Network Center was tasked to develop a contact tracing system. Using the Campus Geographic Information System developed by the General Affairs Office, it sorted out over 13,000 entries involving classrooms, meeting rooms, offices and lecture halls, and generated a QR code for each space. Then the QR codes for the entries were uploaded to the cloud so the various departments and institutions could get access to them. Once the upload was completed, all 13,000 QR codes were put up in their respective places within a day.
Afterwards, faculty members and students could simply scan the QR code on the door or on the seat and fill in the relevant information of their movements when they entered a classroom or meeting room. This information was synchronized with the NCKU Health Center’s healthcare questionnaire. After a QR code was scanned, the system would check the results to determine whether the individual had filled out the healthcare survey and filled in their body temperature. The system would accordingly notified those who missed out the daily entry.
In addition, the Epidemic Prevention Information Website was synchronized with the Epidemic Prevention Roll-call System as well. NCKU has developed multiple means for roll-calls. In the classroom, the check can be done either by the teaching assistant scanning the roll-call QR code or by the students logging into the epidemic prevention check-in system. The epidemic prevention QR code can even be put on a PowerPoint slide. Either way, the data is streamed to the Epidemic Prevention Roll-Call System and entered into a shared database attribute success to contact tracing system.
Prefabricated Outdoor COVID-19 Screening Station
Series: Casting the Light of Knowledge
On January 30, the first COVID-19 screening station in Taiwan opened at NCKU Hospital. NCKU Hospital utilized quarantine tents whose setup could be completed in a matter of hours for the isolation and quarantine of patients with suspected symptoms. After setup was completed, the hospital immediately began planning for
prefab housing to be used as screening stations that provided shelter.
The erection of the prefab houses was planned and guided by Dr. Wen-Chien Ko, infectious disease specialist and Deputy Superintendent of the hospital, as well as Dr. Nan-Yao Lee, Director of the Infectious Disease Control Center. Architectural planning was carried out by a licensed architect in the Engineering Office. Within just 10 days, the prefab quarantine shelters were completed and put into service.
The prefab houses were developed at the beginning of the crisis to keep users warm in winter while checking up the patients with suspected symptoms. Yet, as the need for quarantine quarters persisted into the summer, medical personnel reported that it was too hot inside when wearing isolation gear. To help resolve the issue, the air conditioners were set to bring in outside air instead of recirculating the air. Although it did not achieve an ideal cooling effect as expected, it did reduce discomfort for the medical personnel to a certain extent.
NCKU Hospital eventually procured two container houses with air conditioning: one for medical personnel to get changed, and the other for dining and breaks. These units provided medical personnel with a place to relax and restore their peace of mind after removing their isolation gear.
The First University with Its Own Quarantine Dormitory
Series: Casting the Light of Knowledge
National Cheng Kung University was the first and only school nationwide that established its own quarantine dormitory. This was done to avoid creating a social burden or otherwise impacting the neighboring community. Allowing the returning students to undergo quarantine directly on campus was of paramount importance. The returning policy ensured the learning quality which couldn’t be replaced by remote education. The students would be in a safe, disease-free environment, thus providing them with peace of mind.
After the assessments by multiple parties, Kuang-Fu Dormitory No. 3 was repurposed for isolation and quarantine. This dormitory was chosen because it sits at a corner of the campus where there is little foot traffic, and its 60-bed size was also perfect. It is also a graduate student dormitory with few residents. Twenty-one administrators from the Housing Services Division and Students Affairs Office along with many of their colleagues took turns acting as dorm managers in 3 eight-hour shifts each day.
NCKU’s quarantine dormitory went through three different phases between February and May. Prior to the start of school, residents were new and returning international students; afterward, exchange students returning to Taiwan from other countries were in the majority. Starting in mid-April, the MOE agreed to open the dormitory to international students returning from certain areas to Taiwan.
To avoid cross-transmission, the first step in transforming Kuang-Fu Dorm No. 3 into a quarantine dormitory was to keep clear and make arrangements for the graduate students living there originally to find accommodation in other dormitories. Epidemic prevention measures for the dormitory were listed out in the epidemic prevention plan authored by Prof. Chin-Jean Wang, Director of the NCKU Health Center. Prof. Nai-Ying Ko, Director of the Department of Nursing, College of Medicine, designed the check-in process and conducted health education for the dorm managers. The dorm managers all went through drills to practice every step of the epidemic prevention. The whole procedure was filmed as the teaching video.
Taiwanese university releases book on its COVID-19 experience
National Cheng Kung University and affiliated hospital share experience with outbreak one year after 1st case reported in Taiwan
A book about the case study of a Taiwanese university's coronavirus containment efforts has been released, and it has been hailed as a great example of Taiwan's relative success in controlling the outbreak by CommonWealth Magazine executive Jane Liu (劉鳯珍).
The book launch coincided with the anniversary of the country's first imported COVID-19 cases as well as the current experience of a COVID-19 cluster related to a hospital outbreak. Taiwan’s health minister on Tuesday (Jan. 19) appealed for alertness and vowed a swift response to the dynamic situation.
Lauded for its fast, coordinated response at the beginning of the outbreak, the Tainan-based National Cheng Kung University (NCKU) and its affiliated NCKU Hospital have been approached by their peers from around the world over the past year to share their experience managing the pandemic.
The new book records and recognizes the critical work done by the team members as well as many unknown others. It notes the systematic reflection on the school's risk-mitigation measures taken under the leadership of Su Huey-jen (蘇慧貞), the school’s president, and Shen Meng-ru (沈孟儒), the hospital’s superintendent.
Su recalled that when the global outbreak began in 2020, the school decisively collaborated with hospital executives to hammer out a set of comprehensive disease control solutions.
These included daily emergency response meetings, the postponement of the start of a new semester, the country's first quarantine dormitory for international students, an interdisciplinary epidemic response task force, a prefabricated outdoor screening post adjacent to the hospital, as well as patient flow arrangements to significantly reduce hospital traffic and patient length-of-stay.
Taiwanese university releases book on its COVID-19 experience
NCKUH Superintendent Shen Meng-ru explains how the outdoor screening post works to minimize the risk of cross-infection. (Taiwan News photo)
The school and the hospital also leveraged their academic resources and medical talent to build up various devices to protect health workers from exposure to the virus, such as a full-face nebulizer and a shield box to prevent droplet and aerosol contamination when performing airway intubation.
An AI-enabled algorithm for reading chest X-rays in seconds as well as a low-cost protein chip for detecting COVID-19 antibodies with a sensitivity of 97 percent are among the eye-popping innovations developed by the team. The latter technology has already been transferred to several American labs.
It is noteworthy that the NCKU team’s rapid and innovative AI diagnostic system took home the top award against 1560 competing teams from around the world in the World Health Organization's first COVID-19 hackathon in April last year.
"Taiwan is endeavoring to share its knowledge and to make a notable contribution to the world by showing that #TaiwanCanHelp. NCKU will continue to play a vital role in guarding the local community and making contributions to the global community with our knowledge that upholds our mission and values," said Su.
Pie Chat: Huey-Jen Su, chairperson, FICHET, Taiwan
President of Taiwan’s National Cheng Kung University, Huey-Jen Su, is also the chairperson for the Foundation for International Cooperation in Higher Education of Taiwan. Tasked with promoting the country’s international cooperation in higher education, FICHET was established in 2005. In this PIE Chat, Su spoke about Covid-19’s impact on Taiwan and considers if its government’s relative success will give institutions an advantage going forward.
The PIE: How has the pandemic affected support and inclusion for international students in Taiwan?
Huey-Jen Su: In general the policy should remain very aggressive about the potential of bringing students back to Taiwan. We have a high standard on the border quarantine policy, and that has affected the regular or scheduled inbound travel for new or returning international students.
But support in both financial terms and in institutional policy terms, are very much alive. That includes how we actively expand the level of online or distance learning for nearly every single student; there is quite a bit of flexibility.
Financial support is available, granted either by the government or by the civil society to specifically sponsor and support the inclusion of international students in our society.
The PIE: At the outbreak of the pandemic in Taiwan, how many students stayed in Taiwan?
HJS: The first national announcements for quarantine alerts for Covid-19 came in January in Taiwan – roughly the last week of our previous fall semester and the beginning of our winter vacation in our school system.
I noticed that a great percentage of our foreign students actually remained in the country or on campus because of the trust and the confidence and high performance of Taiwan’s quarantine effort. Nearly all of them have remained in our campuses since that.
The PIE: Have students had different experiences depending on which institution they’re studying with?
HJS: I’m also head of the second-largest research-intensive top tier university in the country – we also have one of the country’s largest medical centres. Therefore we were amongst the very first academic institutions that were able to put together a university policy, and guideline to ensure that the students’ health and safety.
That very quickly became the publicly available template for the other institutions to follow. You can easily imagine universities of smaller-scale would not have as much professional support or resources to prepare those guidelines.
The PIE: That would certainly have made it more difficult…
HJS: Yes. But to specifically respond to your concern, yes, in a way, a more prepared institution did have the benefit of preparing earlier, but soon others very quickly caught up to have an appropriate thorough and sufficient operating manual.
I am very proud, not only of my own institution but also of all my peers in the country. I think we did bear in mind that the better we can look after and take our students and faculty, regardless of local or international, would be the best way to deliver or to reflect our commitment of being a socially responsible institution.
The PIE: How have students remained engaged and connected to their peers?
HJS: We have been very lucky and fortunate to have maintained as vital as a lively campus life as we can for all students. And that has very much been attributable to the great and successful quarantine effort by not only our government but also every individual and institution in the country.
Thus far, almost every student, at least in our campus, has remained physically meeting together regularly, either in the classroom or in student clubs or extracurricular activities.
The PIE: Have things changed much on for students on campus?
HJS: We’ve been very much carrying on ordinary and regular lifestyles as we can, and with proper masks and a very carefully gauged social distancing [initiatives] implemented for social venues. And that has proven to be successful – even our hospital, our practical training and laboratory facilities have been all carrying on regularly.
Of course, at the height of the pandemic period for Taiwan in March, we temporarily stopped some indoor gathering for big groups of more than 100 people. But since then, the pandemic situation’s been well controlled and we have relaxed a few of these restrictions.
The PIE: Do you think the country’s response will help Taiwan attract more students in the future?
HJS: I hope so. We seem to be proving to the international community that we are not only capable, but ready, as well as responsible for what we do as teaching and research institutions. [We have] ensured that studies of students would not be either stopped, postponed or affected should there be any further pandemic situation coming to our society.
[Universities] have aggressively increased the percentage of teaching English as a medium for almost all graduate courses and increasingly so for undergrad courses. We are ready for students and [we offer] very reasonable tuition.
We were lucky that we were not affected as much, but we should not overlook this opportunity to change or prepare for change, because maybe we will forever lose that opportunity or that challenge to better ourselves for an unpredictable future.
The PIE: What sort of opportunities do you see going forward?
HJS: I think on the technical side, we are seeing in the grace of development and very exciting breakthrough of technology or educational technology being developed every day, probably faster than ever.
But again, we should be cautious in how we bring that technology properly into our curriculum and not forget that at our core – and an important treasure of campus – is for people to continue seeing and meet each other as real human beings.
There’s a lot of important things and growing that we learn on a physical campus. When we successfully adopt and include virtual education or distance learning, on one hand, we should, but on the other hand, we should be just as cautious about not overlooking the true value of on-campus education.
The PIE: One other thing I wanted to ask about you’re time at Harvard. How was that experience for you, and would you choose to study in the US if you were a student now?
HJS: You know, when I studied there nearly 30 years ago, it was a very different international geopolitics situation than today. The political environment did not seem to be so much linked to policy by the individual higher institution. And the level of academic freedom seemed to be a much more widely accepted sort of underlying principle for any higher tuition.
I would like to think that the United States continued to have the confidence and commitment to keep those values. So if that’s the case, I would love to [study in the US again]. I had many beautiful and important learning experiences in Boston that carved who I am today.
The PIE: In a recent survey, international students suggested challenges in Taiwan included the costs of living, as well as loneliness, the language barrier – connections with local communities. Do you think that this pandemic would change the answers to that survey if it were taken today?
HJS: My humble observation with my own student group here, which is one of the highest density institutes in Taiwan in terms of international students, I found that because of this pandemic, they end up realising that they might have to stay here for longer than what they thought.
I guess what they have found is that if they are engaging with society with some level of confidence, supported by the institution, they will find that barrier is not as huge as what they think.
The PIE: Have you seen examples of this?
HJS: International graduates from my nursing department voluntarily organised an online webinar with faculty experts [during the pandemic]. Very quickly, they got more than 6,000 participants registered from all over the world.
So they are seen by the Taiwanese community, and they feel they can be as connected globally as anywhere, even being in Taiwan. And that’s a very important sense of confidence-building for them.
National Cheng Kung Univeristy Invents COVID-19 Protein Chip with High Sensitivity and Specificity
At present, nasopharyngeal specimens are often collected for nucleic acid detection if patients suspected of SARS-CoV-2 infections. This nasopharyngeal swab not only causes discomfort to the subjects, but also increases the risk of infection to the medical practitioner. According to the Shenzhen Hospital Research in China, only 59% of people were diagnosed by the first nucleic acid test. Therefore, it is often necessary to take multiple tests to confirm infection. Other than nucleic acid test, serological test is one of the most preferred methods because it detects the immunological responses against SARS-CoV-2 which can be detected in blood from 7 days of infection to several months after recovery. However, most if not all the serological tests detect based on one viral protein and result in insufficient accuracy due to the variety of the immune responses.
Protein microarray is a high-throughput screening platform, which is very suitable for analyzing the humoral immune responses. During the outbreak of the new coronavirus in January, Assistant Professor Guan-Da Syu (Institute of Biotechnology and Industrial Sciences in National Cheng Kung University) began to design the coronavirus protein microarray. The prototype was completed in February and tested in March. Through a series of production and quality controls, the coronavirus protein array with 100% protein expression and 25-50 pg antibody detection limit was built. The detection limit is 1000-fold more sensitive than rapid tests or ELISA methods which can greatly increase the information harness from blood and reduce the sampling amount. They further used clinical specimens to exam the diagnosis ability, by measuring IgG and IgM in the blood of 30 COVID-19 patients and 30 healthy subjects, they obtained 97% sensitivity and 97% specificity. Each coronavirus protein microarray can detect 14 blood samples at a time and with an average 12 minutes per sample. Since there are many viral proteins on each array, they further narrow down to a set of biomarkers that can be used to produce a new generation of accurate rapid tests.
The protein chip technology was original learned by Assistant Professor Guan-Da Syu from Heng Zhu's laboratory, Johns Hopkins, United States. In order to contribute his home town, he returned to Taiwan six months ago and encountered this COVID-19 pandemic. With his expertise, he rapidly built and fabricate coronavirus protein array and recently his technology has been licensed to the world's largest human protein chip company, CDI Laboratories in the United States, sold in Europe and the United States. He wants to thank for the support from the NCKU incubation center and the dream plan for the budget support, Professor Chien-Sheng Chen for the equipment support, Dr. Yi-Ling Lin, Dr. Tzong-Shiann Ho, and Yi-Yiu Chou for clinical assistance and guidance, and students Pinxian Du and Batuhan Keskin for the efforts. Coronavirus protein microarray has entered the stage of mass production and technology authorization. The automatic diagnostic systems for protein microarray and new-generation fast screening reagents are the two directions in the future. He believed the coronavirus protein microarray has great potentials in both clinical and pharmaceutical applications.
Nanotechnology could be used to screen for COVID-19
A form of nanotechnology developed by a professor at National Cheng Kung University (NCKU) could be used to screen patients for COVID-19 in a matter of minutes, the university said in a statement Monday.
Professor Liao Jiunn-der's (廖峻德) use of "nanocavities," which he describes as nanoscale traps that resemble upside-down pyramids, can be used to catch even a single virus, he said.
To screen patients, samples are obtained from their upper respiratory tract, purified, and placed on a testing slide that has the "nanocavities."
A laser is then used to detect if a virus has been trapped inside a cavity, which virus it is, and whether it is active, Liao said.
Liao began developing the nanocavity technology in 2009, and it has proven effective in screening for seven kinds of viruses, including the SARS coronavirus and H1N1, according to the statement.
His team obtained a patent for the technology in 2012, the NCKU statement said.
A variation of the technology developed by Liao's team, which uses the same kind of laser to detect whether viruses are present on a silicon testing slide, could also be applied to COVID-19 screening.
Liao's team has yet to test the technology with the new coronavirus (SARS-CoV-2), but it will work with the university's hospital and College of Medicine to conduct tests over the next six months to determine how well the system works.
Should the technology pan out, the team's goal is to set up testing stations at ports and airports to facilitate COVID-19 testing, and create a mobile testing station that can provide services when needed, NCKU said.
The project is one of seven COVID-19 related studies that is being supported by the Ministry of Science and Technology's Department of Engineering and Technologies, according to NCKU.
CORONAVIRUS/University hospital shows off protective device for COVID-19 care
National Cheng Kung University Hospital unveiled Monday a lightweight protective tent designed to prevent the risk of infection while treating COVID-19 patients.
Fang Pin-hui (方品惠), a physician with the Tainan-based university's Department of Emergency Medicine who helped develop the concept, said doctors must be protected from getting infected, including during intubation after COVID-19 patients suffer respiratory failure.
The intubation process in particular exposes doctors to the risk of aerosol-based transmission of the virus, especially if they lack the protective gear that has been in short supply in many hospitals around the world.
The tent-like device, Fang said, was inspired by an umbrella and a raincoat that consists of two L-shaped frames and a transparent PVC film, materials which are easy to find and relatively inexpensive.
When assembled, the protective accessory can be placed on the sickbed or stretcher and acts as a barrier between the physician and patient, she said, noting that holes can be cut on the film for doctors and nurses to put their hands through to perform procedures while dressed in their protective gear.
Although intubation is typically not performed in an ambulance, the device can also be used by its crew in an emergency to prevent them from being exposed to aerosols, Fang said.
According to National Cheng Kung Hospital, the protective tent was designed so that it would be easy to assemble.
The device was described in an article in the April issue of the Annals of Emergency Medicine, a monthly peer-reviewed international medical journal covering all aspects of emergency medicine care.
A similar device made of acrylic was designed by Lai Hsien-yung (賴賢勇), an anesthesiologist with Mennonite Christian Hospital in Hualien, in mid-March, and has been adopted in the Philippines and Indonesia.
NCKU, BAF co-design for COVID19 prototype of emergency quarantine hospital
“National Cheng Kung University (NCKU) as a research-intensive university recognized for its social undertaking has the responsibilities to be the guiding light and therefore to lead for a better outlook at the time society is meeting its historical challenges,” NCKU President Huey-Jen Jenny Su said in her opening remarks for a recent press conference held in the University community.
NCKU together with Bio-architecture Formosana (BAF) develop an integrated emergency medical shelter named “Quarantine unit for recovery Emergency, and Ecology (QurE)”, which is now available as an open-source document to share with the international community!
The prototype, which is designed as a quarantine unit, considers not only safety but also humanity, especially both patients and medical staffs are under extreme pressure.
President Su hailed the collaboration and stated in today’s press conference that this is an example of intellectuals bearing the pressure and challenge, and shouldering its responsibility, and finally, in front of the world, reveal a spectacular starting point of technology solutions for addressing the COVID-19 pandemic.
“This is how the University serves the world with knowledge,” said President Su. “The core value of the entire project is to make it available for the world, therefore people can really participate in their specific functions or purpose,” Su added.
According to NCKU Hospital Superintendent Meng-Ru Shen, NCKU has organized an R&D design team that spans medicine, architecture, and engineering, and combined the strength of industry and academia to create a prototype of quarantine hospital for COVID-19 treatments.
Ching Hwa Chang, founder of BAF, noted,“we design a prototype in under 2 weeks, it started as a virtual 3D model, to communicate with the general public, we decided to build a 1:1 realistic structure instead.”
One of the most important features is its modular assembly design, enabling workers to be able to assemble a single suite-type negative pressure isolation ward without having to worry about cross-infection between patients in less than three days, said Chang.
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NCKU COVID-19 diagnostic system translated into 6 languages
The National Cheng Kung University (NCKU) Hospital self-developed diagnostic system, which was previously available only in Chinese, enables patients to fill in data on their travel, occupational, contact and virus cluster history electronically before being seen by a doctor. Now the NCKU Hospital added 6 languages to the system, which will help reduce the burden of the medical staff.
To improve accessibility, the hospital added versions of the service in English, Vietnamese, Indonesian, Thai, Japanese and Korean, which then automatically translates the patient data for hospital staff.
An audio Taiwanese-language version of the system is also being developed.
According to Dr. Liu Ping-yen, the director of the NCKU Department of Intensive Care, the hospital initially only planned to add an English version, but later expanded it to better reflect the diversity of foreign languages spoken in Taiwan.
With help from the university's Office of International Affairs, the hospital recruited volunteers to translate the system into six languages.
Korean graduate student Tsui Wen-yu finished the system's Korean translations in a single day, saying that seeing the impact of the COVID-19 pandemic in his own country motivated him to help the hospital's staff "get through this challenge together.”
NCKU develops automatic pneumonia detection system for early detection of COVID-19 patients
Under the lack of doctors and nurses in countries with severe condition of COVID-19, pressure of taking care of patients and diagnosing symptoms are growing bigger. Before the outbreak of Coronavirus, researches on conducting artificial intelligent on healthcare system has been a key development to National Cheng Kung University (NCKU) Hospital, Taiwan.
In the past two years, department of diagnostic radiology of NCKU Hospital has been continuously conducting research on using AI in X-ray for faster chest diagnosis on pneumothorax and aortic dissection.
Using a dataset of chest X-rays, this artificial intelligence tool can alert doctors to a coronavirus infection in as little as a second.
With the existing research foundation on AI chest diagnostics, a team named MedCheX composed of NCKU researchers, Prof. Jung-Hsien Chiang, Dr. Yi-Shan Tsai, graduate and PhD students Chi-Siang Wang, Huang-Bin Chiou, Jhao-Yi Wu, is selected as one of the 89 highlighted projects out of 1560 teams around the world in the “Build for COVID19 Global Online Hackathon” competition. Tiffany Chiang, an elementary school teacher helped in language revision for the video used for competition.
MedChex is an e-Alert system for automatically detecting high-risk patients with pneumonia from chest x-rays. The system learn from the vast negative and positive x-ray image of COVID-19 provided by Dr. Yi-Shan Tsai, then detects pneumonia on x-rays images and identifies whether the person is infected by COVID-19.
The team combined ResNeXt with Feature Pyramid Network (FPN) based deep learning model to automatically detect the presence of pneumonia using this dataset. They also consulted with engineers in order to better integrate the model to assist doctors with their diagnoses. Transfer of x-ray scans, server construction, and prediction response were all needed to build this e-Alert system.
If a positive result is detected, doctors are notified of the suspected case via e-Alert (on computer or smartphone), and labeling of the corresponding area in the diseased lung are accomplished with a deep learning approach. The system’s accuracy can be up to 92%. With all the automatic process, doctors could have more accurate diagnosis and prompt treatments, which saves lots of human labor.
The system has already been tested with and adopted by doctors at the National Cheng Kung University Hospital. With this system, diagnosis could be finished within a second, minimizing time for patients waiting for the result and lowering the risk of infection in the hospital, making NCKU the first hospital in Taiwan to use AI technology in pneumonia diagnosis. Places insufficient with doctors would be hugely benefited from it.
In the future, other medical scans, such as CT scans or MRIs, may be included in this system to provide doctors with more accurate information to diagnose patients.
Taiwan's NCKU holds online summit for world education and medical advancement
National Cheng Kung University (NCKU) on Tuesday (April 21) held a 12-hour-long online meeting attended by over 150 university presidents, scholars, experts, and medical professionals from over 10 countries, to discuss the impact of Wuhan coronavirus (COVID-19) on higher education and how people can minimize impacts from a future plague with new drug R&D processes.
The various stay-at-home orders implemented around the world have resulted in tens of millions of people working from home and using video-conferencing tools to communicate and exchange ideas, fostering a new higher education landscape. As the coronavirus pandemic is still wreaking havoc around the world, NCKU scrambled to host an online international summit of academics and professionals to brainstorm a new solution in fighting a pandemic as well as advancing remote learning.
NCKU President Dr. Huey-Jen Su (蘇慧貞) stated in her opening remarks that in the war against COVID-19, world leaders have incorporated various disciplines including data science, technology, medicine, and management. Of these forward-thinking leaders, Taiwan's president stands out the most with her effective resource integration from various ministries and sectors, Su explained.
"NCKU has been committed to its social responsibility and today we are inviting our global partners to discuss over key world issues in hopes of collecting good ideas and developing new solutions," she said.
Dr. Chih-Hung Jason Wang, a professor from Stanford University who published an article in The Journal of the American Medical Association (JAMA) that attracted international attention to Taiwan’s performance in fighting COVID-19, was invited to deliver a speech at the NCKU online forum. He praised Taiwan's quick and effective measures implemented right after the January outbreak, including border control, cross-department integration, and the application of big data.
Wang added that with its experiences combating and containing SARS in 2003, Taiwan could quickly mobilize resources across public and private sectors to fight the coronavirus in a joint effort. He compared an effective pandemic prevention plan to performing a harmonious symphony, saying that under the direction of the conductor, orchestra members play their respective parts on time and in unison, achieving perfection.
In a sub-forum of the event featuring higher education, participants observed a pandemic-induced shift from the classroom to online instruction as lockdowns remained in place for several months. They agreed that the rise of long-distance learning also points to a new trend that can reach more people across borders and from various socioeconomic groups.
In another sub-forum featuring medicine, participants discussed what global universities, research institutes, and government agencies could do together to develop rapid tests and accelerate research and development of vaccines and medicine, closing the gap between the laboratory and product commercialization.
Participants of the event included presidents and professors from the University of Tsukuba, Japan; the University of Malaya, Malaysia; Mahidol University, Thailand; Ho Chi Minh City Medicine and Pharmacy University, Vietnam; the SRM Institute of Science and Technology, India; Masaryk University, Czech Republic; and the University of Cincinnati, United States; as well as professionals from medical institutes, multiple industries, governments, and academic institutions in Canada, Swaziland, the United Kingdom, Turkey, Thailand, and Laos.
International Virtual Forum on COVID-19, Sharing Taiwan's Success Story (MOST)
At present, many countries in the world are slowing down due to the COVID-19 pandemic. Yet, Taiwan continues to be one of the few that has successfully curbed the spread of the virus, all the while allowing its citizens to maintain their normal lives. Supporting the national effort, the Ministry of Science and Technology (MOST) plays an indispensable role in strengthening Taiwan’s R&D capability on infectious diseases and strengthening the foundation of epidemic prevention for nearly two decades post SARS. To date, more than 150 labs and researchers in related fields were funded under MOST. Also working on the forefront, National Cheng Kung University (NCKU), a leading university in Taiwan, has been one of the forerunners to enact rapid contingency plans and measures since the beginning of the outbreak.
Amid the ongoing development of the virus, MOST and NCKU jointly organized the 2020 NCKU International Virtual Forum on COVID-19 on Tuesday, April 21. The goal of the event was to create a platform for NCKU and its partners around the world to share their experiences, knowledge, and best practices on epidemic prevention.
Having effectively applied its research strengths in engineering and medicine, NCKU has been recognized in the region for its measures to prevent and respond to the virus. To demonstrate universities' shared responsibility to quell this outbreak and to share the best practices, the 2020 NCKU International Virtual Forum on COVID-19 (access the forum here) focused on several aspects: first, how universities have rapidly adopted measures to continue to educate their students, uninterrupted by shutdowns; second, how universities, government agencies, and communities can effectively work together to combat the spread of the virus; last but not least, how innovative research across such fields as big data, AI healthcare, rapid testing devices, and novel treatments have been applied in the response to COVID-19.
Given the objectives of the forum, NCKU has invited all of its local and global partners to join, including 104 member universities of the Presidents' Forum of Southeast Asia and Taiwan Universities (SATU), scholars and administrators from Stanford University (U.S.A.), the University of Cincinnati (U.S.A.), Masaryk University (Czech Republic), Technischen Universität Darmstadt (Germany), University of Bern (Switzerland), University of Tsukuba (Japan), SRM Institute of Science and Technology (India), Mahidol University (Thailand), and University of Malaya (Malaysia), among others. Altogether, online participation in the forum is expected to reach over 100 countries.
The virtual forum began at 9:30 a.m. Taiwan local time, and continued for nearly 12 hours to ensure that participants in different countries have the chance to join. Having garnered praise for its rapid responses to major events and its collaboration with the government in recent years, NCKU once again demonstrated how the university can apply its research strengths to improve the well-being and the advancement of our society.
Pneumonia detection system wins COVID-19 global online competition
An automatic pneumonia detection system developed by a team from Tainan-based National Cheng Kung University (NCKU) has become one of the winners of an online competition organized by the World Health Organization (WHO) to seek solutions for tackling challenges related to the COVID-19 coronavirus pandemic, the university said Monday.
The team, named "MedCheX," headed by NCKU professor Chiang Jung-hsien (蔣榮先), was announced on April 10 as one of the 89 highlighted projects among 1,560 submissions in the COVID-19 Global Online Hackathon, with an e-alert system that can detect pneumonia from chest x-rays and automatically alert the doctor more quickly, NCKU said in a press release.
It is the only Taiwanese team to win the honor, it noted.
According to Chiang, the system was developed over the last two years with the aim of assisting doctors in diagnosing pneumonia more quickly.
The team created a UNet++ machine learning model that can automatically detect the presence of pneumonia.
Using this learning model, the system is able to automatically detect high-risk patients by scanning their chest x-rays to determine more quickly whether they are infected with pneumonia, Chiang said.
If the test proves positive, the doctor will receive an e-alert, either via computer or mobile phone, containing both the original scans and the detection results.
Chiang said the team, which also features three graduate and PhD students, along with Tsai Yi-shan (蔡依珊), a doctor at NCKU Hospital, was able to build the system thanks to a cache of more than 1,000 chest x-rays from patients suspected of having pneumonia provided by the NCKU Department of Medical Imaging.
So far, the system has already been put to use at NCKU Hospital and has greatly increased diagnosis efficiency.
Based on the 1,400 images the system has managed to scan so far, it has achieved 92 percent accuracy in the detection of pneumonia symptoms, Chiang added.
With the coronavirus pandemic, Chiang said that over the past three months, the system has also been used for early detection of potential COVID-19 patients.
The system only takes a single second to determine if the chest X-ray scan of a patient needs further screening for coronavirus, he added.
Chiang said that in the future, the team will include functions for other types of screening, such as CT scans or MRIs, to provide doctors with even more accurate diagnostic information.
Covid-19 Prevention Guide for International Students
NCKU to set up COVID-19 Innovation Center
To meet the global challenge of COVID-19, National Cheng Kung University (NCKU) plans to establish an innovation center to support research and development activities that address medical and socio-economic challenges in relation to the COVID-19 pandemic, and foster collaboration between academic researchers and public, not for profit and industry partners. Research topics include diagnostics, vaccine, antiviral drugs, case tracking, as well as other technologies and tools in relation to the COVID-19. As so many of the world’s researchers focused so urgently on this topic, NCKU professors actively engaged with domestic and international partners, and will continue to bring their expertise and experiences to the global scientific community to help find potential solutions.
To address the medical challenges, a group of physicians and research scientists in biochemistry and immunology from NCKU work closely to develop screening test, vaccine, and antiviral drug. The interdisciplinary group is developing rapid screening kits targeting the antigens or antibodies of the coronavirus. The testing kits under development could return results much faster than the current standard testing, which relies on a time-consuming laboratory process involving the extraction and amplification of nucleic acid from the coronavirus. This NCKU team also aims to develop vaccine to arm the population against new waves of infection, as well as antibody drugs for the treatment.
The other focus of this innovation center will be the application of IoT and AI technology in COVID-19 pandemic. Ongoing research projects in NCKU include AI analyzing chest X-ray image, chatbot in medical frontline, smart stethoscope, intubation device with 3D navigation system, protective suit and smart device for quarantine, automatic disinfection system, and etc. With the interdisciplinary collaboration between technology and medicine, we aim to monitor the real-time status of patients, transfer data to server through IoT network, analyze the information with big data and AI tools, and finally provide guidance to assist medical decision making of COVID-19.
NCKU develops digitized TOCC to ease the spread of COVID-19
National Cheng Kung University (NCKU) in Taiwan has recently set up a “smart” healthcare clinical decision making assistive system, improving the testing efficiency up to 5 to 6 times. Originally it took two and half hours for a high risk patients from testing to decision making, which costs labor force and increases risk of cross-infection. However, with the smart system it cost only less than 30 minutes.
One part of the system includes improvement of the way to ask about TOCC history (Travel, Occupation, Contact, Cluster) of patients. In traditional way it was all conducted on paper and required person to person conversation, then digitized data by hand, which could possibly infect hospital staff and also make the doctor unable to diagnose quickly. In addition, doctors are harder to get the quickly changing information of pandemic without help of technology.
To solve the problems, NCKU Hospital expects to lower the risk of cross-infection and improve the information sharing efficiency. Therefore, the hospital decided to modify the testing station based on medical and information sciences. The hospital started to use tablets with digitized questionnaire designed by Dr. Po-Lin Chen, Dr. Nan-Yao Lee, and Ching Wan from Infection Control Center, to replace the paper work that brings higher workload with higher risk of infection for the nurses. The public could input their travel, occupation, possible contact, and cluster history by themselves on the tablets to shorten their stay at the testing station. Once the information were collected, it will upload directly to HIS system. By applying the smart AI clinical decision-making system, the clinicians could check and make the precise clinical decision right away.
NCKU creates new wearable device for thermal screening to detect infection
The HEARThermo, a watch-like wearable device, can continuously monitor body surface temperature and heart rate to provide real-time data and decision support for early fever detection and point-of-care of suspected cases in the COVID-19 pandemic. The product was developed by an interdisciplinary group of NCKU professors with expertise in medicine, IoT, big data, and AI, as well as an industrial partner.
The interdisciplinary NCKU team includes Prof. Ko Nai-Ying, head of the Department of Nursing; Prof. Ko Wen-Chien, deputy superintendent of NCKU Hospital; Prof. Chen Po-Lin, head of the Center for Disease Control; Prof. Chuang Kun-Ta, assistant professor of the Department of Computer Science and Information Engineering; Prof. Kao Hung-Yu, dean of the Department of Computer Science and Information Engineering; and Prof. Yu-Chen Shu, assistant professor of the Department of Mathematics.
Thermal screening has become a standard protocol to detect early sign of infection. Identifying individuals with elevated body temperature, who should then be further screened with diagnostic tests, can help reduce the spread of viruses.
This HEARThermo system attracted attention during the COVID-19 epidemic for its function in early detection of fever in suspected cases. Potential partners include hospitals, transportation companies, and long-term care organizations. The research team is also interested to collaborate with international partners to provide early detection of suspected patients and help to prevent the rapid spread of COVID-19 in other countries in Europe, the United States, Southeast Asia, and etc.
For future study, the team aims to expand the applications of HEARThermo with the support of IoT technology. The team is currently developing prediction model of body surface temperature and smart cloud service for different population groups.
University-run COVID-19 regional testing station opens in Taiwan
How the coronavirus (COVID-19) pandemic is affecting operations at National Cheng Kung University (NCKU), Taiwan, and how NCKU experts and scientists are responding to the COVID-19 outbreak is crucial to the nation. During the outbreak, NCKU Hospital (NCKUH) has successfully implemented outdoor coronavirus testing stations, using prefabricated modules.
During the Spring Festival, NCKUH set up a tented area in the emergency parking lot as a temporary coronavirus testing tent, as a final safeguard for the emergency department by allowing quick assessment of patients and preventing the risk of an infection outbreak in the hospital.
For NCKUH, this epidemic is just another battle to be fought, and no rest can be found before the enemies are annihilated. In the hopes of providing a safer medical operating environment, Superintendent of NCKUH, Meng-Ru Shen, has arranged an coronavirus testing station to be set up in the outdoor parking lot to replace the temporary coronavirus testing tent.
This testing station was set up in just ten days and is now ready to provide a safe and high-quality coronavirus testing station for both patients and healthcare workers alike.
The outdoor COVID-19 testing stations are fully equipped to ensure the entire coronavirus testing process goes smoothly, accurately, and quickly. Equipment like mobile X-ray machines, tablets to fill in TOCC (travel history, work history, contact history, and group history), as well as sample collection equipment and necessary medical supplies, can all be found in the testing station.
NCKUH Superintendent Meng-Ru Shen indicated that the service targets of the coronavirus testing stations are people who have a history of tourism between China, Hong Kong, and Macau, and those with fever or respiratory symptoms within 14 days.