‘Being in a womb’ or ‘playing musical chairs’ : the impact of place and space on infant feeding in NICUs

Background: Becoming a parent of a preterm baby requiring neonatal care constitutes an extraordinary life situation in which parenting begins and evolves in a medical and unfamiliar setting. Although there is increasing emphasis within maternity and neonatal care on the influence of place and space upon the experiences of staff and service users, there is a lack of research on how space and place influence relationships and care in the neonatal environment. The aim of this study was to explore, in-depth, the impact of place and space on parents’ experiences and practices related to feeding their preterm babies in Neonatal Intensive Care Units (NICUs) in Sweden and England. Methods: An ethnographic approach was utilised in two NICUs in Sweden and two comparable units in England, UK. Over an eleven month period, a total of 52 mothers, 19 fathers and 102 staff were observed and interviewed. A grounded theory approach was utilised throughout data collection and analysis. Results: The core category of ‘the room as a conveyance for an attuned feeding’ was underpinned by four categories: the level of ‘ownership’ of space and place; the feeling of ‘at-homeness’; the experience of ‘the door or a shield’ against people entering, for privacy, for enabling a focus within, and for regulating socialising and the; ‘window of opportunity’. Findings showed that the construction and design of space and place was strongly influential on the developing parent-infant relationship and for experiencing a sense of connectedness and a shared awareness with the baby during feeding, an attuned feeding. Conclusions: If our proposed model is valid, it is vital that these findings are considered when developing or reconfiguring NICUs so that account is taken of the influences of spatiality upon parent’s experiences. Even without redesign there are measures that may be taken to make a positive difference for parents and their preterm babies.

Motion Cues Analysis for Parkinson Gait Recognition

Background: Previous assessment methods for PG recognition used sensor mechanisms for PG that may cause discomfort. In order to avoid stress of applying wearable sensors, computer vision (CV) based diagnostic systems for PG recognition have been proposed. Main constraints in these methods are the laboratory setup procedures: Novel colored dresses for the patients were specifically designed to segment the test body from a specific colored background. Objective: To develop an image processing tool for home-assessment of Parkinson Gait(PG) by analyzing motion cues extracted during the gait cycles. Methods: The system is based on the idea that a normal body attains equilibrium during the gait by aligning the body posture with the axis of gravity. Due to the rigidity in muscular tone, persons with PD fail to align their bodies with the axis of gravity. The leaned posture of PD patients appears to fall forward. Whereas a normal posture exhibits a constant erect posture throughout the gait. Patients with PD walk with shortened stride angle (less than 15 degrees on average) with high variability in the stride frequency. Whereas a normal gait exhibits a constant stride frequency with an average stride angle of 45 degrees. In order to analyze PG, levodopa-responsive patients and normal controls were videotaped with several gait cycles. First, the test body is segmented in each frame of the gait video based on the pixel contrast from the background to form a silhouette. Next, the center of gravity of this silhouette is calculated. This silhouette is further skeletonized from the video frames to extract the motion cues. Two motion cues were stride frequency based on the cyclic leg motion and the lean frequency based on the angle between the leaned torso tangent and the axis of gravity. The differences in the peaks in stride and lean frequencies between PG and normal gait are calculated using Cosine Similarity measurements. Results: High cosine dissimilarity was observed in the stride and lean frequencies between PG and normal gait. High variations are found in the stride intervals of PG whereas constant stride intervals are found in the normal gait. Conclusions: We propose an algorithm as a source to eliminate laboratory constraints and discomfort during PG analysis. Installing this tool in a home computer with a webcam allows assessment of gait in the home environment.

Parent’s experiences of feeding their preterm infant in Neonatal Units in Sweden. : Ethnographic design

Introduction: Studies have shown that having a preterm infant may cause stress and powerlessness for parents. It is important to support parents around the feeding situation, and that the Neonatal Intensive Care Unit (NICU) has appropriate space and place to help the family to bond to each other. For the healthcare professionals it is important to promote skin-to-skin contact and breastfeeding; particularly for preterm infants. There are many studies on parent’s experiences of NICUs and a few studies on parent’s experiences of feeding their infant in the NICU. Objective: The objective of this study was to explore parents experiences of feeding their infant in the NICU. Design: The study was conducted using an ethnographic design. Results: A global theme of ‘The journey in feeding’ was developed from four organising themes: ‘Ways of infant feeding’; ‘Environmental influences’; ‘Relationships’ and ‘Emotional factors’. These themes illustrate the challenges mothers reported with different methods of feeding. The environment had a big impact on parent’s experiences of infant feeding. Some mothers felt that breastfeeding seemed unnatural because their infant was so tiny but breastfeeding and skin-to-skin contact helped them to bond to their infant. The mothers thought it was difficult to keep up with the milk production by only pumping. Routines were not inviting parents to find their own rhythm. They also felt stressed about the weighing. Healthcare professionals had positive and negative influences on the parents. Conclusions: This study demonstrates that while all parents expressed the wish to breastfeed, their ‘journey in feeding’ was highly influenced by method of feeding, environmental, relational and emotional factors. The general focus upon routines and assessing milk intake generated anxiety and reduced relationality. Midwives and neonatal nurses need to ensure that they emphasise and support the relational aspects of parenting and avoid over-emphasising milk intake and associated progress of the infant