Breastfeeding preterm infant from the delivery ward via nicu to home

The aim of this study was to examine how to support breastfeeding of preterm infants immediately after birth in the delivery ward, during their hospital stay in a neonatal intensive care unit (NICU), and at home after hospital discharge. Specifically, the role of early physical contact, maternal breastfeeding attitude, and an internet-based peer support group were investigated. The delivery ward practices concerning the implementation of early physical contact between a mother and her infant admitted to a NICU were examined by a structured survey in two hospitals. An Internet-based, breastfeeding peer-support intervention for the mothers of preterm infants was developed and tested in a randomized controlled design with one year follow-up. The main outcomes were the duration of exclusive and overall breastfeeding, expressing milk, and maternal attitude. In addition, the perceptions of mothers of preterm infants were investigated by analyzing the peer-support group discussions with a qualitative approach. The implementation of early physical contact was different between the two hospitals studied and was based more on hospital routines than the physiological condition of the infant. Preterm infants, who were born before a gestational age (GA) of 32 weeks, were hardly ever allowed to have early contact with their mothers. Both, a higher GA and early physical contact predicted earlier initiation and increased frequency of breastfeeding in the NICU. A maternal breastfeeding-favorable attitude predicted increased frequency of breastfeeding in the NICU and also a longer duration of overall breastfeeding. The actual duration of breastfeeding was, however, shorter than the mothers intended in advance. The internet-based, peer-support intervention had no effect on the duration of breastfeeding, expressing milk, or maternal attitude. The participating mothers enjoyed the possibility of sharing their experiences of preterm infants with other mothers in similar situations. Some of the mothers also experienced being given useful advice for breastfeeding. Based on the mothers’ discussions, a process of breastfeeding preterm infants was created. This included some paradoxical elements in the NICU where, for example, breast milk was emphasized over breastfeeding and support in the hospital varied. Hospital discharge was a critical point, when the mothers faced breastfeeding in reality. Over time, the mothers assimilated their breastfeeding experience into part of being a mother. The care practices related to early physical contact in delivery wards need to be re-evaluated to allow more infants to have a moment with the mother. Maternal attitude could be screened prenatally and attitude-focused interventions developed. Breastfeeding support in the NICU should be standardized. Internet-based breastfeeding peer-support intervention was feasible but additional research is needed.

Synnytyksen ponnistusvaiheen hoidon käytännöt. Yhteys ensisynnyttäjän välilihan kuntoon synnytyksen jälkeen, synnytyskokemukseen, kipuun ja seksuaaliterveyteen

Hyvän syntymän hoidon tavoitteena on turvata synnyttäjän paras mahdollinen terveys, vähentää tarpeetonta puuttumista synnytyksen kulkuun ja mahdollistaa voimaannuttava synnytyskokemus perheelle. Hyvä syntymän hoito ja siihen liittyvä kätilöiden kliinisen hoitotyön osaaminen ei voi kehittyä, ellei hoitotyön käytäntöjä tutkita. Suomalaista hoitotieteellistä syntymän hoitoon liittyvää tutkimusta on vähän. Tämän tutkimuksen tarkoituksena oli kuvata synnytyksen ponnistusvaiheen hoidon käytäntöjä Suomen synnytyssairaaloissa. Lisäksi seurantatutkimuksen avulla selvitettiin, miten ensisynnyttäjät kokivat synnytyksen ponnistusvaiheen, sen aikana saamansa hoidon, ensisynnyttäjien synnytyskokemusta, kivun kokemista, vointia kolmena päivänä synnytyksen jälkeen sekä heidän seksuaaliterveyttään ensimmäisen vuoden aikana synnytyksen jälkeen. Tutkimuksen tavoitteena oli tuottaa tietoa, jonka avulla voidaan kehittää synnytyksen ponnistusvaiheen hoitoa ja lisätä tietoa synnyttäneiden naisten voinnista ja seksuaaliterveydestä. Tutkimuksen ensimmäinen osio toteutettiin poikkileikkaustutkimuksena (2009), johon osallistui Suomen synnytyssairaaloiden synnytysosastoilla työskentelevät kätilöt (N = 662). Tutkimuksen toinen osio toteutettiin seurantatutkimuksena (2009−2011), jossa oli neljä mittausajankohtaa: kolmantena päivänä synnytyksestä sekä kolmen, kuuden ja kahdentoista kuukauden kuluttua synnytyksestä. Tähän osioon osallistui spontaanisti alateitse yhden elävän lapsen (pää tarjoutuvana) synnyttäneet ensisynnyttäjät (N = 453) ja sikiön perätilan vuoksi suunnitellusti keisarileikatut ensisynnyttäjät (N = 84). Aineisto analysoitiin tilastollisin menetelmin. Tutkimustulosten mukaan osa kätilöiden käyttämistä synnytyksen ponnistusvaiheen hoitokäytännöistä ei ole näyttöön perustuvia. Synnytyssairaalan synnytyksen hoidon kulttuuri näyttää siirtyvän mallioppimisen kautta. Ensisynnyttäjät kokivat synnytyksen ponnistusvaiheen hoidon pääsääntöisesti myönteisenä. Alateitse synnyttäneillä ensisynnyttäjillä oli myönteisempi synnytyskokemus ja vähemmän kipua heti synnytyksen jälkeen ja kolmena synnytyksen jälkeisenä päivänä verrattuna keisarileikkauksella synnyttäneisiin ensisynnyttäjiin. Alateitse synnyttäneillä ensisynnyttäjillä kipu ja ompeleet eivät vaikuttaneet haitallisesti vastasyntyneen hoitoon tai imetykseen niin paljon kuin keisarileikkauksella synnyttäneillä ensisynnyttäjillä. Välilihan leikkaus-, repeämä- tai keisarileikkaushaavat olivat täysin parantuneet suurimmalla osalla naisista kolmen kuukauden kuluttua synnytyksestä. Yleisimpiä naisten kokemia oireita ensimmäisen vuoden aikana synnytyksestä olivat emättimen kostumisen vaikeus, yhdyntäkivut, peräpukamat sekä arpikudoksen kipu ja kiristys. Sukupuolinen halukkuus ja tyytyväisyys seksielämään olivat huonompaa ensimmäisen vuoden aikana synnytyksestä verrattuna aikaan ennen raskautta ja synnytystä. Synnytyksen aikaisella hoitotyöllä ja näyttöön perustuvalla synnytyksen ponnistusvaiheen hoidolla on suuri merkitys naisen synnytyskokemukseen, synnytyksen jälkeiseen vointiin ja seksuaaliterveyteen.

Developing cost of poor quality calculations with emphasis on business impact

The main aim of this research was to develop cost of poor quality calculation model which will better reflect business impacts of lost productivity caused by IT incidents for the case company. This objective was pursued by reviewing literature and conducting a study in a Finnish multinational manufacturing company. Broad analysis of the scientific literature allowed to identify main theories and models of Cost of Poor Quality and provided better base for development of measurements of business impacts of lost productivity. Empirical data was gathered with semi-structured interviews and internet based survey. In total, twelve interviews with experts and 39 survey results from business stakeholders were gathered. Main results of empirical study helped to develop the measurement model of cost of poor quality and it was tied to incident priority matrix. Nevertheless, the model was created based on available data. Main conclusions of the thesis were that cost of poor quality measurements could be even further improved if additional data points could be used. New model takes into consideration different cost regions and utilizes on this notion.

The impact of a digital children's literature program on primary students' reading motivation

This qualitative study stemmed from a concern of the perceived decline in students' reading motivation after the early years of schooling, which has been attributed to the disconnect between the media students are accustomed to using outside the classroom and the media they predominantly use within the classroom. This research documented the effectiveness of a digital children's literature program and a postreading multimedia program on eight grade 1 students' reading motivation, word recognition, and comprehension abilities. Eight students were given ten 25-minute sessions with the software program over 15 weeks. Preprogram, interim-program, and postprogram qualitative data were collected from students, teachers, and parents through questionnaires, interviews, standardized reading assessment tools, classroom observations, field notes, and student behaviour observation checklists. Findings are summarized into 3 themes. The motivational aspects and constructivist styles of instruction in the digital reading programs may have contributed to 5 student participants' increased participation in online storybook reading at home. Qualitative data revealed that the digital children's literature program and multimedia postreading activities seemed to have a positive influence on the majority of grade 1 student participants' reading motivation, word recognition, and listening comprehension skills. These findings suggest the promise of multimedia and Internet-based reading software programs in supporting students with reading andlor behavioural difficulties. In keeping with current educational initiatives and efforts, increased use of media literacy practices in the grade 1 curriculum is suggested.

Dispositional Forgiveness and Health in Romantic Relationships: An Exploration of Sex Differences, Actor Effects, and Partner Effects

The individual and dyadic associations between dispositional forgiveness of self, others, and situations and mental and physical health in individuals involved in romantic relationships were examined. Sex differences in the relationship between dispositional forgiveness and health were examined. Sex differences in the dyadic relationship between forgiveness and health were also examined. The dispositional forgiveness scores of 297 partners involved in a romantic relationship were used to predict their own as well as their partners' physical and mental health. Both members of the relationship separately completed an Internet-based questionnaire assessing personality traits, relationship variables, and physical and mental health. The couple was provided with monetary compensation. Analyses revealed that women's dispositional forgiveness of self, others, and situations were positively associated with their own physical and mental health. Similarly, men's dispositional forgiveness of self, others, and situations were positively associated with their own mental and physical health. At the individual level, there were no sex differences in the relationship between dispositional forgiveness and health, nor were there sex differences in men and women's reports of dispositional forgiveness. Analyses revealed that men's forgiveness of others and situations were positively associated with their female partners' mental health. There were no partner effects for women or for physical health. The implications of these results for research in the forgiveness-health literature and research on forgiveness in romantic relationships were discussed as were directions for future research.

Le développement des modes alternatifs de règlement des litiges de consommation : Quelques réflexions inspirées par l’expérience ECODIR

"ECODIR a vu le jour en octobre 2001, à Bruxelles, grâce à la contribution financière entre autres de l’Union européenne. C’est une plate-forme de règlement des litiges de consommation par Internet. Son champ d’action est limité, en raison des termes du contrat de recherche conclu avec la Commission européenne et de certaines contraintes juridiques. Il ne couvre que les conflits mettant en cause au moins un consommateur et relatifs à une transaction effectuée en ligne ; les litiges portant sur des questions complexes (fiscalité, droit de la famille par exemple) sont exclus. ECODIR n’est pas un processus d’arbitrage, mais de médiation : la possibilité d’ester en justice en cas d’échec du processus n’est pas exclue. Les auteurs décrivent les trois phases du processus, puis font le bilan de son fonctionnement. Ils analysent l’incidence des recommandations et des directives de la Commission européenne sur le commerce électronique avant d’examiner enfin la portée des solutions dégagées au terme de toute la procédure."

Le développement des modes alternatifs de règlement des litiges de consommation : quelques réflexions inspirées par l’expérience ECODIR

"ECODIR a vu le jour en octobre 2001, à Bruxelles, grâce à la contribution financière entre autres de l’Union européenne. C’est une plate-forme de règlement des litiges de consommation par Internet. Son champ d’action est limité, en raison des termes du contrat de recherche conclu avec la Commission européenne et de certaines contraintes juridiques. Il ne couvre que les conflits mettant en cause au moins un consommateur et relatifs à une transaction effectuée en ligne ; les litiges portant sur des questions complexes (fiscalité, droit de la famille par exemple) sont exclus. ECODIR n’est pas un processus d’arbitrage, mais de médiation : la possibilité d’ester en justice en cas d’échec du processus n’est pas exclue. Les auteurs décrivent les trois phases du processus, puis font le bilan de son fonctionnement. Ils analysent l’incidence des recommandations et des directives de la Commission européenne sur le commerce électronique avant d’examiner enfin la portée des solutions dégagées au terme de toute la procédure."

Decimal Multiplication using compact BCD Multiplier

Decimal multiplication is an integral part offinancial, commercial, and internet-based computations. The basic building block of a decimal multiplier is a single digit multiplier. It accepts two Binary Coded Decimal (BCD) inputs and gives a product in the range [0, 81] represented by two BCD digits. A novel design for single digit decimal multiplication that reduces the critical path delay and area is proposed in this research. Out of the possible 256 combinations for the 8-bit input, only hundred combinations are valid BCD inputs. In the hundred valid combinations only four combinations require 4 x 4 multiplication, combinations need x multiplication, and the remaining combinations use either x or x 3 multiplication. The proposed design makes use of this property. This design leads to more regular VLSI implementation, and does not require special registers for storing easy multiples. This is a fully parallel multiplier utilizing only combinational logic, and is extended to a Hex/Decimal multiplier that gives either a decimal output or a binary output. The accumulation ofpartial products generated using single digit multipliers is done by an array of multi-operand BCD adders for an (n-digit x n-digit) multiplication.

Performance analysis of double digit decimal multiplier on various FPGA logic families

Decimal multiplication is an integral part of financial, commercial, and internet-based computations. This paper presents a novel double digit decimal multiplication (DDDM) technique that performs 2 digit multiplications simultaneously in one clock cycle. This design offers low latency and high throughput. When multiplying two n-digit operands to produce a 2n-digit product, the design has a latency of (n / 2) 1 cycles. The paper presents area and delay comparisons for 7-digit, 16-digit, 34-digit double digit decimal multipliers on different families of Xilinx, Altera, Actel and Quick Logic FPGAs. The multipliers presented can be extended to support decimal floating-point multiplication for IEEE P754 standard

High performance, low latency double digit decimal multiplier on ASIC and FPGA

Decimal multiplication is an integral part of financial, commercial, and internet-based computations. This paper presents a novel double digit decimal multiplication (DDDM) technique that offers low latency and high throughput. This design performs two digit multiplications simultaneously in one clock cycle. Double digit fixed point decimal multipliers for 7digit, 16 digit and 34 digit are simulated using Leonardo Spectrum from Mentor Graphics Corporation using ASIC Library. The paper also presents area and delay comparisons for these fixed point multipliers on Xilinx, Altera, Actel and Quick logic FPGAs. This multiplier design can be extended to support decimal floating point multiplication for IEEE 754- 2008 standard.

Fixed Point Decimal Multiplication Using RPS Algorithm

Decimal multiplication is an integral part of financial, commercial, and internet-based computations. A novel design for single digit decimal multiplication that reduces the critical path delay and area for an iterative multiplier is proposed in this research. The partial products are generated using single digit multipliers, and are accumulated based on a novel RPS algorithm. This design uses n single digit multipliers for an n × n multiplication. The latency for the multiplication of two n-digit Binary Coded Decimal (BCD) operands is (n + 1) cycles and a new multiplication can begin every n cycle. The accumulation of final partial products and the first iteration of partial product generation for next set of inputs are done simultaneously. This iterative decimal multiplier offers low latency and high throughput, and can be extended for decimal floating-point multiplication.

Performance Analysis of Reversible Fast Decimal Adders

This paper presents a performance analysis of reversible, fault tolerant VLSI implementations of carry select and hybrid decimal adders suitable for multi-digit BCD addition. The designs enable partial parallel processing of all digits that perform high-speed addition in decimal domain. When the number of digits is more than 25 the hybrid decimal adder can operate 5 times faster than conventional decimal adder using classical logic gates. The speed up factor of hybrid adder increases above 10 when the number of decimal digits is more than 25 for reversible logic implementation. Such highspeed decimal adders find applications in real time processors and internet-based applications. The implementations use only reversible conservative Fredkin gates, which make it suitable for VLSI circuits.

Knowledge Building in Landscape Architecture

The objective of this study was to develop an internet-based seminar framework applicable for landscape architecture education. This process was accompanied by various aims. The basic expectation was to keep the main characteristics of landscape architecture education also in the online format. On top of that, four further objectives were anticipated: (1) training of competences for virtual team work, (2) fostering intercultural competence, (3) creation of equal opportunities for education through internet-based open access and (4) synergy effects and learning processes across institutional boundaries. This work started with the hypothesis that these four expected advantages would compensate for additional organisational efforts caused by the online delivery of the seminars and thus lead to a sustainable integration of this new learning mode into landscape architecture curricula. This rationale was followed by a presentation of four areas of knowledge to which the seminar development was directly related (1) landscape architecture as a subject and its pedagogy, (2) general learning theories, (3) developments in the ICT sector and (4) wider societal driving forces such as global citizenship and the increase of open educational resources. The research design took the shape of a pedagogical action research cycle. This approach was constructive: The author herself is teaching international landscape architecture students so that the model could directly be applied in practice. Seven online seminars were implemented in the period from 2008 to 2013 and this experience represents the core of this study. The seminars were conducted with varying themes while its pedagogy, organisation and the technological tools remained widely identical. The research design is further based on three levels of observation: (1) the seminar design on the basis of theory and methods from the learning sciences, in particular educational constructivism, (2) the seminar evaluation and (3) the evaluation of the seminars’ long term impact. The seminar model itself basically consists of four elements: (1) the taxonomy of learning objectives, (2) ICT tools and their application and pedagogy, (3) process models and (4) the case study framework. The seminar framework was followed by the presentation of the evaluation findings. The major findings of this study can be summed up as follows: Implementing online seminars across educational and national boundaries was possible both in term of organisation and technology. In particular, a high level of cultural diversity among the seminar participants has definitively been achieved. However, there were also obvious obstacles. These were primarily competing study commitments and incompatible schedules among the students attending from different academic programmes, partly even in different time zones. Both factors had negative impact on the individual and working group performances. With respect to the technical framework it can be concluded that the majority of the participants were able to use the tools either directly without any problem or after overcoming some smaller problems. Also the seminar wiki was intensively used for completing the seminar assignments. However, too less truly collaborative text production was observed which could be improved by changing the requirements for the collaborative task. Two different process models have been applied for guiding the collaboration of the small groups and both were in general successful. However, it needs to be said that even if the students were able to follow the collaborative task and to co-construct and compare case studies, most of them were not able to synthesize the knowledge they had compiled. This means that the area of consideration often remained on the level of the case and further reflections, generalisations and critique were largely missing. This shows that the seminar model needs to find better ways for triggering knowledge building and critical reflection. It was also suggested to have a more differentiated group building strategy in future seminars. A comparison of pre- and post seminar concept maps showed that an increase of factual and conceptual knowledge on the individual level was widely recognizable. Also the evaluation of the case studies (the major seminar output) revealed that the students have undergone developments of both the factual and the conceptual knowledge domain. Also their self-assessment with respect to individual learning development showed that the highest consensus was achieved in the field of subject-specific knowledge. The participants were much more doubtful with regard to the progress of generic competences such as analysis, communication and organisation. However, 50% of the participants confirmed that they perceived individual development on all competence areas the survey had asked for. Have the additional four targets been met? Concerning the competences for working in a virtual team it can be concluded that the vast majority was able to use the internet-based tools and to work with them in a target-oriented way. However, there were obvious differences regarding the intensity and activity of participation, both because of external and personal factors. A very positive aspect is the achievement of a high cultural diversity supporting the participants’ intercultural competence. Learning from group members was obviously a success factor for the working groups. Regarding the possibilities for better accessibility of educational opportunities it became clear that a significant number of participants were not able to go abroad during their studies because of financial or personal reasons. They confirmed that the online seminar was to some extent a compensation for not having been abroad for studying. Inter-institutional learning and synergy was achieved in so far that many teachers from different countries contributed with individual lectures. However, those teachers hardly ever followed more than one session. Therefore, the learning effect remained largely within the seminar learning group. Looking back at the research design it can be said that the pedagogical action research cycle was an appropriate and valuable approach allowing for strong interaction between theory and practice. However, some more external evaluation from peers in particular regarding the participants’ products would have been valuable.

Face and content validity of smoking-related and matched control pictures

Smoking-related pictures and matched controls are useful tools in experimental tasks of attentional bias. Noteworthy the procedures used to produce and validate these pairs of pictures are poorly reported. This study aimed to describe the production and evidence of validity of a set of smoking-related pictures and their matched controls. Two studies were conducted to assess validity. An online internet-based survey was used to assess face validity of 12 pictures related to smoking behavior and 12 matched controls. All pictures were colored and were 95mm length x 130mm width. Participants were asked if the pictures were related or not to the smoking behavior and also rated how much each picture was related to smoking behavior. The second study investigated attentional bias in smokers (n = 47) and non-smokers (n = 50), and examined how they assessed all pictures in terms of pleasantness and the 12 smoking-related pictures in terms of relevance to their own smoking behavior. Craving was assessed before and after the experiment. Results indicate that this set of pictures are valid since smoking-related pictures were considered more related to smoking behavior compared to their matched controls. Moreover, smokers showed greater attentional bias for smoking-related pictures than non-smokers. Craving and relevance of the smoking-related pictures were higher in smokers than in non-smokers. Smokers considered smoking-related pictures them less unpleasant than non-smokers. These findings provide evidence of face and content validity of this set of pictures, which will be available to researchers, contributing to maximize the standardization of future investigations.

¿Impactó el programa de Tutores Pares a sus tutores?

Introducción: El programa de Tutores Pares-TP es una iniciativa creada en la EMCS de la Universidad del Rosario que brinda acompañamiento académico a través de estudiantes-tutores a pares menos avanzados. Éste entrega a sus Tutores sistemáticamente, herramientas para desempeñarse armónicamente en el ejercicio de guía y provee habilidades para el manejo del saber. Este estudio busca explorar posibles ´impactos´ generados tras la participación de estudiantes de medicina como TPs dentro de un programa estructurado. Materiales y métodos: Estudio cualitativo que involucró la construcción y aplicación de encuestas a grupos focales –TPs, Docentes y Familiares- creadas a partir de seis ejes/categorías que enmarcan al médico ideal. Las respuestas obtenidas de preguntas cerradas –en escala valorativa- y de naturaleza abierta fueron sometidas a análisis descriptivo –modas- y triangulación. Resultados: 41 tutores, agrupados en 4 grupos de análisis, evidenciaron un impacto general positivo con predominio en habilidades interpersonales (60%,65%,66%,45%, respectivamente), funciones/actividades basadas en la práctica y mejoramiento (57%,67%,60%,45%) y la forma como se emplean los conocimientos (47%,70%,67%,48%). Ocho docentes encuestados consideraron relevante el impacto del programa en habilidades interpersonales-(49%), conocimientos-(42%) y la interacción con colegas-(38%). En los padres de familia hay consenso en el cambio en habilidades interpersonales, funciones basadas en la práctica y mejoramiento y en actitudes-valores ético/morales. Dichos resultados están en paralelo con las observaciones plasmadas en las preguntas abiertas. Conclusiones: Se evidenció un impacto general positivo en la formación y desempeño profesional tras la participación como TPs dentro del programa; hallazgo que soporta aquellos publicados de experiencias académicas similares.