Electroencephalographic Activity in Response to Procedural Pain in Preterm Infants Born at 28 and 33 Weeks Gestational Age

OBJECTIVES:: Preterm infants undergo frequent painful procedures in the neonatal intensive care unit. Electroencephalography (EEG) changes in reaction to invasive procedures have been reported in preterm and full-term neonates. Frontal EEG asymmetry as an index of emotion during tactile stimulation shows inconsistent findings in full-term infants, and has not been examined in the context of pain in preterm infants. Our aim was to examine whether heel lance for blood collection induces changes in right-left frontal asymmetry, suggesting negative emotional response, in preterm neonates at different gestational age (GA) at birth and different duration of stay in the neonatal intensive care unit. MATERIALS AND METHODS:: Three groups of preterm infants were compared: set 1: group 1 (n=24), born and tested at 28 weeks GA; group 2 (n=22), born at 28 weeks GA and tested at 33 weeks; set 2: group 3 (n=25), born and tested at 33 weeks GA. EEG power was calculated for 30-second artifact-free periods, in standard frequency bandwidths, in 3 phases (baseline, up to 5 min after heel lance, 10 min after heel lance). RESULTS:: No significant differences were found in right-left frontal asymmetry, or in ipsilateral or contralateral somatosensory response, across phases. In contrast, the Behavioral Indicators of Infant Pain scores changed across phase (P

Cortisol levels in relation to maternal interaction and child internalizing behavior in preterm and full-term children at 18 months corrected age

Cortisol levels were compared in children born preterm at extremely low gestational age (ELGA; 24-28 weeks), very low gestational age (VGLA; 29-32 weeks), and full-term in response to cognitive assessment at 18 months corrected age (CA). Further, we investigated the relationship between maternal interactive behaviors and child internalizing behaviors (rated by the mother) in relation to child cortisol levels. EGLA children had higher "pretest" cortisol levels and a different pattern of cortisol response to cognitive assessment compared to VGLA and full-terms. Higher cortisol levels in ELGA, but not full-term, children were associated with less optimal mother interactive behavior. Moreover, the pattern of cortisol change was related to internalizing behaviors among ELGA, and to a lesser degree VLGA children. In conclusion, our findings suggest altered programming of the hypothalamic-pituitary-adrenal (HPA) axis in preterm children, as well as their greater sensitivity to environmental context such as maternal interactive behavior.

Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18 months in preterm infants

Procedural pain in the neonatal intensive care unit triggers a cascade of physiological, behavioral and hormonal disruptions which may contribute to altered neurodevelopment in infants born very preterm, who undergo prolonged hospitalization at a time of physiological immaturity and rapid brain development. The aim of this study was to examine relationships between cumulative procedural pain (number of skin-breaking procedures from birth to term, adjusted for early illness severity and overall intravenous morphine exposure), and later cognitive, motor abilities and behavior in very preterm infants at 8 and 18 months corrected chronological age (CCA), and further, to evaluate the extent to which parenting factors modulate these relationships over time. Participants were N=211 infants (n=137 born preterm 32 weeks gestational age [GA] and n=74 full-term controls) followed prospectively since birth. Infants with significant neonatal brain injury (periventricular leucomalacia, grade 3 or 4 intraventricular hemorrhage) and/or major sensori-neural impairments, were excluded. Poorer cognition and motor function were associated with higher number of skin-breaking procedures, independent of early illness severity, overall intravenous morphine, and exposure to postnatal steroids. The number of skin-breaking procedures as a marker of neonatal pain was closely related to days on mechanical ventilation. In general, greater overall exposure to intravenous morphine was associated with poorer motor development at 8 months, but not at 18 months CCA, however, specific protocols for morphine administration were not evaluated. Lower parenting stress modulated effects of neonatal pain, only on cognitive outcome at 18 months.

Magnetoencephalography study of brain dynamics in young children born extremely preterm

Magnetoencephalography (MEG) was recorded while 5-7 year-old children were performing a visual-spatial memory recognition task. Full-term children showed greater gamma-band (30-50 Hz) amplitude in the right temporal region during the task, than children who were born extremely preterm. These results may represent altered brain processing in extremely preterm children who escape major impairment.

Neonatal Pain-Related Stress and NFKBIA Genotype Are Associated with Altered Cortisol Levels in Preterm Boys at School Age

Neonatal pain-related stress is associated with elevated salivary cortisol levels to age 18 months in children born very preterm, compared to full-term, suggesting early programming effects. Importantly, interactions between immune/inflammatory and neuroendocrine systems may underlie programming effects. We examined whether cortisol changes persist to school age, and if common genetic variants in the promoter region of the NFKBIA gene involved in regulation of immune and inflammatory responses, modify the association between early experience and later life stress as indexed by hair cortisol levels, which provide an integrated index of endogenous HPA axis activity. Cortisol was assayed in hair samples from 128 children (83 born preterm =32 weeks gestation and 45 born full-term) without major sensory, motor or cognitive impairments at age 7 years. We found that hair cortisol levels were lower in preterm compared to term-born children. Downregulation of the HPA axis in preterm children without major impairment, seen years after neonatal stress terminated, suggests persistent alteration of stress system programming. Importantly, the etiology was gender-specific such that in preterm boys but not girls, specifically those with the minor allele for NFKBIA rs2233409, lower hair cortisol was associated with greater neonatal pain (number of skin-breaking procedures from birth to term), independent of medical confounders. Moreover, the minor allele (CT or TT) of NFKBIA rs2233409 was associated with higher secretion of inflammatory cytokines, supporting the hypothesis that neonatal pain-related stress may act as a proinflammatory stimulus that induces long-term immune cell activation. These findings are the first evidence that a long-term association between early pain-related stress and cortisol may be mediated by a genetic variants that regulate the activity of NF-?B, suggesting possible involvement of stress/inflammatory mechanisms in HPA programming in boys born very preterm. © 2013 Grunau et al.

Integrated care pathways for airway diseases (AIRWAYS-ICPs)

The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will add value to existing public health knowledge by: 1) proposing a common framework of care pathways for chronic respiratory diseases, which will facilitate comparability and trans-national initiatives; 2) informing cost-effective policy development, strengthening in particular those on smoking and environmental exposure; 3) aiding risk stratification in chronic disease patients, using a common strategy; 4) having a significant impact on the health of citizens in the short term (reduction of morbidity, improvement of education in children and of work in adults) and in the long-term (healthy ageing); 5) proposing a common simulation tool to assist physicians; and 6) ultimately reducing the healthcare burden (emergency visits, avoidable hospitalisations, disability and costs) while improving quality of life. In the longer term, the incidence of disease may be reduced by innovative prevention strategies. AIRWAYSICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing. All stakeholders are involved (health and social care, patients, and policy makers).

Stress in parents of children born very preterm is predicted by child externalising behaviour and parent coping at age 7 years

Objective: To examine factors which predict parenting stress in a longitudinal cohort of children born very preterm seen at age seven years.
Methods: We recruited 100 very preterm (< 32 weeks GA) child-parent dyads and a control group of 50 term-born dyads born between 2001 and 2004 with follow-up at seven years. Parents completed the Parenting Stress Index, Ways of Coping Questionnaire, Child Behavior Check List, Beck Depression Inventory and the State Trait Anxiety Inventory questionnaires. Child IQ was assessed using the Wechsler Intelligence Scale-IV.
Results: After controlling for maternal education, parents of preterm children (95% CI, 111.1 to 121.4) scored higher (p = .027) on the Parenting Stress Index than term born controls (95% CI, 97.8 to 113.2). Regression analyses showed that child externalising behaviour, sex and parent escape/avoidance coping style, predicted higher parenting stress in the preterm group. Parents of preterm girls expressed higher levels of stress than those of boys. 
Conclusions: Maladaptive coping strategies contribute to greater stress in parents of very preterm children. Our findings suggest that these parents need support for many years after birth of a very preterm infant.

Cidade Museu

Through the concept of sonic resonance, the project Cidade Museu – Museum City explores five derelict or transitional spaces in the city of Viseu. The activation and capture of these spaces develops an audio- visual memory that reflects architectures, stories and experiences, while creating a sense of place through sounds and images.

The project brings together musicians with a background in contemporary music, electroacoustic music and improvisation and a visual artist focusing on photography and video.

Each member of the collective explores the selected spaces in order to activate them with the help of their respective instruments and through sound projection in an iterative process in which the source of activation gradually gives way to the characteristics of each space, their resonances and acoustic characteristics. The museum city (a nickname for the city of Viseu), in this performance, exposes the contrast between the grandeur and multi-faceted architecture of Viseu’s Cathedral with spaces that spread throughout the city waiting for a new future.

The performance in the Cathedral (Sé) is characterised by a trio ensemble, an eight channel sound system and video projecting audio recordings and images made in each of the five spaces. The audience is invited to explore the relations between the various buildings and their stories while being immersed in their resonances and visual projections.

The performance explores the following spaces in Viseu: the old Orfeão (music hall), an old wine cellar, a mansion home to the national road services, a house with its grounds in Rua Silva Gaio and an old slaughterhouse.

Museum City - Improvisation and the narratives of space

This paper provides four viewpoints on the narratives of space, allowing us to think about possible relations between sites and sounds, reflecting on how places might tell stories, or how practitioners embed themselves in a place in order to shape cultural, social and/or political narratives through the use of sound. I propose four viewpoints that investigate the relationship between sites and sounds, where narratives are shaped and made through the exploration of specific sonic activities. These are:
- sonic activism
- sonic preservation
- sonic participatory action
- sonic narrative of space

I examine each of these ideas in turn before focusing in more detail on the final viewpoint, which provides the context for discussing and analysing a recent site-specific music improvisation project, entitled ‘Museum City’, a work that aligns closely with my proposal for a ‘sonic narrative of space’.
The work ‘Museum City’ by Pedro Rebelo, Franziska Schroeder, Ricardo Jacinto and André Cepeda specifically enables me to reflect on how derelict and/or transitional spaces might be re-examined through the use of sound, particularly through means of live music improvisation. The spaces examined as part ‘Museum City’ constitute either deserted sites or sites about to undergo changes in their architectural layout, their use and sonic make-up. The practice in ‘Museum City’ was born out of a performative engagement with[in] those sites, but specifically out of an intimate listening relationship by three improvisers situated within those spaces.
The theoretical grounding for this paper is situated within a wider context of practising and cognising musical spatiality, as proposed by Georgina Born (2013), particularly her proposition for three distinct lineages that provide an understanding of space in/and music. Born’s third lineage, which links more closely with practices of sound art and challenges a Euclidean orientation of pitch and timbre space, makes way for a heightened consideration of listening and ‘the place’ of sound. This lineage is particularly crucial for my discussion, since it positions music in relation to social experiences and the everyday, which the work ‘Museum City’ endeavoured to embrace.

O artista pelo artista na voz do próprio

Este doutoramento em Estudos de Arte centra-se no artista plástico, em Portugal, hoje. De acordo com o seu carácter projectual, estrutura-se em dois vectores distintos, ainda que relacionados entre si e devedores um do outro: -Um corpo prático, assente na prática artística de atelier e dando continuidade ao percurso artístico autoral próprio (conducente à série de imagens fotográficas “Prática Artística Enquanto Ferramenta de Higiene Pessoal”); -Um eixo reflexivo, construído a partir da análise qualitativa do conteúdo de um conjunto de entrevistas presenciais realizadas a artistas plásticos portugueses (conducente ao manifesto artístico “O Artista pelo Artista”). Neste sentido, este estudo vai ao encontro de vinte e seis artistas plásticos contemporâneos portugueses reunidos numa amostra seleccionada pelo crítico de arte Miguel von Hafe Pérez. A saber: Alberto Carneiro, André Cepeda, André Gonçalves, Ângela Ferreira, António Olaio, Carla Cruz, Carla Filipe, Cristina Mateus, Daniel Blaufuks, Eduardo Batarda, Fernando José Pereira, Francisco Queirós, Gerardo Burmester, Joana Vasconcelos, João Pedro Vale, João Tabarra, José de Guimarães, Mafalda Santos, Marta de Menezes, Miguel Leal, Miguel Palma, Paulo Mendes, Pedro Calapez, Pedro Proença, Rui Chafes e Zulmiro de Carvalho. O documento que reúne o conjunto das entrevistas realizadas, anexo a esta investigação, distancia-se do discurso utilizado nas retóricas das narrativas históricas, teóricas ou críticas. Aqui, procuram-se as palavras dos criadores, sem mais. Decorrente do percurso metodológico que orientou a análise qualitativa do conteúdo, este estudo propõe o manifesto artístico "O Artista pelo Artista" enquanto resultado do exercício de investigação. Ainda, este trabalho apresenta a série de imagens fotográficas “Prática Artística Enquanto Ferramenta de Higiene Pessoal” como projecto-tese centrado no movimento que guiou todo o processo investigativo: da reflexão sobre o outro (e sobre as suas palavras) para a reflexão sobre o próprio (e sobre a sua intimidade). Através das vinte e seis entrevistas, do manifesto “O Artista pelo Artista” e da série de imagens “Prática Artística Enquanto Ferramenta de Higiene Pessoal”, esta investigação devolve a palavra aos próprios artistas, a todos os outros operadores da esfera artística e ao público interessado em conhecer o criador apresentado por si próprio, sem mediadores, num acto sincero, franco e generoso.

Análise da viabilidade da utilização de colectores solares

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia Mecância

Uma só palavra: experiência de narrativa dramática: trabalho de projecto

Trabalho de Projecto submetido à Escola Superior de Teatro e Cinema para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Teatro - especialização em Artes Performativas (Escritas de Cena).