Non-nutritive sucking scoring system for preterm newborns

Aim: To validate a non-nutritive sucking (NNS) scoring system for oral feeding in preterm newborns (PTNB). Methods: A cohort study was carried out in two phases. In phase one of the study, 22 mastered speech-language pathologists received the protocol and procedure for a NNS scoring system to evaluate the content and presentation of the form and to define the grading scale. In phase two, six speech-language pathologists evaluated 51 PTNBs weekly, using the defined scoring system. Setting: This study was carried out in the Nursery Annex to the Maternity at the Intensive and Neonatal Pediatrics Service, Instituto da Crianca, Hospital das Clinicas, School of Medicine, University of Sao Paulo (FMUSP) during the period from May 2004 to May 2006. Participants: A total of 28 speech-language pathologist experts and 51 PTNBs. Results: In the first phase of the study, 22 speech-language pathologists selected the criteria, utilized in the NNS evaluation with 80% agreement. In the second phase of the study, the NNS evaluation was carried out on 51 PTNB, and a scoring system of 50 points was proposed, which corresponds to the smallest number of false positive and negative results regarding oral feeding ability. Conclusion: An NNS evaluation system was validated that was able to indicate when oral feeding could safely begin in PTNBs with a high level of agreement among the speech-language pathologists who have participated.

The old metal-poor open cluster ESO 92-SC05: accreted from a dwarf galaxy ?

The study of old open clusters outside the solar circle can bring constraints on formation scenarios of the outer disc. In particular, accretion of dwarf galaxies has been proposed as a likely mechanism in the area. We use BVI photometry for determining fundamental parameters of the faint open cluster ESO 92-SC05. Colour-magnitude diagrams are compared with Padova isochrones, in order to derive age, reddening and distance. We derive a reddening E(B - V) = 0.17, and an old age of similar to 6.0 Gyr. It is one of the rare open clusters known to be older than 5 Gyr. A metallicity of Z similar to 0.004 or [M/H] similar to -0.7 is found. The rather low metallicity suggests that this cluster might be the result of an accretion episode of a dwarf galaxy.

Substitutional Impurities in PPV Crystals: An Intrinsic Donor-Acceptor System for High V(oc) Photovoltaic Devices

Defects are usually present in organic polymer films and are commonly invoked to explain the low efficiency obtained in organic-based optoelectronic devices. We propose that controlled insertion of substitutional impurities may, on the contrary, tune the optoelectronic properties of the underivatized organic material and, in the case studied here, maximize the efficiency of a solar cell. We investigate a specific oxygen-impurity substitution, the keto-defect -(CH(2)-C=O)- in underivatized crystalline poly(p-phenylenevinylene) (PPV), and its impact on the electronic structure of the bulk film, through a combined classical (force-field) and quantum mechanical (DFT) approach. We find defect states which suggest a spontaneous electron hole separation typical of a donor acceptor interface, optimal for photovoltaic devices. Furthermore, the inclusion of oxygen impurities does not introduce defect states in the gap and thus, contrary to standard donor-acceptor systems, should preserve the intrinsic high open circuit voltage (V(oc)) that may be extracted from PPV-based devices.

Open Issues in Control ofAutomotive R744 Air-ConditioningSystems

In this thesis, one of the current control algorithms for the R744 cycle, which tries tooptimize the performance of the system by two SISO control loops, is compared to acost-effective system with just one actuator. The operation of a key component of thissystem, a two stage orifice expansion valve is examined in a range of typical climateconditions. One alternative control loop for this system, which has been proposed byBehr group, is also scrutinized.The simulation results affirm the preference of using two control-loops instead of oneloop, but refute advantages of the Behr alternate control approach against one-loopcontrol. As far as the economic considerations of the A/C unit are concerned, usinga two-stage orifice expansion valve is desired by the automotive industry, thus basedon the experiment results, an improved logic for control of this system is proposed.In the second part, it is investigated whether the one-actuator control approach isapplicable to a system consisting of two parallel evaporators to allow passengers tocontrol different climate zones. The simulation results show that in the case of usinga two-stage orifice valve for the front evaporator and a fixed expansion valve forthe rear one, a proper distribution of the cooling power between the front and rearcompartment is possible for a broad range of climate conditions.

Real-Time Recognition System for Traffic Signs

The aim of this thesis project is to develop the Traffic Sign Recognition algorithm for real time. Inreal time environment, vehicles move at high speed on roads. For the vehicle intelligent system itbecomes essential to detect, process and recognize the traffic sign which is coming in front ofvehicle with high relative velocity, at the right time, so that the driver would be able to pro-actsimultaneously on instructions given in the Traffic Sign. The system assists drivers about trafficsigns they did not recognize before passing them. With the Traffic Sign Recognition system, thevehicle becomes aware of the traffic environment and reacts according to the situation.The objective of the project is to develop a system which can recognize the traffic signs in real time.The three target parameters are the system’s response time in real-time video streaming, the trafficsign recognition speed in still images and the recognition accuracy. The system consists of threeprocesses; the traffic sign detection, the traffic sign recognition and the traffic sign tracking. Thedetection process uses physical properties of traffic signs based on a priori knowledge to detect roadsigns. It generates the road sign image as the input to the recognition process. The recognitionprocess is implemented using the Pattern Matching algorithm. The system was first tested onstationary images where it showed on average 97% accuracy with the average processing time of0.15 seconds for traffic sign recognition. This procedure was then applied to the real time videostreaming. Finally the tracking of traffic signs was developed using Blob tracking which showed theaverage recognition accuracy to 95% in real time and improved the system’s average response timeto 0.04 seconds. This project has been implemented in C-language using the Open Computer VisionLibrary.

The concept of e-service from a social interaction perspective

Today’s e-services are complex phenomenon consisting of several different e-services linked together. The e-services are provided by IT systems and presented to customers through user interfaces. Within web design research criteria are laid out for the design of good user interfaces, but one problem is that these analyses are performed without a service focus. This lack of service focus can result in the designed user interfaces providing indistinct service concepts, especially where several e-services are intertwined with each other.In order to design IT system interfaces, we have to be clear about which e-services are provided by the IT system and how these e-services are related to each other. This paper presents a framework for the analysis of user interfaces in terms of focused e-service, service environment and two types of intertwined e-services; related e-services and interrelating e-services. The analyses are exemplified by an Internet based e-marketplace. The paper discusses how the framework can be combined with ordinary web design criteria and how it can be used for e-service development.

Combined solar and pellet heating systems for single-family houses : How to achieve decreased electricity usage, increased system efficiency and increased solar gains

In Sweden, there are about 0.5 million single-family houses that are heated by electricity alone, and rising electricity costs force the conversion to other heating sources such as heat pumps and wood pellet heating systems. Pellet heating systems for single-family houses are currently a strongly growing market. Future lack of wood fuels is possible even in Sweden, and combining wood pellet heating with solar heating will help to save the bio-fuel resources. The objectives of this thesis are to investigate how the electrically heated single-family houses can be converted to pellet and solar heating systems, and how the annual efficiency and solar gains can be increased in such systems. The possible reduction of CO-emissions by combining pellet heating with solar heating has also been investigated. Systems with pellet stoves (both with and without a water jacket), pellet boilers and solar heating have been simulated. Different system concepts have been compared in order to investigate the most promising solutions. Modifications in system design and control strategies have been carried out in order to increase the system efficiency and the solar gains. Possibilities for increasing the solar gains have been limited to investigation of DHW-units for hot water production and the use of hot water for heating of dishwashers and washing machines via a heat exchanger instead of electricity (heat-fed appliances). Computer models of pellet stoves, boilers, DHW-units and heat-fed appliances have been developed and the parameters for the models have been identified from measurements on real components. The conformity between the models and the measurements has been checked. The systems with wood pellet stoves have been simulated in three different multi-zone buildings, simulated in detail with heat distribution through door openings between the zones. For the other simulations, either a single-zone house model or a load file has been used. Simulations were carried out for Stockholm, Sweden, but for the simulations with heat-fed machines also for Miami, USA. The foremost result of this thesis is the increased understanding of the dynamic operation of combined pellet and solar heating systems for single-family houses. The results show that electricity savings and annual system efficiency is strongly affected by the system design and the control strategy. Large reductions in pellet consumption are possible by combining pellet boilers with solar heating (a reduction larger than the solar gains if the system is properly designed). In addition, large reductions in carbon monoxide emissions are possible. To achieve these reductions it is required that the hot water production and the connection of the radiator circuit is moved to a well insulated, solar heated buffer store so that the boiler can be turned off during the periods when the solar collectors cover the heating demand. The amount of electricity replaced using systems with pellet stoves is very dependant on the house plan, the system design, if internal doors are open or closed and the comfort requirements. Proper system design and control strategies are crucial to obtain high electricity savings and high comfort with pellet stove systems. The investigated technologies for increasing the solar gains (DHW-units and heat-fed appliances) significantly increase the solar gains, but for the heat-fed appliances the market introduction is difficult due to the limited financial savings and the need for a new heat distribution system. The applications closest to market introduction could be for communal laundries and for use in sunny climates where the dominating part of the heat can be covered by solar heating. The DHW-unit is economical but competes with the internal finned-tube heat exchanger which is the totally dominating technology for hot water preparation in solar combisystems for single-family houses.

Improving continence services for older people from the service-providers’ perspective : a qualitative interview study

Objective: To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI). Design: Qualitative semistructured interviews using a purposive sample recruited across 16 continence services. Setting: 3 acute and 13 primary care National Health Service Trusts in England. Participants: 16 continence service leads in England actively treating and managing older people with UI. Results: In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and highquality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work. Conclusions: Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service facilitators.

Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings

Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.

Healthcare providers balancing norms and practice : challenges and opportunities in providing contraceptive counselling to young people in Uganda - a qualitative study

BACKGROUND: Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among young women. OBJECTIVE: This study aims to explore healthcare providers' (HCPs) perceptions and practices regarding contraceptive counselling to young people. DESIGN: We conducted 27 in-depth interviews with doctors and midwives working in seven health facilities in central Uganda. Interviews were open-ended and allowed the participant to speak freely on certain topics. We used a topic guide to cover areas topics of interest focusing on post-abortion care (PAC) but also covering contraceptive counselling. Transcripts were transcribed verbatim and data were analysed using thematic analysis. RESULTS: The main theme, HCPs' ambivalence to providing contraceptive counselling to sexually active young people is based on two sub-themes describing the challenges of contraceptive counselling: A) HCPs echo the societal norms regarding sexual practice among young people, while at the same time our findings B) highlights the opportunities resulting from providers pragmatic approach to contraceptive counselling to young women. Providers expressed a self-identified lack of skill, limited resources, and inadequate support from the health system to successfully provide appropriate services to young people. They felt frustrated with the consultations, especially when meeting young women seeking PAC. CONCLUSIONS: Despite existing policies for young people's sexual and reproductive health in Uganda, HCPs are not sufficiently equipped to provide adequate contraceptive counselling to young people. Instead, HCPs are left in between the negative influence of social norms and their pragmatic approach to address the needs of young people, especially those seeking PAC. We argue that a clear policy supported by a clear strategy with practical guidelines should be implemented alongside in-service training including value clarification and attitude transformation to equip providers to be able to better cater to young people seeking sexual and reproductive health advice.

Semantic and Personalised Service Discovery

One of the most pervasive classes of services needed to support e-Science applications are those responsible for the discovery of resources. We have developed a solution to the problem of service discovery in a Semantic Web/Grid setting. We do this in the context of bioinformatics, which is the use of computational and mathematical techniques to store, manage, and analyse the data from molecular biology in order to answer questions about biological phenomena. Our specific application is myGrid (www.mygrid.org.uk) that is developing open source, service-based middleware upon which bioinformatics applications can be built. myGrid is specifically targeted at developing open source high-level service Grid middleware for bioinformatics.

Semantic and Personalised Service Discovery

One of the most pervasive classes of services needed to support e-Science applications are those responsible for the discovery of resources. We have developed a solution to the problem of service discovery in a Semantic Web/Grid setting. We do this in the context of bioinformatics, which is the use of computational and mathematical techniques to store, manage, and analyse the data from molecular biology in order to answer questions about biological phenomena. Our specific application is myGrid (http: //www.mygrid.org.uk) that is developing open source, service-based middleware upon which bioin- formatics applications can be built. myGrid is specif- ically targeted at developing open source high-level service Grid middleware for bioinformatics.

Towards a Methodology for Coordination Mechanism Selection in Open Systems

Agent-oriented software engineering (AOSE) is a promising approach to developing applications for dynamic open systems. If well developed, these applications can be opportunistic, taking advantage of services implemented by other developers at appropriate times. However, methodologies are needed to aid the development of systems that are both flexible enough to be opportunistic and tightly defined by the application requirements. In this paper, we investigate how developers can choose the coordination mechanisms of agents so that the agents will best fulfil application requirements in an open system.

Towards a Protocol for the Attachment of Metadata to Service Descriptions and its Use in Semantic Discovery

Service discovery in large scale, open distributed systems is difficult because of the need to filter out services suitable to the task at hand from a potentially huge pool of possibilities. Semantic descriptions have been advocated as the key to expressive service discovery, but the most commonly used service descriptions and registry protocols do not support such descriptions in a general manner. In this paper, we present a protocol, its implementation and an API for registering semantic service descriptions and other task/user-specific metadata, and for discovering services according to these. Our approach is based on a mechanism for attaching structured and unstructured metadata, which we show to be applicable to multiple registry technologies. The result is an extremely flexible service registry that can be the basis of a sophisticated semantically-enhanced service discovery engine, an essential component of a Semantic Grid.