Improving the care of preterm infants: before, during, and after, stabilisation in the delivery room

Introduction Up to 10% of infants require stabilisation during transition to extrauterine life. Enhanced monitoring of cardiorespiratory parameters during this time may improve stabilisation outcomes. In addition, technology may facilitate improved preparation for delivery room stabilisation as well as NICU procedures, through educational techniques. Aim To improve infant care 1) before birth via improved training, 2) during stabilisation via enhanced physiological monitoring and improved practice, and 3) after delivery, in the neonatal intensive care unit (NICU), via improved procedural care. Methods A multifaceted approach was utilised including; a combination of questionnaire based surveys, mannequin-based investigations, prospective observational investigations, and a randomised controlled trial involving preterm infants less than 32 weeks in the delivery room. Forms of technology utilised included; different types of mannequins including a CO2 producing mannequin, qualitative end tidal CO2 (EtCO2) detectors, a bespoke quantitative EtCO2 detector, and annotated videos of infant stabilisation as well as NICU procedures Results Manual ventilation improved with the use of EtCO2 detection, and was positively assessed by trainees. Quantitative EtCO2 detection in the delivery room is feasible, EtCO2 increased over the first 4 minutes of life in preterm infants, and EtCO2 was higher in preterm infants who were intubated. Current methods of heart rate assessment were found to be unreliable. Electrocardiography (ECG) application warrants further evaluation. Perfusion index (PI) monitoring utilised in the delivery room was feasible. Video recording technology was utilised in several ways. This technology has many potential benefits, including debriefing and coaching in procedural healthcare, and warrants further evaluation. Parents would welcome the introduction of webcams in the NICU. Conclusions I have evaluated new methods of improving infant care before, during, and after stabilisation in the DR. Specifically, I have developed novel educational tools to facilitate training, and evaluated EtCO2, PI, and ECG during infant stabilisation. I have identified barriers in using webcams in the NICU, to now be addressed prior to webcam implementation.

A hybrid technology for parallel recording of single ion channels

Hybrid technologies, thanks to the convergence of integrated microelectronic devices and new class of microfluidic structures could open new perspectives to the way how nanoscale events are discovered, monitored and controlled. The key point of this thesis is to evaluate the impact of such an approach into applications of ion-channel High Throughput Screening (HTS)platforms. This approach offers promising opportunities for the development of new classes of sensitive, reliable and cheap sensors. There are numerous advantages of embedding microelectronic readout structures strictly coupled to sensing elements. On the one hand the signal-to-noise-ratio is increased as a result of scaling. On the other, the readout miniaturization allows organization of sensors into arrays, increasing the capability of the platform in terms of number of acquired data, as required in the HTS approach, to improve sensing accuracy and reliabiity. However, accurate interface design is required to establish efficient communication between ionic-based and electronic-based signals. The work made in this thesis will show a first example of a complete parallel readout system with single ion channel resolution, using a compact and scalable hybrid architecture suitable to be interfaced to large array of sensors, ensuring simultaneous signal recording and smart control of the signal-to-noise ratio and bandwidth trade off. More specifically, an array of microfluidic polymer structures, hosting artificial lipid bilayers blocks where single ion channel pores are embededed, is coupled with an array of ultra-low noise current amplifiers for signal amplification and data processing. As demonstrating working example, the platform was used to acquire ultra small currents derived by single non-covalent molecular binding between alpha-hemolysin pores and beta-cyclodextrin molecules in artificial lipid membranes.

Real-time recording of circadian liver gene expression in freely moving mice reveals the phase-setting behavior of hepatocyte clocks.

The mammalian circadian timing system consists of a master pacemaker in the suprachiasmatic nucleus (SCN) in the hypothalamus, which is thought to set the phase of slave oscillators in virtually all body cells. However, due to the lack of appropriate in vivo recording technologies, it has been difficult to study how the SCN synchronizes oscillators in peripheral tissues. Here we describe the real-time recording of bioluminescence emitted by hepatocytes expressing circadian luciferase reporter genes in freely moving mice. The technology employs a device dubbed RT-Biolumicorder, which consists of a cylindrical cage with reflecting conical walls that channel photons toward a photomultiplier tube. The monitoring of circadian liver gene expression revealed that hepatocyte oscillators of SCN-lesioned mice synchronized more rapidly to feeding cycles than hepatocyte clocks of intact mice. Hence, the SCN uses signaling pathways that counteract those of feeding rhythms when their phase is in conflict with its own phase.

A practice perspective on organizational implementation of information technology

Implementering av ett informationssystem ur en organisatorisk synvinkel initieras av en idé om ett system och avslutas då användningen av det inte längre kräver en medveten ansträngning. Ifall tolkningen av implementering är denna, är det fråga om en långsam och komplicerad process, som berör organisationens alla parter. Ny informationsteknologi anses påverka flertalet arbetsprocesser och organiseringen av det dagliga arbetet. Möjligheterna att ta i bruk systemet och utnyttja det är många. I avhandlingen undersöks implementering av ett system för att administrera hemvårdsbesök där hemvårdare använde handdatorer för att registrera information om besökens längd och innehåll. I avhandlingen observeras vilka förändringar som sker i arbetets praxis p.g.a. det nya systemet och hur dessa förändringar påverkar vårdarbetet. Forskningen inleds med att strukturera teorier om arbetspraxis för kommande analys. Arbetspraxis är inarbetade och rutinmässiga arbetssätt i arbetets sociomateriella omgivning. Arbetspraxis i avhandlingen innebär hemvårdarens praxis och upplevd erfarenhet, där verksamheten informeras av gemensamma arbetssätt, projekt, identiteter och intressen. Organisationens auktoritet kommer även fram i den förverkligade arbetspraxisen. Forskningen genomfördes som en etnografisk longitudinell studie under åren 2001-2004. I studien observerades hur nyttjandet av handdatorerna framskred ur ett organisatoriskt perspektiv. Hemvårdares arbete och verksamhet (arbetspraxis) observerades både under vårdsbesök och under pauser. Därtill intervjuades hemvårdarna för att erhålla en bättre förståelse för de rationaliteter som styr arbetet och hur systemet togs i bruk. Dokument relaterade till projektet att införa ett nytt system och administrativa dokument har utnyttjats som källmaterial. Analysen av källmaterialet styrdes av det teoretiska tillvägagångssättet att undersöka arbetspraxis. Problem som identifierades i samband med införandet av systemet och de förändringar som det medförde analyserades i detalj. Parallellt analyserades organisatorisk makt, kontroll och arbetsidentitet. Undersökningen beskriver hur det nya systemet gradvis anpassades till hemvården efter ett initialt motstånd. Under själva implementering av systemet ifrågasattes tidigare arbetspraxis och inställningen till den eftersom arbetspraxisens materiella omgivning förändrades. Det teoretiska tillvägagångssättet i att undersöka arbetspraxis framhäver vårdarens agerande i förändringsprocessen. Resultatet av forskningen visar vikten av realistiska målsättningar, givande av gruppstöd med återkoppling samt förmåga att anpassa sig till det oväntade vid införande av informationssystem.

The Discourse of Home Recording : Accessibility, Exclusion and Power

Ce mémoire propose une analyse critique du discours de l’enregistrement sonore à domicile (home recording). Dans la foulée des propos mettant de l’avant l’ «accessibilité» et la «démocratisation» de l’enregistrement sonore, ce mémoire analyse les relations de savoir/pouvoir produites et légitimées par le discours, ce qu’elles permettent et contraignent, autorisent et excluent. Le corpus à l’étude est issu de la presse musicale ainsi que de forums de discussion en ligne relevant de sites spécialisés. Les méthodes utilisées sont inspirées de l’approche du discours développées par Michel Foucault et de ce que Johnson et. al. (2004) appellent l’interprétation critique. L’analyse met en évidence les deux principaux sujets du discours de l’enregistrement sonore à la maison : les professionnels de l’enregistrement et les «pros» de l’enregistrement à domicile, deux groupes constitués d’hommes financièrement aisés. Les règles qui régissent l’enregistrement à domicile semblent reprendre, en les adaptant, celles régissant les studios professionnels. Ce mémoire suggère que la «démocratisation» telle qu'énoncée dans ce discours articule l'«accessibilité contemporaine» à certains savoirs et certaines technologies à des exclusions singulières – comme des femmes et des personnes de moyens limités – qui rendent ce discours possible. Être dans le vrai, dans ce discours, c’est échanger, argumenter, discuter et prescrire des façons de faire et de dire qui font des studios professionnels l’espace des normes et des légitimités. Mots clés: enregistrement, musique, maison, domicile, studio, démocratisation, technologie, l'analyse du discours, relations de pouvoir/savoir, Michel Foucault.

Methylene Blue Doped Polymers: efficient Media for Optical Recording

Polymer materials find application in optical storage technology, namely in the development of high information density and fast access type memories. A new polymer blend of methylene blue sensitized polyvinyl alcohol (PVA) and polyacrylic acid (PAA) in methanol is prepared and characterized and its comparison with methylene blue sensitized PVA in methanol and complexed methylene blue sensitized polyvinyl chloride (CMBPVC) is presented. The optical absorption spectra of the thin films of these polymers showed a strong and broad absorption region at 670-650 nm, matching the wavelength of the laser used. A very slow recovery of the dye on irradiation was observed when a 7:3 blend of polyvinyl alcohol/polyacrylic acid at a pHof 3.8 and a sensitizer concentration of 4.67 10 5 g/ml were used. A diffraction efficiency of up to 20% was observed for the MBPVA/alcohol system and an energetic sensitivity of 2000 mJ/cm2 was obtained in the photosensitive films with a spatial frequency of 588 lines/mm.

Methylene Blue Doped Polymers:Efficient Media for Optical Recording

Polymer materials find application in optical storage technology, namely in the development of high information density and fast access type memories. A new polymer blend of methylene blue sensitized polyvinyl alcohol (PVA) and polyacrylic acid (PAA) in methanol is prepared and characterized and its comparison with methylene blue sensitized PVA in methanol and complexed methylene blue sensitized polyvinyl chloride (CMBPVC) is presented. The optical absorption spectra of the thin films of these polymers showed a strong and broad absorption region at 670-650 nm, matching the wavelength of the laser used. A very slow recovery of the dye on irradiation was observed when a 7:3 blend of polyvinyl alcohol/polyacrylic acid at a pHof 3.8 and a sensitizer concentration of 4.67 10 5 g/ml were used. A diffraction efficiency of up to 20% was observed for the MBPVA/alcohol system and an energetic sensitivity of 2000 mJ/cm2 was obtained in the photosensitive films with a spatial frequency of 588 lines/mm.

Studies on Photosensitive polymers for Optical Recording

Department of Polymer Science and Rubber Technology,Cochin University of Science and Technology

Recording multiple holographic gratings in silver-doped photopolymer using peristrophic multiplexing

Plane-wave transmission gratings were stored in the same location of silver- doped photopolymer ¯lm using peristrophic multiplexing techniques. Constant and vari- able exposure scheduling methods were adopted for storing gratings in the ¯lm using He{Ne laser (632.8 nm). The role of recording geometry on the dynamic range of the ma- terial was studied by comparing the results obtained from both techniques. Peristrophic multiplexing with rotation of the ¯lm in a plane normal to the bisector of the incident beams resulted in better homogenization of di®raction e±ciencies and larger M/# value.

A new inexpensive method for the preparation of acicular precursors for magnetic recording media

Magnetic materials meant for audio/video recording applications necessitate that polycrystalline materials be in acicular shape. So preparation of acicular precursors for magnetic storage materials assumes significance. The employment of aqueous solutions do not produce needle shape crystallites. Glycerol is one of the complexing media used for the precipitation of ferrous oxalate dihydrate. An inexpensive method using starch for preparation of acicular particles is described. The influence of an additive namely Gd on acicularity is also investigated

Silver-doped photopolymer media for holographic recording

Incorporation of silver ions into a dye-sensitized poly(vinyl alcohol)/acrylamide photopolymer is observed to give better performance compared to other metal-ion-doped photopolymer holographic recording media. Plane-wave transmission gratings were recorded in the photopolymer films using a He–Ne laser, and various holographic parameters were optimized so as to explore maximum potential of the material for various holographic applications. Silver-doped films showed good energy sensitivity, and gratings recorded in optimized film exhibited a diffraction efficiency of more than 75%. The potential of the material for holographic data storage applications is also studied using peristrophic multiplexing

iTrench: a study of user reactions to the use of information technology in field archaeology

This article describes work undertaken by the VERA project to investigate how archaeologists work with information technology (IT) on excavation sites. We used a diary study to research the usual patterns of behaviour of archaeologists digging the Silchester Roman town site during the summer of 2007. Although recording had previously been undertaken using pen and paper, during the 2007 season a part of the dig was dedicated to trials of IT and archaeologists used digital pens and paper and Nokia N800 handheld PDAs to record their work. The goal of the trial was to see whether it was possible to record data from the dig whilst still on site, rather than waiting until after the excavation to enter it into the Integrated Archaeological Database (IADB) and to determine whether the archaeologists found the new technology helpful. The digital pens were a success, however, the N800s were not successful given the extreme conditions on site. Our findings confirmed that it was important that technology should fit in well with the work being undertaken rather than being used for its own sake, and should respect established work flows. We also found that the quality of data being entered was a recurrent concern as was the reliability of the infrastructure and equipment.

Advances in upper limb stroke rehabilitation: a technology push

Strokes affect thousands of people worldwide leaving sufferers with severe disabilities affecting their daily activities. In recent years, new rehabilitation techniques have emerged such as constraint-induced therapy, biofeedback therapy and robot-aided therapy. In particular, robotic techniques allow precise recording of movements and application of forces to the affected limb, making it a valuable tool for motor rehabilitation. In addition, robot-aided therapy can utilise visual cues conveyed on a computer screen to convert repetitive movement practice into an engaging task such as a game. Visual cues can also be used to control the information sent to the patient about exercise performance and to potentially address psychosomatic variables influencing therapy. This paper overviews the current state-of-the-art on upper limb robot-mediated therapy with a focal point on the technical requirements of robotic therapy devices leading to the development of upper limb rehabilitation techniques that facilitate reach-to-touch, fine motor control, whole-arm movements and promote rehabilitation beyond hospital stay. The reviewed literature suggest that while there is evidence supporting the use of this technology to reduce functional impairment, besides the technological push, the challenge ahead lies on provision of effective assessment of outcome and modalities that have a stronger impact transferring functional gains into functional independence.

Compliant Multi-electrode Micro-channel Array for Recording Afferent Nerve Activity

We have fabricated a compliant neural interface to record afferent nerve activity. Stretchable gold electrodes were evaporated on a polydimethylsiloxane (PDMS) substrate and were encapsulated using photo-patternable PDMS. The built-in microstructure of the gold film on PDMS allows the electrodes to twist and flex repeatedly, without loss of electrical conductivity. PDMS microchannels (5mm long, 100μm wide, 100μm deep) were then plasma bonded irreversibly on top of the electrode array to define five parallel-conduit implants. The soft gold microelectrodes have a low impedance of ~200kΩ at the 1kHz frequency range. Teased nerves from the L6 dorsal root of an anaesthetized Sprague Dawley rat were threaded through the microchannels. Acute tripolar recordings of cutaneous activity are demonstrated, from multiple nerve rootlets simultaneously. Confinement of the axons within narrow microchannels allows for reliable recordings of low amplitude afferents. This electrode technology promises exciting applications in neuroprosthetic devices including bladder fullness monitors and peripheral nervous system implants.