Changing rooms in NICU : a comparative descriptive study of parental perceptions of the physical environment of neonatal intensive care units : a thesis presented in partial fulfilment of the requirements for the degree in Master of Philosophy in Nursing at Massey University

The physical environment of a neonatal intensive care unit (NICU) is unique and can be challenging and stressful for families. As infant survival rates and technology improved, many NICUs became 'busy', overcrowded, noisy environments. New directions in the design of newborn nurseries highlight the potential for the physical environment to support parental needs and optimise the parenting experience. In October 2004 the NICU at National Women's Hospital (NWH) in Auckland (New Zealand), relocated to a new facility at Auckland City Hospital (ACH). A key principle in the design of the new NICU was improvement of family space at the cot side. This non-experimental study sought to describe and compare parental perceptions of the physical environment of a traditional NICU configuration with a new custom built NICU. A sample of parents with infants hospitalised in NICU from NWH (n = 30) and a different group of parents from ACH (n = 30) completed a self report Likert-type questionnaire (with a scale from 1 = strongly disagree to 7 = strongly agree). Qualitative data was sought using open ended questions. Significant differences were found between the old NWH NICU and the newly designed ACH NICU. Parents perception of the space at the cot-side was more adequate (p = 0.001), lighting levels more comfortable (p = 0.002), the cot-side was quieter (p = 0.02) and technology less intrusive (p = 0.03) at ACH NICU when compared to NWH NICU. Impact of these design changes on privacy, sense of belonging, and socialisation of parents did not show significant differences. Lack of cot-side space for NWH parents was the predominate theme from the open-ended questions. Parents viewed the family space and aesthetics of the new ACH rooms positively. Providers of newborn services contemplating redesign need to consider that increasing cot side space and decreasing infant numbers in clinical rooms can significantly improve a parent's view of NICU and therefore provide an environment that is supportive to parent's needs

The EU and Civil Society in the Georgian-Abkhaz Conflict

This paper deals with the role of the EU in supporting civil society in the case of the Georgian-Abkhaz conflict. It analyses the patterns of development of civil society actors that played a direct or indirect role in the development of the Georgian-Abkhaz conflict. In the case of Georgia the paper focuses on NGOs representing the interests of internally displaced persons and civil society players involved in promoting dialogue with the Abkhaz. In the case of Abkhazia, the paper focuses on the development of Abkhaz civil society, the relative strength of which is a mini-phenomenon in itself, as well as the Abkhaz approaches to dialogue with Georgia. The paper then outlines the main EU activities vis-à-vis the civil society actors on both sides of the conflict. The paper concludes that in the absence of strong EU political engagement in conflict-resolution, EU assistance to civil society could not prevent the re-escalation of the conflict and the radicalisation of the Abkhaz and Georgian societies. However EU assistance to civil society contributed to the (parallel and separate) strengthening of civil society on both sides of the conflict lines, which can be considered an achievement in itself, however modest.

From early stress to 12-month development in very preterm infants: Preliminary findings on epigenetic mechanisms and brain growth

Very preterm (VPT) infants admitted to Neonatal Intensive Care Unit (NICU) are at risk for altered brain growth and less-than-optimal socio-emotional development. Recent research suggests that early NICU-related stress contributes to socio-emotional impairments in VPT infants at 3 months through epigenetic regulation (i.e., DNA methylation) of the serotonin transporter gene (SLC6A4). In the present longitudinal study we assessed: (a) the effects of NICU-related stress and SLC6A4 methylation variations from birth to discharge on brain development at term equivalent age (TEA); (b) the association between brain volume at TEA and socio-emotional development (i.e., Personal-Social scale of Griffith Mental Development Scales, GMDS) at 12 months corrected age (CA). Twenty-four infants had complete data at 12-month-age. SLC6A4 methylation was measured at a specific CpG previously associated with NICU-related stress and socio-emotional stress. Findings confirmed that higher NICU-related stress associated with greater increase of SLC6A4 methylation at NICU discharge. Moreover, higher SLC6A4 discharge methylation was associated with reduced anterior temporal lobe (ATL) volume at TEA, which in turn was significantly associated with less-than-optimal GMDS Personal-Social scale score at 12 months CA. The reduced ATL volume at TEA mediated the pathway linking stress-related increase in SLC6A4 methylation at NICU discharge and socio-emotional development at 12 months CA. These findings suggest that early adversity-related epigenetic changes might contribute to the long-lasting programming of socio-emotional development in VPT infants through epigenetic regulation and structural modifications of the developing brain

Josephson junctions with centered step and local variation of critical current density

Superconductor-insulator-ferromagnet-superconductor (SIFS) Josephson tunnel junctions based on Nb\Al2O3\Ni\Cu\Nb stacks with a thickness step in the metallic NiCu interlayer were fabricated. The step height of a few 0.1 nm was defined by optical lithography and controlled etching of both Nb and NiCu layers. Experimentally determined junction parameters by current-voltage characteristics and Fraunhofer pattern indicate a uniform NiCu thickness and similar interface transparencies for etched and non-etched parts. The critical current diffraction pattern was calculated and measured for stepped junctions having the same ground phase difference but different critical current densities in both halves. The measured data show a good agreement with simulations.Comment: slight modification

NICU Infants & SNHL: Experience of a western Sicily tertiary care centre

Introduction: The variability of symptoms and signs caused by central nervous system (CNS) lesions make multiple sclerosis difficult to recognize,Introduction: This study adds the evaluation of the independent etiologic factors that may play a role in the development of SNHL in a NICU population. We compared neonatal intensive care unit NICU infants with sensorineural hearing loss SNHL to age and gender matched normal hearing NICU controls. Materials and methods: 284 consecutive NICU infants positive to the presence of risk indicators associated with permanent congenital, delayed-onset, or progressive hearing loss underwent to global audiological assessment. The following risk factors were researched, making a distinction between prenatal and perinatal risk factors: in the first group, family history of permanent childhood hearing impairment, consanguinity, pregnant maternal infection and drugs exposition during pregnancy; in the second group, premature birth, respiratory distress, hyperbilirubinemia requiring exchange tranfusion, very low birth weight, cranio-facial abnormality, perinatal infections, ototoxic drugs administration, acidosis, hyponatremia, head trauma. Results: The analysis of the auditory deficit for infants according to numbers of risk factors showed mean values of: 78 + 28.08 dB nHL for infants positive to two risk factors; 75.71 + 30.30 dB nHL in cases positive to three risk factors; 96.66 + 34.46 dB nHL for four risk factors and 85 + 35 dB nHL in case of >5 risk factors. Conclusion: NICU infants have greater chances of developing SNHL, because of the presence of multiple risk factors; in fact, as the number of coexisting risk factors increases, the prevalence rate of SNHL also increases (r=0.81)

Time-resolved carrier dynamics and electron-phonon coupling strength in proximized weak ferromagnet-superconductor nanobilayers

We present our femtosecond optical pump-probe studies of proximized ferromagnet-superconductor nanobilayers. The weak ferromagnetic nature of a thin NiCu film makes it possible to observe the dynamics of the nonequilibrium carriers through the near-surface optical reflectivity change measurements. The subpicosecond biexponential reflectivity decay has been identified as electron-phonon Debye and acoustic phonon relaxation times, and the decay of Debye phonons versus temperature dependence was used to evaluate the electron-phonon coupling constants for both the pure Nb and proximized Nb/NiCu heterostructures down to low temperatures. We have also demonstrated that the NiCu overlay on top of Nb dramatically reduced the slow, bolometric component of the photoresponse component, making such bilayers attractive for future radiation detector applications

"A roller coaster of emotions": a qualitative study of parents very first experiences with their preterm baby

Objectives: To assess parents 19 first experiences of their very preterm babies and the neonatal intensive care unit (NICU). Design: Qualitative study using semistructured interviews. Participants: 32 mothers and 7 fathers of very preterm babies (<32 weeks gestation). Setting: Three neonatal units in tertiary care hospitals in South East England. Results: Five themes were identified. The first describes parents 19 blurred recall of the birth. The second shows the anticipation of seeing and touching their baby for the first time was characterised by contrasting emotions, with some parents feeling scared and others excited about the event. The third theme describes parents 19 first sight and touch of their babies and their 18rollercoaster 19 of emotions during this time. It also highlights the importance of touch to trigger and strengthen the parent 13baby bond. However, some parents were worried that touching or holding the baby might transmit infection or interfere with care. The fourth theme captures parents 19 impressions of NICU and how overwhelming this was particularly for parents who had not toured NICU beforehand or whose first sight of their baby was on NICU. The final theme captures unique experiences of fathers, in particular that many felt excluded and confused about their role. Conclusions: This study informs family-centred care by providing insight into the experiences of parents of very preterm infants at a time when they are most in need of support. Clinical implications include the importance of offering parents preparatory tours of the NICU and including fathers

New architectural design of delivery room reduces morbidity in preterm neonates: a prospective cohort study

Background: A multidisciplinary committee composed of a panel of experts, including a member of the American Academy of Pediatrics and American Institute of Architects, has suggested that the delivery room (DR) and the neonatal intensive care units (NICU) room should be directly interconnected. We aimed to investigate the impact of the architectural design of the DR and the NICU on neonatal outcome. Methods: Two cohorts of preterm neonates born at < 32weeks of gestational age, consecutively observed during 2years, were compared prospectively before (Cohort 1: "conventional DR") and after architectural renovation of the DR realized in accordance with specific standards (Cohort 2: "new concept of DR"). In Cohort 1, neonates were initially cared for a conventional resuscitation area, situated in the DR, and then transferred to the NICU, located on a separate floor of the same hospital. In Cohort 2 neonates were assisted at birth directly in the NICU room, which was directly connected to the DR via a pass-through door. The primary outcome of the study was morbidity, defined by the proportion of neonates with at least one complication of prematurity (i.e., late-onset sepsis, patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity and necrotizing enterocolitis). Secondary outcomes were mortality and duration of hospitalization. Statistical analysis was performed using standard methods by SPSS software. Results: We enrolled 106 neonates (56 in Cohort 1 and 50 in Cohort 2). The main clinical and demographic characteristics of the 2cohorts were similar. Moderate hypothermia (body temperature ≤ 35.9° C) was more frequent in Cohort 1 (57%) compared with Cohort 2 (24%, p = 0.001). Morbidity was increased in Cohort 1 (73%) compared with Cohort 2 (44%, p = 0.002). No statistically significant differences in mortality and median duration of hospitalization were observed between the 2 cohorts of the study. Conclusions: If realized according to the proposed architectural standards, renovation of DR and NICU may represent an opportunity to reduce morbidity in preterm neonates