Comparison of family centered care with family integrated care and mobile technology (mFICare) on preterm infant and family outcomes: a multi-site quasi-experimental clinical trial protocol.

BackgroundFamily Centered Care (FCC) has been widely adopted as the framework for caring for infants in the Neonatal Intensive Care Unit (NICU) but it is not uniformly defined or practiced, making it difficult to determine impact. Previous studies have shown that implementing the Family Integrated Care (FICare) intervention program for preterm infants in the NICU setting leads to significant improvements in infant and family outcomes. Further research is warranted to determine feasibility, acceptability and differential impact of FICare in the US context. The addition of a mobile application (app) may be effective in providing supplemental support for parent participation in the FICare program and provide detailed data on program component uptake and outcomes.MethodsThis exploratory multi-site quasi-experimental study will compare usual FCC with mobile enhanced FICare (mFICare) on growth and clinical outcomes of preterm infants born at or before 33 weeks gestational age, as well as the stress, competence and self-efficacy of their parents. The feasibility and acceptability of using mobile technology to gather data about parent involvement in the care of preterm infants receiving FCC or mFICare as well as of the mFICare intervention will be evaluated (Aim 1). The effect sizes for infant growth (primary outcome) and for secondary infant and parent outcomes at NICU discharge and three months after discharge will be estimated (Aim 2).DiscussionThis study will provide new data about the implementation of FICare in the US context within various hospital settings and identify important barriers, facilitators and key processes that may contribute to the effectiveness of FICare. It will also offer insights to clinicians on the feasibility of a new mobile application to support parent-focused research and promote integration of parents into the NICU care team in US hospital settings.Trial registrationClinicalTrials.gov, ID NCT03418870. Retrospectively registered on December 18, 2017

Detection of vvIBDV in Vaccinated SPF Chickens

The purpose of our experiment was to investigate, if apparently healthy, vaccinated chickens may be involved in maintaining and spreading infectious bursal disease virus (IBDV) in poultry environments. We aimed at simultaneous detection and identification of very virulent field strain IBDV (vvIBDV) as well as vaccine strain IBDV in experimentally infected chickens. Two groups of specific pathogen free (SPF) chickens were vaccinated using the intermediate infectious bursal disease (IBD) vaccine D78. Group 1 was vaccinated at the age of one week and group 2 at the age of three weeks. Both groups were challenged with vvIBDV at the age of four weeks. A third, vaccinated, non-challenged group served as negative control. No clinical symptoms were observed in any of these groups. The chickens were euthanised and submitted to autopsy and sample preparation in groups of three at fixed intervals from the age of 28 to 44 days. Gross pathological lesions were not observed. Lymphoid tissues from the bursa of Fabricius, bone marrow, spleen and thymus in addition to cloacal- and bursal swaps were analysed by one-step reverse transcription polymerase chain reaction (RT-PCR). Positive results were confirmed by two-step strain specific duplex (DPX) RT-PCR. The vaccine strain was detected in bursa tissues from all groups, while the challenge strain was detected in few bursal as well as non-bursal tissue samples. The results indicate a possibility of replication of vvIBDV in vaccinated chickens

Wat komt er na Lean Six Sigma?

De vraag "Wat komt er na Lean Six Sigma?" is actueel. In dit artikel beargumenteren we dat, los van het specifieke stempel wat je kunt gebruiken, kwaliteit ook in de toekomst bestaansrecht heeft. Maar kwaliteitsmanagement zal zich verder moeten aanpassen en moeten evolueren. Strategisch is het verstandig om de kerncompetentie van deze discipline systematische innovatie te noemen. Om te kunnen concurreren moeten organisaties innoveren en aan verbetering van hun producten, processen en diensten werken. Nu meer dan ooit. De rol van de kwaliteitsprofessional in de moderne kenniseconomie zou er een moeten zijn van een vakspecialist met de nodige onderzoeksvaardigheden en de juiste kennis van systematische innovatie. De huidige situatie is voor deze beroepsgroep een kans om de sleutel te vormen van de kenniseconomie

Three-dimensional reconstructions of intrahepatic bile duct tubulogenesis in human liver

<p>Abstract</p> <p>Background</p> <p>During liver development, intrahepatic bile ducts are thought to arise by a unique asymmetric mode of cholangiocyte tubulogenesis characterized by a series of remodeling stages. Moreover, in liver diseases, cells lining the Canals of Hering can proliferate and generate new hepatic tissue. The aim of this study was to develop protocols for three-dimensional visualization of protein expression, hepatic portal structures and human hepatic cholangiocyte tubulogenesis.</p> <p>Results</p> <p>Protocols were developed to digitally visualize portal vessel branching and protein expression of hepatic cell lineage and extracellular matrix deposition markers in three dimensions. Samples from human prenatal livers ranging from 7 weeks + 2 days to 15½ weeks post conception as well as adult normal and acetaminophen intoxicated liver were used. The markers included cytokeratins (CK) 7 and 19, the epithelial cell adhesion molecule (EpCAM), hepatocyte paraffin 1 (HepPar1), sex determining region Y (SRY)-box 9 (SOX9), laminin, nestin, and aquaporin 1 (AQP1).</p> <p>Digital three-dimensional reconstructions using CK19 as a single marker protein disclosed a fine network of CK19 positive cells in the biliary tree in normal liver and in the extensive ductular reactions originating from intrahepatic bile ducts and branching into the parenchyma of the acetaminophen intoxicated liver. In the developing human liver, three-dimensional reconstructions using multiple marker proteins confirmed that the human intrahepatic biliary tree forms through several developmental stages involving an initial transition of primitive hepatocytes into cholangiocytes shaping the ductal plate followed by a process of maturation and remodeling where the intrahepatic biliary tree develops through an asymmetrical form of cholangiocyte tubulogenesis.</p> <p>Conclusions</p> <p>The developed protocols provide a novel and sophisticated three-dimensional visualization of vessels and protein expression in human liver during development and disease.</p