The Classification of Movement in Infants for the Autonomous Monitoring of Neurological Development

Neurodevelopmental delay following extremely preterm birth or birth asphyxia is common but diagnosis is often delayed as early milder signs are not recognised by parents or clinicians. Early interventions have been shown to improve outcomes. Automation of diagnosis and monitoring of neurological disorders using non-invasive, cost effective methods within a patient’s home could improve accessibility to testing. Furthermore, said testing could be conducted over a longer period, enabling greater confidence in diagnoses, due to increased data availability. This work proposes a new method to assess the movements in children. Twelve parent and infant participants were recruited (children aged between 3 and 12 months). Approximately 25 min 2D video recordings of the infants organically playing with toys were captured. A combination of deep learning and 2D pose estimation algorithms were used to classify the movements in relation to the children’s dexterity and position when interacting with a toy. The results demonstrate the possibility of capturing and classifying children’s complexity of movements when interacting with toys as well as their posture. Such classifications and the movement features could assist practitioners to accurately diagnose impaired or delayed movement development in a timely fashion as well as facilitating treatment monitoring

Physicochemical Characterization and Aerosol Dispersion Performance of Organic Solution Advanced Spray-Dried Cyclosporine A Multifunctional Particles for Dry Powder Inhalation Aerosol Delivery

In this systematic and comprehensive study, inhalation powders of the polypeptide immunosuppressant drug - cyclosporine A - for lung delivery as dry powder inhalers (DPIs) were successfully designed, developed, and optimized. Several spray drying pump rates were rationally chosen. Comprehensive physicochemical characterization and imaging was carried out using scanning electron microscopy, hot-stage microscopy, differential scanning calorimetry, powder X-ray diffraction, Karl Fischer titration, laser size diffraction, and gravimetric vapor sorption. Aerosol dispersion performance was conducted using a next generation impactor with a Food and Drug Administration-approved DPI device. These DPIs displayed excellent aerosol dispersion performance with high values in emitted dose, respirable fraction, and fine particle fraction. In addition, novel multifunctional inhalation aerosol powder formulations of cyclosporine A with lung surfactant-mimic phospholipids were also successfully designed and developed by advanced organic solution cospray drying in closed mode. The lung surfactantmimic phospholipids were 1,2-dipalmitoyl-sn-glycero-3-phosphocholine and 1,2-dipalmitoyl-snglycero- 3-(phosphor-rac-1-glycerol). These cyclosporine A lung surfactant-mimic aerosol powder formulations were comprehensively characterized. Powder X-ray diffraction and differential scanning calorimetry confirmed that the phospholipid bilayer structure in the solid state was preserved following advanced organic solution spray drying in closed mode. These novel multifunctional inhalation powders were optimized for DPI delivery with excellent aerosol dispersion performance and high aerosol performance parameters

Not All Children with Cystic Fibrosis Have Abnormal Esophageal Neutralization during Chemical Clearance of Acid Reflux.

PurposeAcid neutralization during chemical clearance is significantly prolonged in children with cystic fibrosis, compared to symptomatic children without cystic fibrosis. The absence of available reference values impeded identification of abnormal findings within individual patients with and without cystic fibrosis. The present study aimed to test the hypothesis that significantly more children with cystic fibrosis have acid neutralization durations during chemical clearance that fall outside the physiological range.MethodsPublished reference value for acid neutralization duration during chemical clearance (determined using combined impedance/pH monitoring) was used to assess esophageal acid neutralization efficiency during chemical clearance in 16 children with cystic fibrosis (3 to <18 years) and 16 age-matched children without cystic fibrosis.ResultsDuration of acid neutralization during chemical clearance exceeded the upper end of the physiological range in 9 of 16 (56.3%) children with and in 3 of 16 (18.8%) children without cystic fibrosis (p=0.0412). The likelihood ratio for duration indicated that children with cystic fibrosis are 2.1-times more likely to have abnormal acid neutralization during chemical clearance, and children with abnormal acid neutralization during chemical clearance are 1.5-times more likely to have cystic fibrosis.ConclusionSignificantly more (but not all) children with cystic fibrosis have abnormally prolonged esophageal clearance of acid. Children with cystic fibrosis are more likely to have abnormal acid neutralization during chemical clearance. Additional studies involving larger sample sizes are needed to address the importance of genotype, esophageal motility, composition and volume of saliva, and gastric acidity on acid neutralization efficiency in cystic fibrosis children

Active Connections: Means For Faculty To Create An Environment In Which Students WANT To Engage!

This interactive, cross-disciplinary research explores face-to-face and online strategies for faculty to deploy in the classroom that encourage connections beyond forced engagement methodologies commonly used. Concentration is on methods of connecting that are “out of the mainstream” and benefit both students and faculty. Findings indicate that the more students feel as a valued participant of the learning community, the more they engage in the class activities

An automated quasi-continuous capillary refill timing device

Capillary refill time (CRT) is a simple means of cardiovascular assessment which is widely used in clinical care. Currently, CRT is measured through manual assessment of the time taken for skin tone to return to normal colour following blanching of the skin surface. There is evidence to suggest that manually assessed CRT is subject to bias from ambient light conditions, a lack of standardisation of both blanching time and manually applied pressure, subjectiveness of return to normal colour, and variability in the manual assessment of time. We present a novel automated system for CRT measurement, incorporating three components: a non-invasive adhesive sensor incorporating a pneumatic actuator, a diffuse multi-wavelength reflectance measurement device, and a temperature sensor; a battery operated datalogger unit containing a self contained pneumatic supply; and PC based data analysis software for the extraction of refill time, patient skin surface temperature, and sensor signal quality. Through standardisation of the test, it is hoped that some of the shortcomings of manual CRT can be overcome. In addition, an automated system will facilitate easier integration of CRT into electronic record keeping and clinical monitoring or scoring systems, as well as reducing demands on clinicians. Summary analysis of volunteer (n = 30) automated CRT datasets are presented, from 15 healthy adults and 15 healthy children (aged from 5 to 15 years), as their arms were cooled from ambient temperature to 5°C. A more detailed analysis of two typical datasets is also presented, demonstrating that the response of automated CRT to cooling matches that of previously published studies

Accurate neonatal heart rate monitoring using a new wireless, cap mounted device

© 2020 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica Aim: A device for newborn heart rate (HR) monitoring at birth that is compatible with delayed cord clamping and minimises hypothermia risk could have advantages over current approaches. We evaluated a wireless, cap mounted device (fhPPG) for monitoring neonatal HR. Methods: A total of 52 infants on the neonatal intensive care unit (NICU) and immediately following birth by elective caesarean section (ECS) were recruited. HR was monitored by electrocardiogram (ECG), pulse oximetry (PO) and the fhPPG device. Success rate, accuracy and time to output HR were compared with ECG as the gold standard. Standardised simulated data assessed the fhPPG algorithm accuracy. Results: Compared to ECG HR, the median bias (and 95% limits of agreement) for the NICU was fhPPG −0.6 (−5.6, 4.9) vs PO −0.3 (−6.3, 6.2) bpm, and ECS phase fhPPG −0.5 (−8.7, 7.7) vs PO −0.1 (−7.6, 7.1) bpm. In both settings, fhPPG and PO correlated with paired ECG HRs (both R2=0.89). The fhPPG HR algorithm during simulations demonstrated a near-linear correlation (n=1266, R2=0.99). Conclusion: Monitoring infants in the NICU and following ECS using a wireless, cap mounted device provides accurate HR measurements. This alternative approach could confer advantages compared with current methods of HR assessment and warrants further evaluation at birth

REAPERTURA DE PLANTA TEPEYAC

Resumen de Memorias de Trabajo Se tomó el proyecto de la reapertura de planta Gamesa Tepeyac del cual fui parte como líder del área de Ingeniería Industrial y Almacén, este consistió en la reapertura en 2 fases de las Unidades de Negocio de Gamesa Tepeyac, siendo la primera fase la reapertura de la línea de IQO’s y la segunda la apertura de las 4 líneas de Galleta, Equipo 1, Equipo 2, Equipo 3 y Merengue. Considerándose como reapertura todo el proceso de preparación y planeación, la reapertura en sí y el seguimiento a la operación e Indicadores Clave de Desempeño. Esto se llevó a cabo con un apoyo por parte de todas las áreas soporte, Gerencia, Seguridad, Calidad, Inocuidad, Producción, Mejora Continua, Mantenimiento, Recursos Humanos, Contraloría, Lean Six Sigma, Abastecimientos, Capacitación e Ingeniería Industrial y Almacén, creando una serie de pasos críticos a seguir para garantizar que no hubiera problemas antes, durante y después de la reapertura, así mismo el apoyo y disposición de todo el personal. Esta reapertura se requirió por 2 temas, el primero fue la alta demanda de sobres de avena instantánea y que los maquiladores de este producto no alcanzaron a cumplir con los objetivos de producción necesarios para cumplir con la demanda, el segundo tema, y más crítico, fue que debido al sismo del 19 de septiembre de 2017 la planta de Gamesa Vallejo, la cual es la principal productora de galleta en México para grupo PepsiCo, sufrió graves daños estructurales en su edificio, situación que obligó a la compañía a cerrar la planta hasta que se repararán estos daños y se pudiera afianzar la seguridad de todo el personal que ahí labora. Debido a este cierre de Vallejo Gamesa se decidió reabrir la planta de Gamesa Tepeyac, junto con otras medidas que incluían aumentar el volumen de las demás plantas de galleta de grupo PepsiCo, y así poder disminuir la falta de producto en puntos de venta, sin embargo para Gamesa Tepeyac también se planteó el objetivo de hacer una reapertura limpia y operar con los estándares de desempeño que se manejaron antes del cierre. Desafortunadamente muchas plantas no pudieron alcanzar los nuevos objetivos de volumen que se les plantearon, sin embargo planta Gamesa Tepeyac no solo tuvo una reapertura limpia y sin incidentes mayores, si no que también alcanzó y superó los estándares de operación que manejaba anteriormente volviéndose una planta mucho más eficiente en la administración de la misma debido a la reducción de personal así como el aumento de volumen en galleta como en IQO’s; pasando de un máximo de producción de 2,649 toneladas mensuales a 2,925 toneladas mensuales y de 6.5 toneladas por turno a 7 toneladas por turno en galleta e IQO’s respectivamente

Gastroesophageal reflux in cystic fibrosis across the age spectrum.

Background:Scientific advances have improved longevity in cystic fibrosis (CF) patients and many of these patients can expect to experience age-related gastrointestinal co-morbidities. We aimed to assess the extent to which age might impact gastroesophageal reflux (GER) in patients with CF. Methods:Our esophageal pH-multichannel intraluminal impedance monitoring database was searched for tracings belonging to CF patients ≥2 years old without prior fundoplication and not taking anti-reflux medications immediately prior (within 7 days) and during the study. Tracings were retrospectively analyzed; Impedance and pH variables were evaluated with respect to age and pulmonary function. Results:Twenty-eight patients were enrolled; 16 children (3.1-17.7 years) and 12 adults (18.2-48.9 years). Among pH probe parameters, correlation analysis showed DeMeester score (P=0.011) and number of acid reflux events lasting >5 minutes (P=0.047) to be significantly correlated with age. Age was not significantly correlated with any of the impedance parameters. Age was negatively correlated with baseline impedance (BI) in the distal esophagus (r=-0.424, P=0.023) and BI was negatively correlated with several pH parameters, including reflux index (r=-0.553, P=0.002), number of total acid reflux events (r=-0.576, P=0.001), number of acid reflux events lasting >5 minutes (r=-0.534, P=0.003), and DeMeester score (r=-0.510, P=0.006). Pulmonary function (percent predicted forced expiratory volume in one minute; ppFEV1) was negatively correlated with age (r=-0.494, P=0.0007). The interaction of age and ppFEV1 and any of the reflux parameters, however, was not significant (P>0.05); the strongest evidence for an interaction was found for the number of acid reflux events reaching the proximal esophagus, but this interaction still did not reach statistical significance (P=0.070). Conclusions:In a small cohort, we found evidence that age may be associated with increased acid exposure and that both age and increased acid exposure are associated with reduced BI in the distal esophagus. The negative relationship between pulmonary function and age in our cohort is not related to GER. This pilot study supports the need for esophageal assessment and treatment of GER as standard components of clinical care for an aging CF population