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BMC Pregnancy and Childbirth Jan 2017Preterm infants have an immature sucking behavior and the capacity to be exclusively breastfed may be reduced for a period of weeks or months, depending on gestational...
BACKGROUND
Preterm infants have an immature sucking behavior and the capacity to be exclusively breastfed may be reduced for a period of weeks or months, depending on gestational age. Nipple shields have been used, not only as a device to help mothers with sore nipples, but also to facilitate the infant's latch on to the breast. However, the benefits of using nipple shields have been debated. The aim of this study was to explore perceptions and experiences of using a nipple shield among parents and staff in neonatal units in Sweden and England.
METHODS
An ethnographic study was undertaken where observations and interviews were conducted in four neonatal units in Sweden and England. The data were analyzed using a thematic networks analysis.
RESULT
The global theme was developed and named, 'Nipple shield in a liminal time'. This comprised of two organizing themes: 'Relational breastfeeding' and 'Progression'. 'Relational breastfeeding' was underpinned by the basic themes, 'good enough breast', 'something in between' and 'tranquil moment'. 'Progression' was underpinned by the basic themes, 'learning quicker', 'short-term solution' and 'rescue remedy'. Although breastfeeding was seen primarily as a nutritive transaction, the relational aspects of breastfeeding were of crucial importance. These two organizing themes show the tension between acknowledging the relational aspects of breastfeeding and yet facilitating or supporting the progression of breastfeeding in the period from tube feeding or cup feeding to breastfeeding. It is a liminal time as mothers and their infants are "in between" phases and the outcome, in terms of breastfeeding, is yet to be realized.
CONCLUSION
This study demonstrates parents' and staffs' perceptions of the nipple shield as a short term solution to help initiation of breastfeeding but also as a barrier between the mother and infant. It is important that the mother and baby's own particular needs are taken into account, in a person-centred way and on an ongoing basis. Furthermore, we need to emphasise the importance of the 'relational' whilst understanding the need for 'progression'. Holding these in balance may be the key to appropriate use of the nipple shield.
Topics: Adult; Anthropology, Cultural; Breast Feeding; England; Female; Humans; Infant, Newborn; Male; Nipples; Parents; Perception; Perinatal Care; Personnel, Hospital; Protective Devices; Sucking Behavior; Sweden
PubMed: 28049520
DOI: 10.1186/s12884-016-1183-6 -
Cleaner Engineering and Technology Apr 2023Due to global supply chain disruptions and high demand for personal protective equipment (PPE), the rapidly expanding COVID-19 crisis left millions of front-line...
Design and fabrication of a biodegradable face shield by using cleaner technologies for the protection of direct splash and airborne pathogens during the COVID-19 pandemic.
Due to global supply chain disruptions and high demand for personal protective equipment (PPE), the rapidly expanding COVID-19 crisis left millions of front-line fighters unprotected. The disposal of PPE in the environment caused significant environmental pollution. Hence, indigenous initiatives have been taken to fabricate antiviral and biodegradable face shields with the help of neoteric and cleaner technologies. This paper describes a novel endeavor to design, manufacture, and performance analysis of a face shield made by plastic injection molding and LASER Cutting. Because of the requirement of permanent wear, the face shield's ergonomic design is considered low weight and easy head fixation, alongside high production ability. Here, face shield frames are made with lightweight, biodegradable plastic called Poly Lactic Acid (PLA), whereas an optical grade PLA sheet is used as the visor for better clarity. Visors PLA Sheet is coated with Nano-Silver disinfectant spray to incorporate antiviral properties to the Faceshield. Partially circumferential adjustable elastic straps are used for comfortable head fixation. To evaluate the product, clinical fit tests along with statistical survey were conducted, and the feedback from the end-users on comfort (41% Excellent, 30% Good, 26% Average and 3% Poor), clear view (33% Excellent, 38% Good, 24% Average, and 5% Poor), design features (43% Excellent, 35% Good, and 22% Average), simplicity of installation and disassembly (29% Excellent, 33% Good, and 38% Average), and ease of wearing/removing (45% Excellent, 40% Good, and 15%Average) are encouraging.
PubMed: 36911790
DOI: 10.1016/j.clet.2023.100615 -
BMJ Open Oct 2021In COVID-19, transfer of respiratory materials transmits disease and drives the pandemic but the interplay of droplet and aerosol physics, physiology and environment is...
OBJECTIVES
In COVID-19, transfer of respiratory materials transmits disease and drives the pandemic but the interplay of droplet and aerosol physics, physiology and environment is not fully understood. To advance understanding of disease transmission mechanisms and to find novel exposure minimisation strategies, we studied cough-driven material transport modes and the efficacy of control strategies.
DESIGN
Computer simulations and real-world experiments were used for integrating an intensive care setting, multiphysics and physiology. Patient-focused airflow management and air purification strategies were examined computationally and validated by submicron particle exhalation imaging in volunteers.
SETTING
Hospital setting during a respiratory virus pandemic with transmission by respiratory droplets and aerosols.
PARTICIPANTS
Healthy volunteers.
OUTCOME MEASURES
Distribution of, and exposure to, potentially infectious respiratory secretions.
RESULTS
Respiratory materials ejected by cough exhibited four transport modes: long-distance ballistic, short-distance ballistic, 'jet rider' and aerosol modes. Interaction with air conditioning driven flow contaminated a hospital room rapidly. Different than large droplets or aerosols, jet rider droplets travelled with the turbulent air jet initially, but fell out at a distance, were not well eliminated by air conditioning and exposed bystanders at larger distance and longer time; their size predisposes them to preferential capture in the nasal mucosa, the primordial COVID-19 infection site. 'Cough shields' captured large droplets but induced lateral dispersion of aerosols and jet riders. An air purification device alone had limited efficacy. A Shield and Sink' approach combining cough shields with 'virus sinks' minimised exposure to all secretions in modelling and real-life experiments.
CONCLUSIONS
Jet riders have characteristics of highly efficient respiratory infection vectors and may play a role in COVID-19 transmission. Exposure to all droplet types can be minimised through an easily implemented Shield and Sink strategy.
Topics: Aerosols; Air Conditioning; COVID-19; Hospitals; Humans; SARS-CoV-2
PubMed: 34642190
DOI: 10.1136/bmjopen-2020-047772 -
Frontiers in Cardiovascular Medicine 2023Magnetocardiography (MCG), which is nowadays 60 years old, has not yet been fully accepted as a clinical tool. Nevertheless, a large body of research and several... (Review)
Review
Magnetocardiography (MCG), which is nowadays 60 years old, has not yet been fully accepted as a clinical tool. Nevertheless, a large body of research and several clinical trials have demonstrated its reliability in providing additional diagnostic electrophysiological information if compared with conventional non-invasive electrocardiographic methods. Since the beginning, one major objective difficulty has been the need to clean the weak cardiac magnetic signals from the much higher environmental noise, especially that of urban and hospital environments. The obvious solution to record the magnetocardiogram in highly performant magnetically shielded rooms has provided the ideal setup for decades of research demonstrating the diagnostic potential of this technology. However, only a few clinical institutions have had the resources to install and run routinely such highly expensive and technically demanding systems. Therefore, increasing attempts have been made to develop cheaper alternatives to improve the magnetic signal-to-noise ratio allowing MCG in unshielded hospital environments. In this article, the most relevant milestones in the MCG's journey are reviewed, addressing the possible reasons beyond the currently long-lasting difficulty to reach a clinical breakthrough and leveraging the authors' personal experience since the early 1980s attempting to finally bring MCG to the patient's bedside for many years thus far. Their nearly four decades of foundational experimental and clinical research between shielded and unshielded solutions are summarized and referenced, following the original vision that MCG had to be intended as an unrivaled method for contactless assessment of the cardiac electrophysiology and as an advanced method for non-invasive electroanatomical imaging, through multimodal integration with other non-fluoroscopic imaging techniques. Whereas all the above accounts for the past, with the available innovative sensors and more affordable active shielding technologies, the present demonstrates that several novel systems have been developed and tested in multicenter clinical trials adopting both shielded and unshielded MCG built-in hospital environments. The future of MCG will mostly be dependent on the results from the ongoing progress in novel sensor technology, which is relatively soon foreseen to provide multiple alternatives for the construction of more compact, affordable, portable, and even wearable devices for unshielded MCG inside hospital environments and perhaps also for ambulatory patients.
PubMed: 37636301
DOI: 10.3389/fcvm.2023.1232882 -
BMJ Open Quality May 2021Ophthalmologists were concerned about the risk of SARS-COV-2 transmission via droplets given the close proximity to the patient during slit lamp examination. There is a...
Ophthalmologists were concerned about the risk of SARS-COV-2 transmission via droplets given the close proximity to the patient during slit lamp examination. There is a need to design a simple, low-cost, waterproof breath shield to minimise risk of infection.Dimensions of the Haag-Streit slit lamp (model BM 900) were recorded to guide accurate design of the breath shield. A questionnaire was circulated among slit lamp users on their perceived risk and concern about SARS-CoV-2 transmission and their perception of how effective different designs of breath shields would be at protecting them from an infection. A number of breath shield prototypes were designed and trialled. Plan, Do, Study, Act (PDSA) cycles were used to improve the design. Materials used to create the breath shields included transparent A3 laminating pouches and laminator, two sheets of A4 paper, scissors, hole punch and a ruler. The breath shield was designed to fit over the objective lens on the slit lamp after temporarily removing the standard, manufacturer-provided breath shield, before replacing it. The breath shields were cleaned after every patient with alcohol wipes and removed for deep cleaning with hand soap and water after each session. We used a proof of concept experiment using fluorescein instilled spray to test the effectiveness of each breath shield at preventing droplet transmission to the slit lamp user.Following four PDSA cycles, a breath shield that is user-friendly, easy to clean was produced. The percentage of confidence that the final design would be effective at preventing droplet transmission increased from 5.6% to 80%.Implementation of a low cost, simple to make, transparent, waterproof breath shield together with other forms of person protective equipment (PPE) creates a safe working environment for clinicians and patients. This intervention can be readily replicated and modified for other slit lamp models.
Topics: COVID-19; Disease Transmission, Infectious; Equipment Design; Humans; Protective Devices; SARS-CoV-2; Slit Lamp; Slit Lamp Microscopy
PubMed: 34035129
DOI: 10.1136/bmjoq-2021-001361 -
Nature Communications Jan 2018Most systemic viral gene therapies have been limited by sequestration and degradation of virions, innate and adaptive immunity, and silencing of therapeutic genes within...
Most systemic viral gene therapies have been limited by sequestration and degradation of virions, innate and adaptive immunity, and silencing of therapeutic genes within the target cells. Here we engineer a high-affinity protein coat, shielding the most commonly used vector in clinical gene therapy, human adenovirus type 5. Using electron microscopy and crystallography we demonstrate a massive coverage of the virion surface through the hexon-shielding scFv fragment, trimerized to exploit the hexon symmetry and gain avidity. The shield reduces virion clearance in the liver. When the shielded particles are equipped with adaptor proteins, the virions deliver their payload genes into human cancer cells expressing HER2 or EGFR. The combination of shield and adapter also increases viral gene delivery to xenografted tumors in vivo, reduces liver off-targeting and immune neutralization. Our study highlights the power of protein engineering for viral vectors overcoming the challenges of local and systemic viral gene therapies.
Topics: Adenoviruses, Human; Animals; Capsid Proteins; Cell Line, Tumor; Crystallography, X-Ray; ErbB Receptors; Female; Gene Transfer Techniques; Genetic Vectors; Humans; Liver; Mice, Transgenic; Molecular Targeted Therapy; Receptor, ErbB-2; Single-Chain Antibodies; Spleen; Virion; Xenograft Model Antitumor Assays
PubMed: 29386504
DOI: 10.1038/s41467-017-02707-6 -
Frontiers in Public Health 2023During the COVID-19 pandemic in the UK, those considered most vulnerable to adverse outcomes from infection were designated "clinically extremely vulnerable" and advised...
Mental health and life satisfaction among those advised to shield during the COVID-19 pandemic in the UK: a secondary analysis of the Understanding Society longitudinal study.
INTRODUCTION
During the COVID-19 pandemic in the UK, those considered most vulnerable to adverse outcomes from infection were designated "clinically extremely vulnerable" and advised to "shield." This involved prolonged confinement at home with strict limits on face-to-face contact, beyond national restrictions. Shielding ended in September 2021 and was considered likely to have harmed mental health and wellbeing. As the UK moved toward a new phase of "living with COVID-19" the mental health and wellbeing experiences of those advised to shield may have diverged from the general population.
METHODS
This study is a secondary analysis of nine "COVID-19 Survey" waves of Understanding Society, a longitudinal study of UK participants covering April 2020 to September 2021 alongside pre-pandemic baseline data. The prevalence of clinically significant psychological distress (General Health Questionnaire 12) and low life satisfaction were examined at each wave for participants with longitudinal responses across all waves, stratified by receipt of shielding guidance (Received = 410, Not received = 6,878). Mixed effects regression modeling examined associations between shielding guidance receipt and mental health and life satisfaction when adjusting for potential confounders including age and sex, pre-pandemic mental health/life satisfaction, and loneliness.
RESULTS
Those who received shielding guidance were more likely to experience poor mental health and low life satisfaction during the pandemic. However, this largely reflected differences in pre-pandemic baselines. Variation between waves broadly coincided with the changing burden of COVID-19 and associated restrictions, with similar patterns regardless of shielding guidance receipt. Regression modeling combining data across all waves indicated that receipt of shielding guidance did not independently predict adverse outcomes. However, poor pre-pandemic mental health and low life satisfaction, and frequent loneliness, as well as demographic factors including sex and age, consistently predicted adverse pandemic mental health and wellbeing.
DISCUSSION
While those who received shielding guidance did on average experience poorer mental health and life satisfaction during the pandemic, this study suggests this largely reflects existing inequalities. Drawing on data throughout the shielding program, it addresses an existing evidence gap. These findings reinforce the importance of addressing existing mental health inequalities in the recovery from the current pandemic and for future preparedness.
Topics: Humans; Mental Health; COVID-19; Pandemics; Longitudinal Studies; Personal Satisfaction; United Kingdom
PubMed: 37829093
DOI: 10.3389/fpubh.2023.1235903 -
ACS Omega Mar 2023Electromagnetic interference (EMI) shielding effectiveness (SE) systems have received immense attention from researchers owing to the rapid development in electronics... (Review)
Review
Electromagnetic interference (EMI) shielding effectiveness (SE) systems have received immense attention from researchers owing to the rapid development in electronics and telecommunications, which is an alarming matter in our modern society. This radiation can damage the performance of EM devices and may harmfully affect animal/human health. The harmonious utilization of magnetic alloys and conducting but nonmagnetic materials (such as carbon/graphene) is a practical approach toward EMI SE. This review is not exhaustive, although it is comprehensive and aimed at all materials for EMI SE especially graphene-based polymeric composites. It encompasses multifunctional and functional structural EMI shields. These materials comprise polymers, carbons, ceramics, metals, cement composites/nanocomposites, and hybrids. The accessibility of abundant categories of carbon-based materials in their microscale, nanoscale, and quantum forms as EMI shields as polymer-carbon, cement-carbon, ceramic-carbon, metal-carbon, and their hybrids, makes them receive much attention, as a result of their unique amalgamation of electrical, magnetic, dielectric, thermal, and/or mechanical properties. Herewith, we have discussed the principles of EMI shields along with their design and state of the art basis and material architecture along with the drawbacks in research on EMI shields.
PubMed: 36910979
DOI: 10.1021/acsomega.2c05815 -
Current Opinion in HIV and AIDS Sep 2020The surface of the HIV-1 Env glycoprotein, the target of neutralizing antibodies, is extensively covered by N-linked glycans that create a glycan shield. Broadly... (Review)
Review
PURPOSE OF REVIEW
The surface of the HIV-1 Env glycoprotein, the target of neutralizing antibodies, is extensively covered by N-linked glycans that create a glycan shield. Broadly neutralizing antibodies (bNAbs), the primary targets of HIV-1 vaccine design, have to negotiate this glycan shield. Here, we review the barriers and opportunities that the HIV-1 glycan shield presents for vaccine induction of bNAbs.
RECENT FINDINGS
Glycan shields can impact the nature of the antibody response and influence the development of neutralization breadth in HIV-1 infections. The architecture of the glycan shield arising from glycan interactions and dynamics have been modeled, and its fine structure, that is, the site-wise glycan heterogeneity, has been determined for some isolates. Although the extent of glycan shielding is conserved, the precise number, location and processing of glycans, however, is strain-dependent. New insights continue to reveal how such differences can impact bNAb activity and development. Novel approaches have exploited the glycan shield for designing immunogens that bind the germline precursors of bNAbs, a critical roadblock for vaccine-induction of bNAbs.
SUMMARY
The HIV-1 glycan shield can significantly impact the induction and maturation of bNAbs, and a better understanding of how to manipulate it will improve immunogen design.
Topics: Antibodies, Neutralizing; Broadly Neutralizing Antibodies; Epitopes; HIV Antibodies; HIV Infections; HIV-1; Humans; Polysaccharides; env Gene Products, Human Immunodeficiency Virus
PubMed: 32675574
DOI: 10.1097/COH.0000000000000639 -
Advances in Radiation Oncology 2023Purpose: Subtotal skin electron beam therapy may be an option for patients with cutaneous lymphoma receiving radiation therapy to treat large areas of their skin but may...
PURPOSE
Purpose: Subtotal skin electron beam therapy may be an option for patients with cutaneous lymphoma receiving radiation therapy to treat large areas of their skin but may benefit from sparing specific areas that may have had previous radiation therapy, are of specific cosmetic concern, and/or show no evidence of disease. We report here on the design, implementation, and dosimetric characteristics of a reusable and transparent customizable shield for use with the large fields used to deliver total skin electron beam therapy at extended distance with a conventional linear accelerator.
METHODS AND MATERIALS
A shield was designed and manufactured consisting of acrylic blocks that can be mounted on a steel frame to allow patient-specific shielding. The dosimetry of the device was measured using radiochromic film.
RESULTS
The shield is easy to use and well-tolerated for patient treatment, providing minimal electron transmission through the shield with a sharp penumbra at the field edge, with no increase in x-ray dose. We report on the dosimetry of a commercial device that has been used to treat more than 30 patients to date.
CONCLUSIONS
The customizable shield is well suited to providing patient-specific shielding for subtotal skin electron beam therapy.
PubMed: 37457824
DOI: 10.1016/j.adro.2023.101289