Percutaneous endoscopic gastrostomy (PEG) tube placement is one of the methods of providing enteral nutrition support and is often used in critically ill patients. There are several complications of PEG tube placement, including intussusception. Jejunojejunal and retrograde jejunoduodenogastric intussusception are well-documented complications of PEG tube placement. Here we describe the case of a 25-year-old female who was diagnosed with anterograde gastroduodenal intussusception with the PEG tube acting as a lead point. Our case is unique as, to the best of our knowledge, there are no documented cases of PEG tube-related anterograde gastroduodenal intussusception. The reported patient was found to have extensive gastric pneumatosis and portal venous gas concerning for acute ischemia. Such cases warrant immediate surgical intervention. However, in our case, the patient's family opted for comfort care measures.

This report analyzes and examines a hypothesis for finding a method to optimize thelength of the delubrication process time based on a total charge weight. The work hasfocused on the holding time for delubrication and the total charge weight.An important step in the manufacturing chain of cutting tools is when the greenbodies undergo the sintering process. Today, the delubrication step has the sameprocess time independent of the total charge weight. An implementation of a methodto adjust the delubrication process time would give more consistent quality of thecutting tool´s internal characteristics but also reduce the time course of the sinteringprocess. In the present project two methods for this goal were tested, thedevelopment of an algorithm and a weight interval subdivision with associateddelubrication process times.During delubrication a pressure increase is observed due to the decomposition of thePEG in the powder mixture. Previously, a larger total charge weight both increasedthe magnitude of the pressure increase and prolonged the time this increase took toreturn to the background pressure level. Earlier analysis of historical process datashowed indications of the possibility of developing an algorithm between total chargeweight and the time period defined by the time remaining for the delubricating stageafter the pressure increase has returned to its base level. This algorithm could thenbe implemented in production and lead to a charge weight adjusted delubricationprocess time, i.e. larger charge weights will need a longer delubricating period.A second method, involving a weight interval subdivision with specific associateddelubrication process times, was developed and a test was performed to determinewhether these ranges affected the quality of the sintering process.The results from the tests and the analysis of historical process data led to theconclusion that the hypothesis of dependence between the delubrication process timeand the total charge weight was not justified for the process investigated. Throughregression analysis it was found that the delubrication process did not dependsignificantly on the charge weight.The work resulted in a modification so that the delubrication process time couldtheoretically be shortened by approximately 60 minutes for the investigated processindependent of the total charge weight. Further analysis and tests are needed to findthe most optimal time reduction of the delubrication process without negativelyaffecting the internal properties of the inserts. / AB Sandvik Coromant är globalt marknadsledande tillverkare av hårdmetallskär. Dessa skäranvänds inom industrin för metallbearbetning vid svarvning samt fräsning och kräver en högsåväl som jämn kvalitet under tillverkningsprocessen.Man utgår från att blanda råvaror som volframkarbid och kobolt tillsammans med andra ämnensom ger skären deras önskade egenskaper. Hårdmetallpulvret pressas sedan i formar under etthögt tryck för att formas till den önskade geometrin.För att pulvret ska bakas samman och bli till hårdmetallskär så genomgår de en så kalladsintringsprocess som innebär att skären värms upp till höga temperaturer efter specifika receptoch beroende av vilken pulverblandning de består av. Första stadiet i sintringsprocessen är dåpressbindemedlet PEG (polyetylenglykol)drivs av från skären. Det är viktigt att all PEG drivsbort och under rätt förutsättningar för att skären ska få de egenskaper som önskas. Om dennaprocess rubbas får man en ojämn avdrivning som leder till att skären får bl.a. ojämna kolhalter,ökad porositet, vilket i slutändan leder till kvalitets problem.En hypotes som funnits c:a tio år tillbaka är att längden på denna avdrivningstid ska kunnaanpassas utifrån hur mycket en ugns last väger, d.v.s. en lättare last ska kunna ha en kortareavdrivningstid än en tyngre utan att kvalitén på hårdmetallskären ska påverkas. Enanpassningsbar avdrivningstid skulle i sådana fall leda till förkortad bearbetningstid och enjämnare kvalitet på hårdmetallskären.Genom att analysera historiska processdata för ett år tillbaka, hos en utvald ugn, undersöktes omhypotesen stämde. Utifrån dessa data togs en matematisk ekvation fram som beskriver hurlängden på avdrivningen beror av ugnslasten. Det testades även en enklare metod med att enbartdela in tre teoretiska viktintervall med tre respektive förprogrammerade avdrivningslängder.Utifrån analys av diagram samt praktiska testkörningar kunde slutsatsen dras att ett sådantmatematiskt samband inte längre var gångbart genom att ugnarna har genomgått regelbundnaombyggnationer sedan hypotesen för tio år sedan formulerades. En enklareviktintervallsindelning kan användas i produktionen men skulle vara onödig då arbetet ändåresulterade i att hålltiden för avdrivningssteget bör kunna kortas ned approximativt 60 minuter förviktiga produktionssteg oberoende av den totala lastvikten.

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In der vorliegenden Studie wurden 220 Patientinnen und Patienten prospektiv 1 Jahr lang nach der Anlage einer PEG-Sonde verfolgt. Die Studie sollte der Frage nachgehen, welche Patienten bzw. welche Indikationsgruppen in welchem Umfang von einer PEG-Anlage kurz- oder langfristig profitieren. Außerdem wurde die Zufriedenheit der Patienten, ihrer Angehörigen, Betreuer und Hausärzte sowie auf den Einfluss einer PEG-Anlage und der Sondenernährung auf die Lebensqualität der Betroffenen untersucht. Die Befragung wurde über strukturierte Telefoninterviews nach 7 Tagen, 4 Wochen und dann im Abstand von jeweils 3 Monaten bis abschließend ein Jahr nach Sondenanlage durchgeführt. Die Gesamtheit der Patienten setzte sich zu 41% aus Frauen und 59% aus Männern zusammen. Das Durchschnittsalter lag bei 72 Jahren, die Altersspanne bewegte sich zwischen 39 und 97 Jahren. Es zeigte sich eine außergewöhnlich hohe Zufriedenheit aller Befragten mit der PEG-Sonde und deren Auswirkung auf die Lebensqualität. 95,7% der befragten Patienten beurteilten ihre Zufriedenheit mit der PEG als sehr gut oder gut. Der Grad der Zufriedenheit war auch bei den Angehörigen, Pflegekräften und Ärzten sehr hoch: 94%, 95,2% und 92% bewerteten die PEG mit sehr gut/ gut. Die wenigen negativen Beurteilungen basierten im Wesentlichen auf Komplikationen, die in Verbindung mit der Sondenernährung auftraten, und auf dem Hinterfragen der Notwendigkeit der PEG-Anlagen. Unterschiede zwischen den einzelnen Indikationsgruppen gaben die Befragten mit einer Ausnahme nicht an. Während Angehörige und Pflegekräfte ihre hohe Zustimmung zur PEG auch bei den Demenzkranken zum Ausdruck brachten (100%, bzw. 95% sehr gute/gute Bewertung), lassen die Hausärzte in dieser Indikation gewisse Vorbehalte erkennen. 9,1% vergaben die Noten mangelhaft/ungenügend und weitere 13,6% die Bewertung befriedigend/ausreichend. Sie begründen ihre Kritik mit ethischen und medizinischen Überlegungen. Zusammenfassend bestätigt sich die PEG in dieser prospektiven Studie als sichere und effektive Maßnahme zur enteralen Ernährung. Die Indikationsstellung darf nicht nur den Erhalt oder die Steigerung des Körpergewichtes berücksichtigen, sondern sollte auch die Aspekte wie Komorbiditäten, Prognose und nicht zuletzt Allgemeinzustand und Lebensqualität der Patienten beachten. Nach einer PEG-Anlage ist die allgemeine Zufriedenheit bei Patienten Angehörigen, Pflegekräften und Ärzten fast ausnahmslos sehr hoch. / Summary In the present study, 220 patients were prospectively followed for 1 year after implantation of a PEG tube. The study aimed to investigate which patients or which groups of indications to what extent of a PEG placement short or long-term benefit. In addition, the satisfaction of patients, their relatives, carers and GPs and was examined for the influence of PEG placement and tube feeding on the quality of life of those affected. The survey was conducted through structured telephone interviews after 7 days, 4 weeks and then once every 3 months until finally one year after the PEG placement. The totality of the patient included 41% women and 59% men. The average age was 72 years, the age span moved 39-97 years. There was an exceptionally high level of satisfaction of respondents with the PEG tube and their effect on the quality of life. 95.7% of patients surveyed rated their satisfaction with the PEG as very good or good. The degree of satisfaction was very high even with the relatives, nurses and doctors: 94%, 95.2% and 92% rated the PEG with very good / good. The few negative assessments based substantially on complications occurring in connection with the tube feeding, and on the questioning of the need for PEG-systems. Differences between the indication groups gave the respondents except one not to. While relatives and carers their high approval for PEG even in people with dementia to express applied (100%, or 95% excellent / good rating), the GPs reveal certain reservations in this indication. 9.1% gave the marks deficient / insufficient and further 13.6% rating the satisfactory / sufficient. They base their criticism with ethical and medical considerations. In summary, the PEG confirmed in this prospective study as a safe and effective measure for enteral nutrition. The indication must be considered not only to maintain or increase in body weight, but should also refer to the aspects such as comorbidities, prognosis, and not least general condition and quality of life of patients. After a PEG placement the satisfaction in relatives of Patients, in nurses and doctors is almost invariably very high.

<p>Problemformulering: Patienters upplevelser av att nutrieras via gastrostomi eller parenteral nutrition (PN) är ett förbisett område. Det är viktigt att sjuksköterskan har en helhetssyn på patienten för att kunna ge god omvårdnad. Syftet med litteraturstudien var att beskriva patienters upplevelser av att nutrieras i hemmet via gastrostomi eller PN. Metoden var en systematisk litteraturstudie, där elva artiklar bearbetades och analyserades utifrån problemområdet. Resultat och Konklusion: När patienter behandlades i hemmet med antingen gastrostomi eller PN förändrades det dagliga livet för dem. Patienterna upplevde både positiva och negativa effekter av att nutrieras i hemmet. Det positiva med behandlingarna var enligt patienterna att de blev välnutrierade och att behandlingen räddade deras liv. Det negativa med behandlingarna var att de kunde ge fysiska, psykiska och sociala begränsningar. Trots de negativa effekterna upplevde patienterna att de positiva effekterna av behandlingen övervägde de negativa. Implikation: Det finns behov av ytterligare forskning inom området för att sjuksköterskor ska få bättre kunskap om patienters upplevelser av att nutrieras via gastrostomi och PN.</p>

The generation and propagation of fluorescence light within biological tissue offers the potential for biomedical diagnostics and analyte sensing. Arising from an exogenous fluorescent dye injected as a contrast agent or immobilized in a polymer implant, the fluorescent decay kinetics can be sensitive to the tissue??s biochemical environment, providing quantitative in vivo information of the confined tissue site. The impact of light propagation and decay kinetics upon the measured signals is important for consideration, simply because tissue scatters light, giving rise to nanosecond photon time-of-flights that are comparable to fluorescence relaxation kinetics. The goal of this study is to develop a time-dependent model describing (i) the generation of fluorescence from dyes exhibiting multi-exponential or more complex kinetics and (ii) its propagation in scattering media. In the preliminary study, fluorescence lifetime spectroscopy is investigated in tissue-like scattering solution. Two fluorescent dyes, 3,3-diethylthiatricarbocyanine iodide (DTTCI) and Indocynanine Green (ICG), which exhibit distinctly different lifetimes and each exhibits single-exponential decay kinetics, were employed. Measurements of phase-modulation as a function of modulation frequency were made at varying concentration ratios of the two dyes to experimentally simulate fluorescence multi-exponential decay kinetics in non-scattering and scattering solutions. The results suggest that frequency-domain measurements of fluorescent decay kinetics along with models of light propagation may be enhanced by scatter in order to probe kinetics more sensitively than in non-scattering solutions. The next study involved fluorescence lifetime sensing in scattering and non-scattering solutions with a pH sensitive dye, Carboxy Seminaphthofluorescein-1 (C-SNAFL-1), which is known to exhibit multi-exponential decay kinetics. The results demonstrate accurate pH sensing in scattering solution via fluorescence kinetics using a simplified propagation model incorporating an average lifetime. Finally, fluorescence lifetime sensing in immobilized systems were investigated. C-SNAFL-1 was immobilized in poly(ethylene glycol) (PEG) microparticles that were immersed in buffered polystyrene solutions. The results demonstrate the ability to perform pH sensing with fluorescence lifetime without the confounding effect of fluorophore loading or the use of 'reference' measurement within multiply scattering systems. In addition, the stability of the immobilized fluorescence sensor and the reliability of fluorescence lifetime measurement verify the prospect of this technology for implantable purposes.

Problemformulering: Patienters upplevelser av att nutrieras via gastrostomi eller parenteral nutrition (PN) är ett förbisett område. Det är viktigt att sjuksköterskan har en helhetssyn på patienten för att kunna ge god omvårdnad. Syftet med litteraturstudien var att beskriva patienters upplevelser av att nutrieras i hemmet via gastrostomi eller PN. Metoden var en systematisk litteraturstudie, där elva artiklar bearbetades och analyserades utifrån problemområdet. Resultat och Konklusion: När patienter behandlades i hemmet med antingen gastrostomi eller PN förändrades det dagliga livet för dem. Patienterna upplevde både positiva och negativa effekter av att nutrieras i hemmet. Det positiva med behandlingarna var enligt patienterna att de blev välnutrierade och att behandlingen räddade deras liv. Det negativa med behandlingarna var att de kunde ge fysiska, psykiska och sociala begränsningar. Trots de negativa effekterna upplevde patienterna att de positiva effekterna av behandlingen övervägde de negativa. Implikation: Det finns behov av ytterligare forskning inom området för att sjuksköterskor ska få bättre kunskap om patienters upplevelser av att nutrieras via gastrostomi och PN.

Nafion has been the mostly used perfluorosulfonated proton exchange membrane (PEM) in fuel cell. Although a number of problems remain to be resolved on the application of Nafion as a PEM, a less expensive alternative PEM has not been found mainly because of its high proton conductivity. Therefore, much effort has been invested to modify it or find a better and inexpensive material. The exploration of the methods to counter degradation and aging of Nafion is also an important direction of research. In this work, the behavior of PEG in Nafion is investigated with solid state NMR spectroscopy. A series of samples with different PEG sizes and concentrations in Nafion was prepared and the variable temperature proton spectra and longitudinal relaxation times (T1) were measured on two spectrometers. Some interesting findings were made, e.g., the 1H chemical shift of water in concentrated PEG solution decrease while its T1 increase, the higher the concentration of PEG, the larger the increase (of water 1H chemical shift) or decrease (of water 1H T1). These findings provide valuable information on further improving the performance of Nafion in proton conductivity and durability.

There are two primary objectives of this dissertation research. The first objective was to prepare a library of inorganic-organic hydrogels from methacrylated star polydimethylsiloxane (PDMSstar-MA) and diacrylated poly(ethylene oxide) (PEO-DA) with tunable chemical and physical properties for use as tissue engineering scaffolds. These inorganic-organic hydrogels provide a useful platform to study the effect of scaffold properties on cell behavior in tissue culture. Twenty compositionally unique hydrogels were prepared by photo-crosslinking varing molecular weights (Mn) of PEO-DA (Mn = 3.4k and 6k g/mol) and PDMSstar-MA (Mn = 1.8k, 5k and 7k g/mol) at varying weight ratios (up to 20 wt% PDMSstar-MA). Introduction of PDMSstar-MA caused formation of discrete PDMS-enriched "microparticles" dispersed within the PEO hydrogel matrix. The swelling ratio, mechanical properties in tension and compression, non-specific protein adhesion and cytotoxicity of hydrogels were studied. The second objective was to prepare thermoresponsive nanocomposite hydrogels, which are mechanically robust and can remove adhered cells via thermal modulation. Such hydrogels may be useful as "self-cleaning" membranes for implanted biosensors to extend their lifetime and efficiency. These hydrogels are comprised of a poly(Nisopropylacrylamide) (PNIPAAm) hydrogel matrix and polysiloxane colloidal nanoparticles (~220 nm and 50 nm ave. diameter). Due to the low preparation temperature, the nanocomposite hydrogels exhibited a homogeneous morphology by SEM analysis. The volume phase transition temperature (VPTT, ~33 degrees C) of the nanocomposite hydrogels was not altered versus the pure PNIPAAm hydrogel, which is near body temperature. Generally, nanoparticles led to improve mechanical properties versus pure PNIPAAm hydrogels. When these nanocomposite hydrogels are heated above the VPTT, they become more hydrophobic. When they are reversibly switched from a water-swollen to a deswollen state, the change in surface properties, as well as swelling-deswelling, was effective upon the removal of adhered cells.

The generation and propagation of fluorescence light within biological tissue offers the potential for biomedical diagnostics and analyte sensing. Arising from an exogenous fluorescent dye injected as a contrast agent or immobilized in a polymer implant, the fluorescent decay kinetics can be sensitive to the tissue??s biochemical environment, providing quantitative in vivo information of the confined tissue site. The impact of light propagation and decay kinetics upon the measured signals is important for consideration, simply because tissue scatters light, giving rise to nanosecond photon time-of-flights that are comparable to fluorescence relaxation kinetics. The goal of this study is to develop a time-dependent model describing (i) the generation of fluorescence from dyes exhibiting multi-exponential or more complex kinetics and (ii) its propagation in scattering media. In the preliminary study, fluorescence lifetime spectroscopy is investigated in tissue-like scattering solution. Two fluorescent dyes, 3,3-diethylthiatricarbocyanine iodide (DTTCI) and Indocynanine Green (ICG), which exhibit distinctly different lifetimes and each exhibits single-exponential decay kinetics, were employed. Measurements of phase-modulation as a function of modulation frequency were made at varying concentration ratios of the two dyes to experimentally simulate fluorescence multi-exponential decay kinetics in non-scattering and scattering solutions. The results suggest that frequency-domain measurements of fluorescent decay kinetics along with models of light propagation may be enhanced by scatter in order to probe kinetics more sensitively than in non-scattering solutions. The next study involved fluorescence lifetime sensing in scattering and non-scattering solutions with a pH sensitive dye, Carboxy Seminaphthofluorescein-1 (C-SNAFL-1), which is known to exhibit multi-exponential decay kinetics. The results demonstrate accurate pH sensing in scattering solution via fluorescence kinetics using a simplified propagation model incorporating an average lifetime. Finally, fluorescence lifetime sensing in immobilized systems were investigated. C-SNAFL-1 was immobilized in poly(ethylene glycol) (PEG) microparticles that were immersed in buffered polystyrene solutions. The results demonstrate the ability to perform pH sensing with fluorescence lifetime without the confounding effect of fluorophore loading or the use of 'reference' measurement within multiply scattering systems. In addition, the stability of the immobilized fluorescence sensor and the reliability of fluorescence lifetime measurement verify the prospect of this technology for implantable purposes.