In this work, alternating current (AC) electric fields are used in combination with microfluidics to manipulate micro- and nano-sized particles and to probe the electrical characteristics of microchannels with potential application in portable diagnostics. This work was carried out as contribution to a collaborative research project involving researchers from chemistry, electrical engineering and mechanical engineering at the University of Victoria, in addition to researchers from the BC Cancer Deeley Research Centre. The manipulation of particles or cells within a microchannel flow is central to many microfluidic applications. In the context of diagnostics that utilize antibodies in serum, for example, the removal of cells from the sample is often required. Continuous removal of particles and cells is particularly critical in the case of flow-through nanohole array based sensing, as these serve as fine filters and thus are very susceptible to clogging. In this work, chevron shaped, interdigitated electrodes are used to produce dielectrophoretic forces in combination with hydrodynamic drag to displace particles from their corresponding streamlines to the center of a microchannel. Analytical and finite element modeling are used to provide insight into the focusing mechanism. Dielectrophoresis (DEP) also offers opportunities for particle manipulation in combination with porous media. In this preliminary work, the viability of dielectrophoresis tuned nano-particle transport in a nanohole array is investigated through analytical and numerical modeling. The effects of hydrodynamic drag and Brownian motion are considered in the context of applied voltage, flow rate and particle size. Preliminary flow-through tests are performed experimentally as proof of concept. The final contribution focuses primarily on external infrastructure that enables AC microfluidic diagnostics, with particular relevance to portable device applications and so-called point-of-care devices. Cell phones, and mp3 players are examples of consumer electronics that are easily operated and are ubiquitous in both developed and developing regions. Audio output (play) and input (record) signals are voltage-based and contain frequency and amplitude information. Audio signal based concentration, conductivity, flow rate, and particle detection measurements are demonstrated in a microfluidic platform.

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No. of bitstreams: 1 josemunizpazelijunior.pdf: 868943 bytes, checksum: 7c1afb9837b6e1d73d18f7ea10b1401f (MD5) Previous issue date: 2012-11-29 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A Doença Renal Crônica (DRC) é um problema de saúde pública mundial e o número de pacientes inscritos em programas de terapia de substituição de função renal vem crescendo progressivamente. A morbimortalidade dos pacientes com DRC é impressionante e se deve principalmente a doença cardiovascular. A remoção inadequada de líquidos durante a hemodiálise é um dos principais fatores responsáveis por esta evolução desfavorável. A hipervolemia crônica leva a hipertensão, hipertrofia ventricular esquerda, congestão pulmonar e aumenta as taxas de hospitalização e mortalidade. A hipovolemia, por outro lado, se associa com náuseas, vômitos, diminuição da qualidade de vida, perda da função renal residual, trombose do acesso venoso e redução da adequação da diálise, devido às frequentes interrupções das sessões de diálise. O peso seco, definido como o menor peso atingido pelo paciente no final das sessões, quando a maior parte do excesso de líquido acumulado tenha sido removido, ainda é avaliado clinicamente, mas tem fraca correlação com a verdadeira volemia. Apesar de não podermos contar com método que seja “padrão-ouro”, devido às limitações na acurácia e aplicabilidade, várias exames complementares tem sido estudados e validados para a determinação mais precisa da volemia em pacientes dialíticos, incluindo a avaliação ultrassonográfica da veia cava inferior (VCI). O alto custo dos ecocardiógrafos e a necessidade de um ecocardiografista para operá-los têm impedido a disseminação da ultrassonografia para avaliar a VCI e, consequentemente, a volemia. Nós hipotetizamos que a classificação volêmica baseada na determinação do diâmetro expiratório da VCI indexado pela superfície corpórea (DVCIi) e o índice de colabamento inspiratório da VCI (ICVCI) realizada por médico nefrologista, sem especialização em ultrassonografia, é similar àquela obtida no mesmo exame realizado por médico especialista em ecocardiografia utilizando um ecocardiógrafo padrão (ECO) ou um equipamento de ultrassom convencional (US). Neste estudo transversal, um ecocardiografista experiente e um nefrologista sem especialização formal em ultrassonografia avaliaram consecutivamente o DVCIi e o ICVCI de 52 pacientes, durante as sessões de hemodiálise. No protocolo I, o nefrologista usou o US e o cardiologista usou o ECO; no protocolo II os aparelhos foram invertidos entre os pesquisadores. Em ambos os protocolos, os coeficientes de Pearson e kappa foram utilizados para avaliar a correlação entre as variáveis contínuas e categóricas, respectivamente. A concordância entre os examinadores foi avaliada pelo Bland-Altman. Obtivemos imagens de boa qualidade da VCI em 96% dos pacientes. As avaliações do DVCIi apresentaram forte correlação em ambos os protocolos (r= 0,88 e 0,84, nos protocolos I e II, respectivamente). A correlação entre as classificações volêmicas foi excelente no protocolo I (kappa = 0,82 e 0,93 pelo DVCIi e ICVCI, respectivamente) e substancial no protocolo II (kappa = 0,77 e 0,75 pelo DVCIi e ICVCI, respectivamente). A concordância entre os examinadores pelo gráfico de Bland-Altman das avaliações de DVCIi foi também muito boa em ambos os protocolos. Nefrologistas sem especialização formal em ultrassonografia usando um US podem avaliar a volemia de pacientes dialíticos através da ultrassonografia de VCI. O mesmo equipamento que já equipa as clínicas de diálise e é utilizado para diversas outras finalidades, como biópsia renal guiada, acesso venoso guiado, avaliação do trato urinário, mapeamento vascular e estudo das fístulas e enxertos, pode ser utilizado para determinação do peso seco. Esperamos assim, reduzir custos e melhorar a qualidade do atendimento dos pacientes dialíticos, através da disseminação da avaliação ultrassonográfica da VCI. / Chronic kidney disease has emerged as a public health problem of substantial proportions, and the number of patients who require renal replacement therapy has been growing over the years. The mortality rate of patients with ESRD remains amazing, and a large part of this mortality is due to cardiovascular disease. The inadequate fluid removal during hemodialysis is a major factor responsible for this unfavorable development. The hypervolemia leads to chronic hypertension, left ventricular hypertrophy, pulmonary congestion and increased rates of hospitalization and mortality. The hypovolemia, moreover, is associated with nausea, vomiting, diminished quality of life, loss of residual renal function, access thrombosis and reduction of dialysis adequacy, due to frequent interruptions of dialysis sessions. Clinically estimated dry weight, defined as the lowest post-dialysis weight at which most excess body fluid will have been removed, is widely used but is poorly predictive of volemic status. Despite the lack of gold standards, related to limitations in accuracy and feasibility, fluid volume has been assessed by using various tools, including ultrasonographic evaluation of the inferior vena cava (IVC). We sought to determine whether a nephrologist with limited ultrasound training can accurately assess the IVC in patients undergoing haemodialysis compared with a cardiologist by using a regular ultrasound system (RUS) or a full cardiovascular ultrasound system (CVUS). In a cross-sectional study, an experienced cardiologist and a nephrologist without formal ultrasound training consecutively measured the indexed IVC expiratory diameter (VCDi) and IVC collapsibility index (IVCCI) of 52 patients during haemodialysis sessions. In protocol I, the nephrologist used an RUS and the cardiologist used a CVUS; in protocol II, the machines were interchanged. In both protocols, Pearson and kappa correlation coefficients were used to evaluate the 11 interobserver correlation of continuous and categorical data, respectively. The interexaminer agreement was determined by the Bland–Altman method. High-quality IVC images were obtained in 96% of the patients. The VCDi measurements showed strong correlation in both protocols (r = 0.88 and 0.84 in protocols I and II, respectively). The volaemic classifications were excellent in protocol I (kappa = 0.82 and 0.93 by the VCDi and IVCCI, respectively) and substantial in protocol II (kappa = 0.77 and 0.75 by the VCDi and IVCCI, respectively). The interexaminer agreement on the VCDi measurements was also very good in both protocols. Ultrasound evaluation of the IVC can be performed by nephrologists without formal training using an RUS to assess volaemic status in patients undergoing haemodialysis. The same equipment that is already being used in dialysis clinics for several other purposes, such as guided renal biopsy, guided venous access, evaluation of the urinary tract, vascular mapping and study of fistulas and grafts can be used to determine the dry weight. We hope reduce costs and improve the quality of care for dialysis patients, through the spread of ultrasound evaluation of the IVC.

Abstract Point-of-care testing (POCT) is defined as laboratory tests performed outside the traditional clinical laboratory close to the patient at the time and place where care is received, such as hospitals and healthcare centers. The main reason for the use of POCT is that they provide rapid results and enable prompt interventions, with hopefully improved patient outcomes. All phases of laboratory procedure are included in POCT offering many opportunities for errors, which can influence on patients’ treatment. The measurements are more often performed by nurses than by laboratory professionals. These nurses have different kinds of professional backgrounds, e.g. public health nurses, registered and practical nurses, with minimal or no knowledge of laboratory procedures. The aim of the study was to develop a two-step training and management strategy for nurses to do POCT in hospital and primary healthcare center. In accordance with the strategy, with reasonable investment of laboratory resources, designated contact nurses were first trained in POCT by laboratory professionals, after which the contact nurses trained other nurses in POCT their respective units. Blood glucose, the most common point-of-care (POC) test, was chosen as an example to investigate the influence of training on the quality of the test performed by nurses. The quality of blood glucose measurements was studied by analyzing the control results obtained by nurses and biomedical laboratory scientists (BLSs). The study participants included nurses who were either untrained or trained to do POCT by using the developed interactive two-step training strategy. In conclusion, the nurses trained by using interactive two-step strategy achieved near-similar quality of blood glucose measurements as BLSs. The good quality of glucose measurements, once achieved by training, was also sustained in the long-term. / Tiivistelmä Määritelmän mukaan vieritutkimuksiksi kutsutaan laboratoriotutkimuksia, joita tehdään perinteisen laboratorion ulkopuolella, tarvittaessa lähellä potilasta sairaalassa ja perusterveydenhuollon alueella. Pääasiassa vieritutkimuksia tehdään silloin kun tulos halutaan saada nopeasti ennen hoitopäätöstä tai tulevaa toimenpidettä. Vieritutkimusten tekeminen sisältää kaikki laboratoriotyön vaiheet ja jokaisessa vaiheessa on mahdollisuus tehdä virheitä, jotka voivat vaikuttaa potilaiden hoitoon. Laboratorioammattilaisten sijaan määrityksiä tekevät yhä useammin hoitajat sairaalan eri yksiköissä ja perusterveydenhuollon alueella. Näillä hoitajilla on erilainen ammatillinen peruskoulutus, kuten perushoitajan tai sairaanhoitajan koulutus, ja heillä on vähän tai ei ollenkaan tietoa laboratoriomenetelmistä. Tämän tutkimuksen tarkoituksena oli kehittää hoitajien vieritutkimustoimintaan koulutus- ja hallintomalli, joka toimisi sekä sairaalassa että terveyskeskuksessa. Strategian perusteena oli käyttää suhteellisen vähän laboratorioresursseja ja päästä silti hyvään laadulliseen lopputulokseen. Strategiaksi valittiin kaksiportainen, vuorovaikutteinen koulutusmalli, jossa laboratorioammattilaiset kouluttivat sairaalan ja perusterveydenhuollon yksiköissä ns. yhdyshenkilöt, jotka puolestaan kouluttivat edelleen oman yksikkönsä muut hoitajat tekemään vieritutkimuksia. Veren glukoosimääritys, joka on yleisin vieritutkimus, valittiin esimerkkitutkimukseksi tutkittaessa koulutuksen vaikutusta hoitajien tekemien vieritutkimusten laatuun. Veren glukoosimääritysten laatutasoa tutkittiin analysoimalla hoitajien ja laboratoriohoitajien tekemien kontrollinäytteiden tuloksia. Tutkimukseen osallistui hoitajia, jotka oli koulutettu kehitetyllä vuorovaikutteisella kaksiportaisella koulutusstrategialla vieritutkimusten tekemiseen, sekä hoitajia, jotka eivät olleet saaneet vastaavaa koulutusta. Koulutusmallin avulla hoitajien suorittamien vieritutkimusten laatu parani ja he saavuttivat lähes saman laatutason kuin laboratoriohoitajat. Hyvä, kerran saavutettu glukoosimääritysten laatutaso säilyi myös pitkällä aikajaksolla.

No description available.

A aplicação da tecnologia da informação na Saúde tem dado um suporte à prestação do cuidado ao paciente com mais qualidade e propiciado a adesão de processos mais lineares, eficientes e seguros. Apresenta-se, nesta Tese, o desenvolvimento e a avaliação de um módulo, denominado Sistematização da Assistência de Enfermagem (Módulo SAE) que, incorporado ao Sistema de Informação Hospitalar (SIH) do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, seja capaz de automatizar as ações envolvidas no Processo de Enfermagem, identificando os benefícios e as limitações decorrentes da adoção de um sistema informatizado. A metodologia foi desenvolvida em duas etapas, uma para possibilitar o desenvolvimento e a implantação do Módulo SAE, outra para avaliar a contribuição para o enfermeiro e sua aplicabilidade no ponto de cuidado do paciente (PCP). A primeira etapa constou da organização das funcionalidades do Processo de Enfermagem no Módulo SAE. Como resultado, um conjunto de funcionalidades, estruturadas ou em texto livre, foi definido e compreende: coleta dos dados do paciente e exame físico, diagnóstico e evolução de enfermagem, intervenções e prescrição de enfermagem. O uso do Módulo SAE foi realizado em paralelo com a SAE manuscrita durante 6 meses e aprovado por 28 enfermeiros. Após esta fase, 50 outros enfermeiros foram treinados e utilizaram o Módulo SAE no seu trabalho diário, durante 15 meses, finalizando a primeira etapa com 78 enfermeiros treinados. A segunda etapa constou de uma pesquisa com os enfermeiros que responderam dois questionários para avaliar o uso do Módulo SAE, por meio de duas formas diferentes de acesso, uma delas por computador fixo no posto de enfermagem e a outra, um computador móvel desenvolvido no próprio hospital, para levar o sistema ao PCP. Para obter melhores resultados na pesquisa, as características pessoais desses enfermeiros foram analisadas e comparadas. Da homogeneidade dos resultados foram selecionados 42 profissionais aptos para usarem o computador móvel, dos quais, 25 participaram. Mediante os resultados analíticos e estatísticos, concluiu-se que o Módulo SAE incorporado no SIH contribuiu para o enfermeiro obter maior legibilidade e segurança no registro eletrônico, tanto por acesso fixo como por acesso móvel. A comparação entre as formas de acesso para a formulação do diagnóstico e da prescrição de enfermagem demonstrou resultado positivo a despeito das diferenças estatisticamente significantes (teste não paramétrico de Wilcoxon). Além disso, o registro eletrônico permitiu ao enfermeiro dispor de maior tempo para a assistência direta ao paciente (fixo 84% e móvel 60%). Quanto à facilidade do uso do computador móvel no PCP, as respostas positivas (84%) indicaram a diminuição do tempo gasto para a atualização da prescrição de enfermagem. / The application of information technology in health has given support to the patient care with more quality and provides more linear, efficient and safe processes. This thesis presents the development and evaluation of a module called Systematization of Nursing Care (SAE Module) that when incorporated into the Hospital Information System of the Heart Institute of the University of Sao Paulo Medical School is able to automate the actions involved in Nursing Process. The identification of the benefits and limitations resulting from the adoption of an information system are also described. The methodology was developed in two stages: the first involved the development and deployment of the SAE Module, and the second involved the assessment of the nursing computerized system to the nurse and its application at the point of patient care (PCP). The first step included the organization of the nursing process in the SAE Module. As a result, a set of features, structured or free texts were defined and comprised: collection of patient data and physical examination, nursing diagnosis and evolution, nursing interventions and prescription. The use of SAE Module was done in parallel with the SAE handwritten during 6 months and approved by 28 nurses. After this stage, 50 other nurses were trained and used it in their daily work for 15 months, finalizing the first step with 78 trained nurses. The second step involved the evaluation of nurses who replied two forms to evaluate SAE Module usage through two different ways of access, one using a fixed computer in the nursing counter and the other using a mobile computer, developed in the hospital in order to bring the system to the PCP. In order to obtain the best results from the evaluation, personal characteristics of these nurses were reviewed and compared. Fortytwo nurses were selected according to the homogeneity of the results, out of which 25 participated in the evaluation. The analytical and statistical results lead to the conclusion that the SAE Module incorporated into SIH contributed to the nurse to get more readability and security from patient electronic records for both fixed and mobile access. The comparison between the two forms of access to the formulation of nursing diagnosis and prescription has shown positive results despite statiscally significant differences (nonparametric Wilcoxon test). In addition, it was observed that the patient electronic record (fixed 84% and 60%) allowed an increase of the nurse´s time in the direct patient care. Regarding the use of a mobile computer in the PCP, the positive responses (84%) indicated a reduction in the time spent to update the nursing prescription.

Soft materials have gained increasing prominence in science and technology over the last few decades. This shift from traditional rigid materials to soft, compliant materials have led to the emergence of a new class of devices which can interact with humans safely, as well as reduce the disparity in mechanical compliance at the interface of soft human tissue and rigid devices.<br><br>One of the largest application of soft materials has been in the field of flexible electronics, especially in wearable sensors. While wearable sensors for physical attributes such as strain, temperature, etc. have been popular, they lack applications and significance from a healthcare perspective. Point-of-care (POC) devices, on the other hand, provide exceptional healthcare value, bringing useful diagnostic tests to the bedside of the patient. POC devices, however, have been developed for only a limited number of health attributes. In this dissertation I propose and demonstrate wireless, wearable POC devices to measure and communicate the level of various analytes in and the properties of multiple biofluids: blood, urine, wound exudate, and sweat.<br><br>Along with sensors, another prominent area of soft materials application has been in actuators and robots which mimic biological systems not only in their action but also in their soft structure and actuation mechanisms. In this dissertation I develop design strategies to improve upon current soft robots by programming the storage of elastic strain energy. This strategy enables us to fabricate soft actuators capable of programmable and low energy consuming, yet high speed motion. Collectively, this dissertation demonstrates the use of soft compliant materials as the foundation for developing new sensors and actuators for human use and interaction.

Paper-fluidic devices are a popular platform for point-of-care diagnostics due to their low cost, ease of use, and equipment-free detection of target molecules. The most common example is the lateral flow assay, in which samples are added to a paper membrane and a colorimetric indicator provides a binary signal indicating whether the molecule of interest is present. A novel lateral flow assay was developed to detect a protein biomarker for early stage cervical cancer. Cervical cancer can be cured if detected and treated at an early stage, but approximately 90% of cervical cancer deaths occur in low and middle-income countries due to lack of accessible testing. Methods for detecting the biomarker, valosin-containing protein (VCP), were optimized using enzymatic and gold nanoparticle dot blots, then lateral flow assays were developed and validated using purified VCP and cervical cancer HeLa cells. Future validation with patient tissue samples will permit translation of this device to testing clinics in low-resource areas. Despite advantages for use in resource limited settings, lateral flow assays are limited by their inability to perform more complex or multi-step processes, such as nucleic acid amplification or enzymatic signal enhancement. Thermally actuated wax valves are one mechanism that provides complete control over fluid obstruction and release. To better understand how wax valves can be used in fully automated, self-contained lateral flow assays, different sizes and geometries of valves were tested to investigate their effects on actuation time, flow rate, and flow pattern. Another limitation in the understanding of lateral flow assays is the lack of experimental data describing the microscale flow within the pores of the paper membrane that drives the biophysical reactions in the assay. Mathematical models can be designed to explain macroscopic phenomena, but so far, no literature has compared microfluidic models to microfluidic data. To quantify microfluidic properties within lateral flow assays, fluorescent nanoparticles were imaged flowing through different areas of the membrane and their velocity was quantified using micro-particle image velocimetry (µPIV). Scanning electron microscope images were used to verify that this experimental model was reasonable for describing microfluidic properties of the lateral flow assay. Altogether, this document investigates how developing lateral flow assays for cervical cancer detection can save lives by improving the accessibility of an early diagnosis, and how more robust lateral flow assay characterization can expand their applicability to a broad range of detection processes.

No description available.

Mit dieser Arbeit wurde erstmalig eine qualitative und quantitative Analyse zum Status quo der studentischen US-Ausbildung im deutschsprachigen Raum durchgeführt. Eingeschlossen wurden alle medizinischen Fakultäten (n=44) Deutschlands, Österreichs und der deutschsprachigen Schweiz, die im Dezember 2015 auf den Webseiten des MFT und Thieme.de verzeichnet waren [3, 70]. Ein standardisierter Fragebogen mit insgesamt 32 Fragen beleuchtete folgende Aspekte der studentischen US-Ausbildung: 1. Allgemeine Angaben 2. Organisation 3. Ressourcen 4. Überprüfung des Lernerfolgs 5. Evaluation Der Fragebogen wurde an alle LeiterInnen der jeweiligen fakultätseigenen Skillslabs verschickt mit der Bitte nach Beantwortung bzw. Weiterleitung an die US-Verantwortlichen der Fakultät. Die Befragung begann im Dezember 2015 und endete im Mai 2016. Die finale Rücklaufquote betrug 64% (28/44). Die statistische Auswertung erfolgte mit SPSS® 20, IBM Chicago. Die Mehrzahl der medizinischen Fakultäten im deutschsprachigen Raum bieten US-Kurse an. Allerdings ist die studentische US-Ausbildung vielerorts heterogen organisiert mit eher zu kurzer praktischer Übungszeit und zu hohem Studierenden-Lehrenden-Verhältnis. Damit US als bereicherndes Lehrmittel sinnvoll in das bereits überfüllte Curriculum des Humanmedizinstudiums integriert werden kann, sind minimale Standards notwendig. Basierend auf den Ergebnissen dieser Studie und einer Literaturrecherche schlagen der Autor und die Koautoren ein mögliches Rahmenwerk und Meilensteine auf dem Weg zu einem longitudinalen US-Curriculum im Humanmedizinstudium vor.:A Abkürzungsverzeichnis 3 B Einführung 4 1 Ultraschall als Grundkompetenz zukünftiger ÄrztInnen 4 2 Ultraschall als integraler Bestandteil des Humanmedizinstudiums 7 2.1 Ultraschall als Lehrmethode in der Makroanatomie und Physiologie 7 2.2 Ultraschall als Erweiterung der körperlichen Untersuchung 7 2.3 Wesentliche Inhalte publizierter Ultraschall-Curricula 8 2.4 Peer-Teaching und Studierendeninitiativen 10 2.5 Rahmencurriculum für die studentische Ultraschallausbildung 11 3 Ableitung der Rationale für die publizierte Studie 13 C Originalpublikation 14 1 Allgemeine Angaben 14 2 Skizzierung der publizierten Studie 15 3 Formatierte Originalpublikation 16 D Zusammenfassung 28 1 Hintergrund und Durchführung 28 2 Ergebnisse und Auswertung 29 E Literaturverzeichnis 33 F Anlagen 41 1 Anschreiben 41 2 Fragebogen 42 G Darstellung des eigenen Beitrags 52 H Verzeichnis über die wissenschaftlichen Veröffentlichungen und Vorträge 53 I Lebenslauf 54 J Erklärung über die eigenständige Abfassung der Arbeit 56 K Danksagung 57

Trauma-induced coagulopathy (TIC) is a recently described condition which traditionally has been diagnosed by the common coagulation tests (CCTs) such as prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), platelet count, and fibrinogen levels. The varying sensitivity and specificity of these CCTs have led trauma coagulation researchers and clinicians to use Viscoelastic Tests (VET) such as Thromboelastography (TEG) to provide Targeted Thromboelastographic Hemostatic and Adjunctive Therapy (TTHAT) in a goal directed fashion to those trauma patients in need of hemostatic resuscitation. This review describes the utility of VETs, in particular, TEG, to provide TTHAT in trauma and acquired non-trauma-induced coagulopathy.