Cerebrospinal fluid (CSF) fills a system of cavities at the centre of the brain, known as ventricles, and the subarachnoid space surrounding the brain and the spinal cord. In addition, CSF is in free communication with the interstitial fluid of the brain tissue. Disturbances in CSF dynamics can lead to diseases that cause severe brain damage or even death. So-called infusion tests are frequently performed in the diagnosis of such diseases. In this type of test, changes in average CSF pressure are related to changes in CSF volume through infusion of known volumes of additional fluid. Traditionally, infusion tests are analysed with single compartment models, which treat all CSF as part of one compartment and balance fluid inflow, outflow and storage through a single ordinary differential equation. Poroelastic models of the brain, on the other hand, have been used to simulate spatial changes with disease, particularly of the ventricle size, on larger time scales of days, weeks or months. Wirth and Sobey (2008) developed a two-fluid poroelastic model of the brain in which CSF pressure pulsations are linked to arterial blood pressure pulsations. In this thesis, this model is developed further and simulation results are compared to clinical data. At first, the functional form of the compliance, which governs the storage of CSF in single compartment models, is examined by comparison of two different compliance models with clinical data. The derivations of a single-fluid and a two-fluid poroelastic model of the brain in spherical symmetry are laid out in detail and some of the parameters are related to the compliance functions considered earlier. The finite element implementation of the two-fluid model is described and finally simulation results of the average CSF pressure response and the pressure pulsations are compared to clinical data.

Les effets cardiovasculaires des alpha-2 agonistes, particulièrement importants chez les chiens, limitent leur utilisation en pratique vétérinaire. La perfusion à débit constant (PDC) de ces drogues, comme la médétomidine (MED) permettrait un contrôle plus précis de ces effets. Les effets hémodynamiques de plusieurs doses de MED en PDC ont été évalués chez le chien. Lors de cette étude prospective, réalisée en double aveugle, 24 chiens en santé, ont reçu de façon aléatoire une des 6 doses de MED PDC (4 chiens par groupe). Les chiens ont été ventilés mécaniquement pendant une anesthésie minimale standardisée avec de l’isoflurane dans de l’oxygène. Une dose de charge (DC) de médétomidine a été administrée aux doses de 0.2, 0.5, 1.0, 1.7, 4.0 ou 12.0 µg/kg pendant 10 minutes, après laquelle la MED PDC a été injectée à une dose identique à celle de la DC pendant 60 minutes. L’isoflurane a été administré seul pendant une heure après l’administration d’une combinaison d’ISO et de MED PDC pendant 70 minutes. La fréquence cardiaque (FC), la pression artérielle moyenne (PAM) et l’index du débit cardiaque (IC) ont été mesurés. Des prélèvements sanguins ont permis d’évaluer le profil pharmacocinétique. D’après ces études, les effets hémodynamiques de la MED PDC pendant une anesthésie à l’isoflurane ont été doses-dépendants. L’IC a diminué progressivement alors que la dose de MED augmentait avec: 14.9 (12.7), 21.7 (17.9), 27.1 (13.2), 44.2 (9.7), 47.9 (8.1), and 61.2 (14.1) % respectivement. Les quatre doses les plus basses n’ont provoqué que des changements minimes et transitoires de la FC, de la PAM et de l’IC. La pharmacocinétique apparaît clairement dose-dépendante. De nouvelles expériences seront nécessaires afin d’étudier l’utilisation clinique de la MED PDC. / The cardiovascular effects of alpha-2 agonists, particularly pronounced in dogs, limit their use in veterinary practice. The use of these drugs, namely medetomidine (MED), by constant rate infusion (CRI), could allow more precise control of the cardiovascular effects. The haemodynamic responses of MED CRI at several dosages in dogs were investigated. In a prospective, blinded study, 24 healthy beagles randomly received one of 6 MED CRI regimens (4 dogs per regimen). Dogs were mechanically ventilated to maintain stable low-level isoflurane (ISO) anaesthesia in oxygen. A loading MED infusion was administered at 0.2, 0.5, 1.0, 1.7, 4.0 or 12.0 µg•kg-1 for 10 min, followed by maintenance CRI for 60 min providing identical dose amounts for all dogs (total duration for MED and ISO: 70 min). Isoflurane was then administered alone for an additional hour. Heart rate (HR), mean arterial blood pressure (MAP), and cardiac index (CI) were recorded. Blood sampling was performed to establish pharmacokinetic profiles. Based on this study, the hemodynamic effects of MED CRI during ISO anaesthesia were found to be dose-dependent. Baseline CI decreased dose-dependently as MED dose increased by: 14.9 (12.7), 21.7 (17.9), 27.1 (13.2), 44.2 (9.7), 47.9 (8.1), and 61.2 (14.1) % respectively. The four lowest dosages created limited and transient changes in HR, MAP, and CI. Pharmacokinetics were dose-dependent. Further investigations for perioperative use are warranted.

The University of this interest and its library division is involved in a major transformation process, aiming to enhance the learning experience for students by modernizing learning spaces, enhancing the personalized learning, and extending support for faculty and student scholarship. One part of the transformation consist of rearranging the library space and its services and introducing a new media based faculty consisting media related career paths. During the investigation and analysis of the library, we have looked into a wide range of data including history of the library, strategic plan of the university academic technology blueprint, academic plan, the media program, reports on workshops and meeting held by the authority of library, etc. provided by the university. In order to encapsulate more information and insight, we have conducted a couple of meetings with the head of the library and the head of library IT. By considering the stakeholders’ interests, we examine the status quo and illustrate the situation in form of a Rich Picture. By means of the Soft Systems Methodology we try to identify potential relationships between the new media faculty and the library services and eventually finalized our examination by recommending additional value enhancing services. After rigorous analyzing all of the data, specifically strategic mission of the university and library, and the media program, we recommend to establish a Business Incubator, which will enhance core capabilities of a student including creativity , managerial, and analytical ability as well as provide essential guidance, supports, and tools to students to implement their idea. The suggested Business Incubator will act as a bridge between academic learning and the real world applications. Finally, we recommend specific services including market research and assistance, access to networking and funding information, center for research and development, and Entrepreneurship and innovating education forum, which will enhance digital capabilities of students/participants and fulfill some of the core strategic objectives of the library and the university as well. / <p>This specific study is about a report in the Informatics course 5IK501 during the school year of 2016/2017.</p>

Dans cette étude, la stabilité de préparations intraveineuses de cyclosporine (0.2 et 2.5 mg/mL dans NaCl 0.9% ou dextrose 5%) entreposées dans des seringues de polypropylène, des sacs de polypropylène-polyoléfine et des sacs de vinyle acétate d’éthylène a été évaluée. Une méthode HPLC indicatrice de la stabilité à base de méthanol a été développée et validée suite a des études de dégradation forcée. Les solutions évaluées ont été préparées de façon aseptique, puis entreposées à 25°C. La stabilité chimique a été évaluée par HPLC et la stabilité physique a été évaluée par inspection visuelle et aussi par diffusion dynamique de la lumière (DLS). Tous les échantillons sont demeurés stables chimiquement et physiquement dans des sacs de polypropylène-polyoléfine (>98% de cyclosporine récupérée après 14 jours). Lorsqu’entreposés dans des seringues de polypropylène, des contaminants ont été extraits des composantes de la seringue. Toutefois, aucune contamination n’a été observée après 10 min de contact entre la préparation de cyclosporine non-diluée et ces mêmes seringues. Les préparations de 2.5 mg/mL entreposées dans des sacs de vinyle acétate d’éthylène sont demeurés stables chimiquement et physiquement (>98% de cyclosporine récupérée après 14 jours). Toutefois, une adsorption significative a été observée avec les échantillons 0.2 mg/mL entreposés dans des sacs de vinyle acétate d’éthylène (<90% de cyclosporine récupéré après 14 jours). Une étude cinétique a démontré une bonne corrélation linéaire entre la quantité adsorbée et la racine carrée du temps de contact (r2 > 0.97). Un nouveou modèle de diffusion a été établi. En conclusion, les sacs de polypropylène-polyoléfine sont le meilleur choix; les seringues de polypropylène présentent un risque de contamination, mais sont acceptables pour un transfert rapide. Les sacs de vinyle acétate d’éthylène ne peuvent être recommandés à cause d’un problème d’adsorption. / In the present study, the stability of intravenous cyclosporine preparations (0.2 and 2.5 mg/mL in 0.9% sodium chloride injection or 5% dextrose injection) stored in polypropylene (PP) syringes, polypropylene–polyolefin (PP-PO) bags and ethylene vinyl acetate (EVA) bags was evaluated. A methanol-based high-performance liquid chromatography (HPLC) method was developed and validated to be stability-indicating by stress degradation tests. The test solutions were aseptically prepared and stored at 25 °C. Chemical stability was evaluated by HPLC assay. Physical stability was assessed by visual inspection and a dynamic light scattering (DLS) method. All samples were chemically stable (> 98% of recovered cyclosporine) and physically stable when stored in polypropylene–polyolefin bags for 14 days. When stored in polypropylene syringes, some impurities were leached. However, no leaching was detected when the syringes were exposed to undiluted intravenous cyclosporine for 10 minutes. The preparations of 2.5 mg/mL were chemically and physically stable as stored in ethylene vinyl acetate bags for a period of 14 days (> 98% of recovered cyclosporine), while significant cyclosporine adsorption occurred on the samples of 0.2 mg/mL (< 90 % of recovered cyclosporine) after 14 days. Kinetic study showed that good linear correlations were achieved by plotting the adsorption amount versus square root of contact time (r2 > 0.97). A novel diffusion model was established and successfully predicted long-term drug stability. In conclusion, polypropylene–polyolefin bags were the best choice; syringes were inferior because of leachables. However, they were safe for preparation and transferring undiluted intravenous cyclosporine. Ethylene vinyl acetate bags cannot be recommended due to cyclosporine adsorption.

Surfaces that exhibit a gradual change in their chemical and/or physical properties are termed as surface gradients. Based on the changes in properties they are classified either as physical or chemical gradients. Chemical gradients show variations in properties like polarity, charge, functionality concentration and have found potential applications in fields of biology, physics, biosensing, catalysis and separation science. In this dissertation, surface gradients have been prepared using controlled rate infusion (CRI). CRI is a simple method in which a surface gradient is formed by carrying out the infusion of organoalkoxysilane in a time-dependent fashion using a set infusion rate. Depending on concentration of silane, rate of infusion and time of infusion, the gradient profiles on surfaces can be varied and the surface chemistry of the substrate can be altered. Initial work in the dissertation focuses on demonstrating different gradient profiles and selectivity obtained using amine and/ or phenyl functionalized gradient stationary phases on thin layer chromatography (TLC) plates prepared by CRI. The presence of amine and phenyl on the surfaces were confirmed by X-ray Photoelectron Spectroscopy (XPS) and diffuse reflectance spectroscopy, respectively. The change in surface chemistry was demonstrated by changes in the selectivities of water and fat soluble vitamins. After successful preparation and characterization of single and multi-component stationary phase gradients for planar chromatography, single-component gradients were prepared for column chromatography (Silica monolithic columns). Similar to that observed for planar chromatography, the selectivity was evaluated from retention factors and was found to be different for a weak acid/weak base mixture. The results obtained showed the promising approach of using gradient stationary phases in column chromatography. This work was further extended to prepare amine and phenyl multi-component gradients on silica monolithic columns to investigate mixed-mode and synergistic effects. Finally, amine, phenyl and thiol gradients were also prepared on cellulose substrates, particularly water color paper, The goal was to study the formation of functionality gradients on cellulose substrates particularly the interaction between hydroxyl groups on cellulose and silanols and to study the stability of the silanes on the cellulose surface.

This thesis in the field of microdata analysis aims to introduce dose optimizing algorithms for the pharmacological management of Parkinson’s disease (PD). PD is a neurodegenerative disease that mostly affects the motor functions of the patients and it is characterized as a movement disorder. The core symptoms of PD are: bradykinesia, postural instability, rigidity, and tremor. There is no cure for PD and the use of levodopa to manage the core symptoms is considered the gold standard. However, long term use of levodopa causes reduced medication efficacy, and side effects, such as dyskinesia, which can also be attributed to overmedication. When that happens precise individualized dosing schedules are required. The goal of this thesis is to examine if algorithmic methods can be used to find dosing schedules that treat PD symptoms and minimize manifestation of side effects. Data from three different sources were used for that purpose: data from a clinical study in Uppsala University hospital in 2015, patient admission chart data from Uppsala University hospital during 2011-2015, and data from a clinical study in Gothenburg University during 2016-2017. The data were used to develop the methods and evaluate the performance of the proposed algorithms.The first algorithm that was developed was a sensor-based method that derives objective measurements (ratings) of PD motor states. The construction of the sensor index was based on subjective ratings of patients’ motor functions made by three movement disorder experts. This sensor-based method was used when deriving algorithmic dosing schedules. Afterwards, a method that uses medication information and ratings of the patients’ motor states to fit individual patient models was developed. This method uses mathematical optimization to individualize specific parameters of dose-effects models for levodopa intake, through minimizing the distance between motor state ratings and dose-effect curves. Finally, two different dose optimization algorithms were developed and evaluated, that had as input the individual patient models. The first algorithm was specific to continuous infusion of levodopa treatment, where the patient’s state was set to a specific target value and the algorithm made dosing adjustments to keep that patients motor functions on that state. The second algorithm concerned oral administration of microtables of levodopa. The ambition with this algorithm was that the suggested doses would find the right balance between treating the core symptoms of PD and, at the same time, minimizing the side effects of long term levodopa use, mainly dyskinesia. Motor state ratings for this study were obtained through the sensor index. Both algorithms followed a principle of deriving a morning dose and a maintenance dose for the patients, with maintenance dose being an infusion rate for the first algorithm, and oral administration doses at specific time points for the second algorithm.The results showed that the sensor-based index had good test-retest reliability, sensitivity to levodopa treatment, and ability to make predictions in unseen parts of the dataset. The dosing algorithm for continuous infusion of levodopa had a good ability to suggest an optimal infusion rating for the patients, but consistently suggested lower morning dose than what the treating personnel prescribed. The dosing algorithm for oral administration of levodopa showed great agreement with the treating personnel’s prescriptions, both in terms of morning and maintenance dose. Moreover, when evaluating the oral medication algorithm, it was clear that the sensor index ratings could be used for building patient specific models.

INTRODUÇÃO: As vantagens da utilização do Cateter Central de Inserção Periférica (CCIP) no ambiente hospitalar faz com que esse cateter ocupe uma posição de destaque na terapia intravenosa dos pacientes com indicação de administração de drogas com características que danificam a rede venosa periférica. A possibilidade de inserção do cateter a beira do leito por enfermeiros capacitados conferem maior facilidade para a inserção deste dispositivo. Por ser um cateter seguro e de fácil manutenção possibilita ainda a desospitalização precoce dos pacientes em antibioticoterapia e quimioterapia. Este trabalho relata o uso do CCIP nos pacientes do Instituto de Ortopedia e Traumatologia do Hospital das Clinicas da Universidade de São Paulo (IOT-HC-FMUSP) nos últimos 10 anos. MÉTODOS: Foram analisados 1.057 prontuários de pacientes submetidos a inserção do CCIP por enfermeiros qualificados no Instituto de Ortopedia e Traumatologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo entre os anos de 2007 e 2017. Destes, 34 foram excluídos por não apresentar dados completos no prontuário para a análise posterior. Foram incluídos 1023 prontuários no total, onde foram analisados: idade, sexo dos pacientes, veia puncionada, diagnóstico, número de punções, tempo em que o paciente permaneceu com o cateter, motivo da retirada e posicionamento da ponta do CCIP. RESULTADOS: Um total de 1023 CCIPs inseridos durante o período de 10 anos cumpriram os critérios para inclusão neste estudo. Destes, 720 (70,4%) foram considerados adequadamente posicionados. O tempo médio de utilização do cateter foi de 34,3 dias. A veia basílica foi utilizada em 528 (51,6%) pacientes enquanto que a veia cefálica foi utilizada em 392 (38,3%) pacientes. Cento e cinquenta e sete (15,4%) cateteres foram removidos devido a complicações, sendo a oclusão a complicação mais frequentemente reportada, com 58 (5,7%) casos. Nenhum caso de trombose ou infecção relacionada ao cateter foi encontrado. Oitocentos e sessenta e seis (84,6%) pacientes completaram o tratamento. Destes, 791 (77,3%) completaram durante a hospitalização e 75 (7,3%) receberam alta com o dispositivo. A principal indicação do CCIP nos pacientes ortopédicos é a antibioticoterapia. CONCLUSÃO: Este estudo sugere que o CCIP é um dispositivo intravenoso seguro e pode ser utilizado para terapia intravenosa de média e longa duração em pacientes ortopédicos hospitalizados ou desospitalizados Benefits and risks of the peripherally inserted central catheter (PICC) / INTRODUCTION: The advantages of using a Peripherally Inserted Central Catheter (PICC) in hospitalized patients gives this dispositive great importance for the intravenous therapy, especially in patients with the indication of drugs that have a potential to damage peripheral veins. The possibility of inserting this catheter at bedside, procedure that should be realized by trained nurses, gives the use of this device an excellent choice for intravenous therapies. Also, for being a safe an easy maintain dispositive, it gives the patient the option of an early dismissal from the hospital to continue the intravenous therapy at home. This paper describes the uses of the Peripherally Inserted Central Catheter (PICC) in adult patients that used this device for intravenous therapy, and had complete information in the medical records between 2007 and 2016, at the Orthopedics and Traumatology Institute of the Clinics Hospital of the Medical School of the University of São Paulo. METHODS: This is a retrospective study in which we used 1.057 medical records from patients that receive intravenous therapy through a Peripherally Inserted Central Catheter (PICC). The procedure was carried out by trained nurses from the Orthopedics and Traumatology Institute of the Clinics Hospital of the Medical School of the University of São Paulo between 2007 and 2017. From the 1.057 medical records studied, 34 were excluded due to the lack of information or incomplete data at the time of the analyses. There were 1.023 medical files with complete information included in the study. We obtained the following information: age, gender, place of insertion, punctured vein, number of punctures, diagnosis, duration of the catheterization, complications of the catheter and positioning. RESULTS: A total of 1023 PICCs inserted during a 10 year period met eligibility criteria for this study. Of these, 720 (70.4%) were considered successfully positioned. Mean duration of catheterization was 34.3 days. The basilic vein was used in 528 (51.6%) patients, while the cephalic vein was used in 392 (38.3%) patients. One hundred and fifty seven (15.4%) catheters were removed due to complications. Of the complications, occlusion was reported in 58 (5.7%) patients. Incidence of catheter related thrombosis or infection was not found. Eight hundred and sixty six (84.6%) patients completed the treatment. Of these, 791 (77.3%) completed it during hospitalization and 75 (7.3%) were discharged with the catheter. PICCs in orthopedic patients are mainly used for antibiotic treatment. CONCLUSION: Our study suggests that PICC is a safe intravenous device that can be successfully utilized for medium and long lasting intravenous therapy in hospitalized and non-hospitalized orthopedic patients

Submitted by Maicon Juliano Schmidt (maicons) on 2015-05-25T13:46:35Z No. of bitstreams: 1 Mauro Vinicius Silva Rocha.pdf: 469448 bytes, checksum: 92a0600b9a0d76f6b2ef37af189fdc88 (MD5) / Made available in DSpace on 2015-05-25T13:46:35Z (GMT). No. of bitstreams: 1 Mauro Vinicius Silva Rocha.pdf: 469448 bytes, checksum: 92a0600b9a0d76f6b2ef37af189fdc88 (MD5) Previous issue date: 2014-12-15 / Nenhuma / O presente estudo investiga alternativas para o aprimoramento do sistema produto-serviço. Um estudo de casos múltiplos abrangendo oito indústrias de grande porte, nacionais e multinacionais, dos setores químico e automotivo foi realizado. Nessas organizações foram analisados os problemas internos que influenciam o desempenho da prestação de serviços associada a produtos. Para cada problema identificado foram analisadas as alternativas de solução implantadas, ou passíveis de serem adotadas. Os resultados apontam para um conjunto de processos internos, os quais focalizam apenas a atenção às demandas advindas dos produtos. A consideração desses resultados desvelou um conjunto de elementos que precisam ser considerados para o aprimoramento do sistema produto-serviço. / The present study investigates alternatives for the improvement of product-service system. A multiple case study involving eight national and multinational companies, from chemical and automotive industries, was conducted. In these organizations the internal problems that affect the performance of the provision of services associated with the product were analyzed. For each problem identified alternatives implemented, or likely to be adopted solution were analyzed. The results point to a set of internal processes, which focus attention only to the demands from products. Consideration of these results unveiled a set of elements that need to be considered for the improvement of product-service system.

Objetivo: Este estudo objetivou avaliar a precisão de infusões de medicamentos em dois modelos de Bomba de Infusão (BI), de equipo específico do fabricante e de equipo universal, a concordância entre estes dois modelos e sua relação de custo e efetividade. Método: Foi realizado um ensaio clínico randomizado em pacientes internados em um hospital geral universitário de 740 leitos. As unidades de internação foram randomizadas através de sorteio simples para cada modelo de equipamento e os pacientes foram incluídos de acordo com indicação de uso de BI, conforme protocolo institucional. Os tipos de erros e reações adversas foram classificados por meio de algoritmos. Foi calculado o custo de cada sistema de bomba de infusão, pela vida útil da tecnologia. Resultados: Em 55 pacientes foram acompanhadas 310 infusões, 117 no grupo da bomba de infusão de equipo universal e 193 na bomba de infusão de equipo especifico. Houve semelhança (p=0,40) entre o tempo programado e o observado nas infusões por meio da bomba de equipo específico (-2,1 ± 19 min) e universal (0,08 ± 23 min). Percentualmente, também não foi observada diferença (p=0,70) entre a infusão por bomba de equipo específico (-0,15±3,8%) e universal (0,1±6,3%). Foram observados 14 (4,5%) erros de medicação, semelhantes (p=0,58) entre os tipos de BI. Os custos cumulativos entre os dois sistemas de bombas se equivaleram em 30 meses, sendo que após 11 anos, foram significativamente maiores para bomba de equipo específico em 184,29%. Conclusão: Ambos modelos de BI avaliadas mostraram-se igualmente seguras para administração EV de fármacos, sendo o modelo de equipo universal mais vantajoso economicamente ao longo da vida útil dos equipamentos. / Objective: This study aimed to evaluate the accuracy of drug infusion in two models of infusion pumps (IP), one with a specific IV set and other with universal IV set, the correlation between these two models and their relation of cost and effectiveness. Method: A randomized clinical trial was conducted in hospitalized patients in a university general hospital of 740 beds. The ward units were randomly chosen for each type of equipment, and patients were included according to indication for use of IP, based on institutional protocol. The types of errors and adverse reactions were classified by means of algorithms. The costs of each system for IP, was calculated considering the useful life of the technology. Results: 310 infusions were monitored: 117 in the universal infusion pump group and 193 in the specific equipment group, in 55 patients. The average difference between the scheduled time and the actual one in the infusions was -2.1 ± 19 min. and 0.08 ± 23 min. (p = 0.40) for the universal equipment and specific equipment, respectively, which means an average error of -0.15% ± 3.8% for the universal equipment and 0.10% ± 6.3% for the specific equipment, with no difference between the two types of pump. Fourteen (4.5%) medication errors were observed during the administration of medication, similar between the two types of IP. The cumulative costs between the two pump systems were equivalent in 30 months, and after 11 years the costs were meaningfully higher for the specific equipment pumps in 184,29 %. Conclusion: The infusion pumps do not show meaningful difference in accuracy between scheduled time and the actual one qualifying them as safe for the drugs observed. Cumulative costs were significantly distinct between both pieces of equipment.

During the 1990's high expectations were put on telemedicine technology in health care organizations, which can be seen as a reflexion of the society's interest in IT. The use of tele-medicine is expected to improve the quality and decrease costs of health care services. However, if these expectations are to be attained the visions have to be translated into fields of application in local settings where the technology would be used. This could be seen as an infusion process, which means that the technology would incrementally be used in a comprehensive and integrated manner. In this thesis, four Swedish telemedicine projects are analyzed. The approach used is that of Actor network theory (ANT), which has enabled the development of a theory of the infusion process, implementation of IT-projects, and parts of ANT, e.g. the model of the translation process and the notion of inscription. By using the concept of translation, it is possible to see the infusion process as a process where the generic features of the technology (transmitting sound and pictures in real time) are translated into concrete activities in local settings. These fields of application are realized by the mobilization of different task-based networks, where the roles of the actors are defined by the task to be solved. An iterated mobilization of the network implies further that the network will become stabilized, which is a central dimension in the process of infusion. Another way to understand the process of infusion is to describe it as cycles of implementation, where one cycle symbolizes the implementation of a field of application, which is a result of the translation of the generic features of the technology. The inscriptions in the studied technology allow a high degree of flexibility of use and flexibility of action. The flexibility means that fields of application ought to be developed in interaction between actors in local settings, and supporting programs of action are to be identified, or developed, in order to integrate technology use into daily routines. The considerable numbers of failed of IT-project implementations can be explained by the fact that a traditional planning perspective has been used on technologies, which allow a high degree of flexibility of use and flexibility of action. However, by categorizing inscriptions in technological artifacts, it becomes possible to predict what kinds of implementation strategies are appropriate for different kinds of technologies. By viewing the implementation of open networking technologies as a process of translation, the infusion process will be facilitated and a comprehensive and integrated use of technology will be enabled. / digitalisering@umu