Primer registro formal del quitón incubador Calloplax vivipara (Polyplacophora: Callistoplacidae) en Perú

Calloplax vivipara (Plate, 1899) se registra formalmente por primera vez en el litoral sur peruano. Cuatro ejemplares fueron encontrados en el intermareal pedregoso debajo de bloques de piedras en Islay, Arequipa, en diciembre de 2013 y octubre de 2019. Una hembra de 9.2 mm de longitud del cuerpo colectada en la primavera del 2013 presentó seis juveniles en la parte externa de la zona de inserción de los ctenidios en el surco paleal, constituyendo el primer caso de un quitón incubador en Perú.

Calloplax vivipara (Plate, 1899) is formal recorded for the first time in the southern Peruvian coast. Four specimens were found in rocky intertidal environment under blocks of stones in Islay, Arequipa, in December 2013 and October 2019. A female of 9.2 mm body length collected in the spring of 2013 presented six juveniles in the external part of the insertion zone of the ctenidia in the pallial groove, constituting the first case of an incubating chiton in Peru.

A Fuzzy Rule-Based Model for Remote Monitoring of Preterm in the Intensive Care Unit of Hospitals

The use of Remote patient monitoring (RPM) systems to monitor critically ill patients in the Intensive Care Unit (ICU) has enabled quality and real-time healthcare management. Fuzzy logic as an approach to designing RPM systems provides a means for encapsulating the subjective decision-making process of medical experts in an algorithm suitable for computer implementation. In this paper, a remote monitoring system for preterm in neonatal ICU incubators is modeled and simulated. The model was designed with 4 input variables (body temperature, heart rate, respiratory rate, and oxygen level saturation), and 1 output variable (action performed represented as ACT). ACT decides whether an alert is generated or not and also determines the message displayed when a notification is required. ACT classifies the clinical priority of the monitored preterm into 5 different fields: code blue, code red, code yellow, code green, and code black. The model was simulated using a fuzzy logic toolbox of MATLAB R2015A. About 216 IF_THEN rules were formulated to monitor the inputs data fed into the model. The performance of the model was evaluated using the confusion matrix to determine the model’s accuracy, precision, sensitivity, specificity, and false alarm rate. The experimental results obtained shows that the fuzzy-based system is capable of producing satisfactory results when used for monitoring and classifying the clinical statuses of neonates in ICU incubators.

Incubadora neonatal con ventilación mecánica embebida / Mechanical Ventilation embedded in Neonatal Incubator

RESUMEN Se presenta un equipo de soporte de vida neonatal (ESVIN) que emplea la terapia térmica y terapia ventilatoria (neumática) en un solo equipo para proveer ventilación pulmonar con aire caliente, humedecido y enriquecido con oxígeno, en un ambiente caliente, humidificado y estéril. El equipo es capaz de simultáneamente dar ventilación pulmonar e incubar, siendo una de sus características principales la minimización de la condensación del agua en el corrugado y ofrece la característica adicional de evitar la movilización y/o desconexión del neonato para realizar ciertos procedimientos tales como: cirugías e intubaciones, entre otras. Los principales resultados son el tiempo de acceso al neonato menor a 2 s y minimización de la condensación de agua. Asimismo, los resultados del control térmico son de tiempo de estabilización en el habitáculo de 75 minutos para la temperatura de 36 °C y tiempo de estabilización de la temperatura de la piel del neonato de 58 minutos.

ABSTRACT A neonatal life support equipment (ESVIN) employing simultaneously thermal therapy and ventilatory (pneumatic) therapy is presented in a single kit to provide pulmonary ventilation with warm, moistened and oxygen enriched air in a warm, humidified and sterile environment. The invention behind ESVIN provided simultaneously pulmonary ventilation and incubation having optimized the minimization of water condensation in the corrugated pipe and offered the additional feature of avoiding the mobilization and / or disconnection of the neonate to perform certain procedures such as: surgeries and intubations, among others. ESVIN has an access to newborns of less than 2 s and non-visible water condensation. The main results in thermal control were a stabilization time in the newborn compartment of 75 minutes for the temperature of 36 °C and a stabilization of the temperature of the skin of the neonate of 58 minutes.

ANÁLISIS DEL MÉTODO MADRE CANGURO EN RECIÉN NACIDOS PREMATUROS MENORES DE 36 SEMANAS Y MENORES DE 2500 GRAMOS HOSPITALIZADOS EN LA UNIDAD DE CUIDADOS INTENSIVOS NEONATALES DEL HOSPITAL GINECO OBSTÉTRICO DE NUEVA AURORA "LUZ ELENA ARISMENDI" Y "HOSPITAL MATILDE HIDALGO DE PROCEL" EN EL AÑO 2018 / Analysis of the kangaroo mother method in preterm infants under 36 weeks and under 2500 grams hospitalized in the neonatal intensive care unit of the New Aurora obstetric gynecological hospital "Luz Elena Arismendi" and "Hospital Matilde Hidalgo de Procel" in 2018

Contexto: A nivel mundial más de 15 millones de niños nacen prematuros y 1 millón de muertes se dan como resultado directo de las complicaciones del parto prematuro y cuanto más inmaduro es el neonato, más lenta es la recuperación de la pérdida de peso. La estimulación cinestésica en posición con el método madre canguro evidencia mejor ganancia en peso y longitud. El método mejora las tasas de lactancia materna, disminuye los requerimientos neonatales y complicaciones. Propósito: Analizar los beneficios del método madre canguro en prematuros y menores de 2500 gramos hospitalizados en Unidad de Cuidados Intensivos Neonatales del Hospital Gineco Obstétrico Nueva Aurora "Luz Elena Arismendi" y el Hospital Matilde Hidalgo de Procel en 2018. Sujetos y métodos: Diseño observacional, epidemiológico, transversal de 2 cohortes: posición canguro versus los que se encuentran en incubadoras. El estudio se limitó 212 neonatos para el análisis la muestra se distribuyó en partes iguales 106 neonatos de cada cohorte. Resultados y Conclusiones: El rango de edad gestacional en los grupos de investigación mayoritario fueron 32 a 36 semanas 66,98% en grupo de madre canguro y 46,23% incubadora. El método madre canguro se relaciona de hospitalización 7 días, la disminución de requerimientos de oxígeno, ausencia de sepsis clínica y disminución de la necesidad alimentación parenteral, peso >1.500 gr, talla >40 cm y PC >30 cm. Por lo cual es considerado un método eficaz de cuidados neonatales y neonatos de bajo peso en países de recursos bajos

Context: Worldwide more than 15 million children born preterm and 1 million deaths as a direct result of the complications of preterm birth and the more in the newborn the newborn, the slower the recovery of weight loss, the kinesthetic estimation in position with the kangaroo mother method shows better gain in weight and length. The method of improving breastfeeding rates, neonatal requirements and complications. Purpose: To analyze the benefits of the mother method in preterm infants and under 2500 grams hospitalized in the Neonatal Intensive Care Unit of the Nueva Aurora Obstetrician Gynecology Hospital "Luz Elena Arismendi" and the Matilde Hidalgo Hospital in Procel in 2018. Subjects and methods: Observational Design, Epidemiological, transversal of 2 cohorts: kangaroo position versus those found in incubators. The study was limited to 212 infants from each cohort. Results and Conclusions: gestational age range in the major research groups were 32 to 36 weeks 66.98% in the kangaroo mother group and 46.23% incubator. The kangaroo mother method is related to hospitalization 7 days, the decrease in oxygen needs, the absence of clinical sepsis and the decrease in the need for parenteral feeding, weight> 1,500 gr, height> 40 cm and PC> 30 cm. So it is considered an effective method of neonatal care and low birth weight infants in low resource countries.

System Integration of Infant Incubators' Quality Control Testing Based on MCU / 中国医疗器械杂志

This study is aimed to design the testing system of multiple parameters of the incubators, and to make their quality control plans. Also it is required to establish a model of data collection and processing based on MCU, and to program the host computer software in order to analyze data. The result shows that the testing system is accurate and stable; also it is convenient to collect the data. This testing system is a good complement of the quality control of incubators. It has a high practical value in improving medical safety and reducing the occurrence of adverse events.

Development and application of a microbiological incubator for medical examination / 中国医学装备

Objective: To develop a microbiological incubator used in medical examination and explore its application and effect in bacteriological examination. Methods: 160 microbiological specimens which gathered from clinical examination of hospital were enrolled in research sample group that used the developed microbiological incubator to implement microbial cultivation, while other 160 specimens were enrolled in control group that used an opaque incubator to implement microbial cultivation at the same term. The positive rate of microbiological test, total bacterial count and incubation time of the two groups were compared and analyzed. Results: The positive rates of micrograms in blood, sputum, respiratory tract and urine of the research sample group were 40.00%, 38.71%, 58.82% and 68.42%, respectively, and all of them were significantly higher than that of control group, which positive rates for each item were 13.79%, 19.40%, 35.29% and 22.22%, respectively (x2=10.5247, x2=5.8679, x2=4.0139, x2=7.9435, P<0.05). The total bacterial counts of blood, sputum, respiratory tract and urine of the research sample group were (1.69±0.16)×109/CFU·ml-1, (1.59±0.23)×109/CFU·ml-1, (1.77±0.15)×109/CFU·ml-1and (1.73±0.14)×109/CFU·ml-1, respectively, and all of them were significantly more than that of control group, which total bacterial counts for each item were (1.51±0.26)×109/CFU·ml-1, (1.36±0.14)×109/CFU·ml-1, (1.53±0.27)×109/CFU·ml-1and (1.59±0.11)×109/CFU·ml-1, respectively (t=7.4580, t=10.8049, t=9.8287, t=9.9462, P<0.01). The microbial cultivation time of research sample group that was (2.14±1.20)d was significantly shorter than that of control group that was (3.06±1.14)d (t=7.0308, P<0.01). Conclusion: "The microbiological incubator for medical examination" is used in bacteriological examination can significantly enhance the accuracy of positive detection for microorganism, and significantly increase the number of cultivated bacterial colonies and shorten the cultivation time. Therefore, it has higher value in clinical application and should be popularized.

Application of retrospective quality control data analysis in infant incubator risk management / 医疗卫生装备

Objective To analyze retrospectively the quality control data to enhance the infant incubator risk management. Methods The factors influencing the qualified rate of the infant incubator were analyzed by fishbone analysis method,and then the data statistics method was used to analyze the quality control data from 2013 to 2015 to find out the causes of the factors that affected the qualified rate. Some practical improvement measures were put forward. Results The improvement measures enhanced the qualified rate of the infant incubator quality control greatly. Conclusion The retrospective quality control data analysis contributes to bettering the infant incubator quality control and its clinical safety.

Study on quality control before application and after maintenance of the infantincubator / 中国医学装备

Objective:To implement quality control in whole life cycle for infant incubator, and ensure it working in safe and efficient situation.Methods:The parameter detection cases of infant incubator was analyzed and researched according to relative standards and requirements of technique for medical equipment.Results:The detection data and frequent failures of clinical cases revealed that there were parameter deviation existing in infant incubators. These deviations should be adjusted in time according to relative standards and requirements of technique for medical equipment.Conclusion:The quality control of whole life cycle for infant incubator is the necessary condition for ensuring medical quality and safety of patients. To pay attention to the quality control before and after application and after maintenance of the infant medical incubator, in order to ensure the medical equipment can achieve to meet the performance requirement of treatment and provide safe and efficient quality service for patients.

Organizational and institutional change analysis: the case of Barcelona activa business incubator

Introduction. Business incubators play a key role in the development of regional economies that drive job creation, technological development and innovation. However, there is an evident lack of studies that examine successful experiences in detail. Objective. To analyze organizational and institutional change in the Barcelona Activa incubator (BA), in Spain. Materials and methods. The research is qualitative and a case study strategy, by means of document analysis and interviews, was used. Results. BA assumes that the traditional model of incubator may be not enough to ensure the takeoff and the sustainability of the new businesses. Conclusions. Incubators could become an agent of local development that plays an important role in the development of the regional innovation system, assuming additional functions such as the promotion of digital culture, technology transfer, early internationalization of enterprises, the creation of venture capital funds and the management of human talent. In addition, it contributes to the design of public policies on innovation and business development.

Introducción. Las incubadoras de empresas juegan un papel clave en el desarrollo de las economías regionales porque impulsan la creación de empleo, el desarrollo tecnológico y la innovación, sin embargo, es notoria la ausencia de estudios que examinen en detalle experiencias exitosas. Objetivo. Analizar el cambio organizacional e institucional de la incubadora Barcelona Activa (BA) en España. Materiales y métodos. La investigación es cualitativa y se empleó la estrategia del estudio de caso a partir del análisis documental y la realización de entrevistas. Resultados. BA asumió que el modelo tradicional de incubadora puede ser insuficiente para asegurar el despegue y la sostenibilidad de los nuevos negocios. Conclusión. Las incubadoras pueden convertirse en un agente de desarrollo local que juega un papel importante en el desarrollo del sistema regional de innovación, asumiendo funciones adicionales como el fomento de la cultura digital, la transferencia de tecnología, la internacionalización temprana de los emprendimientos, la creación de fondos de capital de riesgo y la gestión del talento humano, además de sus contribuciones al diseño de política pública de innovación y desarrollo empresarial.

Introdução. As incubadoras de empresas jogam um papel importante no desenvolvimento das economias regionais porque impulsam a criação de emprego, o desenvolvimento tecnológico e a inovação, porém, é notório a ausência de estudos que examinem em detalhe experiências exitosas. Objetivo. Analisar o câmbio organizacional e institucional da incubadora Barcelona Ativa (BA) em Espanha. Materiais e métodos. A investigação é qualitativa e se utilizou a estratégia do estudo de caso a partir da análise documental e a realização de entrevistas. Resultados. BA assumiu que o modelo tradicional de incubadora pode ser insuficiente para assegurar o despegue e a sustentabilidade dos novos negócios además. Conclusão. As incubadoras eles podem convertise um agente de desenvolvimento local que joga um papel importante no desenvolvimento do sistema regional de inovação, assumindo funções adicionais como o fomento da cultura digital, a transferência de tecnologia, a internacionalização precoce dos empreendimentos, a criação de fundos de capital de risco e a gestão do talento humano, ademais de suas contribuições ao desenho de política pública de inovação e desenvolvimento empresarial.

Efficacy and strategies of routine cleaning and disinfection for neonatal in-cubators in use / 中国感染控制杂志

Objective To evaluate efficacy of routine cleaning and disinfection methods for incubators,and put forward a feasible improvement solution.Methods 30 incubators used in a neonatal intensive care unit of a hospital between Decem-ber 2013 and June 2014 were chosen and randomly divided into baseline,control,and trial groups(10 incubators in each group).Baseline group and control group were disinfected by routing disinfection method (wiping internal and external sur-faces of incubators with water and chlorine-containing disinfectant),trial group adopted intensified disinfection method (wi-ping internal surfaces of incubators with alcohol)on the basis of routine disinfection,disinfectant efficacy of three groups were compared.Results In baseline group,unqualified incubators were initially detected on the fourth day of monitoring, all incubators were contaminated in varying degrees on the seventh day of monitoring,the detection rate of unqualified spec-imens was 31.43% (88/280).The median time for the initial detection of unqualified incubators in control group and trial group were on the fifth day and seventh day respectively,there was significant difference between two groups(χ2 =12.38, P <0.05);The unqualified rate of trial group was significantly lower than control group (15.36%[43/280]vs 32.86%[92/280],χ2 =23.43,P <0.05 ).Conclusion Intensified disinfection with alcohol on the basis of routine disinfection method can effectively improve the disinfectant efficacy of the surface of incubators,it is convenient,inexpensive and safe, and worth to be popularized in primary hospitals.

Development and effect test of a portbable microorganism incubator / 军事医学

Objective To develop a portbable incubator for on-site cultivation of microorganisms in foods and drinking water.Methods Cultivation temperature was set as required by the temperature for various microorganisms and PID was controlled via the single chip microcomputer and configuration screen .Then, the framework of the incubator was designed and assembled.Finally, the cultivation effect was tested .Results The incubator was compact and portable .The deviation of the temperature was in the range of 1℃.The hold time of self-contained power could exceed 8 h.In addition, the cultivation effect of our fabricated incubator was not significantly different from that of the commercial electro-heating standing-temperature cultivator used in laboratories .Conclusion The incubator is suitable for on-site detection of microorganisms in foods and drinking water , which is significant for spotting and removing the hidden dangers from microorganism contaminations in foods and drinking water in order to protect the health of soldiers .

Design and evaluation of a disinfection device for infant incubator terminal / 中国医学装备

Objective:To design Disinfection device of Infant incubator to address the existing infant incubator terminally sterilized in the presence of ultraviolet light disinfectant wipe and disinfection effect is not complete. Methods:Using vaporized hydrogen peroxide to kill spores of principle, to design a PLC and touch screen technologies such as infant incubator terminal disinfection device, mainly by vaporized hydrogen peroxide generator to accommodate infant incubator stainless steel tanks, gas communication piping, etc., through clean and dry after the infant incubator, pushed into stainless steel tanks, a key parameter set to start after the end of the introduction of the incubator to disinfection, disinfection by chemical and biological indicator discoloration indicator kill situation to judge. Results:The disinfection device for gas distribution, no disinfection dead, low-temperature sterilization effect is good and easy to verify, infant incubator for material compatibility, safe, reliable, easy to operate, chemical indicator from green to yellow, biological indicator Bacillus stearothermophilus cultured for 7 days, sterile growth. Conclusion:The device is easy to verify the sterilization effect, material compatibility, safety and reliability, reduce labor intensity in clinical neonatology and critical sections infant incubator terminal disinfection areas have higher promotion and application value.

The Effect of Timely Infection Evaluation and Intervention on Low-body Mass Incubator Infants in Primary Hospitals / 浙江中医药大学学报

Objective] To discuss the effect of timely infection evaluation and intervention on reducing infection to low-body mass incubator infants of primary hospitals. [Method] Select 98 cases of low-body mass incubator infants of 1210~2000g as control group(routine prevention used), and another 95 cases of 1200~2010g as observation group(taking timely infection evaluation, giving pointing intervention to infants with various infective risk factors). Compare their infection and in-hospital period. [Result]In control group 98 cases, 45 cases(45.92%) had infection; in observation group 95 cases, 11 (11.58%) had infection; the infective rate of observation group was lower than control group, the difference had statistical meaning( P<0.05). [Conclusion] To take timely infection evaluation and preventive intervention can definitely reduce infection.

Application and bacteriological monitoring of humidification of infant in-cubator bx water-filled cup / 中国感染控制杂志

Objective To compare the humidification efficacy of sterile water-filled cup and sterile water-filled wa-ter reservoir on infant incubators,as well as bacterial culture of incubators . Methods Ten infant incubators in a neonatal intensive care unit were randomly divided into observation group and control group,incubators in observa-tion group were humidified through sterile water in single used cups,in control group were through water in water reservoirs ,humidified water,air in incubators,and object surface were performed bacterial culture 24 hours after the change of humidified water. Results The humidity in both groups achieved the requirement of >50% ;the qualified rate of bacterial culture of humidified water in observation group was significantly higher than control group (91.00% vs 74.00% ,χ2= 10.009,P= 0.002);bacterial count in observation group was significantly lower than control group([26.85±16.67]CFU/mL vs [37.20±15.28]CFU/mL,t= 4.577,P<0.001).The qualified rate of bacterial culture of air and surface of incubators in observation group were both significantly higher than control group (94.00% vs 85.00% ;98.00% vs 68.00% ,both P<0.05).Conclusion Water-filled cups can achieve the air humidification efficacy on infant incubators,reduce the growth of bacteria,and is helpful for preventing the occur-rence of healthcare-associated infection.

Improving of infant incubator disinfection and built-in disinfection device / 中国医学装备

Objective: To imrove the current situation that disinfection is inconvenient and ineffective when infant incubators are used. Methods: To make some improvements without changing the structure and performance of existing infant incubators. Results: Built-in disinfection device is designed to overcome the difficult operation, poor effect and inconvenience in use. Conclusion:It has been awarded“the state utility model”for its safety and convenience (patent no:ZL200520117573.9).

Diseño de un control de temperatura inteligente para incubadoras de recién nacidos / Design of an intelligent temperature control for incubators newborns

En este artículo se presenta el diseño de un control de temperatura con técnicas de protección inteligente, con la finalidad de implementarlo en incubadoras para recién nacidos. El funcionamiento del control de temperatura se centra en la utilización de un microcontrolador, programado para responder por modulación de ancho de pulso sobre el calefactor, y así lograr una alta precisión en la regulación de la temperatura. Lo novedoso del proyecto radica en la técnica de protección utilizada. Esta técnica está basada en la supervisión constante de las irregularidades térmicas, en múltiples puntos del ambiente de la incubadora. Esto permite establecer un criterio para el apagado del calefactor y la activación de la alarma en función de la lectura individual de 4 sensores tipo termistor NTC, ubicados estratégicamente dentro de la incubadora. Este diseño se ve motivado a la necesidad de adaptar controles modernos a incubadoras antiguas que pueden ser totalmente recuperadas, además abre la posibilidad de diseñar un equipo de incubadora completo. Cabe destacar que este proyecto contribuye con el desarrollo de tecnología propia en el área de la instrumentación y control aplicado a ingeniería biomédica.

This paper presents an intelligent temperature control design with smart protection techniques, implemented in newborn incubators. The operation of the temperature control was focused on the use of a programmed microcontroller, which respond with pulse width modulation at the heater, and thus achieve, high precision temperature regulation. The novelty of this design, lies, on the protection technique used. That is based, on a constant monitoring of the incubator thermal variations; at several parts of the environment. That allows establishing, an approach for the shutdown of the heater and the alarm on, depending on the individual reading of 4 sensors NTC thermistor, strategically located within the incubator. This design is motivated by the necessity of adapt modern controls to old incubators that can be fully recovered; also opens the possibility to design a complete new incubator. It is important to note that this project contributes with our own development technology; especially on biomedical engineering, instrumentation and control.

Hospital Infection-related Factors for Children in Infant Incubator and Countermeasures / 中华医院感染学杂志

OBJECTIVE To analyze the hospital infection-related factors of infant incubator and their countermeasures.METHODS The hospital infections cases with the use of infant incubators from Jan 2005 to Sept 2008 were retrospectively analyzed.RESULTS From the 205 cases of children with the use of infant incubator,14 cases were infected,the hospital infection rate was 6.82%.Their risk factors were weak immunity,poor hygiene concepts,not strictly executing the hand disinfection systems and hygiene norms,unsatisfactory basic care and high humidity in incubators.CONCLUSIONS To strictly execute the disinfection system and hand hygiene norms,rationally use the antibiotics and to strengthen the basic care and care management can reduce the incidence of hospital infections.

Colombia país de optómetras emprendedores / Colombia: a country of enterpricing optometrist

Es de real importancia realizar cambios que nos conlleven a mejorar las condiciones de nuestra vida y nuestra profesión. Por lo tanto es imprescindible crear, proponer y por supuesto llevar a cabo nuestras mejores ideas y oportunidades que el mundo actual nos ofrece. Es fundamental conocer a nuestro país para tratar de aportar de algún modo desde nuestro campo profesional un cimiento más para construir entre todos una gran pirámide de triunfadores empresarios, apoyados por las nuevas instituciones creadoras e impulsadoras de pequeñas y mediana empresas.

It is really important to carry out changes that involve us to improve living and professional conditions. For instance is essential to create, to propose and carried out all the best ideas and opportunities that the present world offered us. It is basic to know our country and give to people help, since our profession al field. Allow for to build among us, a big pyramid of winning businessmen supported by new creative institutions that drive the small and medium companies.

Equipamento eletrônico para controle automático da temperatura do ar em incubadoras de recém-nascidos / Electronic equipment for automatic control of air temperature in incubators newborns

An electronic equipment to control the temperature and to monitor the relative humidity of the air in incubators of new born was developed in the present work...

A Comparison of Rectal, Axillary, and Skin-to-Mattress Temperatures in Neonates

PURPOSE: This study was conducted to evaluate the comparability and accuracy of body temperatures measured at three different sites: rectum, axilla and between skin and mattress in the newborn infants. METHODS: 168 term and preterm infants admitted to NICU at Kyungpook University Hospital were enrolled in the study. Glass and digital thermometers were used for the simultaneous measurement of rectal, axilla and skin-to-mattress temperatures. RESULTS: Among three different body temperatures measured by glass thermometer, the rectal temperatures recorded the highest in the bassinet, while no differences were found in the incubator. Rectal temperature by glass thermometer agreed most closely with axillary temperature by digital thermometer. The digital thermometers took significantly less time to measure temperatures from rectum and axilla than glass thermometer. Phototherapy did not influence body temperature measured in the incubator. CONCLUSION: In the bassinet, axilla temperature measured by a digital thermometer was as reliable as rectal temperature measured by a glass thermometer. Skin-to-mattress temperature provides an accurate, safe and easily accessible alternative site while infants are in the incubator.