Using Quality Improvement to Design Early Childhood Services Navigation in Primary Care.

Enrollment in high-quality early childhood education (ECE) improves educational and health outcomes and can mitigate racial and economic disparities. Pediatricians are encouraged to promote ECE yet lack the time and knowledge to assist families effectively. In 2016, our academic primary care center hired an ECE Navigator to promote ECE and help families enroll. Our SMART aims were to increase the number of children with facilitated referrals to high-quality ECE programs from 0 to 15 per month and to confirm enrollment on a subset to achieve an enrollment rate of 50% by December 31, 2020. Methods: We used the Institute for Healthcare Improvement's Model for Improvement. Interventions included system changes in partnership with ECE agencies (eg, interactive map of subsidized preschool options, streamlined enrollment forms), case management with families, and population-based approaches to understand families' needs and the program's overall impact. We plotted the number of monthly facilitated referrals and the percentage of referrals enrolled on run and control charts. We used standard probability-based rules to identify special causes. Results: Facilitated referrals increased from 0 to 29 per month and remained above 15. The percentage of enrolled referrals increased from 30% to 74% in 2018, then decreased to 27% in 2020 when childcare availability declined during the pandemic. Conclusions: Our innovative ECE partnership improved access to high-quality ECE. Interventions could be adopted in part or whole by other clinical practices or WIC offices to equitably improve early childhood experiences for low-income families and racial minorities.

Neurotoxic lesions of the medial prefrontal cortex or medial striatum impair multiple-location place learning in the water task: evidence for neural structures with complementary roles in behavioural flexibility.

This series of experiments assessed the effects of neurotoxic damage to either the medial prefrontal cortex or the medial striatum on the acquisition of multiple-location place learning in the water task. During training, normal subjects learn to search for a new hidden platform location at the beginning of each training session and to continue to swim to that location until the end of training during that session. By the end of training, normal subjects show one-trail place learning in which they find the new location on the first trial and swim directly to that location on the second swim. Rats with damage to either the medial prefrontal cortex or dorso-medial striatum showed deficits in learning to swim to the new location each day. These deficits were interpreted as impairments in behavioural flexibility. The lesion-induced impairment was not caused by perseverative errors but was manifested in an inability to rapidly acquire a new spatial position in conflict with the previous position. Interestingly, the subjects from both lesion groups were able to show normal place learning and memory after repeated training within a session. The results were interpreted as suggestive of a complementary role of these neural structures in behavioural flexibility.

Neurotoxic damage to the dorsomedial striatum exaggerates the behavioral influence of a context-specific inhibitory association mediated by the ventral hippocampus.

This study investigated the role of the dorsomedial striatum (DMS) on the acquisition of a context-specific inhibitory association acquired during training on a simple visual discrimination task. The authors have previously shown that this inhibitory association depends on the circuitry of the ventral hippocampus. The authors were interested in the anatomical and functional relationship between the hippocampus and DMS and the potential contribution the DMS makes to this inhibitory behavior. Rats with neurotoxic lesions of the DMS, or shams, were assessed on the acquisition of a visual discrimination task. Following asymptotic performance, they were given reversal training in the same or different context from the original training. The results indicated that the rats with DMS damage showed an exaggerated context-specific inhibition effect. The rats with DMS damage were also impaired on a simultaneously trained tactile/spatial discrimination, a functional effect linked to a neural circuit that includes the dorsal hippocampus. A discussion of potential pathways and mechanisms for these different effects is presented.

A complex associative structure formed in the mammalian brain during acquisition of a simple visual discrimination task: dorsolateral striatum, amygdala, and hippocampus.

A review of empirical evidence supporting the multiple memory systems view of the organization of learning and memory in the mammalian brain is presented as a powerful component of a broader foundation of basic scientific information necessary for understanding human behavior. However, it is argued that there are significant gaps in our knowledge about these different learning and memory systems, how they interact with one another, and how they interact with the rest of the brain. To demonstrate how little we know about these complex processes, this article reviews recent evidence showing the complexity of associative structure formed during the acquisition of a simple visual discrimination task. The results show that the dorsolateral striatum is necessary for the acquisition of this task but that both the amygdala and hippocampus incidentally acquire and store information during this training period. A new experiment is also presented showing that rats with complete or partial (dorsal vs. ventral) hippocampal lesions show a retrograde amnesic effect on the simple visual discrimination task despite the fact that these same lesions produce no impairment in the anterograde direction. Evidence is presented in support of one interpretation of this effect suggesting that the retrograde amnesia occurs, at least in part, because the hippocampus acquires a context-specific inhibitory association during original training. Although this representation is not required for acquisition of the task in the anterograde direction, removal of this representation has a disruptive effect on expression of the task.

Empirical tests of the functional significance of amygdala-based modulation of hippocampal representations: evidence for multiple memory consolidation pathways.

This series of experiments evaluated the effects of amygdala damage on the acquisition and long-term retention of variants of the water task, and tested the hypothesis that the amygdala is an essential neural system for consolidation of hippocampal memories. In Experiment 1, rats with large, neurotoxic lesions of the amygdala (AMYG) showed normal acquisition on the standard spatial version of the water task, as well as normal retention and decay rate profiles on the 24-h and 30-day retention probes. In Experiment 2, AMYG rats showed normal one-trial place learning abilities and could retain this one-trial information over a 24 h delay. Experiment 3 showed that the amygdala lesions used in this study were functionally significant because AMYG rats, from Experiment 2, showed impairments in a discriminative fear conditioning to context paradigm. Experiment 4 was a critical test of the idea that the amygdala is a decisive locus for consolidation of hippocampal memories. AMYG rats were trained to sub-asymptotic levels of performance on the standard version of the water task. Following each training session, the subjects were given a post-training peripheral injection of D-amphetamine. A probe test revealed that normal subjects and AMYG rats showed similar post-training memory improvement effects. Taken together, the results show that hippocampal memory consolidation processes do not require amygdala modulation. Arguments for an alternative view are presented suggesting that there are multiple memory consolidation pathways, one of which may depend on amygdala neural circuitry.

Birth of African Wildcat cloned kittens born from domestic cats.

In the present study, we used the African Wildcat (Felis silvestris lybica) as a somatic cell donor to evaluate the in vivo developmental competence, after transfer into domestic cat recipients, of cloned embryos produced by the fusion of African Wildcat (AWC) fibroblast cell nuclei with domestic cat cytoplasts. Cloned embryos were produced by fusion of a single AWC somatic cell to in vivo or in vitro enucleated domestic cat cytoplasts. When the two sources of oocytes were compared, fusion rate was higher using in vivo-matured oocytes as recipient cytoplasts, but cleavage rate was higher after reconstruction of in vitro-matured oocytes. To determine the number of reconstructed embryos required per domestic cat recipient to consistently establish pregnancies, AWC cloned embryos were transferred within two groups: recipients (n = 24) receiving < or =25 embryos and recipients (n = 26) receiving > or =30 embryos. Twelve recipients (46.2%) receiving > or =30 embryos were diagnosed to be pregnant, while no pregnancies were established in recipients receiving < or =25 NT embryos. Also, to determine the influence of length of in vitro culture on pregnancy rate, we compared oviductal transfer on day 1 and uterine transfer on day 5, 6, or 7. Pregnancy rates were similar after transfer of embryos on day 1 (6/12; 50.0%), day 5 (4/9; 44.4%), or day 6 (2/5; 40.0%) to synchronous recipients, but the number of fetuses developing after transfer of embryos on day 1 (n = 17), versus day 5 (n = 4) or day 6 (n = 3) was significantly different. Of the 12 pregnant recipients, nine (75%) developed to term and fetal resorption or abortion occurred in the other three (25%) from day 30 to 48 of gestation. Of a total of 17 cloned kittens born, seven were stillborn, eight died within hours of delivery or up to 6 weeks of age, and two are alive and healthy. Perinatal mortality was due to lung immaturity at premature delivery, placental separation and bacterial septicemia. Subsequent DNA analysis of 12 cat-specific microsatellite loci confirmed that all 17 kittens were clones of the AWC donor male. These AWC kittens represent the first wild carnivores to be produced by nuclear transfer.

Motivational structure and alcohol use of university students across four nations.

OBJECTIVE: The ability of motivational structure and other variables to predict alcohol consumption was assessed in university students (N = 370; 244 women) in the Czech Republic, The Netherlands, Norway and the United States. METHOD: Motivational structure was assessed with the Motivational Structure Questionnaire (MSQ), which inquires about respondents' individual personal concerns in various areas of life and dimensions of their goal strivings related to the resolution of concerns. Alcohol-related problems were measured with the Short Michigan Alcoholism Screening Test. RESULTS: Factor analysis of MSQ indices yielded a two-factor solution, one factor of which reflects an adaptive motivational structure marked by elements necessary for attaining psychologically satisfying resolutions of personal concerns. The other factor reflects a more maladaptive motivational structure marked by feelings of indifference about the achievement of personal goals. As hypothesized, MSQ Factor I was a significant inverse predictor of the amount of alcohol that students drank, but only among those who experienced alcohol-related problems. CONCLUSIONS: The similarity in results across culturally varied samples suggests the robustness of the relationships for understanding the motivational bases for alcohol use.