Assessment of the validity and feasibility of a novel virtual reality test of emotion regulation in patients with bipolar disorder and their unaffected relatives.

BACKGROUND: Emotion dysregulation has been suggested as an endophenotype of bipolar disorder (BD). Neuroimaging studies show aberrant neural activity during emotion regulation in remitted patients with BD and their unaffected first-degree relatives (UR) compared to healthy controls (HC). However, behavioural studies produce conflicting - generally negative findings - possibly due to limited sensitivity and ecological validity of current behavioural paradigms. METHODS: This study aimed to explore emotion regulation in BD (n = 30) and UR (n = 26) relative to HC (n = 47) by using a novel emotion regulation task in virtual reality (VR). Participants were instructed to either react naturally to, or dampen, their emotional response to highly positive or highly negative scenarios presented in first-person 360-degree spherically camera-recorded VR environments. Participants also completed a more traditional computerised task of emotion regulation for comparison purposes. RESULTS: Patients with BD exhibited difficulties with down-regulating their negative emotions in the VR paradigm compared to HC and UR (ps ≤ .04), whereas UR did not differ from HC (p = .97). There was no emotion regulation difference between groups in the more traditional computerised task (ps ≥ .40). LIMITATIONS: The small sample size limits generalisability. CONCLUSIONS: The results suggest trait-related reduced ability to down-regulate negative emotions in BD patients compared to HC in the VR paradigm, but not in the more traditional task of emotion regulation. This may indicate that VR provides a more sensitive measure relative to traditional paradigms. The findings provided no support for aberrant emotional regulation as an endophenotype of BD given the normal emotion regulation performance in UR.

Video recording as an objective assessment tool of health worker performance in neonatal resuscitation at a district hospital in Pemba, Tanzania: a feasibility study.

OBJECTIVES: To assess the feasibility of using video recordings of neonatal resuscitation (NR) to evaluate the quality of care in a low-resource district hospital. DESIGN: Prospective observational feasibility study. SETTING: Chake-Chake Hospital, a district hospital in Pemba, Tanzania, in April and May 2019. PARTICIPANTS: All delivering women and their newborns were eligible for participation. MAIN OUTCOME MEASURES: Motion-triggered cameras were mounted on resuscitation tables and provided recordings that were analysed for quality of care indicators based on the national NR algorithm. Assessment of feasibility was conducted using Bowen's 8-point framework for feasibility studies. RESULTS: 91% (126 of 139) of women and 96% (24 of 26) of health workers were comfortable or very comfortable with the video recordings. Of 139 newborns, 8 underwent resuscitation with bag and mask ventilation. In resuscitations, heat loss prevention measures were not performed in half of the cases (four of eight), clearing the airway was not performed correctly in five of eight cases, and all newborns were suctioned vigorously and repeatedly, even when not indicated. In a quarter (two of eight) of cases, the newborn's head was not positioned correctly. Additionally, two of the eight newborns needing ventilation were not ventilated within the first minute of life. In none of the eight cases did ventilation appear to be performed effectively. CONCLUSIONS: It proved feasible to use video recordings to assess quality of care during NR in a low-resource setting, and the method was considered acceptable for the delivering women and health workers. Recordings of eight resuscitations all demonstrated deviations from NR guidelines.