What is the role of noninvasive ventilation in cystic fibrosis?

PURPOSE OF REVIEW: The use of noninvasive ventilatory support in patients with cystic fibrosis (CF) has increased exponentially over the past 2 decades. This review examines the current knowledge and considers potential future directions for use of noninvasive ventilation in CF patients. RECENT FINDINGS: Noninvasive ventilation was originally reported as a bridge to transplantation in CF patients with severe respiratory failure but is now used as a long-term treatment modality for patients with respiratory failure independent of transplant status. In 2013 to 2014, over 400 publications on noninvasive ventilation demonstrate its increasing clinical application, however only seven reference CF. Recent technological advances and potential benefits to CF patients are considered. SUMMARY: The role of noninvasive ventilation in CF patients in chronic respiratory failure is established, but future prospective studies are needed to determine further indications and optimal timing of this intervention. Developments in both ventilator and interface design may enhance the efficacy of ventilation in CF patients but require careful individualized assessment and regular review. The implications on treatment burden and quality of life in CF also need to be studied.

Relations between Fathers' and Mothers' Infant Engagement Patterns in Dual-Earner Families and Toddler Competence.

This study examined the trajectories of time new fathers and mothers in dual-earner families (N = 178) reported spending in developmentally appropriate positive engagement activities over the first 9 months of their child's life on both work and non-workdays. We also explored how paternal and maternal engagement patterns in infancy were associated with children's later social-emotional competence during toddlerhood (M = 25 months). Utilizing latent growth models, we found that, compared with mothers, fathers spent significantly less time engaging with their infants; however, both parents increased their engagement over time at relatively the same rate. Fathers' rate of increase over time and mothers' initial starting point of engagement on non-workdays were associated with toddlers' attention and mastery motivation. Findings are discussed with regards to what they mean for dual-earner couples and fathers' investment in their offspring, highlighting what they may imply about the second demographic transition and family functioning.

Benchmark attainment by maternal and child health clients across public health nursing agencies.

OBJECTIVES: Benchmark client outcomes across public health nursing (PHN) agencies using Omaha System knowledge, behavior, and status ratings as benchmarking metrics. DESIGN AND SAMPLE: A descriptive, comparative study of benchmark attainment for a retrospective cohort of PHN clients (low-income, high-risk parents, primarily mothers) from 6 counties. MEASURES: Omaha System Problem Rating Scale for Outcomes data for selected problems. Benchmark measures were defined as a rating of 4 on a scale from 1 (lowest) to 5 (highest). INTERVENTION: Family home visiting services to low-income, high-risk parents. RESULTS: The highest percentage of benchmark attainment was for the Postpartum problem (knowledge, 76.2%; behavior, 94.0%; status, 96.6%), and the lowest was for the Interpersonal relationship problem (knowledge, 21.7%; behavior, 69.0%; status, 40.7%). All counties showed significant increases in client knowledge benchmark attainment, and 4 of 6 counties showed significant increases from baseline in behavior and status benchmark attainment. Significant differences were found between counties in client characteristics and benchmark attainment for knowledge, behavior, and status outcomes. CONCLUSIONS: There were consistent patterns in benchmark attainment and outcome improvement across counties and family home visiting studies. Benchmarking appears to be useful for comparison of population health status and home visiting program outcomes.

Recognizing the role of perception in action at 6 months.

The present research examined whether infants as young as 6 months of age would consider what objects a human agent could perceive when interpreting her actions on the objects. In two experiments, the infants took the agent's actions of repeatedly reaching for and grasping one of two possible objects as suggesting her preference for that object only when the agent could detect both objects, not when the agent's perceptual access to the second object was absent, either because a large screen hid the object from the agent (Experiment 1), or because the agent sat with her back toward the object (Experiment 2). These results suggest that young infants recognize the role of perception in constraining an agent's goal-actions.

Biological motion displays elicit social behavior in 12-month-olds.

To test the hypothesis that biological motion perception is developmentally integrated with important social cognitive abilities, 12-month-olds (N = 36) were shown a display of a human point-light figure turning to observe a target. Infants spontaneously and reliably followed the figure's "gaze" despite the absence of familiar and socially informative features such as a face or eyes. This suggests that biological motion displays are sufficient to convey rich psychological information such as attentional orientation and is the first evidence to show that biological motion perception and social cognitive abilities are functionally integrated early in the course of typical development. The question of whether common neural substrates for biological motion perception and analysis of gaze direction underlies the functional integration seen behaviorally is discussed.

Calculating the Attentional Orientation of an Unfamiliar Agent in Infancy.

By the end of the first year, infants are able to recognize both goal-directed and perceptually guided behavior in the actions of non-human agents, even faceless ones. How infants derive the relevant orientation of an unfamiliar agent in the absence of familiar markers such as eyes, ears, or face is unknown. The current studies tested the hypothesis that infants' calculate an agent's "front" from the geometry of its behavior in the spatial environment. In the first study, 14- to 15-month-old infants observed a symmetrical, faceless agent either interact contingently with a confederate or act randomly. It then turn toward one of two target objects. Infants were more likely to look in the direction the agent turned than the opposite direction, but only in the contingent condition. In the second study, the location of the confederate and target objects was varied, which in turned influenced which end of the agent infants interpreted as the front. Finally, implications for infants' early gaze-following behaviors with humans are tested and implications for theory of mind development more broadly are discussed.

Actors and actions: The role of agent behavior in infants' attribution of goals.

Twelve-month-old infants attribute goals to both familiar, human agents and unfamiliar, non-human agents. They also attribute goal-directedness to both familiar actions and unfamiliar ones. Four conditions examined information 12-month-olds use to determine which actions of an unfamiliar agent are goal-directed. Infants who witnessed the agent interact contingently with a human confederate encoded the agent's actions as goal-directed; infants who saw a human confederate model an intentional stance toward the agent without the agent's participation, did not. Infants who witnessed the agent align itself with one of two potential targets before approaching that target encoded the approach as goal-directed; infants who did not observe the self-alignment did not encode the approach as goal-directed. A possible common underpinning of these two seemingly independent sources of information is discussed.

Variability in social reasoning: the influence of attachment security on the attribution of goals.

Over the last half decade there has been a growing move to apply the methods and theory of cognitive development to questions regarding infants' social understanding. Though this combination has afforded exciting opportunities to better understand our species' unique social cognitive abilities, the resulting findings do not always lead to the same conclusions. For example, a growing body of research has found support for both universal similarity and individual differences in infants' social reasoning about others' responses to incomplete goals. The present research examines this apparent contradiction by assessing the influence of attachment security on the ability of university undergraduates to represent instrumental needs versus social-emotional distress. When the two varieties of goals were clearly differentiated, we observed a universally similar pattern of results (Experiments 1A/B). However, when the goals were combined, and both instrumental need and social-emotional distress were presented together, individual differences emerged (Experiments 2 and 3). Taken together, these results demonstrate that by integrating the two perspectives of shared universals and individual differences, important points of contact can be revealed supporting a deeper, more nuanced understanding of the nature of human social reasoning.

An association between understanding cardinality and analog magnitude representations in preschoolers.

The preschool years are a time of great advances in children's numerical thinking, most notably as they master verbal counting. The present research assessed the relation between analog magnitude representations and cardinal number knowledge in preschool-aged children to ask two questions: (1) Is there a relationship between acuity in the analog magnitude system and cardinality proficiency? (2) Can evidence of the analog magnitude system be found within mappings of number words children have not successfully mastered? To address the first question, Study 1 asked three- to five-year-old children to discriminate side-by-side dot arrays with varying differences in numerical ratio, as well as to complete an assessment of cardinality. Consistent with the analog magnitude system, children became less accurate at discriminating dot arrays as the ratio between the two numbers approached one. Further, contrary to prior work with preschoolers, a significant correlation was found between cardinal number knowledge and non-symbolic numerical discrimination. Study 2 aimed to look for evidence of the analog magnitude system in mappings to the words in preschoolers' verbal counting list. Based on a modified give-a-number task (Wynn, 1990, 1992), three- to five-year-old children were asked to give quantities between 1 and 10 as many times as possible in order to assess analog magnitude variability within their developing cardinality understanding. In this task, even children who have not yet induced the cardinality principle showed signs of analog representations in their understanding of the verbal count list. Implications for the contribution of analog magnitude representations towards mastery of the verbal count list are discussed in light of the present work.

Oxytocin Receptor (OXTR) Polymorphisms and Attachment in Human Infants.

Ordinary variations in human infants' attachment behaviors - their proclivity to seek and accept comfort from caregivers - are associated with a wide range of individual differences in psychological functioning in adults. The current investigation examined variation in the oxytocin receptor (OXTR) gene as one possible source of these variations in infant attachment. One hundred seventy-six infants (77 Caucasian, 99 non-Caucasian) were classified as securely or insecurely attached based on their behavior in the Strange Situation (Ainsworth et al., 1978). The A allele of OXTR rs2254298 was associated with attachment security in the non-Caucasian infants (p < 0.005). These findings underscore the importance of oxytocin in the development of human social behavior and support its role in social stress-regulation and the development of trust.

At the intersection of social and cognitive development: internal working models of attachment in infancy.

Three visual habituation studies using abstract animations tested the claim that infants' attachment behavior in the Strange Situation procedure corresponds to their expectations about caregiver-infant interactions. Three unique patterns of expectations were revealed. Securely attached infants expected infants to seek comfort from caregivers and expected caregivers to provide comfort. Insecure-resistant infants not only expected infants to seek comfort from caregivers but also expected caregivers to withhold comfort. Insecure-avoidant infants expected infants to avoid seeking comfort from caregivers and expected caregivers to withhold comfort. These data support Bowlby's (1958) original claims-that infants form internal working models of attachment that are expressed in infants' own behavior.

The attribution of attention: 9-month-olds' interpretation of gaze as goal-directed action.

The current study distinguishes between attributions of goal-directed perception (i.e. attention) and non-goal-directed perception to examine 9-month-olds' interpretation of others' head and eye turns. In a looking time task, 9-month-olds encoded the relationship between an actor's head and eye turns and a target object if the head and eye turns were embedded in a sequence of multiple, variable actions with equifinal outcomes, but not otherwise. This evidence supports the claim that infants of this age may attribute perception, at least goal-directed perception, to others and undermines arguments that gaze-following at this age consists only of uninterpreted reflexes. The evidence also suggests alternative interpretations of the typical errors infants make in standard gaze-following procedures. Implications for infants' understanding of perception and attention in both human and non-human agents are discussed.

Detecting agents.

This paper reviews a recent set of behavioural studies that examine the scope and nature of the representational system underlying theory-of-mind development. Studies with typically developing infants, adults and children with autism all converge on the claim that there is a specialized input system that uses not only morphological cues, but also behavioural cues to categorize novel objects as agents. Evidence is reviewed in which 12- to 15-month-old infants treat certain non-human objects as if they have perceptual/attentional abilities, communicative abilities and goal-directed behaviour. They will follow the attentional orientation of an amorphously shaped novel object if it interacts contingently with them or with another person. They also seem to use a novel object's environmentally directed behaviour to determine its perceptual/attentional orientation and object-oriented goals. Results from adults and children with autism are strikingly similar, despite adults' contradictory beliefs about the objects in question and the failure of children with autism to ultimately develop more advanced theory-of-mind reasoning. The implications for a general theory-of-mind development are discussed.

Infants' attribution of a goal to a morphologically unfamiliar agent.

How do infants identify the psychological actors in their environments? Three groups of 12-month-old infants were tested for their willingness to encode a simple approach behavior as goal-directed as a function of whether it was performed by (1) a human hand, (2) a morphologically unfamiliar green object that interacted with a confederate and behaved intentionally, or (3) the same unfamiliar green object that behaved in a matched, but apparently random manner. Using a visual habituation technique, only infants in the first two conditions were found to encode the approach behavior as goal-directed Thus infants appear able to attribute goals to non-human, even unfamiliar agents. These results imply that by the end of the first year of life infants have a broad notion of what counts as an agent that cannot easily be reduced to humans, objects that are perceptually similar to humans, or objects that display self-propulsion.