Pandemic play moderates the relation between caregiver stress and child emotional distress in contexts of economic adversity.

It is well-established that caregiver stress is linked to increased emotional distress among children, and recent evidence highlights similar associations between caregiver and child emotional well-being during the coronavirus (COVID-19) pandemic. Examining protective factors and coping mechanisms that are associated with resiliency in the face of pandemic-related stress can highlight potential strategies that may help children adapt to other unexpected hardships outside of a global pandemic. Previous research found that playing about the pandemic moderated an association between caregiver stress and children's emotional distress. However, few studies have explored "pandemic play" among children from low-income households, where pandemic-related stressors were often exacerbated. In the present study, 72 caregivers of Head Start preschoolers between 3 and 6 years of age were surveyed between late 2020 and early 2021. Results revealed that 32% of children engaged in pandemic play frequently. Caregiver stress was positively associated with child emotional distress, but only among children who did not engage in pandemic play frequently. These findings support the idea that child-directed play may be a developmentally appropriate and accessible coping mechanism to reduce the emotional burden of stressful events on children, regardless of economic context.

Pretend play as abstraction: Implications for early development and beyond.

Humans are the only species that engages in sustained, complex pretend play. As pretend play is practically ubiquitous across cultures, it might support or afford a context for developmental advances during the juvenile period that have implications for functioning in adulthood. Early in development, learning to separate our thoughts from reality is practiced in pretend play and is associated with changes not just in cognition, but in emotional and social domains as well. Specifically, pretend play affords opportunities to engage in abstractions that could support abilities such as perspective-taking, emotion recognition and regulation, and cooperation and negotiation in childhood. In turn, the abstraction skills promoted by early pretend play might underlie creativity, innovation, and our capacity to feel empathy and moral obligation to others in later childhood and adulthood. In fact, because pretend play affords sharing our abstractions with others, it might be an early context for behaviors that ultimately promote the shared abstractions of human culture itself.

Child Adjustment During COVID-19: The Role of Economic Hardship, Caregiver Stress, and Pandemic Play.

The coronavirus disease 2019 (COVID-19) led to many lifestyle changes and economic hardships for families with young children. Previous research on risk and resilience highlights that children's adjustment to family hardships is influenced by caregiver stress, but individual child behaviors and characteristics may protect children from negative outcomes. Interestingly, many children have been reported to incorporate COVID-19 themes in their pretend play. Theory suggests children may do so to cope with pandemic-related stress, but no empirical studies have explored this possibility. The purpose of this study was to understand the process by which COVID-19 economic hardships experienced by a family were related to children's emotional well-being and development and to investigate how this process may vary as a function of children's engagement in pandemic-related pretend play. Caregivers (N = 99; mostly high earning families) of preschoolers ages 3-6 years (51% girls, 82% White) living in the United States participated in an online survey at two time points during the pandemic. Result revealed that COVID-19 economic hardships were related to increased caregiver stress, which, in turn, was associated with children's emotional distress and poorer self-regulation. However, engaging in pandemic-related pretend play appeared to protect children's well-being by weakening the adverse association between caregivers' stress and children's emotional distress. Thus, addressing caregiver stress levels and allowing children an outlet to cope with challenges through pretend play could have crucial protective effects on early development and well-being during times of crisis.

Pretending with realistic and fantastical stories facilitates executive function in 3-year-old children.

Fictional stories can affect many aspects of children's behavior and cognition, yet little is known about how they might help or hinder children's executive function skills. The current study investigated the role of story content (fantasy or reality) and mode of engagement with the story (pretense or a non-pretense control) on children's inhibitory control, an important component of early executive function. A total of 60 3-year-olds were randomly assigned to hear a fantastical or realistic story and were encouraged to engage in either pretense or a non-pretense activity related to the story. They then completed the Less Is More task of inhibitory control. Story content had no impact on children's inhibitory control; children performed equally well after hearing a fantastical or realistic story. However, children who engaged in story-related pretend play showed greater inhibitory control than those who engaged in a non-pretense activity. We found no interaction between story content and play engagement type. These results held when controlling for baseline inhibitory control, receptive vocabulary, age, gender, affect, and propensity toward pretense. Therefore, mode of play engagement with a story was more important in promoting children's inhibitory control skills than the degree of realism in the story.

On Command Drug Delivery via Cell-Conveyed Phototherapeutics.

Herein, the use of red blood cells (RBCs) as carriers of cytoplasmically interned phototherapeutic agents is described. Photolysis promotes drug release from the RBC carrier thereby providing the means to target specific diseased sites. This strategy is realized with a vitamin B12-taxane conjugate (B12-TAX), in which the drug is linked to the vitamin via a photolabile CoC bond. The conjugate is introduced into mouse RBCs (mRBCs) via a pore-forming/pore-resealing procedure and is cytoplasmically retained due to the membrane impermeability of B12. Photolysis separates the taxane from the B12 cytoplasmic anchor, enabling the drug to exit the RBC carrier. A covalently appended Cy5 antenna sensitizes the conjugate (Cy5-B12-TAX) to far red light, thereby circumventing the intense light absorbing properties of hemoglobin (350-600 nm). Microscopy and imaging flow cytometry reveal that Cy5-B12-TAX-loaded mRBCs act as drug carriers. Furthermore, intravital imaging of mice furnish a real time assessment of circulating phototherapeutic-loaded mRBCs as well as evidence of the targeted photorelease of the taxane upon photolysis. Histopathology confirms that drug release occurs in a well resolved spatiotemporal fashion. Finally, acoustic angiography is employed to assess the consequences of taxane release at the tumor site in Nu/Nu-tumor-bearing mice.

Experimental Paradigm for Measuring the Effects of Self-distancing in Young Children.

Self-distancing (i.e., creating mental distance between the self and a stimulus by adopting a less egocentric perspective) has been studied as a way to improve adolescents' and adults' emotion regulation. These studies instruct adolescents and adults to use visual imagery or language to create distance from the self before engaging in self-regulation tasks and when thinking about past and future events. For example, adults are asked to recall past, negative emotional experiences from either a first-person perspective (no distance) or a third-person perspective (self-distanced). These studies show that a self-distanced perspective allows adults to cope more adaptively when recalling negative feelings. However, the self-distancing paradigm used with adults was not developmentally appropriate for young children. This modified self-distancing paradigm involves instructing children to think about their thoughts, feelings, and actions from different perspectives that vary in their distance from the self while completing a self-regulation task. The paradigm involves randomly assigning children to use one of three perspectives: self-immersed, third-person, or exemplar. In the self-immersed condition, children are asked to think about themselves using the first-person perspective (e.g., "How am I feeling?") and no distance is created from the self. In the third-person condition, children are asked to create distance from the self by using the third-person perspective (e.g., "How is [child's name] feeling?"). In the exemplar condition, the greatest distance from the self is created by asking children to pretend to be a media character and to think about that character's thoughts and feelings (e.g., "How is Batman feeling?"). Studies using the self-distancing paradigm with 4-6-year-olds have found that as the amount of distance from the self increases (self-immersed < third-person < exemplar), children perform better on self-regulation tasks. These findings suggest that the strategies implemented in the self-distancing protocol may be useful to include in self-regulation interventions for young children.

Focusing on the future from afar: Self-distancing from future stressors facilitates adaptive coping.

Prior research indicates that visual self-distancing enhances adaptive self-reflection about negative past events (Kross & Ayduk, 2011). However, whether this process is similarly useful when people reflect on anxiety-provoking future negative experiences, and if so, whether a similar set of mechanisms underlie its benefits in this context, is unknown. Here we addressed these questions using a combination of experimental and individual difference methods with adults and adolescents (total N = 2,344). In Studies 1 and 2, spontaneous self-distancing predicted less anxious emotional reactivity among adults and adolescents. This effect was mediated by differences in how vividly participants imagined a future anxiety-provoking event. Study 3 provided causal evidence in an adult sample: Adopting a self-distanced (vs. self-immersed) perspective when reflecting on a future stressor led to lower levels of anxiety as well as lower imagery vividness. Consistent with Studies 1 and 2, reductions in imagery vividness mediated the emotion regulatory benefits of self-distancing. A meta-analysis of all three studies further confirmed these findings across samples. Thus, the current studies extend previous research on the benefits of self-distancing to future stressors. In addition, they highlight a novel mechanism for this relation: imagery vividness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The "Batman Effect": Improving Perseverance in Young Children.

This study investigated the benefits of self-distancing (i.e., taking an outsider's view of one's own situation) on young children's perseverance. Four- and 6-year-old children (N = 180) were asked to complete a repetitive task for 10 min while having the option to take breaks by playing an extremely attractive video game. Six-year-olds persevered longer than 4-year-olds. Nonetheless, across both ages, children who impersonated an exemplar other-in this case a character, such as Batman-spent the most time working, followed by children who took a third-person perspective on the self, or finally, a first-person perspective. Alternative explanations, implications, and future research directions are discussed.

A Stitch in Time: Strategic Self-Control in High School and College Students.

A growing body of research indicates that self-control is critical to academic success. Surprisingly little is known, however, about the diverse strategies students use to implement self-control or how well these strategies work. To address these issues, we conducted a naturalistic investigation of self-control strategies (Study 1) and two field experiments (Studies 2 and 3). In Study 1, high school students described the strategies they use to manage interpersonal conflicts, get academic work done, eat healthfully, and manage other everyday self-control challenges. The majority of strategies in these self-nominated incidents as well as in three hypothetical academic scenarios (e.g., studying instead of texting friends) were reliably classified using the process model of self-control. As predicted by the process model, students rated strategies deployed early in the impulse-generation process (situation selection, situation modification) as being dramatically more effective than strategies deployed later (attentional deployment, cognitive change, response modulation). In Study 2, high school students randomly assigned to implement situation modification were more likely to meet their academic goals during the following week than students assigned either to implement response modulation or no strategy at all. In Study 3, college students randomly assigned to implement situation modification were also more successful in meeting their academic goals, and this effect was partially mediated by decreased feelings of temptation throughout the week. Collectively, these findings suggest that students might benefit from learning to initiate self-control when their impulses are still nascent.

What would Batman do? Self-distancing improves executive function in young children.

This experimental research assessed the influence of graded levels of self-distancing - psychological distancing from one's egocentric perspective - on executive function (EF) in young children. Three- (n = 48) and 5-year-old (n = 48) children were randomly assigned to one of four manipulations of distance from the self (from proximal to distal: self-immersed, control, third person, and exemplar) on a comprehensive measure of EF. Performance increased as a function of self-distancing across age groups. Follow-up analyses indicated that 5-year-olds were driving this effect. They showed significant improvements in EF with increased distance from the self, outperforming controls both when taking a third person perspective on the self and when taking the perspective of an exemplar other (e.g., Batman) through role play. Three-year-olds, however, did not show increased EF performance as a function of greater distance from the self. Preliminary results suggest that developments in theory of mind might contribute to these age-related differences in efficacy. These findings speak to the importance of psychological distancing in the expression of conscious control over thought and action from a young age and suggest a promising new avenue for early EF intervention.

Spontaneous Self-Distancing and Adaptive Self-Reflection Across Adolescence.

Experiments performed primarily with adults show that self-distancing facilitates adaptive self-reflection. However, no research has investigated whether adolescents spontaneously engage in this process or whether doing so is linked to adaptive outcomes. In this study, 226 African American adolescents, aged 11-20, reflected on an anger-related interpersonal experience. As expected, spontaneous self-distancing during reflection predicted lower levels of emotional reactivity by leading adolescents to reconstrue (rather than recount) their experience and blame their partner less. Moreover, the inverse relation between self-distancing and emotional reactivity strengthened with age. These findings highlight the role that self-distancing plays in fostering adaptive self-reflection in adolescence, and begin to elucidate the role that development plays in enhancing the benefits of engaging in this process.

The Academic Diligence Task (ADT): Assessing Individual Differences in Effort on Tedious but Important Schoolwork.

The current study reports on the development and validation of the Academic Diligence Task (ADT), designed to assess the tendency to expend effort on academic tasks which are tedious in the moment but valued in the long-term. In this novel online task, students allocate their time between solving simple math problems (framed as beneficial for problem solving skills) and, alternatively, playing Tetris or watching entertaining videos. Using a large sample of high school seniors (N = 921), the ADT demonstrated convergent validity with self-report ratings of Big Five conscientiousness and its facets, self-control and grit, as well as discriminant validity from theoretically unrelated constructs, such as Big Five extraversion, openness, and emotional stability, test anxiety, life satisfaction, and positive and negative affect. The ADT also demonstrated incremental predictive validity for objectively measured GPA, standardized math and reading achievement test scores, high school graduation, and college enrollment, over and beyond demographics and intelligence. Collectively, findings suggest the feasibility of online behavioral measures to assess noncognitive individual differences that predict academic outcomes.

A Behind-the-Scenes Guide to School-Based Research.

Schools are an important context for both basic and applied scientific research. Unlike the laboratory, however, the physical and social conditions of schools are not under the exclusive control of scientists. In this article, we liken collecting data in schools to putting on a theatrical production. We begin by describing the large cast of characters whose collaborative efforts make school-based research possible. Next, we address the critics, including the university Institutional Review Board (IRB) and school administrators, whose feedback often improves the final study design. We then turn our attention to set building, stage directions, and rehearsals - key steps in the iterative process of refining study procedures. We end with a discussion of the day of data collection itself and activities that take place after the curtain drops. Throughout, we make recommendations based on our recent experience collecting data at several high schools. All the world's a stage~William Shakespeare, As You Like It, 2.7.139.

Evidence for a relation between executive function and pretense representation in preschool children.

Several theoretical formulations suggest a relation between children's pretense and executive function (EF) skills. However, there is little empirical evidence for a correlation between these constructs in early development. Preschool children (N = 104; M age = 4-0) were given batteries of EF and pretense representation measures, as well as verbal, memory, and appearance-reality control tasks. Confirmatory factor analysis revealed two separable but overlapping aspects of EF (Conflict and Delay). EF was significantly related to pretense after accounting for all controls. Understanding the pretend-reality distinction was strongly related to Conflict EF, whereas performing pretend actions was more strongly related to Delay EF. These results, although correlational, are consistent with the claim that EF skills are implicated in pretense, such as inhibiting reality and flexibly manipulating dual representations, and offer a potential mechanism by which pretend play interventions may enhance childhood EF.

The effects of interruptions on oncologists' patient assessment and medication ordering practices.

Interruptions are causal factors in medication errors. Although researchers have assessed the nature and frequency of interruptions during medication administration, there has been little focus on understanding their effects during medication ordering. The goal of this research was to examine the nature, frequency, and impact of interruptions on oncologists' ordering practices. Direct observations were conducted at a Canadian cancer treatment facility to (1) document the nature, frequency, and timing of interruptions during medication ordering, and (2) quantify the use of coping mechanisms by oncologists. On average, oncologists were interrupted 17 % of their time, and were frequently interrupted during safety-critical stages of medication ordering. When confronted with interruptions, oncologists engaged/multitasked more often than resorting to deferring/blocking. While some interruptions are necessary forms of communication, efforts must be made to reduce unnecessary interruptions during safety-critical tasks, and to develop interventions that increase oncologists' resiliency to inevitable interruptions.

Optimizing the design of preprinted orders for ambulatory chemotherapy: combining oncology, human factors, and graphic design.

PURPOSE: To establish a set of guidelines for developing ambulatory chemotherapy preprinted orders. METHODS: Multiple methods were used to develop the preprinted order guidelines. These included (A) a comprehensive literature review and an environmental scan; (B) analyses of field study observations and incident reports; (C) critical review of evidence from the literature and the field study observation analyses; (D) review of the draft guidelines by a clinical advisory group; and (E) collaboration with graphic designers to develop sample preprinted orders, refine the design guidelines, and format the resulting content. RESULTS: The Guidelines for Developing Ambulatory Chemotherapy Preprinted Orders, which consist of guidance on the design process, content, and graphic design elements of ambulatory chemotherapy preprinted orders, have been established. CONCLUSION: Health care is a safety critical, dynamic, and complex sociotechnical system. Identifying safety risks in such a system and effectively addressing them often require the expertise of multiple disciplines. This study illustrates how human factors professionals, clinicians, and designers can leverage each other's expertise to uncover commonly overlooked patient safety hazards and to provide health care professionals with innovative, practical, and user-centered tools to minimize those hazards.

Checking it twice: an evaluation of checklists for detecting medication errors at the bedside using a chemotherapy model.

OBJECTIVE: To determine what components of a checklist contribute to effective detection of medication errors at the bedside. DESIGN: High-fidelity simulation study of outpatient chemotherapy administration. SETTING: Usability laboratory. PARTICIPANTS: Nurses from an outpatient chemotherapy unit, who used two different checklists to identify four categories of medication administration errors. MAIN OUTCOME MEASURES: Rates of specified types of errors related to medication administration. RESULTS: As few as 0% and as many as 90% of each type of error were detected. Error detection varied as a function of error type and checklist used. Specific step-by-step instructions were more effective than abstract general reminders in helping nurses to detect errors. Adding a specific instruction to check the patient's identification improved error detection in this category by 65 percentage points. Matching the sequence of items on the checklist with nurses' workflow had a positive impact on the ease of use and efficiency of the checklist. CONCLUSIONS: Checklists designed with explicit step-by-step instructions are useful for detecting specific errors when a care provider is required to perform a long series of mechanistic tasks under a high cognitive load. Further research is needed to determine how best to assist clinicians in switching between mechanistic tasks and abstract clinical problem solving.