What are pharmacists recommending for infant teething treatment?

OBJECTIVES: In 2011, the Food and Drug Administration issued a warning to avoid the use of any benzocaine-containing products for infant teething treatment owing to a risk of methemoglobinemia. Several benzocaine-containing products targeted for infant teething are currently available over the counter. Pharmacists are commonly asked for medical advice in the community, and there is no current literature evaluating what pharmacists are recommending for infant teething. The objectives of this study were to evaluate what pharmacists are currently recommending for infant teething treatment and assess what percentage would inappropriately recommend a benzocaine-containing product. METHODS: From March to June 2016, a 16-item in-person paper-and-pen questionnaire was administered to 200 pharmacists in the San Francisco Bay area at 115 outpatient over-the-counter pharmacies. Questions included demographic information, work and educational background, infant teething recommendations, and preferred educational resources. RESULTS: The overall response rate was 94.3%. One-half (50.5%) of the pharmacists' approaches to infant teething treatment was to recommend a nondrug option first and then, if needed, an over-the-counter medication. A majority (63.0%) of the pharmacists surveyed would inappropriately select a benzocaine-containing product. CONCLUSION: Despite warnings, the majority of pharmacists would still inappropriately recommend a benzocaine-containing product for treatment of infant teething. Further education is warranted to ensure that all pharmacists, health care providers, and consumers are aware of the potential harm of benzocaine use in infants.

Pupillometry shows the effort of auditory attention switching.

Successful speech communication often requires selective attention to a target stream amidst competing sounds, as well as the ability to switch attention among multiple interlocutors. However, auditory attention switching negatively affects both target detection accuracy and reaction time, suggesting that attention switches carry a cognitive cost. Pupillometry is one method of assessing mental effort or cognitive load. Two experiments were conducted to determine whether the effort associated with attention switches is detectable in the pupillary response. In both experiments, pupil dilation, target detection sensitivity, and reaction time were measured; the task required listeners to either maintain or switch attention between two concurrent speech streams. Secondary manipulations explored whether switch-related effort would increase when auditory streaming was harder. In experiment 1, spatially distinct stimuli were degraded by simulating reverberation (compromising across-time streaming cues), and target-masker talker gender match was also varied. In experiment 2, diotic streams separable by talker voice quality and pitch were degraded by noise vocoding, and the time alloted for mid-trial attention switching was varied. All trial manipulations had some effect on target detection sensitivity and/or reaction time; however, only the attention-switching manipulation affected the pupillary response: greater dilation was observed in trials requiring switching attention between talkers.

Sustained Cortical and Subcortical Measures of Auditory and Visual Plasticity following Short-Term Perceptual Learning.

Short-term training can lead to improvements in behavioral discrimination of auditory and visual stimuli, as well as enhanced EEG responses to those stimuli. In the auditory domain, fluency with tonal languages and musical training has been associated with long-term cortical and subcortical plasticity, but less is known about the effects of shorter-term training. This study combined electroencephalography (EEG) and behavioral measures to investigate short-term learning and neural plasticity in both auditory and visual domains. Forty adult participants were divided into four groups. Three groups trained on one of three tasks, involving discrimination of auditory fundamental frequency (F0), auditory amplitude modulation rate (AM), or visual orientation (VIS). The fourth (control) group received no training. Pre- and post-training tests, as well as retention tests 30 days after training, involved behavioral discrimination thresholds, steady-state visually evoked potentials (SSVEP) to the flicker frequencies of visual stimuli, and auditory envelope-following responses simultaneously evoked and measured in response to rapid stimulus F0 (EFR), thought to reflect subcortical generators, and slow amplitude modulation (ASSR), thought to reflect cortical generators. Enhancement of the ASSR was observed in both auditory-trained groups, not specific to the AM-trained group, whereas enhancement of the SSVEP was found only in the visually-trained group. No evidence was found for changes in the EFR. The results suggest that some aspects of neural plasticity can develop rapidly and may generalize across tasks but not across modalities. Behaviorally, the pattern of learning was complex, with significant cross-task and cross-modal learning effects.

Temporal alignment of pupillary response with stimulus events via deconvolution.

Analysis of pupil dilation has been used as an index of attentional effort in the auditory domain. Previous work has modeled the pupillary response to attentional effort as a linear time-invariant system with a characteristic impulse response, and used deconvolution to estimate the attentional effort that gives rise to changes in pupil size. Here it is argued that one parameter of the impulse response (the latency of response maximum, t(max)) has been mis-estimated in the literature; a different estimate is presented, and it is shown how deconvolution with this value of t(max) yields more intuitively plausible and informative results.

Perception of the pitch of unresolved harmonics by 3- and 7-month-old human infants.

Three-month-olds discriminate resolved harmonic complexes on the basis of missing fundamental (MF) pitch. In view of reported difficulty in discriminating unresolved complexes at 7 months and striking changes in the organization of the auditory system during early infancy, infants' ability to discriminate unresolved complexes is of some interest. This study investigated the ability of 3-month-olds, 7-month-olds, and adults to discriminate the pitch of unresolved harmonic complexes using an observer-based method. Stimuli were MF complexes bandpass filtered with a -12 dB/octave slope, combined in random phase, presented at 70 dB sound pressure level (SPL) for 650 ms with a 50 ms rise/fall with a pink noise at 65 dB SPL. The conditions were (1) "LOW" unresolved harmonics (2500-4500 Hz) based on MFs of 160 and 200 Hz and (2) "HIGH" unresolved harmonics (4000-6000 Hz) based on MFs of 190 and 200 Hz. To demonstrate MF discrimination, participants had to ignore spectral changes in complexes with the same fundamental and respond only when the fundamental changed. Nearly all infants tested categorized complexes by MF pitch suggesting discrimination of pitch extracted from unresolved harmonics by 3 months. Adults also categorized the complexes by MF pitch, although musically trained adults were more successful than musically untrained adults.

Perception of missing fundamental pitch by 3- and 4-month-old human infants.

A hallmark of complex pitch perception is that the pitch of a harmonic complex is the same whether or not the fundamental frequency is present. By 7 months, infants appear to discriminate on the basis of the pitch of the missing fundamental (MF). Although electrophysiological cortical responses to MF pitch changes have been recorded in infants younger than 7 months, no psychophysical studies have been published. This study investigated the ability of 3- and 4-month-olds to perceive the pitch of MF harmonic complexes based on fundamentals of 160 Hz and 200 Hz using an observer-based method. In experiment I, to demonstrate MF pitch discrimination, 3- and 4-month-olds were required to ignore spectral changes in complexes with the same fundamental and to respond only when the fundamental changed. In experiment II, a 60-260 Hz noise was presented with complexes to mask combination tones at the fundamental frequency. In experiment III, complexes were bandpass filtered with a -12 dB/octave slope to limit use of spectral edge cues and presented with a pink noise to mask all distortion products. Nearly all infants tested categorized complexes by MF pitch in these experiments, suggesting perception of the missing fundamental at 3 months.