Multidimensional assessment of infant, parent and staff outcomes during a family centered care enhancement project in a tertiary neonatal intensive care unit: study protocol of a longitudinal cohort study.

BACKGROUND: The therapeutic advances and progress in the care for preterm infants have enabled the regular survival of very immature infants. However, the high burden of lifelong sequelae following premature delivery constitutes an ongoing challenge. Regardless of premature delivery, parental mental health and a healthy parent-child relationship were identified as essential prerogatives for normal infant development. Family centered care (FCC) supports preterm infants and their families by respecting the particular developmental, social and emotional needs in the Neonatal Intensive Care Unit. Due to the large variations in concepts and goals of different FCC initiatives, scientific data on the benefits of FCC for the infant and family outcome are sparse and its effects on the clinical team need to be elaborated. METHODS: This prospective single centre longitudinal cohort study enrols preterm infants ≤ 32 + 0 weeks of gestation and/or birthweight ≤ 1500 g and their parents at the neonatal department of the Giessen University Hospital, Giessen, Germany. Following a baseline period, the rollout of additional FCC elements is executed following a stepwise 6-months approach that covers the NICU environment, staff training, parental education and psychosocial support for parents. Recruitment is scheduled over a 5.5. year period from October 2020 to March 2026. The primary outcome is corrected gestational age at discharge. Secondary infant outcomes include neonatal morbidities, growth, and psychomotor development up to 24 months. Parental outcome measures are directed towards parental skills and satisfaction, parent-infant-interaction and mental health. Staff issues are elaborated with particular focus on the item workplace satisfaction. Quality improvement steps are monitored using the Plan- Do- Study- Act cycle method and outcome measures cover the infant, the parents and the medical team. The parallel data collection enables to study the interrelation between these three important areas of research. Sample size calculation was based on the primary outcome. DISCUSSION: It is scientifically impossible to allocate improvements in outcome measures to individual enhancement steps of FCC that constitutes a continuous change in NICU culture and attitudes covering diverse areas of change. Therefore, our trial is designed to allocate childhood, parental and staff outcome measures during the stepwise changes introduced by a FCC intervention program. TRIAL REGISTRATION: Clinicaltrials.gov, trial registration number NCT05286983, date of registration 03/18/2022, retrospectively registered, http://clinicaltrials.gov .

The role of implementation organizations in scaling evidence-based psychosocial interventions.

BACKGROUND: To bring evidence-based interventions (EBIs) to individuals with behavioral health needs, psychosocial interventions must be delivered at scale. Despite an increasing effort to implement effective treatments in communities, most individuals with mental health and behavioral problems do not receive EBIs. We posit that organizations that commercialize EBIs play an important role in disseminating EBIs, particularly in the USA. The behavioral health and implementation industry is growing, bringing the implementation field to an important inflection point: how to scale interventions to improve access while maintaining EBI effectiveness and minimizing inequities in access to psychosocial intervention. MAIN BODY: We offer a first-hand examination of five illustrative organizations specializing in EBI implementation: Beck Institute for Cognitive Behavioral Therapy; Incredible Years, Inc.; the PAXIS Institute; PracticeWise, LLC; and Triple P International. We use the Five Stages of Small Business Growth framework to organize themes. We discuss practical structures (e.g., corporate structures, intellectual property agreements, and business models) and considerations that arise when trying to scale EBIs including balancing fidelity and reach of the intervention. Business models consider who will pay for EBI implementation and allow organizations to scale EBIs. CONCLUSION: We propose research questions to guide scaling: understanding the level of fidelity needed to maintain efficacy, optimizing training outcomes, and researching business models to enable organizations to scale EBIs.

What a difference a syllable makes-Rhythmic reading of poetry.

In reading conventional poems aloud, the rhythmic experience is coupled with the projection of meter, enabling the prediction of subsequent input. However, it is unclear how top-down and bottom-up processes interact. If the rhythmicity in reading loud is governed by the top-down prediction of metric patterns of weak and strong stress, these should be projected also onto a randomly included, lexically meaningless syllable. If bottom-up information such as the phonetic quality of consecutive syllables plays a functional role in establishing a structured rhythm, the occurrence of the lexically meaningless syllable should affect reading and the number of these syllables in a metrical line should modulate this effect. To investigate this, we manipulated poems by replacing regular syllables at random positions with the syllable "tack". Participants were instructed to read the poems aloud and their voice was recorded during the reading. At the syllable level, we calculated the syllable onset interval (SOI) as a measure of articulation duration, as well as the mean syllable intensity. Both measures were supposed to operationalize how strongly a syllable was stressed. Results show that the average articulation duration of metrically strong regular syllables was longer than for weak syllables. This effect disappeared for "tacks". Syllable intensities, on the other hand, captured metrical stress of "tacks" as well, but only for musically active participants. Additionally, we calculated the normalized pairwise variability index (nPVI) for each line as an indicator for rhythmic contrast, i.e., the alternation between long and short, as well as louder and quieter syllables, to estimate the influence of "tacks" on reading rhythm. For SOI the nPVI revealed a clear negative effect: When "tacks" occurred, lines appeared to be read less altering, and this effect was proportional to the number of tacks per line. For intensity, however, the nPVI did not capture significant effects. Results suggests that top-down prediction does not always suffice to maintain a rhythmic gestalt across a series of syllables that carry little bottom-up prosodic information. Instead, the constant integration of sufficiently varying bottom-up information appears necessary to maintain a stable metrical pattern prediction.

Assessing students' mental health in two American dental hygiene programs.

OBJECTIVES: Dental hygiene students adapt to new environments while learning technical skills and providing clinical care during their education. Understanding how stress affects students in their professional healthcare program warrants exploration. This study assessed stress among dental hygiene students in two educational settings in the Southeastern United States. METHODS: First and second-year dental hygiene students (N = 136) from a community college setting (n = 67) and a university setting (n = 69) were invited to complete an anonymous online survey on mental health in fall 2019. Validated surveys on depression, anxiety, social support, and burnout were included. Data analysis included chi-squared and Mantel-Haenszel statistics, depending on the scale of measurement, with the level of significance set at 0.05 for all analyses. RESULTS: Participants included 54 dental hygiene students from a community college (Response rate = 80.6%) and 69 dental hygiene students from a university (RR = 100%). There was a statistically significant difference in the proportion of students reporting moderately severe or severe anxiety (p = 0.007), with 56% (n = 30) of the community college respondents and 36% (n = 24) of the university reporting these anxiety levels. Students attending a community college were also more likely to express feelings of worry (n = 34) compared to students in a university setting (p = 0.005). There was no statistically significant difference in depression (p = 0.07) or suicidal thoughts (p = 0.41). CONCLUSION: Dental hygiene students enrolled in these two programs reported high levels of self-reported stress, mental and emotional concerns that may increase suicidal tendencies.

Insulin sensitivity in mesolimbic pathways predicts and improves with weight loss in older dieters.

Central insulin is critically involved in the regulation of hedonic feeding. Insulin resistance in overweight has recently been shown to reduce the inhibitory function of insulin in the human brain. How this relates to effective weight management is unclear, especially in older people, who are highly vulnerable to hyperinsulinemia and in whom neural target systems of insulin action undergo age-related changes. Here, 50 overweight, non-diabetic older adults participated in a double-blind, placebo-controlled, pharmacological functional magnetic resonance imaging study before and after randomization to a 3-month caloric restriction or active waiting group. Our data show that treatment outcome in dieters can be predicted by baseline measures of individual intranasal insulin (INI) inhibition of value signals in the ventral tegmental area related to sweet food liking as well as, independently, by peripheral insulin sensitivity. At follow-up, both INI inhibition of hedonic value signals in the nucleus accumbens and peripheral insulin sensitivity improved with weight loss. These data highlight the critical role of central insulin function in mesolimbic systems for weight management in humans and directly demonstrate that neural insulin function can be improved by weight loss even in older age, which may be essential for preventing metabolic disorders in later life.

Valence Encoding Signals in the Human Amygdala and the Willingness to Eat.

One of the strongest drivers of food consumption is pleasure, and with a large variety of palatable food continuously available, there is rarely any necessity to eat something not tasty. The amygdala is involved in hedonic valuation, but its role in valence assignment during food choices is less understood. Given recent evidence for spatially segregated amygdala signatures encoding palatability, we applied a multivariate approach on fMRI data to extract valence-specific signal patterns during an explicit evaluation of food liking. These valence localizers were then used to identify hedonic valuation processes while the same healthy human participants (14 female, 16 male; in overnight fasted state on both scanning days) performed a willingness-to-eat task in a separate fMRI measurement. Valence-specific patterns of amygdala signaling predicted decisions on food consumption significantly. Findings could be validated using the same valence localizers to predict consumption decisions participants made on a separate set of food stimuli that had not been used for localizer identification. Control analyses revealed these findings to be restricted to a multivariate compared with a univariate approach, and to be specific for valence processing in the amygdala. Spatially distributed valuation signals of the amygdala thus appear to modulate appetitive consumption decisions, and may be useful to identify current hedonic valuation processes triggering food choices even when not explicitly instructed.SIGNIFICANCE STATEMENT The expectation of tastiness is a particularly strong driver in everyday decisions on food consumption. The amygdala is important for hedonic valuation processes and involved in valence-related behavior, but the relationship between both processes is less understood. Here, we show that hedonic values of food are represented in spatially distributed activation patterns in the amygdala. The engagement of these patterns during food choices modulates consumption decisions. Findings are stable in a separate stimulus set. These results suggest that valence-specific amygdala signals are integrated into the formation of food choices.

Rhythmic subvocalization: An eye-tracking study on silent poetry reading.

The present study investigates effects of conventionally metered and rhymed poetry on eyemovements in silent reading. Readers saw MRRL poems (i.e., metrically regular, rhymed language) in two layouts. In poem layout, verse endings coincided with line breaks. In prose layout verse endings could be mid-line. We also added metrical and rhyme anomalies. We hypothesized that silently reading MRRL results in building up auditive expectations that are based on a rhythmic "audible gestalt" and propose that rhythmicity is generated through subvocalization. Our results revealed that readers were sensitive to rhythmic-gestalt-anomalies but showed differential effects in poem and prose layouts. Metrical anomalies in particular resulted in robust reading disruptions across a variety of eye-movement measures in the poem layout and caused re-reading of the local context. Rhyme anomalies elicited stronger effects in prose layout and resulted in systematic re-reading of pre-rhymes. The presence or absence of rhythmic-gestalt-anomalies, as well as the layout manipulation, also affected reading in general. Effects of syllable number indicated a high degree of subvocalization. The overall pattern of results suggests that eye-movements reflect, and are closely aligned with, the rhythmic subvocalization of MRRL. This study introduces a two-stage approach to the analysis of long MRRL stimuli and contributes to the discussion of how the processing of rhythm in music and speech may overlap.

Mesolimbic white matter connectivity mediates the preference for sweet food.

Dopaminergic brain structures like the nucleus accumbens (NAc) are thought to encode the incentive salience of palatable foods motivating appetitive behaviour. Animal studies have identified neural networks mediating the regulation of hedonic feeding that comprise connections of the NAc with the ventral tegmental area (VTA) and the lateral hypothalamus (LH). Here, we investigated how structural connectivity of these pathways relates to individual variability in decisions on sweet food consumption in humans. We therefore combined probabilistic tractography on diffusion imaging data from 45 overnight fasted lean to overweight participants with real decisions about high and low sugar food consumption. Across all individuals, sugar preference and connectivity strength were not directly related, however, multiple regression analysis revealed interaction of mesolimbic structure and sugar preference to depend on individuals' BMI score. In overweight individuals (BMI: ≥25 kg/m², N = 22) higher sugar preference was thereby specifically related to stronger connectivity within the VTA-NAc pathway while the opposite pattern emerged in participants with normal BMI (BMI: <25 kg/m², N = 23). Our structural results complement previous functional findings on the critical role of the human mesolimbic system for regulating hedonic eating in overweight individuals.

Vascular Risk Factors in Patients with Different Subtypes of Ischemic Stroke May Affect Their Outcome after Intravenous tPA.

Intravenous (i.v.) tissue-type plasminogen activator (tPA) is the only approved noninvasive therapy for acute ischemic stroke (AIS). However, after tPA treatment, the outcome of patients with different subtypes of stroke according to their vascular risk factors remains to be elucidated. We aim to explore the relationship between the outcome and different risk factors in patients with different subtype of acute strokes treated with i.v. tPA. Records of patients in this cohort were reviewed. Data collected and analysed included the demographics, vascular risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) scores, 90-day modified Rankin Scores (mRS), and subtypes of stroke. By using the 90-day mRS, patients were dichotomized into favorable versus unfavorable outcome in each subtype of stroke. We identified the vascular risk factors that are likely associated with the poor outcome in each subtype. Among 570 AIS patients received i.v. tPA, 217 were in the large artery atherosclerosis (LAA) group, 146 in the small vessel occlusion (SVO) group, and 140 in the cardioaortic embolism (CE) group. Lower NIHSS score on admission was related to favorable outcome in patients in all subtypes. Patients with history of dyslipidemia were likely on statin treatment before their admission and hence less likely to have elevated cholesterol level on admission. Therefore, there was a possible paradoxical effect on the outcome in patients with LAA and SVO subtypes of strokes. SVO patients with history of diabetes had higher risk of unfavorable outcome. SVO patients had favorable outcome if their time from onset to treatment was short. In conclusion, the outcome of patients treated with i.v. tPA may be related to different vascular risk factors associated with different subtypes of stroke.

Intravenous Tissue Plasminogen Activator Can Be Safely Given without Complete Blood Count Results Back.

INTRODUCTION: It is well known that the efficacy of intravenous (i.v.) tissue plasminogen activator (tPA) is time-dependent when used to treat patients with acute ischemic strokes. AIM: Our study examines the safety issue of giving IV tPA without complete blood count (CBC) resulted. MATERIALS AND METHODS: This is a retrospective observational study by examining the database from Huashan Hospital in China and OSF/INI Comprehensive Stroke Center in United States. Patient data collected included demographics, occurrence of symptomatic intracranial hemorrhage, door to needle intervals, National Institute of Health Stroke Scale scores on admission, CBC results on admission and follow-up modified Rankin Scale scores. Linear regression and multivariable logistic regression analysis were used to identify factors that would have an impact on door-to-needle intervals. RESULTS: Our study included 120 patients from Huashan Hospital and 123 patients from INI. Among them, 36 in Huashan Hospital and 51 in INI received i.v. tPA prior to their CBC resulted. Normal platelet count was found in 98.8% patients after tPA was given. One patient had thrombocytopenia but no hemorrhagic event. A significantly shorter door to needle interval (DTN) was found in the group without CBC resulted. There was also a difference in treatment interval between the two hospitals. Door to needle intervals had a strong correlation to onset to treatment intervals and NIHSS scores on admission. CONCLUSION: In patients presented with acute ischemic stroke, the risk of developing hemorrhagic event is low if i.v. tPA is given before CBC has resulted. The door to needle intervals can be significantly reduced.

Myocardial infarction and incidence of type 2 diabetes mellitus. Is admission blood glucose an independent predictor for future type 2 diabetes mellitus?

BACKGROUND: Although blood glucose levels in patients with acute myocardial infarction (AMI) are frequently elevated, studies investigating the future risk of type 2 diabetes mellitus (T2DM) in patients with AMI are scarce. We sought to investigate whether increased blood glucose levels on admission in nondiabetic patients with first AMI are predictive for future T2DM. METHODS: We used the KORA MI register database in Augsburg, Germany, and included 1,239 nondiabetic patients aged 25 to 74 years who were admitted to hospital between 1998 and 2003 with a diagnosis of a first AMI and who had survived at least 28 days. Incident cases of T2DM and the date of diagnosis were validated by hospital records or by contacting the patient's treating physician. RESULTS: A total of 108 cases of incident T2DM were registered during a mean follow-up of 4.7 years. Cox proportional hazards regression analysis was done, and admission blood glucose was divided into quartiles (Q). Compared to AMI patients with blood glucose on admission <111 mg/dL (Q1), patients with levels > or =153 mg/dL (Q4) showed an age and sex-adjusted relative risk of 2.76 (95% CI 1.61-4.75) for incident T2DM. This association was only slightly attenuated after multivariable adjustment (hazard ratio 2.59, 95% CI 1.49-4.49). CONCLUSIONS: Admission blood glucose in nondiabetic AMI patients could offer an initial screening tool during the short-term event to select those patients with high risk for future T2DM requiring a close monitoring of glucose metabolism.

Effect of blood glucose concentrations on admission in non-diabetic versus diabetic patients with first acute myocardial infarction on short- and long-term mortality (from the MONICA/KORA Augsburg Myocardial Infarction Registry).

The aim of this study was to investigate the association between increased admission glucose in nondiabetic (ND) patients and in patients with type 2 diabetes mellitus (T2DM) with first acute myocardial infarctions (AMIs) and 28-day as well as 1- and 3-year case fatality. The Monitoring Trends and Determinants in Cardiovascular Disease (MONICA)/Cooperative Health Research in the Region of Augsburg (KORA) myocardial infarction registry database in Augsburg, Germany, was used, and 1,631 patients without and 659 patients with T2DM (aged 25 to 74 years) who were admitted from 1998 to 2003 with first AMIs were included. Mortality follow-up was carried out in 2005. ND patients with AMIs with admission glucose >152 mg/dl (top quartile) compared with those in the bottom quartile had an odds ratio of 2.82 (95% confidence interval [CI] 1.30 to 6.12) for death within 28 days after multivariate adjustment; correspondingly, patients with T2DM with admission glucose >278 mg/dl (top quartile) compared with those in the bottom quartile (<152 mg/dl) showed a nonsignificantly increased odds ratio of 1.45 (95% CI 0.64 to 3.31). After the exclusion of patients who died within 28 days, a nonsignificantly increased relative risk (RR) was seen between admission blood glucose and 1-year mortality in ND subjects (RR 2.71, 95% CI 0.90 to 8.15), whereas no increased RR was found in subjects with diabetes (RR 0.99, 95% CI 0.34 to 2.82). After 3 years, there was no increased risk for death in patients with high admission blood glucose levels, neither for ND patients nor for those with T2DM. In conclusion, elevated admission blood glucose is associated with increased short-term mortality risk in patients with AMIs, particularly in ND subjects. These patients constitute a high-risk group needing aggressive, comprehensive polypharmacotherapy.

Effects of cognitive therapy for depression on daily stress-related variables.

This study used a daily diary design to evaluate depressed patients' changes on daily stress-related variables during cognitive therapy (CT). Patients completed daily diaries on two week-long occasions: after the intake interview and again after the sixth session of CT. Patients also completed a measure of depressive symptoms before every treatment session. After six sessions of CT, patients reported a significant reduction in: (a) depressive symptoms; (b) daily sad affect (SA); (c) daily negative thoughts associated with the day's most stressful event; and (d) SA reactivity to daily stressors. In addition, patients reported a significant increase in: (e) daily positive affect (PA); and (f) SA reactivity to daily negative thoughts. The results suggest that CT has its intended effects on the daily lives of depressed adults, and highlight the value of a daily diary methodology for research on CT.

Negative affective spillover from daily events predicts early response to cognitive therapy for depression.

This study evaluated the predictive role of depressed outpatients' (N = 62) affective reactivity to daily stressors in their rates of improvement in cognitive therapy (CT). For 1 week before treatment, patients completed nightly electronic diaries that assessed daily stressors and negative affect (NA). The authors used multilevel modeling to compute each patient's within-day relationship between daily stressors and daily NA (within-day reactivity), as well as the relationship between daily stressors and next-day NA (next-day reactivity; affective spillover). In growth model analyses, the authors evaluated the predictive role of patients' NA reactivity in their early (Sessions 1-4) and late (Sessions 5-12) response to CT. Within-day NA reactivity did not predict early or late response to CT. However, next-day reactivity predicted early response to CT, such that patients who had greater NA spillover in response to negative events had a slower rate of symptom change during the first 4 sessions. Affective spillover did not influence later response to CT. The findings suggest that depressed patients who have difficulty bouncing back the next day from their NA reactions to a relative increase in daily negative events will respond less quickly to the early sessions of CT.

Cognitive behavioral therapy: a blueprint for attaining and assessing psychiatry resident competency.

BACKGROUND: The Residency Review Committee (RRC) for Psychiatry of the Accreditation Council on Graduate Medical Education (ACGME) now requires that all psychiatric residency programs demonstrate competency for all psychiatric residents in cognitive behavior therapy (CBT). OBJECTIVE: To increase awareness about specific knowledge, skills, and attitudes necessary to perform competent CBT, optimal teaching methods available to insure competency, and valid assessment tools and resources available to training programs. METHODS: Literature review and discussion of common features of successful training programs. RESULTS AND CONCLUSIONS: Training programs have resources and standardized methods of training, supervision, and assessment available to help residents meet the ACGME mandated competency requirements in CBT.

Readiness of psychiatry residency training programs to meet the ACGME requirements in cognitive-behavioral therapy.

The authors assessed the readiness of adult psychiatry residency programs to train residents in cognitive-behavioral therapy (CBT) prior to the January 2001 revision of program requirements by the Accreditation Council for Graduate Medical Education (ACGME). Adult residency training program directors were surveyed. Data analysis evaluated relationships between directors' confidence in CBT training and the program and faculty characteristics. Responses were received from 54.2% of programs. Half had no requirement for resident-performed CBT. Directors' confidence in CBT training was significantly related to didactic hours (P=0.041), psychotherapy hours (P=0.007), and ACT-certified faculty (P=0.035). A substantial lack of required training in CBT exists in least 25% of accredited programs. Assessing faculty credentials and working with specialty organizations recommended in this article could assist in developing better programs in CBT.