In-person and online mixed method non-randomised studies exploring feasibility and acceptability of HEADS: UP, an adapted Mindfulness-Based Stress Reduction programme for stroke survivors experiencing symptoms of anxiety and depression.

BACKGROUND: Depression and anxiety are prevalent after stroke and associated with poor outcomes. We previously co-developed a stroke-specific self-management intervention, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). The two studies reported here aimed to test the feasibility and acceptability of the HEADS: UP course and supporting materials, and research processes ahead of a definitive trial. METHODS: We recruited community-dwelling stroke survivors (SS) ≥ 3 months post-stroke, with symptoms of mood disorder (Hospital Anxiety and Depression Scale ≥ 8). Participants could 'enrol' a family member/ 'other' to take part with them, if desired. Study 1 tested HEADS: UP delivered in-person, and informed optimisation of research processes and intervention delivery and materials. In a pragmatic response to Covid-related socialising restrictions, HEADS: UP was then adapted for online delivery, tested in Study 2. The primary outcome (both studies) was the feasibility (acceptability, fidelity) of the intervention and of research processes. Quantitative data (including patient-reported outcome measures (PROMs) assessing mood and quality of life) and qualitative data were collected pre-/post-intervention. Descriptive statistics were used to analyse quantitative data; a thematic framework approach was used to analyse qualitative data. Both studies received ethical approval prior to commencement. RESULTS: Study 1 Feasibility: 13 (59.1%) of 22 potentially eligible stroke survivors consented; aged 66 (median, interquartile range (IQR) 14); male (n = 9; 69%); 28 (IQR 34) months post-stroke. Of these, n = 10 (76.9%) completed PROMS pre-intervention; n = 6 (46.2%) post-intervention. Acceptability: Nine (69.2%) of the 13 participants attended ≥ 4 core intervention sessions. Aspects of screening and data collection were found to be burdensome. Study 2 Feasibility: SS n = 9 (41%) of 22 potentially eligible stroke survivors consented; aged 58 years (median; IQR 12); male (n = 4; 44.4%); 23 (IQR 34) months post-stroke. Of these, n = 5 (55.6%) completed PROMS pre-intervention; n = 5 (55.6%) post-intervention. Acceptability: Five (55.6%) of the 9 participants attended ≥ 4 core sessions. They found online screening and data collection processes straightforward.

The Situated Assessment Method (SAM2): Establishing individual differences in habitual behavior.

From the perspectives of grounded, situated, and embodied cognition, we have developed a new approach for assessing individual differences. Because this approach is grounded in two dimensions of situatedness-situational experience and the Situated Action Cycle-we refer to it as the Situated Assessment Method (SAM2). Rather than abstracting over situations during assessment of a construct (as in traditional assessment instruments), SAM2 assesses a construct in situations where it occurs, simultaneously measuring factors from the Situated Action Cycle known to influence it. To demonstrate this framework, we developed the SAM2 Habitual Behavior Instrument (SAM2 HBI). Across three studies with a total of 442 participants, the SAM2 HBI produced a robust and replicable pattern of results at both the group and individual levels. Trait-level measures of habitual behavior exhibited large reliable individual differences in the regularity of performing positive versus negative habits. Situational assessments established large effects of situations and large situation by individual interactions. Several sources of evidence demonstrated construct and content validity for SAM2 measures of habitual behavior. At both the group and individual levels, these measures were associated with factors from the Situated Action Cycle known to influence habitual behavior in the literature (consistency, automaticity, immediate reward, long-term reward). Regressions explained approximately 65% of the variance at the group level and a median of approximately 75% at the individual level. SAM2 measures further exhibited well-established interactions with personality measures for self-control and neuroticism. Cognitive-affective processes from the Situated Action Cycle explained nearly all the variance in these interactions. Finally, a composite measure of habitualness established habitual behaviors at both the group and individual levels. Additionally, a composite measure of reward was positively related to the composite measure of habitualness, increasing with self-control and decreasing with neuroticism.

Congenital Cytomegalovirus Screening in Massachusetts Birth Hospitals: A Statewide Survey.

This study sought to assess the current state of screening for congenital cytomegalovirus infection in newborns among birth hospitals and newborn nurseries in the state of Massachusetts. A survey assessing hospital protocols for cytomegalovirus testing in newborns was distributed to all birth hospitals and newborn nurseries in Massachusetts from November 2020 to February 2021. 73.3% of hospitals responded to at least one survey question. Of these, fewer than half (48.5%) had any established approach for neonatal cytomegalovirus screening. Salivary polymerase chain reaction was the most common testing modality. Most hospitals did not perform confirmatory testing for positive test results. Most respondents (87.9%) did not know or did not answer how results of cCMV screening were reported to families and who was responsible for coordinating care for cCMV-infected infants. We conclude that congenital cytomegalovirus screening protocols are absent or incomplete in most Massachusetts birth hospitals and newborn nurseries. A cohesive strategy involving standardized education and screening guidelines is needed to reduce the incidence and burden of congenital cytomegalovirus disease on children and their families.