Implementation of the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) programme: an interdisciplinary, generalisable approach to inpatient neurodevelopmental care.

BACKGROUND: Children with CHD are at risk for neurodevelopmental delays, and length of hospitalisation is a predictor of poorer long-term outcomes. Multiple aspects of hospitalisation impact neurodevelopment, including sleep interruptions, limited holding, and reduced developmental stimulation. We aimed to address modifiable factors by creating and implementing an interdisciplinary inpatient neurodevelopmental care programme in our Heart Institute. METHODS: In this quality improvement study, we developed an empirically supported approach to neurodevelopmental care across the continuum of hospitalisation for patients with CHD using three plan-do-study-act cycles. With input from multi-level stakeholders including parents/caregivers, we co-designed interventions that comprised the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) programme. These included medical/nursing orders for developmental care practices, developmental kits for patients, bedside developmental plans, caregiver education and support, developmental care rounds, and a specialised volunteer programme. We obtained data from the electronic health record for patients aged 0-2 years admitted for at least 7 days to track implementation. RESULTS: There were 619 admissions in 18 months. Utilisation of CINCO interventions increased over time, particularly for the medical/nursing orders and caregiver handouts. The volunteer programme launch was delayed but grew rapidly and within six months, provided over 500 hours of developmental interaction with patients. CONCLUSIONS: We created and implemented a low-cost programme that systematised and expanded upon existing neurodevelopmental care practices in the cardiac inpatient units. Feasibility was demonstrated through increasing implementation rates over time. Key takeaways include the importance of multi-level stakeholder buy-in and embedding processes in existing clinical workflows.

Assessing the Russian Internet Research Agency's impact on the political attitudes and behaviors of American Twitter users in late 2017.

There is widespread concern that Russia and other countries have launched social-media campaigns designed to increase political divisions in the United States. Though a growing number of studies analyze the strategy of such campaigns, it is not yet known how these efforts shaped the political attitudes and behaviors of Americans. We study this question using longitudinal data that describe the attitudes and online behaviors of 1,239 Republican and Democratic Twitter users from late 2017 merged with nonpublic data about the Russian Internet Research Agency (IRA) from Twitter. Using Bayesian regression tree models, we find no evidence that interaction with IRA accounts substantially impacted 6 distinctive measures of political attitudes and behaviors over a 1-mo period. We also find that interaction with IRA accounts were most common among respondents with strong ideological homophily within their Twitter network, high interest in politics, and high frequency of Twitter usage. Together, these findings suggest that Russian trolls might have failed to sow discord because they mostly interacted with those who were already highly polarized. We conclude by discussing several important limitations of our study-especially our inability to determine whether IRA accounts influenced the 2016 presidential election-as well as its implications for future research on social media influence campaigns, political polarization, and computational social science.