Publication Recommendations to Report Laboratory Data of Neonates - a Modified Delphi Approach.

BACKGROUND: Clinical and analytical information on laboratory data of neonates in scientific publications is sparse and incomplete. Furthermore, interpreting neonatal laboratory data can be complex due to their time-dependent and developmental physiology, and paucity of well-established age-appropriate reference ranges for neonates. This study aims to develop publication recommendations to report laboratory data of neonates to enhance the quality of these data in research and clinical care. METHODS: A modified Delphi approach was used to develop recommendations in cooperation with the International Neonatal Consortium. A Core Group, including different stakeholders, was responsible for developing the recommendations, in collaboration with a Reflection Group, responsible for providing additional input. RESULTS: The recommendations were classified into three categories: 'Clinical Characteristics', 'Bio-analytical Information' and 'Data-analytical Information'. These were each divided into 'Core Data' (always to be reported) and 'Supplemental Considerations' (to be reported when considered relevant to the study). CONCLUSION: Our recommendations provide guidance on standardization of neonatal laboratory data in publications. This will enhance the comparison, replication, and application of study results in research initiatives and clinical practice. Furthermore, these recommendations also serve as foundational work to develop reference ranges for neonatal laboratory values by standardizing the quality of information needed for such efforts. IMPACT: Standardized reporting of neonatal laboratory data in scientific publications will enhance the comparison, replication, and application of study results in research initiatives and clinical practice, as well as improve reporting to regulatory agencies. To integrate multistakeholder perspectives, a modified Delphi approach was used to develop publication recommendations which strengthens the applicability of the recommendations. Implementation of standardization will likely improve the overall quality of neonatal clinical research and neonatal healthcare. In addition, these recommendations are foundational to develop reference ranges for neonatal laboratory values by standardizing the quality of information needed for such efforts.

Parental Influence on Child Mental Health Post-Hurricane Harvey.

Purpose: Many children who face natural disasters experience significant mental health consequences. Parents play a prominent role in the likelihood of child mental health outcomes after a weather-related disaster. This study aimed to examine the relationship between parent risk factors and children's psychological well-being post Hurricane Harvey. Methods: Parents (n = 140) completed a survey that measured hurricane exposure, parental depression and anxiety, parenting behaviors, and assistance given and received during or after Hurricane Harvey. Additionally, parents were asked to complete questionnaires assessing one of their children's post-disaster psychosocial functioning and distress. Results: Results indicated that heightened parent anxiety was significantly associated with an increased risk for emotional symptoms, conduct problems, and hyperactivity-inattention symptoms in children. Additionally, inconsistency in parental discipline was significantly associated with an increased risk of child conduct problems. Further, higher numbers of assistance types received by parents-a proxy indicator of resource loss-was associated with higher child emotional distress scores. Conclusions: Broader systems-level interventions that address parents' physical and emotional needs may help mitigate maladaptive reactions in children and facilitate greater post-disaster psychosocial adjustment.

Implementing a Bundle to Improve Surgical Site Infection Rates for Patients Undergoing Nonvaginal-Approach Hysterectomy at a Midwestern Teaching Hospital.

Accrediting organizations, third-party payers, and patients review the surgical site infection (SSI) rates of health care organizations. Infection preventionists collaborate with perioperative personnel to decrease SSI rates; they also monitor and report SSI information to national organizations. The standard infection ratio is a comparison of the observed number of SSIs to the predicted number of SSIs based on national benchmark data. Leaders of a midwestern teaching hospital convened an interdisciplinary team (eg, surgeons, perioperative leaders, infection preventionists) to address a standard infection ratio after hysterectomies that was greater than 1.0. The team reviewed national guidelines and published articles on decreasing SSIs (including recommendations for vaginal preparation) before developing and implementing a hysterectomy-specific bundle for SSI prevention. The rate of SSIs decreased 68% after the implementation of the bundle. Perioperative personnel at this facility continue to use the bundle and infection preventionists monitor and report compliance with the bundle's elements.

Brief Online Intervention Model Promotes Sustained Helping Behavior Across 6 Months Following a Population-Wide Traumatic Event.

BACKGROUND: Following natural disasters, early helping behavior often dissipates despite remaining disaster-related suffering and affective vulnerability in the community. Interventions that have successfully increased helping behaviors have included components of motivational interviewing (MI) and mindful compassion; however, this research is limited by laboratory-based settings and lengthy training sessions. Brief, portable, and efficient intervention is needed to increase accessibility to large groups simultaneously. METHOD: The current study piloted a brief, online, self-administered MI and mindful compassion intervention administered 4-10 weeks post-Hurricane Harvey examining if it would sustain helping behaviors over the ensuing year. The study also examined potential moderators of the relationship between compassion for others and internalizing symptoms, and whether helping behaviors predicted post-traumatic stress symptoms. RESULTS: The intervention group sustained the use of helping behaviors more than an active control group after 9-12 months. Also, compassion satisfaction and burnout moderated the relationship between compassion for others and post-traumatic stress and depressive symptoms at follow-up. CONCLUSIONS: Results suggest a potentially useful model of how an efficiently distributed intervention might sustain helping behaviors after a natural disaster and provide insight into possible longitudinal risk and protective factors for post-traumatic stress and depressive symptoms among helping volunteers.

Nurses' Knowledge, Communication Needs, and Future Directions in Neonatal Research: Results of an International Survey.

BACKGROUND: Preterm birth is a significant contributor to neonatal morbidity and mortality. Despite legislative efforts to increase pediatric drug development, neonatal clinical trials continue to be infrequent. The International Neonatal Consortium (INC) includes nurses as key stakeholders in their mission to accelerate safe and effective therapies for neonates. PURPOSE: INC developed a survey for nurses, physicians, and parents to explore communication practices and stakeholders' perceptions and knowledge regarding clinical trials in neonatal intensive care units (NICUs). METHODS: A stepwise consensus approach was used to solicit responses to an online survey. The convenience sample was drawn from INC organizations representing the stakeholder groups. Representatives from the National Association of Neonatal Nurses and the Council of International Neonatal Nurses, Inc, participated in all stages of the survey development process, results analysis, and publication of results. RESULTS: Participants included 188 nurses or nurse practitioners, mainly from the United States, Canada, the European Union, and Japan; 68% indicated some level of research involvement. Nurses expressed a lack of effective education to prepare them for participation in research. Results indicated a lack of a central information source for staff and systematic approaches to inform families of studies. The majority of nurses indicated they were not asked to provide input into clinical trials. Nurses were uncertain about research consent and result disclosure processes. IMPLICATIONS FOR PRACTICE AND RESEARCH: This study indicates the need to educate nurses in research, improve NICU research communication through standardized, systematic pathways, and leverage nurse involvement to enhance research communication.

The neonatal adverse event severity scale: current status, a stakeholders' assessment, and future perspectives.

To support informed decisions on drug registration and prescription, clinical trials need tools to assess the efficacy and safety signals related to a given therapeutic intervention. Standardized assessment facilitates reproducibility of results. Furthermore, it enables weighted comparison between different interventions, instrumental to facilitate shared decisions. When focused on adverse events in clinical trials, tools are needed to assess seriousness, causality and severity. As part of such a toolbox, the international Neonatal Consortium (INC) developed a first version of the neonatal adverse event severity scale (NAESS). This version underwent subsequent validation in retro-and prospective trials to assess its applicability and impact on the inter-observer variability. Regulators, sponsors and academic researchers also reported on the use of the NAESS in regulatory documents, trial protocols and study reports. In this paper, we aim to report on the trajectory, current status and impact of the NAESS score, on how stakeholders within INC assess its relevance, and on perspectives to further develop this tool.

Understanding factors associated with intent to receive the COVID-19 vaccine.

INTRODUCTION: As of December 1, 2020, when the Advisory Committee on Immunization Practices published their COVID-19 vaccine distribution and prioritization recommendations, health care workers (HCWs) and the elderly were deemed to be at greatest risk of contracting the coronavirus. Limited extant research suggests that most HCWs are willing to receive the COVID-19 vaccine, and findings from studies examining vaccine uptake in non-HCW samples also have reported high vaccination willingness. The health belief model (HBM) and the theory of planned behavior (TPB) suggest that beliefs about severity and susceptibility of disease, perceived benefits of and obstacles to vaccination, and normative beliefs of others affect vaccine uptake. Further, perceptions of safety, side effects, and demographic factors can uniquely impact COVID-19 vaccine uptake. METHOD: Using a cross-sectional design, we recruited 526 participants via social media, through snowball emailing methods, and from university settings. RESULTS: The present findings demonstrate that 37% of participants intend to get the vaccine, and 35% reported that they might get the vaccine. No relationships among demographic factors, willingness to receive the vaccine, and level of intent were observed. However, those who reported that they would not receive the COVID-19 vaccine demonstrated fewer positive attitudes, less agreement, fewer normative views, and less anticipatory regret regarding the COVID-19 vaccine. Also, perceptions of susceptibility, severity, and barriers were associated with participants' willingness to get the COVID-19 vaccine. DISCUSSION: Our results suggest that factors related to the HBM and TPB might uniquely impact COVID-19 vaccine acceptability and could guide the crafting of interventions meant to encourage vaccine uptake. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The culture of research communication in neonatal intensive care units: key stakeholder perspectives.

OBJECTIVE: To assess the perspectives of neonatologists, neonatal nurses, and parents on research-related education and communication practices in the neonatal intensive care unit (NICU). STUDY DESIGN: Questionnaire circulated through interest groups and administered using the internet. RESULTS: 323 respondents responded to the survey. 52 were neonatologists, 188 were neonatal nurses, and 83 were parents of NICU graduates. Analysis was descriptive. Differences were noted between stakeholder groups with respect to whether current medications meet the needs of sick neonates, research as central to the mission of the NICU, availability of appropriate education/training for all members of the research team, and adequacy of information provided to parents before, during, and after a research study is completed. CONCLUSION: Engagement of nurses and parents at all stages of NICU research is currently suboptimal; relevant good practices, including education, should be shared among neonatal units.

Generalized Verbal Behavior Increases Following a Speaker Immersion Intervention.

A goal of behavior-analytic interventions is to produce behavior that is maintained under naturalistic conditions. In this experiment, we studied the effects of a speaker immersion protocol (SIP) on the number of speaker responses (tacts and mands) emitted by 3 preschool students under naturalistic, not directly targeted, conditions. During the SIP, the researchers provided 100 daily opportunities for the participants to emit mands using the target mand form by contriving establishing operations (EOs) throughout the school day. The effects of the intervention were evaluated using a multiple-probe design by measuring target mands during EO probe sessions and the number of mands and tacts emitted during noninstructional-setting probe sessions. The researchers found that the SIP produced increases in both targeted and generalized verbal behavior.

Sleep Problems and Posttraumatic Stress: Children Exposed to a Natural Disaster.

OBJECTIVE: Sleep plays a critical role in children's growth and development. This study examined the frequency and persistence of children's sleep problems following a natural disaster, risk factors for children's sleep problems, and the bidirectional relationship between children's sleep problems and posttraumatic stress symptoms (PTSS) over time. METHODS: This study assessed 269 children (53% female, M = 8.70 years, SD = 0.95) exposed to Hurricane Ike at 8 months (Time 1) and 15 months (Time 2) post-disaster. Children completed measures of hurricane exposure and related stressors, stressful life events, sleep problems, and PTSS. RESULTS: Children's sleep problems were significantly correlated from Time 1 to Time 2 (r = .28, p < .001). Risk factors for sleep problems at Time 2 were younger age, sleep problems at Time 1, and PTSS, not including sleep items, at Time 1. Examinations of the bidirectional relationship between sleep problems and PTSS indicated that PTSS significantly predicted later sleep problems, but sleep problems did not significantly predict later PTSS. CONCLUSIONS: Findings demonstrate that PTSS may contribute to the development and course of children's sleep problems post-disaster.

The Potential Unique Impacts of Hope and Resilience on Mental Health and Well-Being in the Wake of Hurricane Harvey.

Natural disasters can lead to mental health problems, such as posttraumatic stress disorder (PTSD). Higher levels of loss and/or disruption and prior trauma exposure constitute risk factors for mental illness, whereas protective factors, including hope and resilience, support positive functioning. The present cross-sectional study used structural equation modeling to examine the relative influence of resilience and hope on mental health and well-being 1-3 months after Hurricane Harvey made landfall in August 2017, among a sample of 829 adults in the Greater Houston, Texas area. Resilience was more strongly associated with reduced PTSD symptoms, ß = -.31, 95% CI [-.42, -.21], than was hope, ß = -.17, 95% CI [-;.30, -.04], whereas hope was more strongly associated with components of well-being, ßs = .47-.63. Hope was positively associated with posttraumatic growth, ß = .30, 95% CI [.19, .41], whereas resilience was negatively associated with posttraumatic growth, ß = -.24, 95% CI [-.35, -.12]. These associations remained consistent after considering risk factors, although more variance in trauma-related outcomes was risk factors were included in the model. The present results suggest that considering the influence of both risk and resilience factors provides an enhanced picture of postdisaster mental health.

Ovarian Cancer, Cancer Stem Cells and Current Treatment Strategies: A Potential Role of Magmas in the Current Treatment Methods.

Epithelial ovarian cancer (EOC) constitutes 90% of ovarian cancers (OC) and is the eighth most common cause of cancer-related death in women. The cancer histologically and genetically is very complex having a high degree of tumour heterogeneity. The pathogenic variability in OC causes significant impediments in effectively treating patients, resulting in a dismal prognosis. Disease progression is predominantly influenced by the peritoneal tumour microenvironment rather than properties of the tumor and is the major contributor to prognosis. Standard treatment of OC patients consists of debulking surgery, followed by chemotherapy, which in most cases end in recurrent chemoresistant disease. This review discusses the different origins of high-grade serous ovarian cancer (HGSOC), the major sub-type of EOC. Tumour heterogeneity, genetic/epigenetic changes, and cancer stem cells (CSC) in facilitating HGSOC progression and their contribution in the circumvention of therapy treatments are included. Several new treatment strategies are discussed including our preliminary proof of concept study describing the role of mitochondria-associated granulocyte macrophage colony-stimulating factor signaling protein (Magmas) in HGSOC and its unique potential role in chemotherapy-resistant disease.

The sexual reproductive health of women: Unfinished business in the Eastern Europe and Central Asia region.

EBCOG and ESCRH are committed to work with UNFPA- EECA Region to reduce high maternal mortality, preventing unwanted pregnancies, improving adolescent health, reducing the burden of STDs including HIV, safeguarding and protecting sexual health and achieving gender equality to achieve the objectives of ICPD 25 as agreed in Nairobi on 12th November 2019. Both organisations will provide technical assistance to support the development of country level SRH strategies to achieve these objectives as outlined in this joint position statement. We advocate policies developments for knowledge transfer from west to the east to address the unmet need for effective contraceptive methods, to reduce the rates of teenage and adolescent pregnancy rates. All this can be achieved by developing a work force fit for purpose to support the implementation of national SRH strategies. We urge upon international and national funders to work with us to develop sustainable models of care in the Eastern Europe and Central Asian Region.

Food cultures and aging: a qualitative study of grandparents' food perceptions and influence of food choice on younger generations.

OBJECTIVE: To explore food perceptions among grandparents and understand the influence of these perceptions on food choice for the younger generations in their family. DESIGN: Qualitative methodology, thematic analysis of the transcripts from fourteen focus groups. SETTING: Grandparents in the southern region of the United States. SUBJECTS: Participants were fifty-eight Black, Hispanic, and White grandparents, predominantly women (72%), ranging in age from 44-86 years (mean age = 65·4 (sd 9·97) years). RESULTS: Grandparents' perceptions related to personal food choice were related to health issues and the media. Grandparents' perceived influence on their children's and grandchildren's food choices was described through the themes of proximity and power (level of influence based on an interaction of geographic proximity to grandchildren and the power given to them by their children and grandchildren to make food decisions), healthy v. unhealthy spoiling, cultural food tradition, and reciprocal exchange of knowledge. CONCLUSION: Our results highlight areas for future research including nutrition interventions for older adults as well as factors that may be helpful to consider when engaging grandparents concerning food decisions for younger generations to promote health. Specifically, power should be assessed as part of a holistic approach to addressing dietary influence, the term 'healthy spoiling' can be used to reframe notions of traditional spoiling, and the role of cultural food tradition should be adapted differently by race.

Attentional Avoidance of Historically Relevant, Task-Irrelevant Facial Affect: Past Depression, Interpersonal Characteristics, and Ethnicity.

Experiential background can influence how individuals respond to affective interpersonal information. For formerly depressed individuals, sad facial expressions are presumably salient. If so, when performing affectively neutral daily tasks, these individuals would find peripheral sad faces particularly distracting, and thus, they might shift their attention from them. The present study examined this hypothesis by comparing how euthymic formerly depressed and never depressed adults attended to sad and happy task-irrelevant emotional facial expression stimuli. The study also measured constructs linked to interpersonal functioning and depression and conducted exploratory analyses to examine whether Hispanic ethnicity status would moderate effects of study outcomes. Results of analyses indicated that formerly depressed individuals directed more attention away from sad faces than never depressed individuals. There were no significant between-group effects for happy faces and no moderation by ethnicity on attention to affective faces. However, irrespective of depression history, Hispanic individuals reported lower fear of negative evaluation compared to non-Hispanic Caucasian individuals. Findings are in line with hypothesized attentional avoidance among formerly depressed individuals and consistent with prior research suggesting that some Hispanic individuals experience protective mental health benefits through engagement with aspects of their culture. Directions for future research are discussed.

Development of a neonatal adverse event severity scale through a Delphi consensus approach.

BACKGROUND: Assessment of the seriousness, expectedness and causality are necessary for any adverse event (AE) in a clinical trial. In addition, assessing AE severity helps determine the importance of the AE in the clinical setting. Standardisation of AE severity criteria could make safety information more reliable and comparable across trials. Although standardised AE severity scales have been developed in other research fields, they are not suitable for use in neonates. The development of an AE severity scale to facilitate the conduct and interpretation of neonatal clinical trials is therefore urgently needed. METHODS: A stepwise consensus process was undertaken within the International Neonatal Consortium (INC) with input from all relevant stakeholders. The consensus process included several rounds of surveys (based on a Delphi approach), face-to-face meetings and a pilot validation. RESULTS: Neonatal AE severity was classified by five grades (mild, moderate, severe, life threatening or death). AE severity in neonates was defined by the effect of the AE on age appropriate behaviour, basal physiological functions and care changes in response to the AE. Pilot validation of the generic criteria revealed κ=0.23 and guided further refinement. This generic scale was applied to 35 typical and common neonatal AEs resulting in the INC neonatal AE severity scale (NAESS) V.1.0, which is now publicly available. DISCUSSION: The INC NAESS is an ongoing effort that will be continuously updated. Future perspectives include further validation and the development of a training module for users.

Surviving the storm: Avoidant coping, helping behavior, resilience and affective symptoms around a major hurricane-flood.

BACKGROUND: As extreme weather events increasingly affect the global population, it is valuable to understand their impacts on mental health. Extending upon previous theory and research, the current study examined a hypothesized framework of direct and indirect pathways. Exposure and psychosocial resource factors at the time of the hurricane/flood were expected to help explain post-disaster behavioral responses, such as avoidant coping, positive coping, and helping behaviors, which, in turn, would help account for post-traumatic stress symptoms (PTSS) and depressive symptoms (DS). METHODS: Survey data were collected from adult survivors (n = 801) of Hurricane Harvey 1-3 months post-disaster. PTSS, DS, and needing help were common, and loss/disruption and helping behavior were widespread. Structural equation modeling was used to examine the hypothesized framework. RESULTS: Models accounted for substantial variance in PTSS (70%) and DS (61%), with immediate loss/disruption, low self-reported resilience, and avoidant coping showing the strongest associations with symptoms. As predicted, results provided support for several modeled indirect pathways through avoidant coping to PTSS and DS. Further, helping behavior was consistently associated with increased PTSS, but not DS. LIMITATIONS: Cross-sectional design and online data collection methods precluded testing of causal directionality and confirming clinical diagnoses. CONCLUSIONS: The current study represents a step toward elucidating potential mediators of avoidant coping and how helping behavior might relate to post-disaster psychopathology. Individuals in heavily hurricane/flood-exposed areas who have low psychosocial resources (social support and resilience) might be most vulnerable and most in need of intervention.