Implementation of Interprofessional Meetings Preparing Caregivers of Patients With Brain Injury for Discharge: A Pilot Study.

PURPOSE OF STUDY: Caregivers are often unprepared to care for patients discharged with brain injury. Interprofessional team meetings with the caregiver used in some specialties improve discharge planning. The purpose of this study was to evaluate the effect of a standardized interprofessional caregiver meeting on caregiver readiness for caregiving. PRIMARY PRACTICE SETTING: The study was implemented on an eight-bed brain injury unit within a 73-bed Magnet-designated surgery and rehabilitation hospital in south central Pennsylvania. METHODOLOGY AND SAMPLE: This study used a pre-/post-quasi-experimental retrospective design. Caregivers of patients admitted to the brain injury unit completed the Preparedness for Caregiving Scale at admission and discharge. The intervention group received an interprofessional team meeting focused on the needs of the caregiver in preparation for caregiving within 3-4 days of admission compared with unscheduled meetings as needed. RESULTS: Scores improved significantly from admission to discharge in usual care and intervention groups. Sample size was insufficient to detect differences between groups. Health care providers and caregivers expressed improvement in communication and readiness for discharge. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Early interprofessional meetings with the purpose of getting to know and understanding the needs of caregivers of patients with brain injury could guide us to better prepare the caregiver for caregiving at home. The Preparedness for Caregiving Scale can be useful to assess multiple domains of caregiving. This proactive approach may improve communication and discharge readiness for patients with brain injury.

Sleep Patterns of Resident Physicians and the Effect of Heartfulness Meditation.

BACKGROUND: Medical residents are vulnerable to poor sleep quality due to intense work shifts and academic load. Studies objectively quantified with sleep quantity and quality among resident physicians are limited. Meditation techniques have been shown to improve sleep but are rarely studied in this population. The aim of the present study is to evaluate sleep patterns of internal medicine residents and the effect of a structured Heartfulness meditation program to improve sleep quality. METHODS: A total of 36 residents participated in a pre-post cohort study from January 2019 through April 2019. Sleep was monitored during a one-week outpatient rotation with two validated assessment tools, namely consensus sleep diary and actigraphy. After four intervening weeks, when the residents returned to the same rotation, Heartfulness meditation was practiced and the same parameters were measured. At the end of the study period, an anonymous qualitative feedback survey was collected to assess the feasibility of the intervention. RESULTS: All 36 residents participated in the study (mean age 31.09 years, SD 4.87); 34 residents (94.4%) had complete pre-post data. Consensus sleep diary data showed decreased sleep onset time from 21.03 to 14.84 min (P = .01); sleep quality and restfulness scores increased from 3.32 to 3.89 and 3.08 to 3.54, respectively (P < .001 for both). Actigraphy showed a change in sleep onset time from 20.9 min to 14.5 min (P = .003). Sleep efficiency improved from 83.5% to 85.6% (P = .019). Wakefulness after initial sleep onset changed from 38.8 to 39.9 min (P = .682). Sleep fragmentation index and the number of awakenings decreased from 6.16 to 5.46 (P = .004) and 41.71 to 36.37 (P = .013), respectively. CONCLUSIONS: Residents obtained nearly 7 h of sleep during outpatient rotation. Findings suggest a structured Heartfulness meditation practice to be a feasible program to improve subjective sleep onset time and several objective measures among resident physicians.

Demographics and Clinical Characteristics of Adult Patients Hospitalized due to COVID-19 in a Rural/Suburban Integrated Health System in Southcentral Pennsylvania, March Through May 2020.

Existing characterizations of coronavirus disease 2019 (COVID-19) admissions have occurred primarily in urban settings. This report describes demographic and clinical characteristics of the first COVID-19 patients presenting to a 6-hospital integrated health care system in rural/suburban southcentral Pennsylvania. Medical records of adult patients admitted with COVID-19 between March and May of 2020 were retrospectively reviewed for demographics, symptomatology, imaging, and lab values. Results were largely consistent with previous studies, although gastrointestinal manifestations were more prevalent, with diarrhea reported in 25.4% of patients hospitalized due to COVID-19. Nursing home patients represented 10.1% of admissions but accounted for 35.5% of total deaths in our sample. Patients self-identifying as Hispanic were disproportionately affected. Although Hispanic ethnicity was self-reported in only 9% of the community population, Hispanic patients accounted for 34% of admissions. Our data provide a unique focused review of hospitalized COVID-19 patients in a rural/suburban setting.

Heartfulness meditation improves loneliness and sleep in physicians and advance practice providers during COVID-19 pandemic.

Objective: Unprecedented work pressures and social isolation during the COVID-19 pandemic may worsen loneliness and sleep problems in health-care professionals. Heartfulness meditation has been shown to improve burnout and sleep. In the current study, the effects of remote Heartfulness meditation in improving loneliness and sleep quality were measured. Methods: Physicians and advance practice providers were randomly assigned to receive either daily Heartfulness Meditation program or no intervention (control group) in a prospective four-week randomized control study design. UCLA loneliness and PSQI scores were collected at baseline and after the program duration of 4 weeks. The study was retrospectively registered with trial Number, ISRCTN85787008 (8 January 2021). Results: Of the 155 subjects enrolled in the study, 50% were lonely and 97% had sleep problems. Attrition rate was 36%. Among those who completed the study, the mean UCLA loneliness scores decreased from 42.1 to 39.4 in the Heartfulness group (N = 40, p = 0.009) and 42.2 to 41.15 in the control group (N = 57, p = 0.254). The mean PSQI scores decreased from 10.75 to 9.14 in the Heartfulness group (N = 41, p = 0.001) and 9.41 to 8.87 in the control group (N = 58, p = 0.122). Younger participants aged 30 and under had higher loneliness and sleep problems. Conclusions: The current study is one of the first attempts to assess loneliness and sleep problems among physicians and advance practice providers during COVID-19 pandemic in the US. A significant burden of loneliness and sleep problems was identified. An improvement of sleep and loneliness was noted with the practice of Heartfulness meditation. This remote intervention might be a useful tool to be explored in larger studies.

Heartfulness meditation improves sleep in chronic insomnia.

Background: Chronic insomnia is characterized by disturbed sleep that occurs despite adequate opportunity and circumstances to sleep. Many patients with chronic insomnia have comorbid mental illnesses or medical illnesses that contribute and precipitate insomnia. Hallmark of chronic insomnia treatment includes non-pharmacological measures such as Cognitive Behavioral Therapy for Insomnia (CBT-I). Pharmacologic treatment (sedative or hypnotic agents) has been disappointing because of poor efficacy and numerous undesirable side effects. Other new therapies including meditation have been proven to be effective. Objective: This study investigates the effectiveness of Heartfulness meditation coupled with sleep hygiene to treat chronic insomnia. Methods: In this prospective pre-post design cohort study, 32 adult patients with chronic primary insomnia engaged in Heartfulness meditation along with appropriate sleep hygiene for eight weeks. Insomnia Severity Index (ISI) scores, usage of sedative or hypnotic agents were measured at baseline and at the end of the eight-week period. Results: There was a significant decrease in the mean ISI scores from 20.9 to 10.4 (p < 0.001) after eight weeks of Heartfulness meditation. Twenty four of 32 patients were initially on sedative or hypnotic medications. At week eight, 21 of 24 patients (87.5%) were off these medications or the dosage was reduced (p < 0.001). Conclusion: This study demonstrated statistical improvements in the measures of ISI in patients undergoing a Heartfulness meditation program. Heartfulness meditation may facilitate the taper and eventual cessation of sedative hypnotics in patients suffering from chronic insomnia.

ECMO survivors' quality of life and needs after discharge: A descriptive, comparative cross-sectional pilot study.

OBJECTIVES: To describe gender differences in health-related quality of life and characterise discharged patients' perceptions of follow-up needs after extracorporeal membrane oxygenation. RESEARCH METHODOLOGY/DESIGN: A descriptive, comparative cross-sectional pilot design was used. Adult patients receiving extracorporeal membrane oxygenation discharged between January 1, 2016 and March 31, 2018 participated in telephone interviews. SETTING: A 580-bed community teaching hospital in south central Pennsylvania. MAIN OUTCOME MEASURES: Health-related quality of life was measured with the Rand 36-item Short Form Health Survey. Open-ended questions identified post-discharge healthcare services and perceived follow-up needs. RESULTS: Of 30 eligible patients, 24 completed a telephone interview. All health-related quality of life dimensions, except for role-emotional and mental health, were lower in post- extracorporeal membrane oxygenation patients at follow-up compared to national norms. Women scored lower than men in all health-related quality of life dimensions. The most frequent post-discharge services used were physical therapy (66.7%), rehabilitation (62.5%) and occupational therapy (54.2%). The need for coordination of care post-discharge was identified. CONCLUSIONS: Given long-term sequelae of extracorporeal membrane oxygenation on health-related quality of life and gender differences in health-related quality of life outcomes, ongoing interdisciplinary follow-up is imperative to ensure comprehensive patient management across the continuum of care.

A comparison of cervical ripening modalities among overweight and obese nulliparous gravidas.

Objective: To determine if differences exist among nulliparous overweight and obese gravidas undergoing cervical ripening employing three different agents (dinoprostone, misoprostol, or cervical catheter).Methods: A retrospective cohort study of nulliparous overweight and obese women who underwent induction of labor at two south-central Pennsylvania hospitals between January 2014 and December 2017. Nulliparous gravidas, ≥37 weeks' gestational age, with singleton pregnancies in the vertex presentation, were included in the study. We employed the following definitions: (1) overweight: BMI 25.0-29.9 kg/m2; (2) class I obesity: BMI 30.0-34.9 kg/m2; (3) class II obesity: BMI 35.0-39.9 kg/m2; and (4) class III obesity: BMI >40.0 kg/m2. The primary outcome measure was the mean difference in induction-to-birth time. A subanalysis was performed to assess the effect of BMI on the primary outcome. Secondary outcome measures included mode of delivery, induction-to-second-stage-of-labor time, estimated blood loss, neonatal feeding type, neonatal Apgar scores, and neonatal admission to triage or intensive care unit (ICU) after delivery. A priori power calculation estimated that 156 patients would be needed using the medium effective size. Data analysis was performed using ANOVA for continuous variables and chi-square tests for categorical variables.Results: Among 192 nulliparous overweight and obese gravidas, 70 received dinoprostone, 72 were given misoprostol, and 50 had cervical ripening with cervical catheters. There were no significant differences in mean induction to birth times among overweight and obese women when comparing the three cervical ripening agents (dinoprostone 24.5 ± 15.2 versus misoprostol 28.7 ± 12.3 and catheters 25.1 ± 12.9 hours), (p = .145, 95% CI -8.7 to 0.2 and -5.5 to 4.3, respectively). Overweight nulliparous women had shorter mean induction to birth time (22.9 ± 11.4 versus 29.2 ± 15.8 hours) as compared to class II obese women, (p = .037, 95% CI -12.0 to -0.38). When overweight women were compared to class III obese women, shorter mean induction to birth time (22.9 ± 11.4 versus 30.9 ± 13.9 hours) was also found, (p = .005, 95% CI -13.4 to -2.4).Conclusion: Among nulliparous overweight and obese gravidas, neither dinoprostone, misoprostol, or cervical catheter significantly impacted the induction to birth time. There was a longer induction to birth time for class II and class III obese women when compared to overweight women. Additional studies are warranted to improve cervical ripening in nulliparous overweight and obese women.

Understanding the Trauma/Acute Care Surgery Workforce.

As the roles of trauma/acute care surgeons continue to evolve, it is imperative that health-care systems adapt to meet workforce needs. Tailoring retention strategies that elicit workforce satisfaction ensure continued coverage that is mutually beneficial to surgeons and health-care systems. We sought to elicit factors related to career characteristics and expectations of the trauma/acute care surgery (ACS) workforce to assist with such future progress. In this study, 1552 Eastern Association for the Surgery of Trauma members were anonymously surveyed. Data collected included demographics, career expectations, and motivators of trauma/ACS. Four hundred eight (26%) Eastern Association for the Surgery of Trauma members responded. Respondents were 78 per cent male and had a median age of 47.3 years. Forty-six per cent of surgeons reported earning $351K-$475K and 23 per cent >$475K. At this point in their career, 49 per cent of surgeons felt quality of life was "most important", followed by 31 per cent career ambitions and 13 per cent salary. Prominent career satisfiers were patient care and teaching. Greatest detractors were burnout, bureaucracy, and work environment. Eighty per cent would change jobs in the final 10 years of practice, 31 per cent because of family/retirement, 29 per cent because of professional growth, 24 per cent because of workload, and 7 per cent because of salary. This study could be used to help develop trauma/ACS workforce strategies. This workforce remains mobile into late career; personal happiness and patient ownership overshadow financial rewards, and most prefer a total and shared patient care model compared with no patient ownership. Burnout, bureaucracy, and work environment are dominant detractors of job satisfaction among surveyed trauma/ACS surgeons.

Maternal ABO Blood Type and Factors Associated With Preeclampsia Subtype.

BACKGROUND: The pathophysiology of preeclampsia remains unclear. The disorder is heterogeneous, and the pathophysiology may vary by subtype. Identification of relevant biomarkers will help to better elucidate the pathophysiologic basis of each preeclampsia subtype. Blood type may be a biomarker that allows risk identification for preeclampsia. OBJECTIVE: The purpose of this study was to investigate the associations among maternal ABO blood type and preeclampsia subtype and fetal growth restriction (FGR). METHOD: Medical records of 126 women with early-onset preeclampsia (≤33 6/7 weeks' gestation), 126 women with late-onset preeclampsia (≥34 0/7 weeks' gestation), and 259 controls who gave birth between January 2012 and June 2016 were retrospectively abstracted from a large suburban tertiary referral center in South Central Pennsylvania for this hospital-based case-control study. RESULTS: Women with AB blood type had >3 times the odds of late-onset preeclampsia (odds ratio [ OR] = 3.35, 95% confidence interval (CI) = [1.02, 11.05]) compared to those with O blood type. Among women with early-onset preeclampsia, those with B blood type had 5 times the odds of having a growth-restricted fetus than did women with O blood type ( OR = 5.44, 95% CI [1.65, 17.94]). DISCUSSION: Our findings suggest that AB blood type may be an important risk factor for late-onset preeclampsia and that among women with early-onset preeclampsia, those with B blood type have increased odds of FGR. These findings warrant further study in women and their offspring to identify the pathophysiologic processes that may link ABO blood type, preeclampsia subtype, and FGR.

Factors Influencing Work-Life Balance in Physicians and Advance Practice Clinicians and the Effect of Heartfulness Meditation Conference on Burnout.

BACKGROUND: Burnout levels have risen in recent years and satisfaction with work-life balance has decreased. Individual and organizational factors may affect burnout in physicians and advance practice clinicians (APCs). Meditation is a tool to mitigate stress and enhance well-being. In this study, we assessed the factors affecting work-life balance in physicians and APCs. We also measured the impact of Heartfulness meditation conference on burnout. METHODS: Physicians and APCs were surveyed through an abbreviated Maslach burnout inventory (aMBI) to assess the burnout levels and a question to assess the factors influencing work-life balance. Wellness initiatives included either attending a Heartfulness meditation conference or reading a book about burnout and wellness (approximated at a 3-h read). A repeat aMBI survey was sent 8 weeks after the conference. Pre- and postburnout scores were assessed. RESULTS: Of the 1393 physicians and APCs, 537 responded to the aMBI, and there were 414 comments (663 factors) for the question on work-life balance. Among the respondents, 60.5% and 32% had symptoms of moderate to severe emotional exhaustion (EE) and depersonalization, respectively. Twenty-eight percent of the respondents had symptoms of moderate to low personal accomplishment. The major factors impacting work-life balance included work load, work flow, and scheduling. A follow-up aMBI survey was completed by 79 from the conference group and 264 from the nonconference group. In the age-group between 30 and 50 for the conference group (n = 40), mean EE decreased from 9.8 to 8.6 with statistical significance (P = .014). There was no statistically significant change in the nonconference group in any age-group. CONCLUSION: Workload, workflow, and scheduling issues were the major factors affecting work-life balance. There is a significant level of burnout in physicians and APCs. Heartfulness meditation conference was associated with a significant decrease in EE in those aged 30 to 50 years. There was no significant change seen in the nonconference/book reading group.

Effect of a Scheduled Nurse Intervention on Thirst and Dry Mouth in Intensive Care Patients.

BACKGROUND: Thirst is a common, intense symptom reported by hospitalized patients. No studies indicate frequency of use of ice water and lip moisturizer with menthol to ameliorate thirst and dry mouth. In an audit of 30 intensive care unit patients at a 580-bed community teaching hospital, 66% reported dry mouth with higher thirst distress and intensity scores than in published studies. OBJECTIVES: To evaluate the effectiveness of scheduled use of ice water oral swabs and lip moisturizer with menthol compared with unscheduled use in relieving thirst and dry mouth for intensive care unit patients. METHODS: In a quasi-experimental design, adult patients admitted to 2 intensive care units at a community hospital were provided with ice water oral swabs and lip moisturizer with menthol upon request. The intervention was unscheduled in 1 unit and scheduled in the other unit. The scheduled intervention was provided hourly during a 7-hour period (n = 62 participants). The unscheduled intervention consisted of usual care (n = 41 participants). A numeric rating scale (0-10) was used to measure thirst intensity, thirst distress, and dry mouth before and after 7 hours in both groups. RESULTS: The scheduled-use group had significant lessening of thirst intensity (P = .02) and dry mouth (P = .008). Thirst distress in the scheduled-use group did not differ from that in the unscheduled-use group (P = .07). CONCLUSION: Scheduled use of ice water oral swabs and lip moisturizer with menthol may lessen thirst intensity and dry mouth in critical care patients.

Postnatal Growth Restriction Is Reduced If Birth Weight Is Used for Nutritional Calculations in ELBW Infants.

Since fluid and nutrition needs and delivery in ELBW infants are calculated based on their body weights, there could be a measurable difference in fluid, nutrition, and protein intake calculations based on birth weight (BW) or current weight of the infant, especially in the first two weeks of life. Theoretically, the use of current daily weight (CW) for calculations may result in decreased fluid, nutrition, and protein delivery as well as a cumulative protein deficit (cPD) over the first two weeks of life until the infant regains birth weight. However, there have been no clinical studies comparing the clinical and nutritional impact of these two strategies is unknown. Aims. The aims of this study were to quantify the amount of protein intake and to compare growth parameters at hospital discharge (as measured by discharge weight and head circumference percentiles) when using two different methodologies (BW vesrsus current daily weight until BW is regained) for calculating fluid and protein intake in the first two weeks after birth in ELBW infants. Methods. A retrospective review of infants weighing ≤ 1kg at birth was conducted from January 2005 to December 2009 (Phase 1; P1) and January 2012 to December 2014 (Phase 2; P2) in a tertiary care NICU. At this center, in P1 (2005-09) CW was exclusively used for calculating fluid, calorie, and protein administration till BW was regained. In P2 (2012-14), BW was exclusively used for all calculations. Both P1 and P2 periods were compared and analyzed for differences in demographics, nutritional intake, comorbid conditions, and growth outcomes. Results. We studied 146 infants with 84 and 62 infants in P1 and P2 periods, respectively. The mean gestational age was lower during Phase 1 (25.74 ±1.32 vs. 26.47 ±1.82 weeks. P value =0.01). However, the birth weights were not different between the two periods. When the multiple-regression analysis was done using a discharge weight of >10th percentile as the dependent variable, protein intake before regaining of BW (OR of 4.126 with 95th CI of 2.03-8.36, a P value of 0.00) and AGA status at birth (OR of 8.37 with 95th CI of 2.67-26.24) remained significant factors. Compared to P1, babies in P2 received 1g/kg/day more protein till BW was regained. In P1, 27% of babies who were appropriate for gestational age (AGA) for head circumference at birth became microcephalic by discharge, compared to 15.6% in P2 (p=0.03). Similarly, 75.3% of the babies who were AGA for weight at birth in P1 became small for gestational age (SGA) by discharge, compared to 16.7% in P2 (p=<0.0001). The number of days it took to regain BW was 9.6 days in P1 vs. 7 days in P2 (p=<0.0001). Conclusions. Basing nutrition calculations in ELBW on birth weight rather than current daily weight until the birth weight is regained resulted in significantly greater protein delivery, a significant decrease in the incidence of failure to thrive and smaller head circumference percentiles at discharge in ELBW infants.

Effects of early adversity on neural mechanisms of distractor suppression are mediated by sympathetic nervous system activity in preschool-aged children.

Multiple theoretical frameworks posit that interactions between the autonomic nervous system and higher-order neural networks are crucial for cognitive regulation. However, few studies have simultaneously examined autonomic physiology and brain activity during cognitive tasks. Such research is promising for understanding how early adversity impacts neurocognitive development in children, given that stress experienced early in life impacts both autonomic function and regulatory behaviors. We recorded event-related potentials (ERPs) as a neural measure of auditory selective attention, and cardiovascular measures of high-frequency heart rate variability (HF-HRV) and preejection period (PEP), in 105 3-5-year-old children with varying degrees of socioeconomic risk. First, we replicated a previous study from our lab: Increased socioeconomic risk was associated with larger ERP amplitudes elicited by distracting sounds. Next, we tested whether PEP and HF-HRV (at rest and during the task) were associated with the distractor ERP response, and found that a physiological profile marked by heightened sympathetic nervous system activity, indexed by shorter PEP, was associated with better ERP suppression of distractor sounds in lower SES children. Finally, we found that PEP mediated the relationship between socioeconomic risk and larger ERP responses to distractor sounds. In line with similar reports, these results suggest that for lower SES children, there is a potential biological cost of achieving better cognitive performance, seen here as increased cardiovascular arousal both at rest and in response to task demands. (PsycINFO Database Record

Evaluation of Nursing School Educators' Knowledge and Attitudes Regarding Infant Sleep Safety.

AIM: The purpose of this study was to evaluate nursing educators' attitudes and knowledge regarding current American Academy of Pediatrics recommendations for a safe infant sleeping environment. METHOD: This was a cross-sectional prospective survey of all nursing programs with associate degrees or higher in the United States. Instructors teaching pediatric and obstetric didactic or clinical material at an Accreditation Commission for Education in Nursing-approved nursing school could participate. RESULTS: Of 396 educators surveyed, 70 percent identified all sudden infant death syndrome risk factors. Correct responses for individual safe sleep recommendations ranged from 99 percent for correct room temperature to 53 percent for pacifier use; 9 percent said it was safest for infants to sleep in a position other than on the back. CONCLUSION: Nursing educators need ongoing training on infant sleep safety to maintain mastery of the information that students need for competency in the workforce involving infant care.

Parasympathetic and sympathetic activity are associated with individual differences in neural indices of selective attention in adults.

Multiple theoretical frameworks posit that interactions between the autonomic nervous system and higher-order neural networks are crucial for cognitive and emotion regulation. However, few studies have directly examined the relationship between measures of autonomic physiology and brain activity during cognitive tasks, and fewer studies have examined both the parasympathetic and sympathetic autonomic branches when doing so. Here, 93 adults completed an ERP auditory selective attention task concurrently with measures of parasympathetic activity (high-frequency heart rate variability; HF-HRV) and sympathetic activity (preejection period; PEP). We focus on the well-studied N1 ERP component to test for associations with baseline values of HF-HRV and PEP. Individuals with higher resting HF-HRV and shorter resting PEP showed larger effects of selective attention on their ERPs. Follow-up regression models demonstrated that HF-HRV and PEP accounted for unique variance in selective attention effects on N1 mean amplitude. These results are consistent with the neurovisceral integration model, such that greater parasympathetic activity is a marker of increased selective attention, as well as other theoretical models that emphasize the role of heightened sympathetic activity in more efficient attention-related processing. The present findings highlight the importance of autonomic physiology in the study of individual differences in neurocognitive function and, given the foundational role of selective attention across cognitive domains, suggest that both parasympathetic and sympathetic activity may be key to understanding variability in brain function across a variety of cognitive tasks.

Stock Photographs Do Not Comply With Infant Safe Sleep Guidelines.

We evaluated images in popular stock photography websites for adherence with American Academy of Pediatrics (AAP) guidelines for safe infant sleep practices. Three top stock photo websites were used to collect photographs generated from key phrases. All images depicting an infant sleep environment were analyzed for consistency with AAP guidelines. Descriptive statistics, chi-square and z test of proportions, were conducted. A total of 1233 of 1947 stock photographs showed sleeping infants on a flat surface. In all, 627 (50.8%) photographs showed the infant in the supine position and 79 (5%) of all infant sleep environments were adherent with AAP recommendations. Bedding inconsistent with safe sleep recommendations was identified in 1133 images (71.3%), with blankets noted in 49.5%. Images depicting sleeping infants on stock photography sites do not routinely adhere to AAP recommendations. Media messages inconsistent with health care messages create confusion and misinformation about infant sleep safety and may lead inadvertently to unsafe practices.

Cultural Adaptation of a Neurobiologically Informed Intervention in Local and International Contexts.

The relationship between early adversity and numerous negative outcomes across the lifespan is evident in a wide range of societies and cultures (e.g., Pakulak, Stevens, & Neville, 2018). Among the most affected neural systems are those supporting attention, self-regulation, and stress regulation. As such, these systems represent targets for neurobiologically informed interventions addressing early adversity. In prior work with monolingual native English-speaking families, we showed that a two-generation intervention targeting these systems in families improves outcomes across multiple domains including child brain function for selective attention (for detail, see Neville et al., 2013). Here, we discuss the translation and cultural adaptation (CA) of this intervention in local and international contexts, which required systematic consideration of cultural differences that could affect program acceptability. First, we conducted a translation and CA of our program to serve Latino families in the United States using the Cultural Adaptation Process (CAP), a model that works closely with stakeholders in a systematic, iterative process. Second, to implement the adapted program in Medellín, Colombia, we conducted a subsequent adaptation for Colombian culture using the same CAP. Our experience underscores the importance of consideration of cultural differences and a systematic approach to adaptation before assessing the efficacy of neurobiologically informed interventions in different cultural contexts.

Neuroplasticity of selective attention: Research foundations and preliminary evidence for a gene by intervention interaction.

This article reviews the trajectory of our research program on selective attention, which has moved from basic research on the neural processes underlying selective attention to translational studies using selective attention as a neurobiological target for evidence-based interventions. We use this background to present a promising preliminary investigation of how genetic and experiential factors interact during development (i.e., gene × intervention interactions). Our findings provide evidence on how exposure to a family-based training can modify the associations between genotype (5-HTTLPR) and the neural mechanisms of selective attention in preschool children from lower socioeconomic status backgrounds.

Development of selective attention in preschool-age children from lower socioeconomic status backgrounds.

Although differences in selective attention skills have been identified in children from lower compared to higher socioeconomic status (SES) backgrounds, little is known about these differences in early childhood, a time of rapid attention development. The current study evaluated the development of neural systems for selective attention in children from lower SES backgrounds. Event-related potentials (ERPs) were acquired from 33 children from lower SES and 14 children from higher SES backgrounds during a dichotic listening task. The lower SES group was followed longitudinally for one year. At age four, the higher SES group exhibited a significant attention effect (larger ERP response to attended compared to unattended condition), an effect not observed in the lower SES group. At age five, the lower SES group exhibited a significant attention effect comparable in overall magnitude to that observed in the 4-year-old higher SES group, but with poorer distractor suppression (larger response to the unattended condition). Together, these findings suggest both a maturational delay and divergent developmental pattern in neural mechanisms for selective attention in young children from lower compared to higher SES backgrounds. Furthermore, these findings highlight the importance of studying neurodevelopment within narrow age ranges and in children from diverse backgrounds.

5-HTTLPR polymorphism is linked to neural mechanisms of selective attention in preschoolers from lower socioeconomic status backgrounds.

While a growing body of research has identified experiential factors associated with differences in selective attention, relatively little is known about the contribution of genetic factors to the skill of sustained selective attention, especially in early childhood. Here, we assessed the association between the serotonin transporter linked polymorphic region (5-HTTLPR) genotypes and the neural mechanisms of selective attention in young children from lower socioeconomic status (SES) backgrounds. Event-related potentials (ERPs) were recorded during a dichotic listening task from 121 children (76 females, aged 40-67 months), who were also genotyped for the short and long allele of 5-HTTLPR. The effect of selective attention was measured as the difference in ERP mean amplitudes elicited by identical probe stimuli embedded in stories when they were attended versus unattended. Compared to children homozygous for the long allele, children who carried at least one copy of the short allele showed larger effects of selective attention on neural processing. These findings link the short allele of the 5-HTTLPR to enhanced neural mechanisms of selective attention and lay the groundwork for future studies of gene-by-environment interactions in the context of key cognitive skills.