[Application of artificial intelligence systems in the emergency room : Do the communication patterns give indications for possible starting points? An observational study]. / Anwendung von Systemen der künstlichen Intelligenz im Schockraum : Geben die Kommunikationsmuster Hinweise auf mögliche Ansatzpunkte? Eine Beobachtungsstudie.

BACKGROUND: High expectations are currently attached to the application of artificial intelligence (AI) in the resuscitation room treatment of trauma patients with respect to the development of decision support systems. No data are available regarding possible starting points for AI-controlled interventions in resuscitation room treatment. OBJECTIVE: Do information request behavior and quality of communication indicate possible starting points for AI applications in the emergency room? MATERIAL AND METHODS: A 2­stage qualitative observational study: 1. Development of an observation sheet based on expert interviews that depicts the following six relevant topics: situational factors (course of accident, environment), vital parameters, treatment-specific Information (treatment carried out). trauma-specific factors (injury patterns), medication, special features of the patient (anamnesis, etc.) 2. Observational study Which topics were inquired about during emergency room treatment? Was the exchange of information complete? RESULTS: There were 40 consecutive observations in the emergency room. A total of 130 questions: 57/130 inquiries about medication/treatment-specific Information and vital parameters, 19/28 of which were inquiries about medication. Questions about injury-related parameters 31/130 with 18/31 regarding injury patterns, course of accident (8/31) and type of accident (5/31). Questions about medical or demographic background 42/130. Within this group, pre-existing illnesses (14/42) and demographic background (10/42) were the most frequently asked questions. Incomplete exchange of information was found in all six subject areas. CONCLUSION: Questioning behavior and incomplete communication indicate a cognitive overload. Assistance systems that prevent cognitive overload can maintain decision-making abilities and communication skills. Which AI methods can be used requires further research.

Parental protection in fathers with negative caregiving experiences: Heightened amygdala reactivity to infant threatening situations.

Parental protection is an important, yet understudied, aspect of parenting behavior. Predictors of the quality of protection and potential underlying neural mechanisms are still unknown. In this study, we examined whether negative caregiving experiences in fathers' own childhood are related to protective behavior and neural reactivity to infant threatening situations. Paternal protective behavior was measured with self- and partner-reported protective behavior and behavioral observations in an experimental set-up (auditory startling task) in 121 first-time fathers (mean age child = 19.35 weeks, SD = 11.27). Neural activation during exposure to videos of infant-threatening (vs. neutral) situations was measured with functional magnetic resonance imaging (fMRI). We found a significant and positive association between negative caregiving experiences and amygdala reactivity to infant-threatening situations. A history of negative caregiving experiences was not significantly related to reported or observed paternal protective behavior. Our findings suggest that fathers with negative caregiving experiences show emotional hyperreactivity to cues of infant threat.

Is paternal oxytocin an oxymoron? Oxytocin, vasopressin, testosterone, oestradiol and cortisol in emerging fatherhood.

How do hormonal levels in men change from pregnancy to after the birth of their firstborn child, and what is the role of oxytocin, alone or in interplay with other hormones, in explaining variance in their parenting quality? We explored in 73 first-time fathers the development of five hormones that have been suggested to play a role in parenting: oxytocin (OT), vasopressin (AVP), testosterone (T), oestradiol (E2) and cortisol (Cort). In an extended group of fathers (N = 152) we examined associations with fathers' behaviour with their 2-month-old infants. OT and E2 showed stability from the prenatal to the postnatal assessments, whereas AVP and T decreased significantly, and Cort decreased marginally. OT on its own or in interplay with other hormones was not related to paternal sensitivity. Using an exploratory approach, the interaction between T and E2 emerged as relevant for fathers' sensitive parenting. Among fathers with high E2, high T was associated with lower sensitivity. Although we did not find evidence for the importance of OT as stand-alone hormone or in interplay with other hormones in this important phase in men's lives, the interaction between T and E2 in explaining variation in paternal behaviour is a promising hypothesis for further research. This article is part of the theme issue 'Interplays between oxytocin and other neuromodulators in shaping complex social behaviours'.

Fathers' involvement in early childcare is associated with amygdala resting-state connectivity.

Becoming a parent requires new skills and frequent task switching during daily childcare. Little is known about the paternal brain during the transition to fatherhood. The present study examined intrinsic neuronal network connectivity in a group of first-time expectant and new fathers (total N = 131) using amygdala seed-based resting-state functional connectivity analysis. Furthermore, we examined the association between paternal involvement (i.e. hours spent in childcare and real-time push notifications on smartphone) and connectivity within the parental brain network in new fathers. There were no significant differences in functional connectivity between expectant and new fathers. However, results show that in new fathers, time spent in childcare was positively related to amygdala connectivity with the supramarginal gyrus, postcentral gyrus and the superior parietal lobule-all regions within the cognition/mentalizing network that have been associated with empathy and social cognition. Our results suggest that fathers' time investment in childcare is related to connectivity networks in the parental brain.

A soft baby carrier intervention enhances amygdala responses to infant crying in fathers: A randomized controlled trial.

New fathers may grow into their parental role through active involvement in childcare. Spending time in physical contact with the child may promote an adaptive transition to fatherhood. In this randomized controlled trial, we tested the effects of a baby carrier intervention on fathers' hormonal and neural functioning. Using functional magnetic resonance imaging (fMRI), we examined whether infant carrying affects neural reactivity to infant crying in first-time fathers, taking into account the role of the hormone oxytocin as a mediating mechanism and fathers' own childhood experiences as a potential moderating factor. Sixty first-time fathers (infant age M = 11.18 weeks, SD = 2.08) were randomly assigned to a baby carrier intervention group (n = 32 fathers) or a control group (n = 28 fathers). Fathers in the intervention group were instructed to use a baby carrier for three weeks, whereas fathers in the control group were instructed to use a baby seat. Before and after the intervention salivary oxytocin was measured and neural reactivity to infant crying was assessed using fMRI. Results showed that the infant carrier intervention increased amygdala reactivity to infant crying compared to the infant seat users. This effect was most pronounced in fathers with experiences of childhood abuse. The carrier intervention did not affect fathers' oxytocin levels. Our findings indicate that spending time in physical contact with the infant may promote attention to and accurate perception of infant signals, in particular in fathers with more adverse childhood experiences. Soft baby carriers may, therefore, facilitate an adaptive transition to fatherhood.

Child maltreatment affects fathers' response to infant crying, not mediated by cortisol or testosterone.

Parents' ability to appropriately respond to infant crying is essential for parental care and has been found to relate to parents' own childhood experiences. Additionally, childhood experiences can affect endocrine factors, which may subsequently affect behavior. In the current study, preregistered on https://osf.io/hwgtu, we examined in expectant and new fathers (N = 152) associations between experiences of maltreatment in their own childhood, hair cortisol and testosterone concentrations and their ability to modulate handgrip force when exposed to infant crying. Cortisol and testosterone were quantified from the 1 cm of hair most proximal to the scalp using Liquid chromatography-tandem mass spectrometry. Participants were asked to squeeze a handgrip dynamometer at full and half strength while listening to infant cries and control sounds. Results indicated that fathers who experienced more childhood maltreatment used more excessive handgrip force during infant cry sounds. Hair cortisol and testosterone were not related to either experienced childhood maltreatment or handgrip strength modulation. These findings confirm that fathers' early experiences of maltreatment reduce their ability to modulate their behavioral responses during infant cries, but suggest that hair cortisol and testosterone concentrations do not identify the underlying mechanism of this association.

Vasopressin and parental expressed emotion in the transition to fatherhood.

In the last decades, parenting researchers increasingly focused on the role of fathers in child development. However, it is still largely unknown which factors contribute to fathers' beliefs about their child, which may be crucial in the transition to fatherhood. In the current randomized within-subject experiment, the effect of nasal administration of vasopressin (AVP) on both Five Minute Speech Sample-based (FMSS) expressed emotion and emotional content or prosody was explored in 25 prospectivefathers. Moreover, we explored how the transition to fatherhood affected these FMSS-based parameters, using prenatal and early postnatal measurements. Analyses revealed that FMSS-based expressed emotion and emotional content were correlated, but not affected by prenatal AVP administration. However,child's birth was associated with an increase in positivity and a decrease in emotional prosody, suggesting that the child's birth is more influential with regard to paternal thoughts and feelings than prenatal AVP administration.

Exploring the hormonal and neural correlates of paternal protective behavior to their infants.

Infant protection is an important but largely neglected aspect of parental care. Available theory and research suggest that endocrine levels and neural responses might be biological correlates of protective behavior. However, no research to date examined associations between these neurobiological and behavioral aspects. This study, preregistered on https://osf.io/2acxd, explored the psychobiology of paternal protection in 77 new fathers by combining neural responses to infant-threatening situations, self-reported protective behavior, behavioral observations in a newly developed experimental set-up (Auditory Startling Task), and measurements of testosterone and vasopressin. fMRI analyses validated the role of several brain networks in the processing of infant-threatening situations and indicated replicable findings with the infant-threat paradigm. We found little overlap between observed and reported protective behavior. Robust associations between endocrine levels, neural responses, and paternal protective behavior were absent.

White matter integrity moderates the relation between experienced childhood maltreatment and fathers' behavioral response to infant crying.

The ability to provide appropriate responses to infant distress is vital to paternal care, but may be affected by fathers' experiences of childhood maltreatment. Detrimental effects of childhood maltreatment have been found in the adult brain's white matter fibers, accompanied with impaired emotional and cognitive functioning. In the current study (N = 121), we examined new and expectant fathers' childhood maltreatment experiences (i.e. emotional and physical abuse and neglect), current behavioral responses (i.e. handgrip force) to infant cry sounds, and white matter integrity using diffusion tensor imaging. First, more exposure to childhood maltreatment was associated with more use of excessive handgrip force in response to infant crying by fathers. Second, the association between experienced childhood maltreatment and white matter integrity was not significant in whole-brain analyses. Lastly, we found that the association between maltreatment exposure and excessive handgrip force during infant crying was absent in fathers with high tract integrity in the bilateral uncinate fasciculus. These findings possibly point to insufficient behavioral inhibition or emotional dysregulation in fathers who experienced childhood maltreatment, but buffering for this effect in those with larger integrity in brain fibers connecting the amygdala and prefrontal cortex.

Vasopressin Differentially Affects Handgrip Force of Expectant Fathers in Reaction to Own and Unknown Infant Faces.

The underlying mechanisms of paternal responses to infant signals are poorly understood. Vasopressin has previously been proposed to affect these responses. Using a double-blind, placebo-controlled, within-subject design (N = 25 expectant fathers), we examined the effect of vasopressin administration on the use of excessive handgrip force during exposure to infant crying versus matched control sounds, while participants saw morphed images representing their own infant versus an unknown infant. We found that, compared to placebo, AVP administration elicited more excessive force while viewing an unknown infant image compared to viewing the image representing one's own infant, while the reverse was true under placebo. The results are discussed in light of vasopressin's role in parenting and parental protection among human fathers.

Birth of a Father: Fathering in the First 1,000 Days.

As a result of societal changes, fathers participate more actively in child care than they used to. In this article, we propose a context-dependent biobehavioral model of emergent fatherhood in which sociocultural, behavioral, hormonal, and neural factors develop and interact during the first 1,000 days of fatherhood. Sociocultural factors, including different expectations of fathers and varying opportunities for paternal caregiving through paid paternal leave, influence paternal involvement. Levels of hormones (e.g., testosterone, vasopressin, oxytocin, cortisol) predict fathers' parenting behaviors, and involvement in caregiving in turn affects their hormones and brain responses to infant stimuli. The birth of the first child marks the transition to fatherhood and may be a critical period in men's lives, with a smoother transition to fatherhood predicting more optimal involvement by fathers in subsequent years. A focus on prenatal and early postnatal fathering may pave the way for developing interventions that effectively support fathering during pregnancy and in the first years of their children's lives.