Tactile localization promotes infant self-recognition in the mirror-mark test.

Mirror self-recognition has been hailed by many as a milestone in the acquisition of self-awareness with respect to phylogenesis and human ontogenesis.1,2,3,4,5,6 Yet there has been considerable controversy over the extent to which species other than humans and their closest primate relatives are capable of mirror self-recognition, and to the mechanisms that give rise to this ability.1,7 One influential view is that mirror self-recognition in humans and their closest primate relatives is a cognitive advance that is a product of primate evolution, stemming from more recently evolved neural structures and networks that develop through experience-independent mechanisms during ontogenesis.1 In contrast, we show that the development of mirror self-recognition in human infants is a perception-action achievement, building on infants' ability to localize and reach to targets on the body. Infants who were given experience reaching to tactile targets on their bodies in the months prior to recognizing themselves in a mirror achieved mirror self-recognition earlier than infants in either a yoked age-matched control group or a longitudinal control group without such experience. Our results demonstrate that self-touch functions as an intermodal gateway through which infants learn how to localize and reach to stimuli on their bodies, including those that can only be seen in a mirror. These findings identify an overlooked role for the routine activity of self-touch in establishing a representation of the body and suggest that the development of human self-awareness is rooted in self-directed action.

Managing the Impact of COVID-19 in Nursing Homes and Long-Term Care Facilities: An Update.

Older adults in nursing homes are at greatest risk of morbidity and mortality from SARS-CoV-2 infection. Nursing home residents constituted one-third to more than half of all deaths during the early waves of the COVID-19 pandemic. Following this, widespread adaptation of infection prevention and control measures and the supply and use of personal protective equipment resulted in a significant decrease in nursing home infections and deaths. For nursing homes, the most important determinant of experiencing a SARS-CoV-2 outbreak in the first instance appears to be community-transmission levels (particularly with variants of concern), although nursing home size and quality, for-profit status, and sociodemographic characteristics are also important. Use of visitation bans, imposed to reduce the impact of COVID-19 on residents, must be delicately balanced against their impact on resident, friend or family, and staff well-being. The successful rollout of primary vaccination has resulted in a sharp decrease in morbidity and mortality from SARS-CoV-2 in nursing homes. However, emerging evidence suggests that vaccine efficacy may wane over time, and the use of a third or additional vaccine "booster" doses in nursing home residents restores protection afforded by primary vaccination. Ongoing monitoring of vaccine efficacy in terms of infection, morbidity, and mortality is crucial in this vulnerable group in informing ongoing SARS-CoV-2 vaccine boosting strategies. Here, we detail the impact of SARS-CoV-2 on nursing home residents and discuss important considerations in the management of nursing home SARS-CoV-2 outbreaks. We additionally examine the use of testing strategies, nonpharmacologic outbreak control measures and vaccination strategies in this cohort. Finally, the impact of SARS-CoV-2 on the sector is reflected on as we emphasize the need for adoption of universal standards of medical care and integration with wider public health infrastructure in nursing homes in order to provide a safe and effective long-term care sector.

Hospital transfer rates and advance care planning following a nursing home-targeted video-conference education series (Project ECHO): a prospective cohort study.

AIM: What effect does a novel education programme have on emergency hospital transfers of, and advance care planning decisions among, nursing home residents? FINDINGS: This education programme did not affect overall rates of emergency hospital transfer. It did increase advance care planning discussions, increase compliance with the results of these discussions and increase "DNR" orders among nursing home residents. MESSAGE: Novel tele-education programmes have the potential to improve advance care planning discussions in nursing homes.

Previous SARS-CoV-2 Infection, Age, and Frailty Are Associated With 6-Month Vaccine-Induced Anti-Spike Antibody Titer in Nursing Home Residents.

OBJECTIVES: Older nursing home residents make up the population at greatest risk of morbidity and mortality from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. No studies have examined the determinants of long-term antibody responses post vaccination in this group. DESIGN: Longitudinal cohort study. SETTING AND PARTICIPANTS: Residents from 5 nursing homes assessed before vaccination, and 5 weeks and 6 months post vaccination, with the BNT162b2 messenger RNA SARS-CoV-2 vaccine. METHODS: Comprehensive clinical assessment was performed, including assessment for comorbidity, frailty, and SARS-CoV-2 infection history. Serum nucleocapsid and anti-spike receptor binding domain (RBD) antibodies were analyzed at all timepoints. An in vitro angiotensin-converting enzyme (ACE2) receptor-spike RBD neutralization assay assessed serum neutralization capacity. RESULTS: Of 86 participants (81.1 ± 10.8 years; 65% female), just under half (45.4%; 39 of 86) had evidence of previous SARS-CoV-2 infection. All participants demonstrated a significant antibody response to vaccination at 5 weeks and a significant decline in this response by 6 months. SARS-CoV-2 infection history was the strongest predictor of antibody titer (log-transformed) at both 5 weeks [ß: 3.00; 95% confidence interval (CI): 2.32-3.70; P < .001] and 6 months (ß: 3.59; 95% CI: 2.89-4.28; P < .001). Independent of SARS-CoV-2 infection history, both age in years (ß: -0.05; 95% CI: -0.08 to -0.02; P < .001) and frailty (ß: -0.22; 95% CI: -0.33 to -0.11; P < .001) were associated with a significantly lower antibody titer at 6 months. Anti-spike antibody titers at both 5 weeks and 6 months significantly correlated with in vitro neutralization capacity. CONCLUSIONS AND IMPLICATIONS: In older nursing home residents, SARS-CoV-2 infection history was the strongest predictor of anti-spike antibody titers at 6 months, whereas age and frailty were independently associated with lower titers at 6 months. Antibody titers significantly correlated with in vitro neutralization capacity. Although older SARS-CoV-2 naïve nursing home residents may be particularly vulnerable to breakthrough SARS-CoV-2 infection, the relationship between antibody titers, SARS-CoV-2 infection, and clinical outcomes remains to be fully elucidated in this vulnerable population.

Dynamic emotional messages differentially affect 6-month-old infants' attention to eyes and gaze cues.

Infants often experience interactions in which caregivers use dynamic messages to convey their affective and communicative intent. These dynamic emotional messages may shape the development of emotion discrimination skills and shared attention by influencing infants' attention to internal facial features and their responses to eye gaze cues. However, past research examining infants' responses to emotional faces has predominantly focused on classic, stereotyped expressions (e.g., happy, sad, angry) that may not reflect the variability that infants experience in their daily interactions. The present study therefore examined forty-two 6-month-old infants' attention to eyes vs. mouth and gaze cueing responses across multiple dynamic emotional messages that are common to infant-directed interactions. Overall, infants looked more to the eyes during messages with negative affect, but this increased attention to the eyes during these message conditions did not directly facilitate gaze cueing. Infants instead showed reliable gaze cueing only after messages with positive and neutral affect. We additionally observed gender differences in infants' attention to internal face features and subsequent gaze cueing responses. Female infants spent more time looking at the eyes during the dynamic emotional messages and showed increased initial orienting and longer looking to gaze-cued objects following positive messages, whereas male infants showed these gaze cueing effects following neutral messages. These results suggest that variability in caregivers' communication can shape infants' attention to and processing of emotion and gaze information.

The Human Face Becomes Mapped as a Sensorimotor Reaching Space During the First Year.

Although recent behavioral and neural research indicates that infants represent the body's structure, how they engage self-representations for action is little understood. This study addressed how the human face becomes a reaching space. Infants (N = 24; 2-11 months) were tested longitudinally approximately every 3 weeks on their ability to reach to a vibrating target placed at different locations on the face. Successful reaches required coordinating skin- and body-based codes for location, a problem known as tactile remapping. Findings suggest that a functional representation of the face is initially fragmented. Infants localized targets in the perioral region before other areas (ears/temples). Additionally, infants predominantly reached ipsilaterally to targets. Collectively, the findings illuminate how the face becomes an integrated sensorimotor space for self-reaching.

Asymptomatic carriage rates and case fatality of SARS-CoV-2 infection in residents and staff in Irish nursing homes.

BACKGROUND: SARS-CoV-2 has disproportionately affected nursing homes (NH). In Ireland, the first NH case COVID-19 occurred on 16 March 2020. A national point-prevalence testing programme of all NH residents and staff took place (18 April 2020 to 5 May 2020). AIMS: to examine characteristics of NHs across three Irish Community Health Organisations, proportions with COVID-19 outbreaks, staff and resident infection rates symptom profile and resident case fatality. METHODS: in total, 45 NHs surveyed, requesting details on occupancy, size, COVID-19 outbreak, outbreak timing, total symptomatic/asymptomatic cases and outcomes for residents from 29 February 2020 to 22 May 2020. RESULTS: surveys were returned from 62.2% (28/45) of NHs (2,043 residents, 2,303 beds). Three-quarters (21/28) had COVID-19 outbreaks (1,741 residents, 1,972 beds). Median time from first COVID-19 case in Ireland to first case in these NHs was 27.0 days. Resident incidence was 43.9% (764/1,741)-40.8% (710/1,741) laboratory confirmed, with 27.2% (193/710) asymptomatic and 3.1% (54/1,741) clinically suspected. Resident case fatality was 27.6% (211/764) for combined laboratory-confirmed/clinically suspected COVID-19. Similar proportions of residents in NHs with 'early-stage' (<28 days) versus 'later-stage' outbreaks developed COVID-19. Lower proportions of residents in 'early' outbreak NHs had recovered compared with those with 'late' outbreaks (37.4 versus 61.7%; χ2 = 56.9, P < 0.001). Of 395 NH staff across 12 sites with confirmed COVID-19, 24.7% (99/398) were asymptomatic. There was a significant correlation between the proportion of staff with symptomatic COVID-19 and resident numbers with confirmed/suspected COVID-19 (Spearman's rho = 0.81, P < 0.001). CONCLUSION: this study demonstrates the significant impact of COVID-19 on the NH sector. Systematic point-prevalence testing is necessary to reduce risk of transmission from asymptomatic carriers and manage outbreaks in this setting.

Development of Infant Reaching Strategies to Tactile Targets on the Face.

Infant development of reaching to tactile targets on the skin has been studied little, despite its daily use during adaptive behaviors such as removing foreign stimuli or scratching an itch. We longitudinally examined the development of infant reaching strategies (from just under 2 to 11 months) approximately every other week with a vibrotactile stimulus applied to eight different locations on the face (left/right/center temple, left/right ear, left/right mouth corners, and chin). Successful reaching for the stimulus uses tactile input and proprioception to localize the target and move the hand to it. We studied the developmental progression of reaching and grasping strategies. As infants became older the likelihood of using the hand to reach to the target - versus touching the target with another body part or surface such as the upper arm or chair - increased. For trials where infants reached to the target with the hand, infants also refined their hand postures with age. As infants became older, they made fewer contacts with a closed fist or the dorsal part of the hand and more touches/grasps with the fingers or palm. Results suggest that during the first year infants become able to act more precisely on tactile targets on the face.