Pre- and postnatal safe sleep knowledge and planned as compared to actual infant sleep practices.

BACKGROUND: Our objectives were to compare safe sleep knowledge, attitudes and planned vs. actual infant sleep practices among expectant mothers before and after their infant's birth and to determine whether differences (if present) were associated with any demographic variables. METHODS: Study participants were surveyed at their 28-week prenatal and 6-week postpartum obstetric clinic visits from November 2019-February 2021. Due to COVID-19 pandemic cancellation of in-person postpartum visits, many participants received text messaging encouraging them to take the follow-up survey online. Frequency and comparative analyses were performed. RESULTS: 355 women (44%) completed both pre- and postnatal surveys. Many participants increased their safe sleep knowledge during the study. For example, of those who were unsure or thought it safe for a baby to sleep in a baby swing/bouncy seat, two-thirds (67/102, 66%) stated it was unsafe on the postnatal survey. In addition, many who were unsure or planned sleep practices considered unsafe prenatally reported utilizing safe sleep practices on their postnatal survey. For example, of those unsure or planning to use a crib bumper (17% of the total), almost all (88%) were not using one postnatally. Conversely, some participants who reported they would be following safe sleep practices prenatally were not doing so postpartum. For example, 13% of those stating they would place their child on their back reported using another sleep position on the postnatal survey. Certain demographics had higher proportions reporting this reversal for specific safe sleep practices. For example, non-Hispanic Whites (19%) as compared to other races/ethnicities (5%) and those with incomes ≥ $75,000 (21%) as compared with those with less income (9%) had higher proportions stating their infant would sleep in the same room but then reported postnatally they were sleeping in a different room, p = 0.0094 and p = 0.0138, respectively. CONCLUSIONS: We observed increases in safe sleep knowledge and that some participants followed safer sleep practices than they had planned. However, there were also participants who planned to use safe sleep practices prenatally who were not doing so after their baby's birth. Our study identified demographics for which targeted safe sleep education and more effective interventions may be needed.

Effects of COVID-19 on Health Care Workers.

COVID-19 continues to spread across the United States with a continued increase in reported infections and deaths. How this virus effects pregnancy, particularly mothers and their infants around and after delivery, is of particular concern for health care workers. Moreover, concerns for compassion fatigue in the health care worker, as they attempt to provide comprehensive care to this population, is a documented concern that could have long-term effects on workers' ability to provide care. This article will describe the current concerns for the transmission of COVID-19 from the mother to the infant and how that has affected recommendations from several national and international organizations around maternal/infant testing, isolation, breastfeeding, and the infant requiring neonatal intensive care. Effects that changing recommendations may have on health care workers and care delivery, and how these may contribute to compassion fatigue, will also be discussed.

Recognition and nursing management of reflex anoxic seizures in children.

Reflex anoxic seizures (RAS) present with a transient loss of consciousness and are triggered by an unexpected stimuli. These are paroxysmal, short-lived episodes of pronounced bradycardia or transient asystole; the episodes are self-limiting, lasting between 15 seconds and 1 minute. RAS are an important differential diagnosis of transient loss of consciousness but they are commonly misdiagnosed as epileptic events. An accurate and focused history is key to the diagnosis. They are mostly managed by performing an ECG to rule out other causes of arrhythmia, with subsequent explanation of the condition and reassurance given to parents. Nurses play an important role in eliciting the history and providing support to parents following the diagnosis. This article addresses the epidemiology and pathophysiology of RAS, with suggestions for management. An illustrative case study is included to highlight some of the challenges that health professionals working in different clinical set-ups are likely to come across while managing a child with RAS.

Adaptation and implementation of a trauma-focused cognitive behavioral intervention for girls in child welfare.

This study describes the process of adapting and implementing Girls Aspiring toward Independence (GAIN), a trauma-focused, group-based therapy adapted from Cognitive Behavioral Intervention for Trauma in Schools (CBITS) for girls in child welfare. Descriptive data were examined on 3 outcomes: posttraumatic stress disorder (PTSD), depression, and social problem-solving skills among adolescent girls in the child welfare system. Qualitative and quantitative methods were utilized to inform the adaptation of the CBITS intervention, evaluate feasibility, treatment fidelity, and acceptability, and to test the effects of the intervention. Girls ages 12 to 18 (N = 27) were randomly assigned to the experimental and usual care conditions. Participants' symptoms of PTSD and depression and social problem-solving skills were evaluated at pre, post- (3 months), and follow-up (6 months) assessments. Adaptations for GAIN were primarily related to program structure. Data indicated that the program was receptive to girls in child welfare and that it was feasible to recruit, randomize, assess outcomes, and implement with adequate fidelity. Retention was more successful among younger girls. Descriptive initial data showed greater reductions in the percentage of girls with PTSD and depression, and modest increases in social problem-solving skills in the experimental versus usual care condition. Despite the growth of knowledge in dissemination and implementation research, the application of trauma-focused empirically supported treatment to child welfare populations lags behind. A large-scale RCT is needed to determine if GAIN is effective in reducing mental health problems and social problem-solving in the child welfare population. (PsycINFO Database Record

Safe sleep for pediatric inpatients.

PURPOSE: To improve sleep environment safety for inpatient infants. DESIGN AND METHODS: This quality improvement project involved assessment of sleep environment safety for inpatient infants before and after a bundled intervention of staff education and introduction of swaddle sacks and bedside storage bins. RESULTS: The proportion of infant cribs without loose objects in them increased (32-72%, p = .025), and safe sleep positioning remained stable (82% vs. 95%, p = .183). PRACTICE IMPLICATIONS: Staff education, swaddle sleep sacks, and bedside storage containers were associated with improved sleep safety among pediatric inpatients at our institution and may help at other institutions.

Active involvement of learning disabilities service users in the development and delivery of a teaching session to pre-registration nurses: Students' perspectives.

A teaching session about service users' experiences of accessing and receiving health and social care was designed and delivered by service users to first year BSc Nursing students. The aim was to enhance students' knowledge, skills and confidence in caring for people with a learning disability. An evaluation research study was undertaking at one university in London into the perceived effectiveness of the teaching session, including students' perceptions of the extent to which the service users' teaching session was useful, the impact of the session, its benefits and challenges and the sustainability of teaching sessions delivered by service users. Data were collected through an online questionnaire. Quantitative analysis was undertaken of Likert-style questions and qualitative analysis was undertaken using the Framework Method. The session impacted on students' knowledge and understanding of people with a learning disability. Students reported that they felt more comfortable and confident interacting with people with a learning disability. In addition, they reflected on their feelings about caring for people with a learning disability.

Passive acoustic mapping utilizing optimal beamforming in ultrasound therapy monitoring.

Passive acoustic mapping (PAM) is a promising imaging method that enables real-time three-dimensional monitoring of ultrasound therapy through the reconstruction of acoustic emissions passively received on an array of ultrasonic sensors. A passive beamforming method is presented that provides greatly improved spatial accuracy over the conventionally used time exposure acoustics (TEA) PAM reconstruction algorithm. Both the Capon beamformer and the robust Capon beamformer (RCB) for PAM are suggested as methods to reduce interference artifacts and improve resolution, which has been one of the experimental issues previously observed with TEA. Simulation results that replicate the experimental artifacts are shown to suggest that bubble interactions are the chief cause. Analysis is provided to show that these multiple bubble artifacts are generally not reduced by TEA, while Capon-based methods are able to reduce the artifacts. This is followed by experimental results from in vitro experiments and in vivo oncolytic viral therapy trials that show improved results in PAM, where RCB is able to more accurately localize the acoustic activity than TEA.

Fast transient networks in spontaneous human brain activity.

To provide an effective substrate for cognitive processes, functional brain networks should be able to reorganize and coordinate on a sub-second temporal scale. We used magnetoencephalography recordings of spontaneous activity to characterize whole-brain functional connectivity dynamics at high temporal resolution. Using a novel approach that identifies the points in time at which unique patterns of activity recur, we reveal transient (100-200 ms) brain states with spatial topographies similar to those of well-known resting state networks. By assessing temporal changes in the occurrence of these states, we demonstrate that within-network functional connectivity is underpinned by coordinated neuronal dynamics that fluctuate much more rapidly than has previously been shown. We further evaluate cross-network interactions, and show that anticorrelation between the default mode network and parietal regions of the dorsal attention network is consistent with an inability of the system to transition directly between two transient brain states. DOI: http://dx.doi.org/10.7554/eLife.01867.001.

Non-Gaussian probabilistic MEG source localisation based on kernel density estimation.

There is strong evidence to suggest that data recorded from magnetoencephalography (MEG) follows a non-Gaussian distribution. However, existing standard methods for source localisation model the data using only second order statistics, and therefore use the inherent assumption of a Gaussian distribution. In this paper, we present a new general method for non-Gaussian source estimation of stationary signals for localising brain activity from MEG data. By providing a Bayesian formulation for MEG source localisation, we show that the source probability density function (pdf), which is not necessarily Gaussian, can be estimated using multivariate kernel density estimators. In the case of Gaussian data, the solution of the method is equivalent to that of widely used linearly constrained minimum variance (LCMV) beamformer. The method is also extended to handle data with highly correlated sources using the marginal distribution of the estimated joint distribution, which, in the case of Gaussian measurements, corresponds to the null-beamformer. The proposed non-Gaussian source localisation approach is shown to give better spatial estimates than the LCMV beamformer, both in simulations incorporating non-Gaussian signals, and in real MEG measurements of auditory and visual evoked responses, where the highly correlated sources are known to be difficult to estimate.

Tremor suppression by rhythmic transcranial current stimulation.

Tremor can dominate Parkinson's disease and yet responds less well to dopaminergic medications than do other cardinal symptoms of this condition. Deep brain stimulation can provide striking tremor relief, but the introduction of stimulating electrodes deep in the substance of the brain carries significant risks, including those of hemorrhage. Here, we pioneer an alternative approach in which we noninvasively apply transcranial alternating current stimulation (TACS) over the motor cortex to induce phase cancellation of the rest tremor rhythm. We first identify the timing of cortical oscillations responsible for rest tremor in the periphery by delivering tremor-frequency stimulation over motor cortex but do not couple this stimulation to the on-going tremor-instead, the rhythms simply "drift" in and out of phase alignment with one another. Slow alternating periods of phase cancellation and reinforcement result, informing on the phase alignments that induce the greatest change in tremor amplitude. Next, we deliver stimulation at these specified phase alignments to demonstrate controlled suppression of the on-going tremor. With this technique we can achieve almost 50% average reduction in resting tremor amplitude and in so doing form the basis of a closed-loop tremor-suppression therapy that could be extended to other oscillopathies.

Transforming retirement: new definitions of life after work.

This quantitative research study uses survey data of women born between 1946 and 1951 in Australia. It follows earlier work that identified the importance of transitions from work for women of the baby boomer generation. We provide important insights into the lives of women who have partially or fully retired and the changing nature of women's work and retirement. For many women, retirement is characterized by newfound freedoms, opportunities, career change, and evolving identities, yet others view retirement as a continuation of previous occupational and gendered roles and commitments. This study has important implications for retirement policies for women.

Thin-film sparse boundary array design for passive acoustic mapping during ultrasound therapy.

A new 2-D hydrophone array for ultrasound therapy monitoring is presented, along with a novel algorithm for passive acoustic mapping using a sparse weighted aperture. The array is constructed using existing polyvinylidene fluoride (PVDF) ultrasound sensor technology, and is utilized for its broadband characteristics and its high receive sensitivity. For most 2-D arrays, high-resolution imagery is desired, which requires a large aperture at the cost of a large number of elements. The proposed array's geometry is sparse, with elements only on the boundary of the rectangular aperture. The missing information from the interior is filled in using linear imaging techniques. After receiving acoustic emissions during ultrasound therapy, this algorithm applies an apodization to the sparse aperture to limit side lobes and then reconstructs acoustic activity with high spatiotemporal resolution. Experiments show verification of the theoretical point spread function, and cavitation maps in agar phantoms correspond closely to predicted areas, showing the validity of the array and methodology.

MEG can map short and long-term changes in brain activity following deep brain stimulation for chronic pain.

Deep brain stimulation (DBS) has been shown to be clinically effective for some forms of treatment-resistant chronic pain, but the precise mechanisms of action are not well understood. Here, we present an analysis of magnetoencephalography (MEG) data from a patient with whole-body chronic pain, in order to investigate changes in neural activity induced by DBS for pain relief over both short- and long-term. This patient is one of the few cases treated using DBS of the anterior cingulate cortex (ACC). We demonstrate that a novel method, null-beamforming, can be used to localise accurately brain activity despite the artefacts caused by the presence of DBS electrodes and stimulus pulses. The accuracy of our source localisation was verified by correlating the predicted DBS electrode positions with their actual positions. Using this beamforming method, we examined changes in whole-brain activity comparing pain relief achieved with deep brain stimulation (DBS ON) and compared with pain experienced with no stimulation (DBS OFF). We found significant changes in activity in pain-related regions including the pre-supplementary motor area, brainstem (periaqueductal gray) and dissociable parts of caudal and rostral ACC. In particular, when the patient reported experiencing pain, there was increased activity in different regions of ACC compared to when he experienced pain relief. We were also able to demonstrate long-term functional brain changes as a result of continuous DBS over one year, leading to specific changes in the activity in dissociable regions of caudal and rostral ACC. These results broaden our understanding of the underlying mechanisms of DBS in the human brain.

Fusion of magnetometer and gradiometer sensors of MEG in the presence of multiplicative error.

Novel neuroimaging techniques have provided unprecedented information on the structure and function of the living human brain. Multimodal fusion of data from different sensors promises to radically improve this understanding, yet optimal methods have not been developed. Here, we demonstrate a novel method for combining multichannel signals. We show how this method can be used to fuse signals from the magnetometer and gradiometer sensors used in magnetoencephalography (MEG), and through extensive experiments using simulation, head phantom and real MEG data, show that it is both robust and accurate. This new approach works by assuming that the lead fields have multiplicative error. The criterion to estimate the error is given within a spatial filter framework such that the estimated power is minimized in the worst case scenario. The method is compared to, and found better than, existing approaches. The closed-form solution and the conditions under which the multiplicative error can be optimally estimated are provided. This novel approach can also be employed for multimodal fusion of other multichannel signals such as MEG and EEG. Although the multiplicative error is estimated based on beamforming, other methods for source analysis can equally be used after the lead-field modification.

An adaptive spectral estimation technique to detect cavitation in HIFU with high spatial resolution.

In ultrasound-guided high-intensity focused ultrasound (HIFU) therapy, the changes observed on tissue are subtle during treatment; some ultrasound-guided HIFU protocols rely on the observation of significant brightness changes as the indicator of tissue lesions. The occurrence of a distinct hyperechogenic region ("bright-up") around the focus is often associated with acoustic cavitation resulting in microbubble formation, but it may indicate different physical events such as larger bubbles from boiling (known to alter acoustic impedance) or sometimes lesion formation. A reliable method to distinguish and spatially localize these causes within the tissue would assist the control of HIFU delivery, which is the subject of this paper. Spectral analysis of the radio frequency (RF) signal underlying the B-mode image provides more information on the physical cause, but the usual techniques that are methods on the Fourier transform require a long series for good spectral resolution and so they give poor spatial resolution. This paper introduces an active spectral cavitation detection method to attain high spatial resolution (0.15 × 0.15 mm per pixel) through a parametric statistical method (ARMA modeling) used on finite-length data sets, which enables local changes to be identified more easily. This technique uses the characteristics of the signal itself to optimize the model parameters and structure. Its performance is assessed using synthesized cavitation RF data, and it is then demonstrated in ex vivo bovine liver during and after HIFU exposure. The results suggest that good spatial and spectral resolution can be obtained by the design of suitable algorithms. In ultrasound-guided HIFU, the technique provides a useful supplement to B-mode analysis, with no additional time penalty in data acquisition.

Macromolecules in phloem exudates--a review.

Proteomic and transcriptomic analyses using the growing resources of genomic information have been applied to identification of macromolecules in exudates collected from phloem. Most of the analyses rely on collection of exudate following incisions made to the vasculature, but some limited data are available for exudates collected from excised aphid stylets. Species examined, to date, include a number of cereals (rice, barley, and wheat), a number of cucurbits, castor bean, members of the genus Lupinus, brassicas, and Arabidopsis. As many as 1,100 proteins, some hundreds of transcripts, and a growing number of small ribonucleic acids (RNAs), including micro-RNAs, have been identified across the species with a high degree of commonality. Questions relating to the nature and extent of contamination of sieve element contents with those of surrounding companion cells and nonvascular cells are addressed together with likely functions of identified macromolecules. The review considers likely translocation and systemic signaling functions among the macromolecular inventory of phloem exudates.

A bio-impedance probe to assess liver steatosis during transplant surgery.

This work addresses the design of a bioimpedance probe to assess steatosis on the exposed liver in the donor during liver transplant surgery. Whereas typically bioimpedance uses needle probes to avoid surface effects, for clinical reasons a non-penetrative probe is required. In addition the need to ensure that the measurement is representative of the bulk tissue suggests a larger probe than is normally used to ensure a sufficiently large measurement volume. Using a simple model, simulations and tests on bovine liver, this paper investigates the relationship between probe dimensions and depth of measurement penetration and investigates the accuracy which might be expected in a configuration suitable for use in the operating theatre on intact but exposed livers. A probe using ECG electrodes is proposed and investigated.

Demand driven deep brain stimulation: regimes and autoregressive hidden Markov implementation.

Deep brain stimulation is an increasingly prevalent surgical option in the treatment of a multitude of neurological conditions, most notably Parkinson's disease. The development of a neurofeedback device is driven primarily by stimulator habituation, surgical risk factors, the cost of battery replacement, and reported neuropsychiatric side-effects under prolonged chronic administration. Here we present two distinct regimes for stimulation delivery in chronic and acute symptomatic conditions, presented in the context of Parkinsonian bradykinesias and tremor. Implementation strategies are discussed with a focus on vector-autoregressive hidden Markov models for tremor prediction. Detection of simple motor actions versus tremor are compared in a preliminary performance analysis.

Application of a null-beamformer to source localisation in MEG data of deep brain stimulation.

In this paper, we present an analysis of magnetoencephalography (MEG) signals from a patient with whole-body chronic pain in order to investigate changes in neural activity induced by DBS. The patient is one of the few cases treated using DBS of the anterior cingulate cortex (ACC). Using MEG to reconstruct the neural activity of interest is challenging because of interference to the signal from the DBS device. We demonstrate that a null-beamformer can be used to localise neural activity despite artefacts caused by the presence of DBS electrodes and stimulus pulses. We subsequently verified the accuracy of our source localisation by correlating the predicted DBS electrode positions with their actual positions, previously identified using anatomical imaging. We also demonstrated increased activity in pain-related regions including the pre-supplementary motor area, brainstem periaqueductal gray and medial prefrontal areas when the patient was in pain compared to when the patient experienced pain relief.