Feeling Stressed and Unproductive? A Field Evaluation of a Therapy-Inspired Digital Intervention for Knowledge Workers

Today’s knowledge workers face cognitively demanding tasks and blurred work-life boundaries amidst rising stress and burnout in the workplace. Holistic approaches to supporting workers, which consider both productivity and well-being, are increasingly important. Taking this holistic approach, we designed an intervention inspired by cognitive behavioral therapy that consists of: (1) using the term “Time Well Spent” (TWS) in place of “productivity”, (2) a mobile self-logging tool for logging activities, feelings, and thoughts at work, and (3) a visualization that guides users to reflect on their data. We ran a 4-week exploratory qualitative comparison in the field with 24 graduate students to examine our Therapy-inspired intervention alongside a classic Baseline intervention. Participants who used our intervention often shifted toward a holistic perspective of their primary working hours, which included an increased consideration of breaks and emotions. No such change was seen by those who used the Baseline intervention

Neonatal Face and Facial Landmark Detection from Video Recordings

This paper explores automated face and facial landmark detection of neonates, which is an important first step in many video-based neonatal health applications, such as vital sign estimation, pain assessment, sleep-wake classification, and jaundice detection. Utilising three publicly available datasets of neonates in the clinical environment, 366 images (258 subjects) and 89 (66 subjects) were annotated for training and testing, respectively. Transfer learning was applied to two YOLO-based models, with input training images augmented with random horizontal flipping, photo-metric colour distortion, translation and scaling during each training epoch. Additionally, the re-orientation of input images and fusion of trained deep learning models was explored. Our proposed model based on YOLOv7Face outperformed existing methods with a mean average precision of 84.8% for face detection, and a normalised mean error of 0.072 for facial landmark detection. Overall, this will assist in the development of fully automated neonatal health assessment algorithms.Comment: 5 pages, 2 tables. Paper submitted for potential publication as a conference paper at the 45th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 202

Acute Pain Assessment in Prematurely Born Infants Below 29 Weeks A Long Way to Go

Objectives: Neonates born extremely prematurely are at high risk of acute and prolonged pain. Effective treatment requires reliable pain assessment, which is currently missing. Our study explored whether existing pain assessment tools and physiological indicators measure pain and comfort accurately in this population. Materials and Methods: We prospectively collected data in 16 neonates born at less than 29 weeks’ gestational age during 3 conditions: skin-to-skin care, rest, and heelstick procedure for capillary blood sampling in the incubator. The neonates were video recorded in these situations, and recordings were coded using 5 observational pain assessment tools and numeric rating scales for pain and distress. We simultaneously collected heart rate, respiratory rate, arterial oxygen saturation, regional cerebral oxygenation, and the number of skin conductance peaks. All measures across the 3 conditions were compared using general linear modeling. Results: The median gestational age was 27.1 weeks (range: 24.1 to 28.7). Forty measurement periods across the 3 conditions were analyzed. Heart rate was significantly higher during heelstick procedures compared with during rest, with a mean difference of 10.7 beats/min (95% confidence interval [CI]: 2.7-18.6). Oxygen saturation was significantly higher during skin-to-skin care compared with during heelstick procedures with a mean difference of 5.5% (95% CI: 0.2-10.8). The Premature Infant Pain Profile-revised (PIPP-R) score was significantly higher during heelstick procedures compared with skin-to-skin care with a mean difference of 3.2 points (95% CI: 1.6-5.0). Discussion: Pain measurement in clinical practice in prematurely born infants below 29 weeks remains challenging. The included behavioral and physiological indicators did not adequately distinguish between a painful situation, rest, and skin-to-skin care in premature neonates

Adverse Behavioral Changes in Adult Mice Following Neonatal Repeated Exposure to Pain and Sucrose

Sucrose is recommended for the treatment of pain during minor procedures in preterm infants in the neonatal intensive care unit (NICU) and is currently used worldwide as the standard of care. We recently reported that adult mice repetitively exposed to sucrose compared to water during the first week of life, irrespective of exposure to an intervention, had significantly smaller brain volumes in large white matter, cortical and subcortical structures (e.g., hippocampus, striatum, fimbria). These structures are important for stress regulation and memory formation. Here, we report the effects of repeated neonatal exposure to pain and sucrose on adult behavior in mice. Neonatal C57BL/6J mice (N = 160, 47% male) were randomly assigned to one of two treatments (sucrose, water) and one of three interventions (needle-prick, tactile, handling). Pups received 10 interventions daily from postnatal day 1 (P1) to P6. A single dose of 24% sucrose or water was given orally 2 min before each intervention. At adulthood (P60-85) mice underwent behavioral testing to assess spatial memory, anxiety, motor function, pain sensitivity, and sugar preference. We found that mice that had received sucrose and handling only, had poorer short-term memory in adulthood compared to water/handling controls (p < 0.05). When exposed to pain, mice treated with repetitive sucrose or water did not differ on memory performance (p = 0.1). A sugar preference test showed that adult mice that received sucrose before an intervention as pups consumed less sugar solution compared to controls or those that received water before pain (p < 0.05). There were no significant group differences in anxiety, motor, or pain sensitivity. In a mouse model that closely mimics NICU care, we show for the first time that memory in adulthood was poorer for mice exposed to pain during the first week of life, irrespective of sucrose treatment, suggesting that sucrose does not protect memory performance when administered for pain. In the absence of pain, early repetitive sucrose exposure induced poorer short-term memory, highlighting the importance of accurate pain assessment

The role of capital controls in mediating global shocks

To compare the effect of oral glucose given with or without facilitated tucking (FT), versus placebo (water) to facilitate image acquisition during a targeted neonatal echocardiography (TNE).Factorial, double blind, randomized controlled trial.Tertiary neonatal intensive care unit (NICU).Infants born between 26 and 42 weeks of gestation (GA).One of four treatment groups: oral water (placebo), oral glucose (25%), facilitated tucking with oral water or facilitated tucking with oral glucose, during a single, structured TNE. All infants received a soother.Change in Behavioral Indicators of Infant Pain (BIIP) scores.104 preterm infants were randomized (mean ± SD GA: 33.4 ± 3.5 weeks). BIIP scores remained low during the echocardiography scan (median, [IQ range]: 0, [0 to 1]). There were no differences in the level of agitation of infants amongst the treatment groups, with estimated reductions in mean BIIP relative to control of 0.27 (95%CI -0.40 to 0.94) with use of oral glucose and .04 (-0.63 to 0.70) with facilitated tucking. There were also no differences between treatment groups in the quality and duration of the echocardiography scans.In stable infants in the NICU, a TNE can be performed with minimal disruption in a majority of cases, simply by providing a soother. The use of 25% glucose water in this context did not provide further benefit in reducing agitation and improving image acquisition.Clinical Trials.gov: NCT01253889

Validation of the synactive theory of development : are body movements in preterm infants signs of stress?

The synactive theory of development, a widely used theory which has revolutionalized the assessment and treatment of preterm infants in the NICU, consists of five principles which are applied through a model of care. This model, the Newborn Individualized Developmental Care and Assessment Program® (NIDCAP) directs developmental specialists to interpret preterm infant movements either as stress or stability cues. However, limited empirical validation of this dualistic classification system has been reported. The primary aim of this dissertation is to examine the validity of the NIDCAP® by studying the motor reactions of preterm infants in response to a continuum of stressor intensities which range from no stimulus to a painful stimulus. First, along with other valid biobehavioural measures of pain and in infants at 32 weeks corrected gestational age (GA), I examine the frequency of NIDCAP® movements during blood collection. Then, in a within subjects cross-over study (random order), I compare preterm infant biobehavioural pain reactions to responses during a tactile procedure. The secondary aim is to increase the accuracy and specificity of preterm infant pain assessment by determining whether NIDCAP® behaviours are reliable pain indicators and whether these indicators distinguish between pain and stress responses. Of the 26 NIDCAP® stress cues, 14 movements (flex arms and legs, extend arms and legs, hand on face, finger splay, fisting, salute, yawn, sit on air, frown, tongue extension, air plane, eye floating) are associated with intrusive and painful procedures. Finger splay, fisting and hand on face are particularly salient stress cues in infants born at earlier GA (< 30 weeks). Contrary to the NIDCAP®, twitches decrease during the stressor phases in both studies. In addition, in response to painful and tactile procedures, preterm infant body movements are often exaggerated, whereas facial responses are dampened. In conclusion, the dualistic classification of the NIDCAP® needs revision; it also should incorporate alternative explanations of preterm infant movements. The use of body movements as stress response indicators is promising; however, facial reactivity the most specific behavioural pain indicator in preterm infants. Future research is needed to refine further the measurement of stress responses in this vulnerable population.Graduate and Postdoctoral StudiesGraduat

Extremity movements help occupational therapists identify stress responses in preterm infants in the neonatal intensive care unit:a systematic review

Background. Accurate assessment and treatment of pain and stress in preterm infants in neonatal intensive care units (NICU) is vital because pain and stress responses have been linked to long-term alterations in development in this population. Purpose. To review the evidence of specific extremity movements in preterm infants as observed during stressful procedures. Methods. Five on-line databases were searched for relevant studies. For each study, levels of evidence were determined and effect size estimates were calculated. Each study was also evaluated for specific factors that presented potential threats to its validity. Results. Eighteen studies were identified and seven comprised the review. The combined sample included 359 preterm infants. Six specific movements were associated with painful and intrusive procedures. Clinical Implications. A set of specific extremity movements, when combined with other reliable biobehavioural measures of pain and stress, can form the basis for future research and development of a clinical stress scale for preterm infants. </jats:p

Considerations for using sucrose to reduce procedural pain in preterm infants

Preterm and critically ill newborns admitted to a NICU undergo repeated skin-breaking procedures that are necessary for their survival. Sucrose is rapidly becoming the accepted clinical standard nonpharmacologic intervention for managing acute procedural pain for these infants. Although shown to be safe in single doses, only 4 studies have evaluated the effects of repeated doses of sucrose over relatively short periods of time. None has examined the use of sucrose throughout the NICU stay, and only 1 study evaluated the neurodevelopmental outcomes after repeated doses of sucrose. In that study, infants born at <31 weeks’ gestational age and exposed to >10 doses per day in the first week of life were more likely to show poorer attention and motor development in the early months after discharge from the NICU. Results of studies in animal models have suggested that the mechanism of action of sucrose is through opioid pathways; however, in human infants, little has been done to examine the physiologic mechanisms involved, and the findings reported thus far have been ambiguous. Drawing from the growing animal literature of research that has examined the effects of chronic sugar exposure, we describe alternative amine and hormone pathways that are common to the processing of sucrose, attention, and motor development. In addition, are view of the latest research to examine the effects of repeated sucrose on pain processing is presented. These 2 literatures each can inform the other and can provide an impetus to initiate research to examine not only the mechanisms involved in the calming mechanisms of sucrose but also in the long-term neurodevelopmental effects of repeated sucrose in those infants born extremely preterm or critically ill

Initial validation of the Behavioral Indicators of Infant Pain (BIIP)

Accurate pain assessment in preterm infants in the neonatal intensive care unit (NICU) is complex. Infants who are born at early gestational ages (GA), and who have had greater early pain exposure, have dampened facial responses which may lead to under-treatment. Since behavioral and physiological responses to pain in infants are often dissociated, using multidimensional scales which combine these indicators into a single score may limit our ability to determine the effects of interventions on each system. Our aim was to design a unidimensional scale which would combine the relatively most specific, individual, behavioral indicators for assessing acute pain in this population. The Behavioral Indicators of Infant Pain (BIIP) combines sleep/wake states, 5 facial actions and 2 hand actions. Ninety two infants born between 23-32 weeks GA were assessed during 3, one minute Phases of blood collection. Outcome measures included changes in BIIP and in Neonatal Infant Pain Scale (NIPS) scores coded in real time from continuous bedside video recordings; changes in heart rate (HR) were obtained using custom physiological processing software. Scores on the BIIP changed significantly across Phases of blood collection (p < 0.01). Internal consistency (0.82) and inter-rater reliability (0.80-0.92) were high. Correlations between the BIIP and NIPS were modest (r = 0.64, p < 0.01) as were correlations between the BIIP and mean heart rate (r = 0.45, p < 0.01). In this initial study, the BIIP has been shown to be a reliable, valid scale for assessing acute pain in preterm infants in the NICU

A Systematic Review of the Predictive Validity of Neurobehavioral Assessments During the Preterm Period

<p><i>Aims:</i> For high-risk newborns, early assessment of neurobehavior that accurately predicts neurodevelopmental outcome is the first step towards determining early intervention needs. This study reviews systematically the validity of neurobehavioral assessments administered to premature newborns before term-equivalent age to predict long-term neurodevelopmental outcome. <i>Methods:</i> A systematic literature search of CINAHL, EMBASE, MEDLINE, PubMed, Web of Science, PsychInfo, Cochrane Library databases was conducted. PRISMA and COSMIN guidelines were followed. <i>Results:</i> Five assessments and 11 studies were identified: (a) Neonatal Behavioral Assessment Scale (NBAS); (b) Test of Infant Motor Performance (TIMP); (c) General Movements (GMs); (d) Neurobehavioral Assessment of the Preterm Infant (NAPI); (e) Neonatal Oral Motor Assessment Scale (NOMAS). Predictive validity estimates were variable. The GMs and TIMP showed the strongest associations with neurodevelopmental outcome. Threats to validity included small sample size, sample bias, limited reliability testing. <i>Conclusions:</i> Five neurobehavioral measures have established predictive validity for the assessment of premature newborns while they reside in the NICU. Although the GMs and TIMP have the strongest evidence, further higher quality research is required. New methods of testing should be developed that provide accurate prediction and minimize the potential stress induced during developmental assessments.</p