Name: a novel method for involving women of color at high risk for preterm birth in research priority setting
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这项研究得到了加州 UCSF 早产倡议的支持。作者希望感谢布列塔尼、爱德华兹和奥尔加努涅斯的帮助, 以及他们分享他们的经验和观点的参与者。

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作者没有什么可透露的。

《 RPAC 议定书》是专门为指导初步的、探索性研究确定优先事项而制定的, 该方案涉及的少数群体人数不足, 他们的健康问题高风险, 并面临着不成比例的疾病负担。这是第一次试用与妇女在高社会人口的早产风险, 产生一个优先研究的问题和主题, 关于怀孕, 分娩和新生儿护理和治疗。RPAC 所产生的优先顺序列表可以被包括在资助者和研究人员的研究优先级设置中。RPAC 遵循国家一级患者参与量规的原则, 如以患者为中心的结局研究所9,21在美国和英国 JLA 优先设置伙伴关系。10 RPAC 使用优先级设置伙伴优先级协议的元素, 但不同于优先级设置伙伴协议的重要方式。首先, RPAC 只关注受健康状况影响的社区成员, 不包括 front-line 的临床医生, 他们的声音可能在讨论中是有特权的 (甚至是被参与者无意识的)。其次, RPAC 协议的目的是从组内生成最初的问题列表, 而不是以前的研究文献或调查。第三, RPAC 的目的是要更深入地探讨这些优先事项的优先事项、经验和背景, 并根据个人和社区的经验, 对少数具有专长的个人进行调查, 而优先建立伙伴关系议定书的目的是使大量的个人和组织代表了解情况及其对患者和家庭的影响, 在研究优先事项的制定过程中。但是, 使用 RPAC 和 JLA 优先级设置伙伴关系并不是相互排斥的, RPAC 可以自然导致形成 JLA 式优先级设置伙伴关系, 或者反过来, JLA 优先级设置伙伴关系工作可能导致使用 RPAC受健康状况影响的特定社区的更深参与。一旦研究的重点已经建立在病人和公众的参与, 由其中一种或两种方法, 基于社区的参与性研究方法可以用来设计和执行具体的研究项目。3,4
本白皮书中描述的代表性结果说明了 RPAC 协议在确定特定的研究问题和更广泛的研究课题时迅速和深入地与处于高社会人口风险的妇女早产的权力最重要的是他们和他们的社区。这些妇女没有事先的研究经验, 与调解人或他们的组织没有事先的关系。他们中没有一个在临床上工作, 也没有受过任何科学训练。然而, 在第一个两个小时的会议结束时, 他们根据自己的护理经验和未回答的健康问题, 以及他们对母婴健康的普遍好奇心, 产生了135多个独特的研究问题。在小组讨论与其他妇女象他们自己。此外, 作为两届会议议定书的一部分, 参加者在怀孕、分娩和养育子女期间对自己的健康和保健经验进行了深入的讨论。这些数据为进一步定性地分析这些经验提供了一个丰富的基板, 特别关注病人提供者和病人与健康系统的相互作用。
RPAC 协议是新的, 在评估它是否适合其他调查时, 有许多问题需要考虑。首先, 有明确的意向和计划的研究重点将如何告知研究战略和供资决定是必不可少的, 因为没有这样做将损害可信度重点小组会议之间的研究人员和社区。其次, 有一个 CBO 的合作伙伴谁是信任和融入社会的利益也是必不可少的成功。第三, 研究人员应该准备好与 CBO 和 RPAC 的参与者讨论个人和历史上的不当行为, 因为这可能会出现, 因为这一课题是由色彩社区提出的。12到目前为止, RPAC 协议仅与加利福尼亚州的非洲裔和拉美妇女一起使用, 他们的早产的社会人口风险很高。因此, 该方法的普遍性需要进一步的评价。然而, 这是一个有希望的方法, 以探索性研究为重点确定参与的少数群体人数不足的风险, 并不成比例地受到其他健康问题的影响。
与信任的 CBO 和熟练的便利化的合作对于快速建立和转移参与者之间的信任是至关重要的, 这样他们就能轻松自如地畅所欲言, 并产生丰富的数据。与所有方便的小组活动一样, 产出的质量很大程度上取决于调解人的技能, 使参与者参与主题和彼此。由于对健康研究的关注, 至少有一个辅导员应该有一个强有力的临床护理工作知识和研究证据的具体健康状况正在讨论中。这一点很重要, 这样, 主持人就可以在必要时提供示例问题, 以刺激讨论或引导对话, 以探讨参与者不自发提出的健康状况的其他方面。同时, 主持人必须避免对参加者提出的任何研究问题提供答案, 或在本届会议期间从事任何教学或咨询。这种行动可以迅速阻止参与者发展更多的问题或探索不确定性, 并不惜一切代价避免。主持人应与 CBO 伙伴合作, 在2届会议结束后向参与者提供健康信息或研究证据。
在对早产的社会人口风险较高的妇女使用 RPAC 时, 出现了一些重要的结果。首先, 在旧金山、奥克兰和弗雷斯诺加利福尼亚的 RPAC 工作中所产生的研究优先权列表被包括在 PTBi 的征求建议书中。第二, 参加 RPAC 的一些妇女申请并被选为 PTBi-CA 社区咨询委员会成员, 并参加了提案审查和建议, 以根据征求建议书的要求为提交的提案提供资金。这一投入对于 PTBi CA 来说是非常宝贵的, 确保委托的研究能够解决对科学和对社区有重要意义的问题 (参见简短的视频示例: https://www.youtube.com/watch？v=df1qRu4wzJo).
总之, RPAC 议定书是一种有用的方法, 可以迅速、in-depth 地了解妇女在早产的高社会人口风险中的研究优先事项。《 RPAC 议定书》为正在进行的病人和公众参与研究提供了坚实的基础, 并可在研究筹资决定中产生有意义的伙伴关系, 以更好地解决早产的流行。该议定书可进一步定制, 以便与受其他健康状况影响的社区的少数群体成员一起使用, 以便在关于研究重点的决定和解决这些健康状况的资金问题上有意义地参与。

患者和公众参与医疗保健研究提高了结果的相关性和可信度, 增加了招生和保留, 并加速了临床实践的翻译。1虽然这些术语经常交替使用, 但参与、参加和参与代表了研究人员和个人患者或一般公众之间三不同级别的联系。参与是最低水平, 包括研究人员和机构的活动, 以分享有关研究与病人和公众的信息和知识。参与是研究对象参加研究性学习的活动。参与是最高级别的接触, 病人、受影响社区成员或一般公众积极参与从设计到传播的研究项目, 包括 co-researchers。2,3社区成员或代表与研究人员或学术机构共同开发研究问题和研究项目共有性的伙伴关系, 俗称社区参与性研究。4这些方法有效地提高了患者和公众对研究的参与程度以及研究结果与受影响社区的相关性。5最近, 研究资助者开始认识到患者和公众参与战略研究议程的重要性, 并寻求患者和公众参与确定研究重点领域资助和优先考虑什么研究基金。病人和公众参与研究优先事项的确定是最高级别的参与, 是从社区参与性研究的上游。患者和公众参与研究优先事项的确定对于研究资助战略的制定是至关重要的, 这样, 对提案和供资决定的要求反映了公众以及研究界最感兴趣的专题。6有一个明确的和日益增长的国际期望, 即在合作伙伴与患者和社区进行高质量的研究, 而不是他们仅作为研究对象. 
方法为患者和公众参与研究优先权设置是相对地新和演变。到目前为止, 主要的资助者倾向于争取有耐心和公众参与的病人宣传组织的代表参与, 而不是直接来自受影响社区的成员或一般公众。患者或患者代表的介入通常是作为更大的利益相关者小组的一部分, 可能包括前线医护专业人员和行业通过在线调查方法和焦点小组以主要地专业风险承担者7、8、9或 "市政厅" 样式会议。9
最行之有效的研究病人和公众参与的方法是詹姆斯-林德联盟 (JLA) 优先设置合作方法。建立于2004年的 JLA 优先级设置伙伴关系方法10是一种结构化的方法, 它将患者、他们的护理人员和临床医生组一起确定治疗的不确定性 (即, 不能对所有群体都很重要的现有研究的回答)。建立伙伴关系的优先目标是就优先不确定因素达成共识, 并制定共同商定的研究优先事项的最后清单 (通常是 "前 10"), 然后广泛宣传这些优先事项, 以影响研究人员和研究资助者解决这些问题。JLA 优先级设置伙伴关系方法已有效地用于各种条件。JLA 指南10提供了一个详细的 step-by 步骤协议, 用于为任何健康主题建立和实施优先级设置伙伴关系。它包括一个多阶段的方法, 从广泛的文献审查和网上或邮政调查, 与广泛的利益相关者, 以产生一个具体的健康问题的不确定性综合清单。然后, 如果需要, 调查一致的方法, 如修改过的 Delphi 技术, 其中重复的排名 (通常通过调查问卷) 和报告后组的结果是用来达成共识和缩小不确定性列表到一个可管理的数字。然后, 将该列表提交给混合的利益相关者焦点小组, 他们使用小组协商一致的方法, 如名义分组技术, 对最重要的研究课题进行排序, 并生成一个优先顺序列表。7,8
值得注意的是, 没有发表关于病人和公众参与研究优先事项的文献, 是病人和公众对少数群体成员的参与。这加剧了少数族裔人口在医疗保健研究方面的不平等和公众参与, 总体而言,11 , 也许会使因研究的历史不端行为而产生的不信任, 特别是与颜色的社区。12此外, 在研究优先级的确定方面, 很少侧重于具体参与少数群体成员人数不足的方法。11,13这是一个重要的遗漏, 因为如果没有证据证明方法的有效性, 成功地让少数群体中的个人参与研究优先次序, 可能会产生意想不到的后果, 例如特权对某些利益攸关者的看法, 导致这些少数群体进一步脱离接触。例如, JLA 优先级设置合作伙伴关系10方法不专门解决确保少数群体参与的挑战, 而在进程的几个阶段, 他们的意见可能会被赋予较少优先于其他利益攸关者。首先, 依赖于文学和传统利益相关者代表群体的第一层次不确定性特权的研究, 已进行的基础上研究界和已建立的组织的优先事项,这并不代表少数群体人数不足的不确定性和问题。其次, 即使有技术娴熟的调解人和行之有效的方法, 与少数族裔人士和医疗保健专业人士一起举行协商一致的小组, 也可能无意间对专业人士的呼声和看法有所优待。因此, 需要采取新的方法, 侧重和发展代表不足的少数群体参与研究优先事项的能力, 特别是当他们受到严重的健康状况的不成比例的影响时。
一个这样的健康状况是早产, 定义为出生前37孕周的完成。早产是一种复杂的疾病, 具有医疗和社会人口风险因素, 与许多不良母婴结局有关, 影响到儿童和家庭的生活, 并使社会花费数十亿美元。14非裔美国人的种族、低社会经济地位和有限的教育是早产的主要原因之一, 但却是无法解释的危险因素。14,15,16,17直到最近, 关于早产的高社会人口风险的妇女的经验和看法的研究很少,14和早产研究优先级设置在美国没有直接的病人和公共参与.第一个病人和公众参与早产研究优先设置的报告在2014年英国 (联合王国)。18,19虽然开创性的领域, 英国早产优先设置伙伴关系16没有包括妇女在高社会人口风险的早产, 如那些 at-risk 由于社会决定健康或健康差距.由于这些群体承受着不成比例的疾病负担, 必须将他们的观点纳入研究优先事项的确定之中。
UCSF 加利福尼亚早产倡议 (PTBi) 是一项多年期、philanthropically 资助的研究倡议, 目的是减轻加利福尼亚 (www.pretermbirth.ucsf.edu) high-disparity 地区未检查的早产流行病的负担。PTBi 汇集了来自众多专业和学科、公共卫生机构和社区领导人的研究人员, 与受这一流行病影响最严重的妇女和家庭建立直接伙伴关系。早产的妇女和那些在社会人口中早产的高危人群, 以及与这些妇女及其家人一起工作的第一线临床和社会护理人员参与了研究过程的各个阶段--从发展研究重点, 设计研究方案, 进行研究, 传播结果, 并将调查结果转化为实践和政策。
鉴于少数群体在研究优先事项方面具体涉及的方法有限, 而且由于不知道在高社会人口风险下早产的肤色妇女是否有兴趣或愿意参与研究优先设置过程中, 建立的 JLA 优先级设置伙伴关系方法不适宜作为患者和公众参与这一人口和主题的第一步。本文介绍了一种新的方法来启动病人和公众参与, 研究受影响社区 (RPAC) 的优先次序, 并描述它的使用与妇女在高社会人口风险早产。RPAC 的目标是直接让来自少数群体的个人, 在这种情况下的有色人种妇女, 在确定和优先考虑他们的健康状况未回答的问题, 在这种情况下, 怀孕, 分娩和新生儿护理和治疗.RPAC 方法能够发现对受影响社区最优先的研究未回答的研究问题, 以便将它们纳入资助者和研究人员的研究优先次序。UCSF PTBi 在其征求建议书时纳入了在高社会人口风险下早产的妇女的研究优先事项, 包括参与提案审查和供资决定的 RPAC 进程的妇女 (见简短的视频例子: https://www.youtube.com/watch？v=df1qRu4wzJo)。RPAC 协议可以导致有意义的伙伴关系的个人来自受健康状况影响的决策研究的焦点和资金。

<table><tbody><tr><td>&lt;strong&gt;Session 1: Room arrangement and supplies&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Room arrangement: Arrange tables and seating in a U-shape facing a large whiteboard or smooth wall (10 to 12 feet in length ideal) on which self-adhesive flip chart paper can be mounted and written on. If easels are used, have a minimum of 2, ideally 3)</td><td></td><td></td><td></td></tr><tr><td>Self-adhesive flip chart paper (at least 110 sheets)</td><td></td><td></td><td></td></tr><tr><td>Markers and pens</td><td></td><td></td><td></td></tr><tr><td>Pens and note-taking pads for all participants</td><td></td><td></td><td></td></tr><tr><td>Audio recorder</td><td></td><td></td><td></td></tr><tr><td>Name tags</td><td></td><td></td><td></td></tr><tr><td>Required forms (e.g., photo consents, reimbursement forms)</td><td></td><td></td><td></td></tr><tr><td>Options (but strongly recommended): Refreshments, gift cards or gifts to acknowledge participant time and contribution to the project</td><td></td><td></td><td></td></tr><tr><td>&lt;strong&gt;Session 2: Room arrangement and supplies&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Room arrangement: Arrange tables and seating in a U-shape facing a large whiteboard or smooth wall (10 to 12 feet in length ideal) on which self-adhesive flip chart paper can be mounted and written on. If easels are used, have a minimum of 3, ideally 4)</td><td></td><td></td><td></td></tr><tr><td>Individual research questions (from Session 1 analysis) printed in large font on self-stick* half-sheets of 8.5 x 11 paper *If not available, also need tape or spray adhesive</td><td></td><td></td><td></td></tr><tr><td>Blank half-sheets (in a different color paper) for new questions generated in session 2</td><td></td><td></td><td></td></tr><tr><td>Research topics (from Session 1 analysis) printed in bold large font on self-stick* half-sheets of 8.5 x 11 paper *If not available, also need tape or spray adhesive</td><td></td><td></td><td></td></tr><tr><td>Blank half-sheets (in a different color paper) for new topics generated in session 2</td><td></td><td></td><td></td></tr><tr><td>Post-it flip chart paper (at least 15 sheets)</td><td></td><td></td><td></td></tr><tr><td>Markers and pens</td><td></td><td></td><td></td></tr><tr><td>Sticker dots in different colors or patterns &amp;mdash; each participant will need 20 sticker dots in a different color or pattern (15 dots for round 1 and 5 dots for round 2 of the prioritization exercise)</td><td></td><td></td><td></td></tr><tr><td>Paper copies for all participants and facilitators with the research questions organized by topic</td><td></td><td></td><td></td></tr><tr><td>Audio recorder</td><td></td><td></td><td></td></tr><tr><td>Name tags</td><td></td><td></td><td></td></tr><tr><td>Required forms (e.g., photo consents, reimbursement forms)</td><td></td><td></td><td></td></tr><tr><td>Options (but strongly recommended): Refreshments, gift cards or gifts to acknowledge participant time and contribution to the project</td><td></td><td></td><td></td></tr></tbody></table>

a novel method for involving women of color at high risk for preterm birth in research priority setting

现在人们认识到病人和公众的参与对良好的研究行为至关重要。病人和公众参与研究优先事项的确定和供资决定才开始被认为是重要的, 这样做的方法是新生的。本议定书描述了受影响社区 (RPAC) 议定书的研究优先次序, 以及它与妇女在早产的高社会人口风险中的使用结果。其目的是直接让这些妇女参与确定和优先考虑她们未回答的关于怀孕、分娩和新生儿护理以及治疗的问题, 以便他们的观点能够被包括在资助者和研究人员的研究优先次序中。《 RPAC 议定书》可用于在研究战略和供资优先事项的确定方面, 使代表人数不足的群体有意义地参与高风险的特定健康问题, 或那些面临疾病负担过重的人。

下列结果是从一个正在进行的项目中获得的: 在旧金山、奥克兰和加利福尼亚州弗雷斯诺的研究战略和供资优先事项中, 涉及妇女处于社会人口高风险早产的 PTBI。代表的结果来自于旧金山的两个社区服务妇女: 无家可归的产前计划和黑人婴儿健康计划 (波黑)。这些组织可以直接提供或主持各种服务, 包括产前、分娩准备和产后班。额外的免费服务包括案例管理、个性化生活和目标规划、公共卫生护士咨询、医疗、社会、经济和精神卫生服务的转诊服务和交通。每个组织的工作人员都邀请怀孕或有年幼早产儿参加该项目的客户。
总共有14名参加者, 6 人来自水电站, 8 来自波黑, 年龄从20岁到42人不等。参加者共有44儿童 (各1至5人), 21% (n=9) 出生早产儿。参加者自我为非裔美国人 (n=12)、拉丁裔 (n=1) 或亚洲/太平洋岛民 (n=1)。三的妇女在重点小组时怀孕, 2 人在各小组工作, 1 名在波黑。参加者获得了时间的补偿。在研究期间没有磨损。
在删除有系统审查或国家准则的有力证据的与会者提出的问题以及两个小组之间的重复问题之后, 1 届会议产生了135项独特研究问题的综合清单。两个地点的活动。使用主题分析, 这些问题被归类在11项主要研究主题的下面。这些问题和议题分别提交给了2届会议的每一个小组, 前10个小组和前 15 (波黑) 研究问题得到了集团协商一致的同意。图 1显示了执行点投票的参与者, 以指示他们的2轮优先研究问题。两个组的结果再次被一起检查, 并删除了重复项, 从而最终列出了组合的前10特定研究问题 (表 1) 和前9研究主题 (表 2)。
在两届会议期间, 与会者对自己的健康和保健经验进行了密切的讨论。参加者报告说, 听到其他妇女讲她们的故事促使她们更多地分享自己。在每届会议期间, 与会者就妇女保健经验对个人和社区的影响进行了讨论。这些数据被记录和转录为会议的一部分, 后来受到定性分析, 增加了背景、意义, 有时还建议进一步研究妇女认为重要的研究优先主题 (数据不显示)。在每个地点2届会议结束时的述职讨论中, 所有妇女都报告说, 参与是一种积极的学习经验, 他们都表示有兴趣继续参与研究人员的工作。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/56220/56220fig1.jpg"> 图 1.2届会议的参与者执行点投票, 以表明他们的2轮优先研究问题。<a href="//cloudflare.jove.com/files/ftp_upload/56220/56220fig1large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody>
<tr>
<td>母亲的压力如何影响婴儿？</td>
		</tr>
<tr>
<td>什么是改善病人提供者沟通的最有效的方法, 特别是当病人觉察到医护人员的麻木不仁和粗鲁的评论？</td>
		</tr>
<tr>
<td>什么是最有效的照顾怀孕和高危怀孕？例如, 如果非洲裔美国妇女面临更高的风险, 为什么没有专门的护理来改善结果？</td>
		</tr>
<tr>
<td>什么导致婴儿猝死综合症？</td>
		</tr>
<tr>
<td>你的保险类型决定了你的护理类型, 或你的护理质量和照顾不同的基于保险地位或种族？</td>
		</tr>
<tr>
<td>什么可以使医院的访问和住院更容易为家庭和什么支持是最有帮助的母亲有孩子在家？</td>
		</tr>
<tr>
<td>孕期服用哪些药物是安全的？</td>
		</tr>
<tr>
<td>计划生育如何帮助, 医疗保健团队如何更好地遵循妇女的生育计划？</td>
		</tr>
<tr>
<td>当虐待和忽视不清楚时, 保健提供者如何决定在孕期保健中涉及儿童保护服务？</td>
		</tr>
<tr>
<td>有经验的妈妈可以更有效地使用母乳喂养支持吗？</td>
		</tr>
</tbody></table>表 1.早产妇女高社会人口风险的前10项具体研究问题
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody>
<tr>
<td>优先</td>
			<td colspan="4">研究课题</td>
		</tr>
<tr>
<td>1</td>
			<td colspan="4">孕期压力及其对妇女和婴儿的影响</td>
		</tr>
<tr>
<td>2</td>
			<td colspan="4">高危妊娠妇女的监测和护理标准</td>
		</tr>
<tr>
<td>3</td>
			<td colspan="4">就业和保险覆盖面对护理和结果的影响</td>
		</tr>
<tr>
<td>4</td>
			<td colspan="4">孕期和新生儿药物和物质的安全</td>
		</tr>
<tr>
<td>5</td>
			<td colspan="4">提供者-患者沟通和 decision-making</td>
		</tr>
<tr>
<td>6</td>
			<td colspan="4">母乳喂养支助</td>
		</tr>
<tr>
<td>7</td>
			<td colspan="4">将妇女和家庭转用于社会服务的标准</td>
		</tr>
<tr>
<td>8</td>
			<td colspan="4">婴幼儿猝死综合征的病因及预防</td>
		</tr>
<tr>
<td>9</td>
			<td colspan="4">家庭中的母亲和婴儿的支持</td>
		</tr>
</tbody></table>表 2.早产高危妇女的优先研究课题

Watch this Scientific Journal Video about A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting at JoVE.com

A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting

这份手稿描述了受影响社区 (RPAC) 协议的研究优先顺序, 以及其对早产风险妇女的使用结果。通过使用该议定书, 妇女确定并将其未回答的关于怀孕、分娩和新生儿护理的问题列为优先事项, 目的是影响资助者和研究人员的研究重点。

一种新的方法, 让孕妇在研究中优先考虑早产高危因素

Involvement of patients and the public is now recognized to be essential for the good conduct of research. Patient and public involvement in research ...

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11.7K 次观看.  University of California, San Francisco. 这份手稿描述了受影响社区 (RPAC) 协议的研究优先顺序, 以及其对早产风险妇女的使用结果。通过使用该议定书, 妇女确定并将其未回答的关于怀孕、分娩和新生儿护理的问题列为优先事项, 目的是影响资助者和研究人员的研究重点。

视频: A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

There has been a long-standing interest in the assessment of the neurobehavioral integrity of the newborn infant. The NICU Network Neurobehavioral Scale (NNNS) was developed as an assessment for the at-risk infant. These are infants who are at increased risk for poor developmental outcome because of insults during prenatal development, such as substance exposure or prematurity or factors such as poverty, poor nutrition or lack of prenatal care that can have adverse effects on the intrauterine environment and affect the developing fetus. The NNNS assesses the full range of infant neurobehavioral performance including neurological integrity, behavioral functioning, and signs of stress/abstinence. The NNNS is a noninvasive neonatal assessment tool with demonstrated validity as a predictor, not only of medical outcomes such as cerebral palsy diagnosis, neurological abnormalities, and diseases with risks to the brain, but also of developmental outcomes such as mental and motor functioning, behavior problems, school readiness, and IQ. The NNNS can identify infants at high risk for abnormal developmental outcome and is an important clinical tool that enables medical researchers and health practitioners to identify these infants and develop intervention programs to optimize the development of these infants as early as possible. The video shows the NNNS procedures, shows examples of normal and abnormal performance and the various clinical populations in which the exam can be used.

The NICU Network Neurobehavioral Scale (NNNS) was developed as an assessment for the at-risk infant. The purpose of this article is to describe the NNNS, provide video examples of the NNNS procedures and discuss the ways in which the exam has been used.

评估和高危新生儿的评价：新生儿重症监护病房的网络神经行为量表

There has been a long-standing interest in the assessment of the neurobehavioral integrity of the newborn infant.  The NICU Network Neurobehavioral Scale ...

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Preterm EEG: A Multimodal Neurophysiological Protocol

Since its introduction in early 1950s, electroencephalography (EEG) has been widely used in the neonatal intensive care units (NICU) for assessment and monitoring of brain function in preterm and term babies. Most common indications are the diagnosis of epileptic seizures, assessment of brain maturity, and recovery from hypoxic-ischemic events. EEG recording techniques and the understanding of neonatal EEG signals have dramatically improved, but these advances have been slow to penetrate through the clinical traditions. The aim of this presentation is to bring theory and practice of advanced EEG recording available for neonatal units. 
In the theoretical part, we will present animations to illustrate how a preterm brain gives rise to spontaneous and evoked EEG activities, both of which are unique to this developmental phase, as well as crucial for a proper brain maturation. Recent animal work has shown that the structural brain development is clearly reflected in early EEG activity. Most important structures in this regard are the growing long range connections and the transient cortical structure, subplate. Sensory stimuli in a preterm baby will generate responses that are seen at a single trial level, and they have underpinnings in the subplate-cortex interaction. This brings neonatal EEG readily into a multimodal study, where EEG is not only recording cortical function, but it also tests subplate function via different sensory modalities. Finally, introduction of clinically suitable dense array EEG caps, as well as amplifiers capable of recording low frequencies, have disclosed multitude of brain activities that have as yet been overlooked.
In the practical part of this video, we show how a multimodal, dense array EEG study is performed in neonatal intensive care unit from a preterm baby in the incubator. The video demonstrates preparation of the baby and incubator, application of the EEG cap, and performance of the sensory stimulations.

This video explains the background theory of the neonatal EEG activity and the sensory responses, followed by a live demonstration of their recording in neonatal intensive care unit.

早产儿的脑电图：多式联运神经生理学议定书

Since its introduction in early 1950s, electroencephalography (EEG) has been widely used in the neonatal intensive care units (NICU) for assessment and ...

神经科学

Dried Blood Spot Collection of Health Biomarkers to Maximize Participation in Population Studies

Biomarkers are directly-measured biological indicators of disease, health, exposures, or other biological information. In population and social sciences, biomarkers need to be easy to obtain, transport, and analyze. Dried Blood Spots meet this need, and can be collected in the field with high response rates. These elements are particularly important in longitudinal study designs including interventions where attrition is critical to avoid, and high response rates improve the interpretation of results. Dried Blood Spot sample collection is simple, quick, relatively painless, less invasive then venipuncture, and requires minimal field storage requirements (i.e.&#160;samples do not need to be immediately frozen and can be stored for a long period of time in a stable freezer environment before assay). The samples can be analyzed for a variety of different analytes, including cholesterol, C-reactive protein, glycosylated hemoglobin, numerous cytokines, and other analytes, as well as provide genetic material. DBS collection is depicted as employed in several recent studies.

Biomarkers are directly-measured biological indicators of disease or health. In population and social sciences, biomarkers need to be easy to obtain, transport, and analyze. Dried Blood Spot (DBS) collection meets this need, can be collected in the field with high response rates&#160;and analyzed for a variety of biomarkers.

干生生物标志物的血斑收藏最大限度地参与人口研究

Biomarkers are directly-measured biological indicators of disease, health, exposures, or other biological information. In population and social sciences, ...

医学

Isolation of Leukocytes from the Human Maternal-fetal Interface

Pregnancy is characterized by the infiltration of leukocytes in the reproductive tissues and at the maternal-fetal interface (decidua basalis and decidua parietalis). This interface is the anatomical site of contact between maternal and fetal tissues; therefore, it is an immunological site of action during pregnancy. Infiltrating leukocytes at the maternal-fetal interface play a central role in implantation, pregnancy maintenance, and timing of delivery. Therefore, phenotypic and functional characterizations of these leukocytes will provide insight into the mechanisms that lead to&#160;pregnancy disorders. Several protocols have been described in order to isolate infiltrating leukocytes from the decidua basalis and decidua parietalis; however, the lack of consistency in the reagents, enzymes, and times of incubation makes it difficult to compare these results. Described herein is&#160;a novel approach that combines the use of gentle mechanical and enzymatic dissociation techniques to preserve the viability and integrity of extracellular and intracellular markers in leukocytes isolated from the human tissues at the maternal-fetal interface. Aside from immunophenotyping, cell culture, and cell sorting, the future applications of this protocol are numerous and varied. Following this protocol, the isolated leukocytes can be used to determine DNA methylation, expression of target genes, in vitro leukocyte functionality (i.e., phagocytosis, cytotoxicity, T-cell proliferation, and plasticity, etc.), and the production of reactive oxygen species at the maternal-fetal interface. Additionally, using the described protocol, this laboratory has been able to describe new and rare leukocytes at the maternal-fetal interface.

Described herein is a protocol to isolate and further study the infiltrating leukocytes of the decidua basalis and decidua parietalis - the human maternal-fetal interface. This protocol maintains the integrity of cell surface markers and yields enough viable cells for downstream applications as proven by flow cytometry analysis.

从人类母胎界面分离白细胞

Pregnancy is characterized by the infiltration of leukocytes in the reproductive tissues and at the maternal-fetal interface (decidua basalis and decidua ...

免疫与感染

<meta charset="utf8"></head><body>用于分析 MRI 环境中对外部线索的行为反应的管道

Profiling Maternal Behavior Responses During Whole-Brain Imaging

Recent advancements in whole-brain imaging tools have enabled neuroscientists to investigate how coordinated brain activity processes external cues, influencing internal state changes and eliciting behavioral responses. For example, functional magnetic resonance imaging (fMRI) is a noninvasive technique that allows for the measurement of whole-brain activity in awake, behaving mice using the blood oxygenation-level-dependent (BOLD) response. However, to fully understand BOLD responses evoked by external stimuli, it is crucial that experimenters also assess behavioral responses during scans. The MRI environment poses challenges to this goal, rendering commonly employed methods of behavioral monitoring incompatible. These challenges include (1) a restricted field of view and (2) the limited availability of equipment without ferromagnetic components. Presented here is a behavioral video analysis pipeline that overcomes these limitations by extracting valuable information from videos acquired within these environmental constraints, enabling the evaluation of behavior during the acquisition of whole-brain neural data. Employing methods such as optical flow estimation and dimensionality reduction, robust differences can be detected in behavioral responses to stimuli presented during fMRI scans. For example, representative results suggest that mouse pup vocalizations, but not pure tones, evoke significantly different behavioral responses in maternal versus virgin female mice. Moving forward, this behavioral analysis pipeline, initially tailored to overcome challenges in fMRI experiments, can be extended to various neural recording methods, providing versatile behavioral monitoring in constrained environments. The coordinated evaluation of behavioral and neural responses will offer a more comprehensive understanding of how the perception of stimuli leads to the coordination of complex behavioral outputs.

<meta charset="utf8"></head><body>在全脑成像过程中分析母体行为反应

Presented here is a video analysis pipeline that overcomes challenges in behavioral monitoring within MRI environments, allowing for the detection of uninstructed behavioral responses to external cues. This analysis will facilitate a more comprehensive understanding of evoked internal state changes and brain-wide activity.

在全脑成像过程中分析母体行为反应

Recent advancements in whole-brain imaging tools have enabled neuroscientists to investigate how coordinated brain activity processes external cues, ...

Transcutaneous Microcirculatory Imaging in Preterm Neonates

Microcirculatory imaging (MI) is a relatively new research tool mainly used in the intensive care setting. MI provides a clear view of the smallest capillaries, arterioles and venules. The magnifying effect visualizes the flow pattern of erythrocytes through these vessels.
It's non-invasive character makes it suitable to apply in (preterm) neonates, even in cardiorespiratory unstable patients. In adults and children, MI is mainly performed sublingually, but this is not possible in preterm infants as these cannot cooperate and the size of the probe is problematic. In preterm infants, MI is therefore performed transcutaneously. Their thin skin makes it possible to obtain high quality images of peripheral microcirculation. 
In this manuscript we will demonstrate the method of transcutaneous MI in preterm infants. We will focus on the different techniques and provide tips to optimize image quality. The highlights of software settings, safety and offline analysis are also addressed.

Microcirculatory imaging (MI) is used to monitor peripheral perfusion in critically ill or preterm neonates. This manuscript and video demonstrates the optimal approach for obtaining high-quality images.

经皮微循环成像在早产儿

Microcirculatory imaging (MI) is a relatively new research tool mainly used in the intensive care setting. MI provides a clear view of the smallest ...

The 4-vessel Sampling Approach to Integrative Studies of Human Placental Physiology In Vivo

The human placenta is highly inaccessible for research while still in utero. The current understanding of human placental physiology in vivo is therefore largely based on animal studies, despite the high diversity among species in placental anatomy, hemodynamics and duration of the pregnancy. The vast majority of human placenta studies are ex vivo perfusion studies or in vitro trophoblast studies. Although in vitro studies and animal models are essential, extrapolation of the results from such studies to the human placenta in vivo is uncertain. We aimed to study human placenta physiology in vivo at term, and present a detailed protocol of the method. Exploiting the intraabdominal access to the uterine vein just before the uterine incision during planned cesarean section, we collect blood samples from the incoming and outgoing vessels on the maternal and fetal sides of the placenta. When combining concentration measurements from blood samples with volume blood flow measurements, we are able to quantify placental and fetal uptake and release of any compound. Furthermore, placental tissue samples from the same mother-fetus pairs can provide measurements of transporter density and activity and other aspects of placental functions in vivo. Through this integrative use of the 4-vessel sampling method we are able to test some of the current concepts of placental nutrient transfer and metabolism in vivo, both in normal and pathological pregnancies. Furthermore, this method enables the identification of substances secreted by the placenta to the maternal circulation, which could be an important contribution to the search for biomarkers of placenta dysfunction.

The 4-vessel Sampling Approach to Integrative Studies of Human Placental Physiology In Vivo

We present a detailed method to study human placental physiology in vivo at term. The method combines blood sampling from the incoming and outgoing vessels on the maternal and fetal sides of the placenta with ultrasound measurements of volume blood flow and placental tissue sampling.

人体胎盘生理学综合研究的4血管取样方法<em&gt;体内</em

The human placenta is highly inaccessible for research while still in utero. The current understanding of human placental physiology in vivo is therefore ...

通过 EMMI 可视化子宫收缩以改善劳动力管理

Electromyometrial Imaging of Uterine Contractions in Pregnant Women

During normal pregnancy, the uterine smooth muscle, the myometrium, begins to have weak, uncoordinated contractions at late gestation to help the cervix remodel. In labor, the myometrium has strong, coordinated contractions to deliver the fetus. Various methods have been developed to monitor uterine contraction patterns to predict labor onset. However, the current techniques have limited spatial coverage and specificity. We developed electromyometrial imaging (EMMI) to noninvasively map uterine electrical activity onto the three-dimensional uterine surface during contractions. The first step in EMMI is to use T1-weighted magnetic resonance imaging to acquire the subject-specific body-uterus geometry. Next, up to 192 pin-type electrodes placed on the body surface are used to collect electrical recordings from the myometrium. Finally, the EMMI data processing pipeline is performed to combine the body-uterus geometry with body surface electrical data to reconstruct and image uterine electrical activities on the uterine surface. EMMI can safely and noninvasively image, identify, and measure early activation regions and propagation patterns across the entire uterus in three dimensions.

作者聚焦：通过肌电成像推进劳动力管理以了解子宫收缩 

We present a protocol for conducting electromyometrial imaging (EMMI), including the following procedures: multiple electromyography electrode sensor recordings from the body surface, magnetic resonance imaging, and uterine electrical signal reconstruction.

孕妇子宫收缩的肌电图成像

During normal pregnancy, the uterine smooth muscle, the myometrium, begins to have weak, uncoordinated contractions at late gestation to help the cervix ...

一种新的方法, 让孕妇在研究中优先考虑早产高危因素

摘要

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早产儿的脑电图：多式联运神经生理学议定书

干生生物标志物的血斑收藏最大限度地参与人口研究

从人类母胎界面分离白细胞

在全脑成像过程中分析母体行为反应

在全脑成像过程中分析母体行为反应

在全脑成像过程中分析母体行为反应

经皮微循环成像在早产儿

人体胎盘生理学综合研究的4血管取样方法

孕妇子宫收缩的肌电图成像