Program evaluation of cognitive behavioral therapy in burn survivors

Mental health is a component of care that should be addressed for burn patients while they are hospitalized. Unfortunately, dedicated burn psychotherapists are rare in burn centers in the United States (US), and it can take months for patients to be seen by a mental health professional after referral. Our burn center has a dedicated licensed clinical social worker who sees patients within two business days of referral. She uses cognitive behavioral therapy (CBT), which is designed to alleviate symptoms of anxiety, depression, and acute stress by modifying the individual's maladaptive thoughts. To evaluate the timely use of CBT as a treatment for depression in burn patients, we measured depressive symptoms before and after psychotherapy. Burn clinic nurses administered the Patient Health Questionnaire (PHQ-9) depression screener as part of standard care. We computed difference scores to determine change in PHQ-9 scores at both group and individual levels. At a group level, psychotherapy significantly improved symptoms of depression, indicated by a decreased mean PHQ-9 score. On an individual level, half of the patients (50.7%) experienced a meaningful improvement in their symptoms, indicated by a change in their PHQ-9 depression category, while 35.6% showed no change. Although it was not an effective solution for all patients in this study, timely use of CBT could be an important component of burn care for many and should be considered as part of standard care in burn centers across the US.

Serum SNTF, a Surrogate Marker of Axonal Injury, Is Prognostic for Lasting Brain Dysfunction in Mild TBI Treated in the Emergency Department

Mild traumatic brain injury (mTBI) causes persisting post-concussion syndrome for many patients without abnormalities on conventional neuroimaging. Currently, there is no method for identifying at-risk cases at an early stage for directing concussion management and treatment. SNTF is a calpain-derived N-terminal proteolytic fragment of spectrin (α_II-spectrin1-1176) generated in damaged axons following mTBI. Preliminary human studies suggest that elevated blood SNTF on the day of mTBI correlates with white matter disruption and lasting brain dysfunction. Here, we further evaluated serum SNTF as a prognostic marker for persistent brain dysfunction in uncomplicated mTBI patients treated in a Level I trauma center emergency department. Compared with healthy controls (n = 40), serum SNTF increased by 92% within 24 h of mTBI (n = 95; p < 0.0001), and as a diagnostic marker exhibited 100% specificity and 37% sensitivity (AUC = 0.87). To determine whether the subset of mTBI cases positive for SNTF preferentially developed lasting brain dysfunction, serum levels on the day of mTBI were compared with multiple measures of brain performance at 90 days post-injury. Elevated serum SNTF correlated significantly with persistent impairments in cognition and sensory-motor integration, and predicted worse performance in each test on a case by case basis (AUC = 0.68 and 0.76, respectively). SNTF also predicted poorer recovery of cognitive stress function from 30 to 90 days (AUC = 0.79–0.90). These results suggest that serum SNTF, a surrogate marker for axonal injury after mTBI, may have potential for the rapid prognosis of lasting post-concussion syndrome and impaired functional recovery following CT-negative mTBI. They provide further evidence linking axonal injury to persisting brain dysfunction after uncomplicated mTBI. A SNTF blood test, either alone or combined with other markers of axonal injury, may have important utilities for research, prognosis, management and treatment of concussion.

Placement of a cervical collar increases the optic nerve sheath diameter in healthy adults

INTRODUCTION

Blunt head trauma is a common cause of increased intracranial pressure (ICP). Ultrasound measurement of the optic nerve sheath diameter (OSND) is an accurate and non-invasive way to detect increased ICP. Blunt trauma patients are often immobilized in a rigid cervical spine collar. Our objective was to describe the changes in ONSD following the placement of a c-collar and determine if any changes were time-dependent.

METHODS

We performed a prospective cohort study measuring the ONSD of healthy volunteers before and after placement of a c-collar. Two physicians obtained the measurements. Each eye was scanned twice using a standardized technique. This was done before c-collar placement, 5min after placement and 20min after placement. A mean of both eyes was calculated and analyzed using descriptive statistics. An intraclass correlation coefficient (ICC) was used to assess inter-rater reliability.

RESULTS

Twenty study participants with a mean age of 37.1years old were enrolled. The mean baseline ONSD was 3.77mm (95% CI 3.48-4.07). The mean ONSD 5 min after the c-collar was placed was 4.47 (95% CI 4.17-4.78). The mean ONSD at 20min after c-collar placement was 4.53 (95% CI 4.13-4.92). These changes were statistically significant (p=0.003 and <0.001). Reliability was relatively strong overall (ICC=0.74; 95% CI: 0.65, 0.81).

CONCLUSION

The placement of a cervical collar increased the ONSD at 5min and this change remained increased at 20min. Future study should assess whether similar results are found in patients with blunt head trauma.

Intraosseous Pressure Monitoring in Healthy Volunteers

STUDY OBJECTIVE

Invasively monitoring blood pressure through the IO device has not been thoroughly demonstrated. This study attempted to establish baseline values of IO pressure in a healthy human population.

METHODS

This was a prospective, healthy volunteer, observational study. Participants had two IO devices placed (humerus and tibia), and participant IO pressures, vital signs, and pain scores were monitored for up to 60 minutes. Participants were contacted at 24-hours and 7 days post-testing to assess for adverse events. Summary statistics were calculated for systolic, diastolic, and mean humeral and tibial IO pressure. The ratio of IO to non-invasive blood pressure was calculated, and Bland Altman plots were created. The slope (linear) of the mean humeral and the tibial IO pressures were also calculated.

RESULTS

Fifteen subjects were enrolled between April and July 2015. Fourteen of 15 humeral IOs were placed successfully (93.3%) and all 15 of the tibial IOs were placed successfully. Mean tibial systolic, diastolic, and mean IO pressure were 55.8 ± 27.9, 49.3 ± 27.1, and 48.4 ± 29.4 mm Hg, respectively. Humeral systolic, diastolic, and mean IO pressure were 32.9 ± 16.0, 27.4 ± 15.2, and 24.5 ± 14.3 mm Hg. The mean tibial IO pressure was 52.5% ± 32.0% of external cuff pressure ratio. The mean humeral IO pressure was 26.5% ± 15.2% of the external mean blood pressure. The Bland Altman plots showed an inconsistent relationship between the systolic and diastolic cuff pressure and the IO pressures. We observed a 1% per minute decrease in IO pressure from the initial placement until the final reading.

CONCLUSIONS

Intraosseous pressure readings can be obtained in healthy human volunteers. However, absolute IOP values were not consistent between subjects. Future research may determine how IO pressure can be used to guide therapy in ill and injured patients.

The association of health status and providing consent to continued participation in an out-of-hospital cardiac arrest trial performed under exception from informed consent

OBJECTIVES

Emergency medical research performed under federal regulation 21 § CFR 50.24 provides a means to protect human subjects and investigate novel time-sensitive treatments. Although prospective individual consent is not required for studies conducted under this regulation, consent from a legally authorized representative (LAR) or the patient at the earliest feasible opportunity is required to obtain short- and long-term outcome data. The objective of this study was to determine which demographic, cardiac arrest, and patient outcome characteristics predicted the likelihood of obtaining informed consent following enrollment under exception from informed consent in a multicenter cardiac arrest study.

METHODS

This investigation was an analysis of data collected during a multisite, randomized, controlled, out-of-hospital cardiac arrest clinical trial performed under 21 § CFR 50.24. Research personnel attempted to obtain informed consent from LARs and subjects for medical records review of primary outcome data, as well as consent for neurologic outcome assessments up to 1 year post-cardiac arrest. Hospital discharge and neurologic status were obtained from public records and/or medical records up until the time consent was formally denied, in accordance with federal regulations and guidance. Local institutional review boards also allowed medical records review for cases where consent was neither obtained nor declined despite multiple consent attempts. Patient demographic, cardiac arrest, and clinical outcome characteristics were analyzed in univariate multinomial regression models, with consent status (obtained, denied, neither obtained nor denied) as the dependent variable. A multivariate multinomial logistic regression was then performed. An exploratory secondary analysis following the same process was performed after assigning patients who neither consented nor declined to the declined consent group.

RESULTS

Among a total study population of 1,655 cardiac arrest subjects, 457 were transported and had consent attempted (27.6%). The survival status and neurologic function at the time of hospital discharge were known in 440 of 457 (96%) subjects. In the multivariate analysis, initial rhythm of ventricular fibrillation/ventricular tachycardia (VF/VT) and survival with good neurologic outcome were strong predictors of obtaining consent (odds ratio [OR] = 3.15, 95% confidence interval [CI] = 1.73 to 5.75; OR = 7.64, 95% CI = 2.28 to 25.63, respectively). The exploratory secondary analysis also showed initial rhythm of VF/VT and survival with good neurologic outcome as strong predictors of obtaining consent (OR = 1.86, 95% CI = 1.17 to 2.95; OR = 4.52, 95% CI = 2.21 to 9.26, respectively).

CONCLUSIONS

Initial arrest rhythm and survival with good neurologic outcome were highly predictive of obtaining consent in this cardiac arrest trial. This phenomenon could result in underrepresentation of outcome data in the study arm with the worse outcome and represents a significant potential confounder in studies performed under 21 § CFR 50.24. Future revisions to the exception from informed consent regulations should allow access to critical survival data recorded as part of standard documentation, regardless of patient consent status.

Debunking three rape myths

BACKGROUND

Stereotypes and prejudicial misconceptions are prevalent regarding sexual assaults and victims' responses. These are collectively referred to as rape myths. This study examines three rape myths purporting that sexual assault victims (1) immediately report the crime, (2) experience severe physical and/or anogenital injuries, and (3) forcefully resist their assailant.

STUDY DESIGN

This is a cross-sectional descriptive study examining presence of physical or anogenital injury, level of physical resistance during a sexual assault, and time to sexual assault report. Study subjects were female sexual assault victims examined by a sexual assault nurse examiner at Regions Hospital in St. Paul, Minnesota, in 2011 and 2012.

RESULTS

Sexual assault nurse examiner reports for 317 subjects met the inclusion criteria and were reviewed. Twelve (4%) victims experienced physical injury requiring medical intervention. Thirty-four (11%) sustained anogenital injuries requiring medical intervention. Overall, 253 (81%) victims did not actively resist at some point during the assault, with 178 (57%) victims never actively resisting. Nearly half (129, 43%) did not appear in the emergency department for 12 or more hours from the time of the assault.

CONCLUSION

Women who seek emergency department assistance after a sexual assault take a variable amount of time to present to the emergency department, rarely experience moderate or severe physical or anogenital injury, and commonly do not exert strong physical resistance against their attacker during at least part of the assault.

Comparison of success rates between two video laryngoscope systems used in a prehospital clinical trial

OBJECTIVES

The primary aims of this study were to compare paramedic success rates and complications of two different video laryngoscopes in a prehospital clinical study.

METHODS

This study was a multi-agency, prospective, non-randomized, cross over clinical trial involving paramedics from four different EMS agencies. Following completion of training sessions, six Storz CMAC™ video laryngoscopes and six King Vision™ (KV) video laryngoscopes were divided between agencies and placed into service for 6 months. Paramedics were instructed to use the video laryngoscope for all patients estimated to be ≥ 18 years old who required advanced airway management per standard operating procedure. After 6 months, the devices were crossed over for the final 6 months of the study period. Data collection was completed using a telephone data collection system with a member of the research team (available 24/7). First attempt success, overall success, and success by attempt, were compared between treatment groups using exact logistic regression adjusted for call type and user experience.

RESULTS

Over a 12-month period, 107 patients (66 CMAC, 41 KV) were treated with a study device. The CMAC had a significantly higher likelihood of first attempt success (OR = 1.85; 95% CI 0.74, 4.62; p = 0.188), overall success (OR = 7.37; 95% CI 1.73, 11.1; p = 0.002), and success by attempt (OR = 3.38; 95% CI 1.67, 6.8; p = 0.007) compared to KV. Providers reverted to direct laryngoscopy in 80% (27/34) of the video laryngoscope failure cases, with the remaining patients having their airways successfully managed with a supraglottic airway in 3 cases and bag-valve mask in 4 cases. The provider-reported complications were similar and none were statistically different between treatment groups. Complication rates were not statistically different between devices.

CONCLUSION

The CMAC had a higher likelihood of successful intubation compared to the King Vision. Complication rates were not statistically different between groups. Video laryngoscope placement success rates were not higher than our historical direct laryngoscopy success rates.

Supraglottic airway device use as a primary airway during rapid sequence intubation

INTRODUCTION

This study compared first-attempt placement success rates of the King LTS-D as a primary airway for patients requiring medication-assisted airway management (MAAM) against historical controls.

SETTING

Rotor-wing division of a single critical care transportation company

METHODS

53 providers (RNs/EMT-P) consented to participation and were trained in the use of the King LTS-D. All patients in need of MAAM per agency treatment guidelines were screened for inclusion and exclusion criteria. After each placement attempt, providers completed data collection via telephone. The primary endpoint was comparison of first-attempt placement success rate between the King LTS-D and historical control endotracheal intubation (ETI) MAAM patients. Overall placement success, time to placement, pre- and post-placement SaO2, ETCO2 at 2 minutes after placement, and complications were also analyzed.

RESULTS

38 patients received rapid sequence intubation with the King LTS-D by 23 of 58 consented providers. First-attempt success rate was 76% (29/38), with an overall success rate of 84% (32/38). The primary endpoint analysis showed no difference in first-attempt success rate between historical control ETI MAAM data and King LTS-D (71% vs 76%; OR = 0.1.34 [95% CI Intubation time to insertion was 26 seconds (IQR = 12-46). Pre- and post-insertion SaO(1)2 values were 88.9 ± 12.6% and 92.1 ± 12.7%, respectively. Mean ETCO2 at 2 minutes after placement was 34.8 ± 4.0. Vomit in the patient's airway was the most frequently reported complication (46%).

CONCLUSION

Success rates with the King LTS-D were not significantly different from historical control ETI data. Time to placement was comparable to previous reports.

Treatment of non-traumatic out-of-hospital cardiac arrest with active compression decompression cardiopulmonary resuscitation plus an impedance threshold device

BACKGROUND

A recent out-of-hospital cardiac arrest (OHCA) clinical trial showed improved survival to hospital discharge (HD) with favorable neurologic function for patients with cardiac arrest of cardiac origin treated with active compression decompression cardiopulmonary resuscitation (CPR) plus an impedance threshold device (ACD+ICD) versus standard (S) CPR. The current analysis examined whether treatment with ACD+ITD is more effective than standard (S-CPR) for all cardiac arrests of non-traumatic origin, regardless of the etiology.

METHODS

This is a secondary analysis of data from a randomized, prospective, multicenter, intention-to-treat, OHCA clinical trial. Adults with presumed non-traumatic cardiac arrest were enrolled and followed for one year post arrest. The primary endpoint was survival to hospital discharge (HD) with favorable neurologic function (Modified Rankin Scale score ≤ 3).

RESULTS

Between October 2005 and July 2009, 2738 patients were enrolled (S-CPR=1335; ACD+ITD=1403). Survival to HD with favorable neurologic function was greater with ACD+ITD compared with S-CPR: 7.9% versus 5.7%, (OR 1.42, 95% CI 1.04, 1.95, p=0.027). One-year survival was also greater: 7.9% versus 5.7%, (OR 1.43, 95% CI 1.04, 1.96, p=0.026). Nearly all survivors in both groups had returned to their baseline neurological function by one year. Major adverse event rates were similar between groups.

CONCLUSIONS

Treatment of out-of-hospital non-traumatic cardiac arrest patients with ACD+ITD resulted in a significant increase in survival to hospital discharge with favorable neurological function when compared with S-CPR. A significant increase survival rates was observed up to one year after arrest in subjects treated with ACD+ITD, regardless of the etiology of the cardiac arrest.

Evaluation of the Storz CMAC®, Glidescope® GVL, AirTraq®, King LTS-D™, and direct laryngoscopy in a simulated difficult airway

OBJECTIVE

The aim of this study was to compare first-attempt and overall success rates and success rates in relation to placement time among 5 different airway management devices: Storz CMAC, Glidescope GVL, AirTraq, King LTS-D, and direct laryngoscopy (DL).

METHODS

Emergency medical technician basic (EMT-B), EMT-paramedics (EMT-P), and emergency medicine residents and staff physicians placed each of the 5 devices in a random order into an AirSim (TruCorp, Belfast, UK) part-task training manikin. The difficult airway scenario was created by fixing the manikin head to a stationary object and introducing simulated emesis into the hypopharynx. First-attempt and overall success and success in relation to placement time were compared. Provider feedback about device performance was also evaluated.

RESULTS

Ninety-four providers (16 EMT-basics, 54 EMT-paramedics, and 24 emergency department doctors of medicine) consented to participation. First-attempt and overall success rates for DL, King LTS-D, GVL, and CMAC were not statistically different. Compared with DL, the AirTraq was 96% less likely to be placed successfully (odds ratio, 0.04; 95% confidence interval [CI], 0.01-0.14). When time was factored into the model, the odds of successful placement of the King LTS-D were higher compared with DL (hazard ratio [HR], 1.80; 95% CI, 1.34-2.42) and lower for GVL (HR, 0.59; 95% CI, 0.44-0.80) and AirTraq (HR, 0.228; 95% CI, 0.16-0.325). Providers ranked the CMAC first in terms of performance and preference for use in their practice setting.

CONCLUSION

Overall success rates for DL, King-LTS-D, and both video laryngoscope systems were not different. When time was factored into the model, the King LTS-D was more likely to be placed successfully.

Neurodevelopmental effects of early deprivation in postinstitutionalized children

The neurodevelopmental sequelae of early deprivation were examined by testing (N = 132) 8- and 9-year-old children who had endured prolonged versus brief institutionalized rearing or rearing in the natal family. Behavioral tasks included measures that permit inferences about underlying neural circuitry. Children raised in institutionalized settings showed neuropsychological deficits on tests of visual memory and attention, as well as visually mediated learning and inhibitory control. Yet, these children performed at developmentally appropriate levels on similar tests where auditory processing was also involved and on tests assessing executive processes such as rule acquisition and planning. These findings suggest that specific aspects of brain-behavioral circuitry may be particularly vulnerable to postnatal experience.

Moderate versus severe early life stress: associations with stress reactivity and regulation in 10-12-year-old children

Early life stress (ELS) is expected to increase reactivity of the hypothalamic-pituitary-adrenocortical (HPA) axis; however, several recent studies have shown diminished cortisol reactivity among adults and children with ELS exposure. The goal of this study was to examine cortisol activity in 10-12-year-old internationally adopted children to determine if moderate and severe ELS have different impacts on the HPA axis. Salivary cortisol and two measures of autonomic activity were collected in response to the Trier Social Stress Test for Children (TSST-C). Three groups reflecting moderate, severe, and little ELS were studied: early adopted children who came predominantly from foster care overseas (early adopted/foster care (EA/FC), n=44), later adopted children cared for predominantly in orphanages overseas (late adopted/post-institutionalized (LA/PI), n=42) and non-adopted (NA) children reared continuously by their middle- to upper-income parents in the United States (n=38). Diminished cortisol activity was noted for the EA/FC group (moderate ELS), while the LA/PI group (severe ELS) did not differ from the NA group. Overall, few children showed cortisol elevations to the TSST-C in any group. The presence/absence of severe growth delay at adoption proved to be a critical predictive factor in cortisol activity. Regardless of growth delay, however, LA/PI children exhibited higher sympathetic tone than did NA children. These results suggest that moderate ELS is associated with diminished cortisol activity; however, marked individual differences in cortisol activity among the LA/PI children suggest that child factors modify the impact of severe ELS. Lack of effects of severe ELS even for growth delayed children may reflect the restorative effects of adoption or the generally low responsiveness of this age group to the TSST-C.

Electrophysiologic evidence of impaired cross-modal recognition memory in 8-month-old infants of diabetic mothers

OBJECTIVES

Previous studies have shown deficits in auditory and visual recognition memory in infants of diabetic mothers. The purpose of this study was to further investigate memory development in infants of diabetic mothers (IDMs) by evaluating cross-modal recognition memory followed by behavioral memory testing at 8 months of age.

STUDY DESIGN

Cross-modal (tactile to vision) recognition memory was evaluated using event related potentials. Control and IDMs palpated an object without seeing it and were then tested on their ability to recognize that object visually. Infants were then tested behaviorally on their ability to recognize and discriminate faces. The Bayley Scales of Infant Development was administered at 12 months of age.

RESULTS

Control infants showed typical event-related potential patterns indicative of intact cross-modal recognition memory, whereas the IDMs did not show any evidence of recognition of the palpated object. Neither group showed behavioral evidence of visual recognition memory. Both groups had Bayley scores in the normal range, although controls had slightly higher mental development index scores than IDMs.

CONCLUSIONS

IDMs showed neurophysiologic evidence of persistent subtle impairments in hippocampally-based recognition memory, despite having normal one-year developmental scores.

Parameters of remembering and forgetting in the transition from infancy to early childhood

The ability to recall is something that most intact adults take for granted. For much of the last century, this feature of mental life was not considered to extend to very young children. There now is evidence that 1- to 2-year-olds are able to recall specific events after delays of several months. Over the short term, 1- to 2-year-olds' recall is affected by the same factors that affect older children's recall; it is not clear whether similar effects are apparent over the long term. Moreover, although age-related increases in long-term recall are assumed, there have been few empirical tests of the question. We examined recall by 14- to 32-month-olds for events experienced at 13 to 20 months. Using elicited imitation of novel multistep event sequences we examined effects of (a) delay length, (b) age at the time of experience, (c) temporal structure of events, (d) mode of experience of events, and (e) availability of verbal reminders, on long-term recall. Participants were 360 children enrolled at 13 (n = 90), 16 (n = 180), and 20 (n = 90) months. All of the 13-month-olds and half of the 16-month-olds were tested on 3-step event sequences; all of the 20-month-olds and half of the 16-month-olds were tested on 4-step event sequences. Within each age and step-length group, equal numbers of children were tested after intervals of 1, 3, 6, 9, and 12 months (n = 18 per cell). Children were tested on a variety of sequence types. For half of the events, imitation was permitted prior to the delay; for the other half, children were not permitted imitation. At delayed testing, children experienced a recall period during which they were cued by the event-related props alone, followed by a period in which recall was cued both by the event-related props and by verbal labels for the event sequences. Within step-length groups, the length of time for which older and younger children showed evidence of memory did not differ. Nevertheless, when the children were prompted by the event-related props alone, there were age-related differences in the robustness of children's memories (as indexed by higher levels of recall for older children relative to younger children). When the children were prompted by the props and by verbal labels for the event sequences, at the longer retention intervals, there were age-related differences in the robustness of children's memories and in the reliability with which recall was evidenced (as indexed by the larger numbers of older children evincing recall). Age-related effects were particularly apparent on children's ordered recall. Across the entire age range, the children were similarly affected by the variables of sequence type, opportunity for imitation, and verbal reminding.

Planning ahead: goal-directed problem solving by 2-year-olds

On tasks that require overcoming an obstacle along an existing path to a physically present goal, infants and very young children evince planning. In each of 3 experiments, the authors tested 21- and 27-month-olds' ability to construct a path to a mentally re-presented goal. Across experiments, the authors varied the number and type of cues to the solution provided. After exposure to the goal-state configuration of problems, both age groups showed evidence of planning (Experiment 1). Demonstration of the initial step in the solution path in Experiment 2 was not as effective as exposure to the goal state in Experiment 1. Even with specification of a greater proportion of the goal path, goal-state configuration information was particularly effective in facilitating performance (Experiment 3). The results suggest productive generation of solutions to novel problems by young children; planning is facilitated by goal-state configuration information.

Planning ahead: goal-directed problem solving by 2-year-olds

On tasks that require overcoming an obstacle along an existing path to a physically present goal, infants and very young children evince planning. In each of 3 experiments, the authors tested 21- and 27-month-olds' ability to construct a path to a mentally re-presented goal. Across experiments, the authors varied the number and type of cues to the solution provided. After exposure to the goal-state configuration of problems, both age groups showed evidence of planning (Experiment 1). Demonstration of the initial step in the solution path in Experiment 2 was not as effective as exposure to the goal state in Experiment 1. Even with specification of a greater proportion of the goal path, goal-state configuration information was particularly effective in facilitating performance (Experiment 3). The results suggest productive generation of solutions to novel problems by young children; planning is facilitated by goal-state configuration information.

If memory serves, will language? Later verbal accessibility of early memories

Of major interest to those concerned with early mnemonic process and function is the question of whether early memories likely encoded without the benefit of language later are accessible to verbal report. In the context of a controlled laboratory study, we examined this question in children who were 16 and 20 months at the time of exposure to specific target events and who subsequently were tested for their memories of the events after a delay of either 6 or 12 months (at 22-32 months) and then again at 3 years. At the first delayed-recall test, children evidenced memory both nonverbally and verbally. Nonverbal mnemonic expression was related to age at the time of test; verbal mnemonic expression was related to verbal fluency at the time of test. At the second delayed-recall test, children evidenced continued accessibility of their early memories. Verbal mnemonic expression was related to previous mnemonic expression, both nonverbal and verbal, each of which contributed unique variance. The relevance of these findings on memory for controlled laboratory events for issues of memory for traumatic experiences is discussed.

Delayed recognition memory in infants and adults as revealed by event-related potentials

The present study sought to compare adult and infant ERP responses in analogous tests of visual recognition memory. Adults were tested under two test conditions, in which they were given either explicit instructions to respond to a previously-seen stimulus, or no instructions. Testing in both conditions took place after either a 1- or 5-min delay between familiarization and test. Eight-month-old infants were tested under the same 'passive' (no instruction) conditions as adults. ERP morphology differed across age groups. Adults evinced a P300 that was larger under 'active' as compared to 'passive' test conditions, and a late positive slow wave response that was greater to novel than familiar stimuli. There was no evidence in infants of a P300, although infants did demonstrate a late positive slow wave that was greater to familiar than to novel stimuli. Parallels between the infant and adult findings are discussed and in particular, whether the infant slow wave response is the precursor to the adult P300.

One- to two-year-olds' recall of events: the more expressed, the more impressed

The literature on stylistic differences in mother-child conversations about ongoing and past events can be interpreted to suggest that the opportunity to verbally elaborate on an event facilitates preschoolers' memory. In this research we examined whether similar effects would obtain in children who are just acquiring language and, thus, the opportunity for verbal encoding. Using elicited imitation, 12 groups, formed by a between-subjects crossing of 3 levels of age (13, 16, and 20 months) with 4 levels of delay (1-3, 6, 9, and 12 months), were tested for memory for specific laboratory events; children's event-relevant verbalizations also were recorded. The children remembered the events that they had experienced, regardless of their age at the time of exposure and of the delay interval imposed. Memories were demonstrated both nonverbally and verbally; nonverbal and verbal measures bore a modest relation with one another. Language ability at the time of exposure to the events predicted verbal expression of memory after the delay. Thus, the availability of a verbal mode of elaboration facilitated 1- to 2-year-olds' event memory.

Effects of experience and reminding on long-term recall in infancy: remembering not to forget

We examined whether some of the factors that facilitate recall in older children also extend to 1- to 2-years-olds. Using elicited imitation we assessed the efficacy of verbal (Experiment 1), and verbal plus nonverbal (Experiment 2) reminding on 15-month-olds' recall after a 1-week delay. Reminding ameliorated forgetting: Performance at delayed and immediate recall was equivalent. The addition of nonverbal information did not enhance recall above verbal information alone. In Experiment 3 we investigated the influence of verbal reminding, repeated experience, and mode of experience (i.e., imitate vs watch only) on recall after 1 month. The effects of reminding depended on event type: Reminding facilitated recall of events with enabling relations, but not of events lacking them. Repeated experience and the opportunity to imitate facilitated recall; children who watched events only once nevertheless recalled them. Results suggest that the strength of organization of an event representation, rather than retention interval, is a major determinant of remembering during the second year of life.