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PURPOSE To review the extant literature relevant to perceptions by direct care nurses toward clinical research endeavors. DESIGN An integrative review guided by the socioecological model was conducted. METHODS Five databases were searched to identify relevant peer-reviewed articles; there was no limitation on publication date. FINDINGS The final sample (N = 9) was systematically appraised. Numerous barriers to direct care nurses' ability to perform study activities on clinical research trials were encountered at all levels: (1) personal-comprehension, education, and training; (2) interpersonal-communication issues within or from the study team, failure to advocate for the patient; (3) organizational-lack of leadership support, knowledge, and time; and (4) community-insufficient guidance and oversight by research-governing bodies. CONCLUSIONS Direct care nurses report numerous barriers to completing protocol-administered activities for their patients participating in clinical research. A dearth of robust research exists in describing the reasons for, or persistence of, barriers faced by direct care nurses to assisting with research, and there have been little to no interventions to address them. CLINICAL RELEVANCE As translational research evolves and becomes more complex, there is the need to ensure both the care of clinical research participants and the integrity of the research. Direct care nurses are critical to this endeavor, and potential barriers they face may have significant ramifications for the research enterprise. Recognition of these barriers and eventual interventions designed to address them are needed.

We have created an innovative new method which uses frequency domain near-infrared spectroscopy (FDNIRS) in combination with diffuse correlation spectroscopy (DCS) to quantitatively measure cerebral blood flow (CBF) and oxygen metabolism (CMRO 2 ) right at the infant’s bedside. We have previously found CBF and CMRO 2 are more sensitive indicators of cerebral pathophysiology than hemoglobin saturation (SO 2 ). Using FDNIRS-DCS, we had found extremely premature infants with germinal matrix hemorrhage (GMH) have lower cerebral blood flow (CBF) and oxygen metabolism (CMRO 2 ) than gestational age-matched controls. For this study, we investigate whether GMH, along with age and hematocrit levels, affect evoked hemodynamic responses. The study protocol was reviewed and approved by the Institutional Review Board for Partners Healthcare. We enrolled eleven premature infants in the neonatal intensive care unit at Brigham and Women’s Hospital. Three of them had Grade I GMH diagnosed by head ultrasound on the first three days of life. We integrated continuous wave NIRS (CWNIRS) with DCS to measure dynamic changes of cerebral hemoglobin concentrations (HbO) and CBF in response to somatosensory stimuli. For each measurement, we measured differential path length factors and baseline cerebral hemoglobin concentrations with FDNIRS to quantify relative hemodynamic and metabolic changes (rHbO, rCBF and rCMRO 2 ) in response to tactile stimulation. We observed a faster response time to reach peak value in preterm infants with increasing postmenstrual age (PMA), demonstrating the response matures with age to become more adult-like (r=-0.513, p=0.007). In addition, infants measured at older PMA tend to have responses with a larger undershoot in HbO. However, the HbO undershoot did not translate into an undershoot in CMRO 2 . The HbO undershoot may therefore be a consequence of low hematocrit during the first two months of life which results in insufficient oxygen supply and leads to abnormally large oxygen extraction from the blood. We found the activation pattern of Grade I GMH infants did not differ from premature infants without hemorrhage. The study is ongoing and shows our method is suitable to measure cerebral maturation in neonates with hemorrhage.

Objective To assess heritable contributions to bronchopulmonary dysplasia (BPD) risk in a twin cohort restricted to gestational age at birth Study design A total of 250 twin pairs (192 dichorionic, 58 monochorionic) born Results χ2 analyses comparing whether neither, 1, or both of monochorionic (23, 19, 16) and dichorionic (88, 56, 48) twin pairs developed BPD revealed no difference. Although there was similarity in BPD outcome within both monochorionic and dichorionic twin pairs by ICC (monochorionic ICC = 0.34, 95% CI [0.08, 0.55]; dichorionic ICC = 0.39, 95% CI [0.25, 0.51]), monochorionic twins were not more likely than dichorionic twins to have the same outcome (P = .70). ACE modeling revealed no contribution of heritability to BPD risk (% A = 0.0%, 95% CI [0.0%, 43.1%]). Validation and zygosity based cohort results were similar. Conclusions Our analysis suggests that heritability is not a major contributor to BPD risk in preterm infants