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OBJECTIVE: We used machine learning to identify the highest impact components of emergency department (ED) pediatric readiness for predicting in-hospital survival among children cared for in US trauma centers. BACKGROUND: ED pediatric readiness is associated with improved short-term and long-term survival among injured children and part of the national verification criteria for US trauma centers. However, the components of ED pediatric readiness most predictive of survival are unknown. METHODS: This was a retrospective cohort study of injured children below 18 years treated in 458 trauma centers from January 1, 2012, through December 31, 2017, matched to the 2013 National ED Pediatric Readiness Assessment and the American Hospital Association survey. We used machine learning to analyze 265 potential predictors of survival, including 152 ED readiness variables, 29 patient variables, and 84 ED-level and hospital-level variables. The primary outcome was in-hospital survival. RESULTS: There were 274,756 injured children, including 4585 (1.7%) who died. Nine ED pediatric readiness components were associated with the greatest increase in survival: policy for mental health care (+8.8% change in survival), policy for patient assessment (+7.5%), specific respiratory equipment (+7.2%), policy for reduced-dose radiation imaging (+7.0%), physician competency evaluations (+4.9%), recording weight in kilograms (+3.2%), life support courses for nursing (+1.0%-2.5%), and policy on pediatric triage (+2.5%). There was a 268% improvement in survival when the 5 highest impact components were present. CONCLUSIONS: ED pediatric readiness components related to specific policies, personnel, and equipment were the strongest predictors of pediatric survival and worked synergistically when combined.

BackgroundLong-term follow-up for clinician-scientist training programs is sparse. We describe the outcomes of clinician-scientist scholars in the National Heart Lung and Blood Institute (NHLBI) K12 program in emergency care research up to 8.7 years after matriculation in the program.MethodsThis was a cohort study of faculty clinician-scientist scholars enrolled in a NHLBI K12 research training program at 6 sites across the US, with median follow-up 7.7 years (range 5.7-8.7 years) from the date of matriculation. Scholars completed electronic surveys in 2017 and 2019, with the 2019 survey collecting information for their current work setting, percent time for research, and grant funding from all sources. We used NIH RePorter and online resources to verify federal grants through March 2021. The primary outcome was a funded career development award (CDA) or research project grant (RPG) where the scholar was principal investigator. We included funding from all federal sources and national foundations.ResultsThere were 43 scholars, including 16 (37%) women. Over the follow-up period, 32 (74%) received an individual CDA or RPG, with a median of 36 months (range 9-83 months) after entering the program. Of the 43 scholars, 23 (54%) received a CDA and 22 (51%) received an RPG, 7 (16%) of which were R01s. Of the 23 scholars who received a CDA, 13 (56%) subsequently had an RPG funded. Time to CDA or RPG did not differ by sex (women vs. men log-rank test p = 0.27) or specialty training (emergency medicine versus other specialties, p = 0.59).ConclusionsAfter 7 years of follow-up for this NHLBI K12 emergency care research training program, three quarters of clinician-scientist scholars had obtained CDA or RPG funding, with no notable differences by sex or clinical training.

To date, studies have not established whether autistic and non-autistic individuals differ in emotion recognition from facial motion cues when matched in terms of alexithymia. Here, autistic and non-autistic adults (N = 60) matched on age, gender, non-verbal reasoning ability and alexithymia, completed an emotion recognition task, which employed dynamic point light displays of emotional facial expressions manipulated in terms of speed and spatial exaggeration. Autistic participants exhibited significantly lower accuracy for angry, but not happy or sad, facial motion with unmanipulated speed and spatial exaggeration. Autistic, and not alexithymic, traits were predictive of accuracy for angry facial motion with unmanipulated speed and spatial exaggeration. Alexithymic traits, in contrast, were predictive of the magnitude of "both" correct and incorrect emotion ratings.

BackgroundBenzodiazepine-refractory, or established, status epilepticus is thought to be of similar pathophysiology in children and adults, but differences in underlying aetiology and pharmacodynamics might differentially affect response to therapy. In the Established Status Epilepticus Treatment Trial (ESETT) we compared the efficacy and safety of levetiracetam, fosphenytoin, and valproate in established status epilepticus, and here we describe our results after extending enrolment in children to compare outcomes in three age groups.MethodsIn this multicentre, double-blind, response-adaptive, randomised controlled trial, we recruited patients from 58 hospital emergency departments across the USA. Patients were eligible for inclusion if they were aged 2 years or older, had been treated for a generalised convulsive seizure of longer than 5 min duration with adequate doses of benzodiazepines, and continued to have persistent or recurrent convulsions in the emergency department for at least 5 min and no more than 30 min after the last dose of benzodiazepine. Patients were randomly assigned in a response-adaptive manner, using Bayesian methods and stratified by age group (65 years), to levetiracetam, fosphenytoin, or valproate. All patients, investigators, study staff, and pharmacists were masked to treatment allocation. The primary outcome was absence of clinically apparent seizures with improved consciousness and without additional antiseizure medication at 1 h from start of drug infusion. The primary safety outcome was life-threatening hypotension or cardiac arrhythmia. The efficacy and safety outcomes were analysed by intention to treat. This study is registered in ClinicalTrials.gov, NCT01960075.FindingsBetween Nov 3, 2015, and Dec 29, 2018, we enrolled 478 patients and 462 unique patients were included: 225 children (aged 65 years). 175 (38%) patients were randomly assigned to levetiracetam, 142 (31%) to fosphenyltoin, and 145 (31%) were to valproate. Baseline characteristics were balanced across treatments within age groups. The primary efficacy outcome was met in those treated with levetiracetam for 52% (95% credible interval 41-62) of children, 44% (33-55) of adults, and 37% (19-59) of older adults; with fosphenytoin in 49% (38-61) of children, 46% (34-59) of adults, and 35% (17-59) of older adults; and with valproate in 52% (41-63) of children, 46% (34-58) of adults, and 47% (25-70) of older adults. No differences were detected in efficacy or primary safety outcome by drug within each age group. With the exception of endotracheal intubation in children, secondary safety outcomes did not significantly differ by drug within each age group.InterpretationChildren, adults, and older adults with established status epilepticus respond similarly to levetiracetam, fosphenytoin, and valproate, with treatment success in approximately half of patients. Any of the three drugs can be considered as a potential first-choice, second-line drug for benzodiazepine-refractory status epilepticus.FundingNational Institute of Neurological Disorders and Stroke, National Institutes of Health.

Scant literature exists assessing the effectiveness of video modeling (VM) alone in the sports literature. Further evaluations of VM to improve sports skills is warranted because VM is an accessible and efficient procedure that has successfully improved skills in other fields of practice (e.g., staff training, medical procedures). Additionally, behavior analysts have not evaluated interventions for improving goalkeeping skills for individual soccer players. Therefore, we replicated the 1 behavior-analytic sports study on VM (Quinn et al., 2020), using a multiple baseline design across behaviors to evaluate the effects of VM and VM + video feedback (VF) to train 3 goalkeeper skills to two 9-year-old soccer players. The results showed that, although VM had some effect on performance compared to baseline, VM + VF resulted in the robust outcomes necessary for proficient performance of the goalkeeper skills. We discuss the results and limitations.

A key element in teaching the anthropology of im/migration is fostering critical analysis of the discursive frames used in conversations about im/migrants. In this article I describe an in-class activity I use to foster critical thinking about discursive frames on im/migration—specifically those which are embedded into U.S. immigration law. Students are asked to play the role of an immigration judge deciding on a de-identified version of an actual “hardship waiver” case—a petition for relief from deportation. By putting themselves in the shoes of an immigration judge, students must work to disconnect from their own biases and assumptions in order to attempt to apply immigration law. In the process, students learn about the inner workings of the immigration system and interrogate how discursive frames shape the application of immigration law.

Many theories are used to conceptualize adolescent substance use, yet none adequately assist mental health professionals in assessing adolescents' strengths and risk factors while incorporating cultural factors. The authors reviewed common adolescent substance abuse theories and their strengths and limitations, and offer a new model to conceptualize adolescent substance use: The Adolescent Substance Use Risk Continuum. We posit that this strengths-based continuum enables clinicians to decrease stigma and offer hope to adolescents and their caregivers, as it integrates relevant factors to strengthen families and minimize risk. This model is a tool for counselors to use as they conceptualize client cases, plan treatment and focus counseling interventions. A case study illustrates the model and future research is suggested.

Walking is a common and preferred form of exercise. Although there are current recommendations for walking volume (e.g., steps per day), recent research has begun to distinguish volume from intensity (e.g., "brisk" walking) as an important dimension of exercise. Increasing intensity may confer health advantages beyond volume measures because it shifts cardiovascular performance to more vigorous training zones. Reinforcement‐based approaches have been valuable in increasing volume measures of exercise, and the present study sought to develop a corresponding reinforcement approach to training walking intensity. For this study, we used a continuous reinforcement paradigm where music played only while walking met specified criteria; otherwise, music playback stopped. As a result, music was synchronized with walking performance. Seventeen participants walked on a nonmotorized treadmill at a self‐selected pace. Across the session, different conditions arranged for music to play independent of walking speed or contingent on speed increases or decreases. An extinction component assessed performance when music was withdrawn completely. Walking speed was selectively increased and decreased by adjusting the contingencies that were arranged for music, and variability in speed increased during extinction, with both findings indicating that music was a reinforcer. Heart rate was also increased to moderate–vigorous intensities during reinforcement. The findings provide a compelling case that walking intensity can be modified by music reinforcement. We suggest that synchronous schedules may be an important foundation for future exercise technologies that are based on reinforcement. [ABSTRACT FROM AUTHOR]

More faculty are making the foray into digital scholarship as its tools offer novel and efficient approaches to answering research questions. However, faculty seeking to incorporate digital methods into their research may not have the necessary technical skills. Increasingly, libraries are adding digital scholarship support to the research support offered to faculty. In this article, we document the collaboration between a team of librarians and researchers to leverage each group's unique skills to analyse and better understand the breadth and specific usage of social class and socioeconomic status terminology used in American Counselling Association (ACA) journal articles over a 17-year span. The work process and outcomes of this project are explained to offer an example of how such collaborative digital scholarship projects can be implemented.

Study objectiveWe assess the productivity, outcomes, and experiences of participants in the National Institutes of Health/National Heart, Lung, and Blood Institute-funded K12 institutional research training programs in emergency care research.MethodsWe used a mixed-methods study design to evaluate the 6 K12 programs, including 2 surveys, participant interviews, scholar publications, grant submissions, and funded grants. The training program lasted from July 1, 2011, through June 30, 2017. We tracked scholars for a minimum of 3 years and up to 5 years, beginning with date of entry into the program. We interviewed program participants by telephone using open-ended prompts.ResultsThere were 94 participants, including 43 faculty scholars, 13 principal investigators, 30 non-principal investigator primary mentors, and 8 program administrators. The survey had a 74% overall response rate, including 95% of scholars. On entry to the program, scholars were aged a median of 37 years (interquartile range [IQR] 34 to 40 years), with 16 women (37%), and represented 11 disciplines. Of the 43 scholars, 40 (93%) submitted a career development award or research project grant during or after the program; 26 (60%) have secured independent funding as of August 1, 2017. Starting with date of entry into the program, the median time to grant submission was 19 months (IQR 11 to 27 months) and time to funding was 33 months (IQR 27 to 39 months). Cumulative median publications per scholar increased from 7 (IQR 4 to 15.5) at program entry to 21 (IQR 11 to 33.5) in the first post-K12 year. We conducted 57 semistructured interviews and identified 7 primary themes.ConclusionThis training program produced 43 interdisciplinary investigators in emergency care research, with demonstrated productivity in grant funding and publications.

This study examines the experiences of ten first-year English teachers in various school contexts in two Northeastern states. Through a phenomenological approach to in-depth interviewing, teachers were interviewed at the end of their first year of teaching. Commonalities in teachers' experiences include former teachers' influences on their teacher personae, negotiating their authoritative role in the classroom, understanding how and why to set boundaries with students, and demonstrating resilience and resolve in the face of multiple challenges. Implications for teacher education and induction programs are to address the disequilibrium of the self in early teaching experiences and to model habits of mind that promote "productive disequilibrium." (Contains 1 table.)

The authors recruited 11 doctoral-level counseling students to participate in a study exploring the lived experiences of people who have encountered social class microaggressions (SCMs). Findings (consisting of 6 themes) suggest that SCMs are a distinct phenomenon arising from interpersonal and environmental exchanges that damage recipients. The authors present implications for counselor education and future research trajectories.

Grazing management concepts can be hard for learners to grasp in a classroom setting. A grazing demonstration plot is a useful field tool that Extension professionals can implement to visually illustrate how various grazing regimes affect grass health and yields. Specifically, the educator can show how forage harvest timing, frequency, and intensity affect above-ground plant biomass production. A grazing demonstration plot has become a tool of the trade for a small number of Extension professionals in Colorado's Front Range. As a result, land managers in the area have been better able to evaluate how to meet their own needs while considering the importance of addressing environmental impacts and stewarding the land for future generations.

Difficulties in reasoning about others' mental states (i.e., mentalising/Theory of Mind) are highly prevalent among disorders featuring dopamine dysfunctions (e.g., Parkinson's disease) and significantly affect individuals' quality of life. However, due to multiple confounding factors inherent to existing patient studies, currently little is known about whether these sociocognitive symptoms originate from aberrant dopamine signalling or from psychosocial changes unrelated to dopamine. The present study, therefore, investigated the role of dopamine in modulating mentalising in a sample of healthy volunteers. We used a double-blind, placebo-controlled procedure to test the effect of the D2/D3 antagonist haloperidol on mental state attribution, using an adaptation of the Heider and Simmel (1944) animations task. On 2 separate days, once after receiving 2.5 mg haloperidol and once after receiving placebo, 33 healthy adult participants viewed and labelled short videos of 2 triangles depicting mental state (involving mentalistic interaction wherein 1 triangle intends to cause or act upon a particular mental state in the other, e.g., surprising) and non-mental state (involving reciprocal interaction without the intention to cause/act upon the other triangle's mental state, e.g., following) interactions. Using Bayesian mixed effects models, we observed that haloperidol decreased accuracy in labelling both mental and non-mental state animations. Our secondary analyses suggest that dopamine modulates inference from mental and non-mental state animations via independent mechanisms, pointing towards 2 putative pathways underlying the dopaminergic modulation of mental state attribution: action representation and a shared mechanism supporting mentalising and emotion recognition. We conclude that dopaminergic pathways impact Theory of Mind, at least indirectly. Our results have implications for the neurochemical basis of sociocognitive difficulties in patients with dopamine dysfunctions and generate new hypotheses about the specific dopamine-mediated mechanisms underlying social cognition. Difficulties in reasoning about others' mental states ("Theory of Mind") are highly prevalent among disorders featuring dopamine dysfunctions, but it is not clear if these difficulties are a direct consequence of aberrant dopamine signaling. This psychopharmacology study provides insights into the role of dopamine in Theory of Mind, showing that the D2-receptor antagonist haloperidiol reduces the accuracy with which healthy adults attribute mental states. [ABSTRACT FROM AUTHOR]