Evolution of conflict management style during first year of paediatric residency.

BACKGROUND: First-year residents frequently encounter conflict during their training. Residents' conflict management strategies can influence patient safety, quality of care and perceptions of performance on competency evaluations. Existing literature inadequately describes how first-year resident conflict management styles evolve over time. OBJECTIVE: The objective of this study is to assess if and how conflict management styles change during first year of paediatric residency in the United States. METHODS: In 2021-2022, we conducted a non-experimental, longitudinal, survey study of first-year residents from 16 US-based paediatric residency programmes. Using the Thomas-Kilmann Conflict Mode Instrument, we scored first-year residents' use of five conflict management modes twice, 6 months apart. We calculated the percentage of first-year residents who experienced a change in predominant conflict management mode and assessed for changes in score and variance for each conflict management mode. RESULTS: Fifty-seven (18%) first-year residents participated in the first survey. Of those, 45 (14%) also completed the follow-up survey. Nonresponse bias analysis showed no significant difference in scores for early and late respondents or for second-survey respondents and non-respondents. Half of respondents experienced a change in predominant conflict management mode, but the distribution of predominant modes remained largely unchanged. When residents changed modes, they typically moved from one low-assertiveness mode, such as avoiding or accommodating, to the other. Only the use of the compromising conflict management mode significantly decreased. Variance did not significantly change. CONCLUSIONS: The overall lack of change in conflict management style may suggest the need for specific and focused educational interventions to help residents adjust their conflict handling strategies.

Social-contextual factors interact with masculinity to influence college men's HPV vaccination intentions: The role of descriptive norms, prototypes, and physician gender.

Men's low HPV vaccination uptake and HPV-related disease incidence are public health issues; gendered social-contextual factors likely play a role. In Study 1, college men (N = 130; Mage = 19.55; white = 58.1%) reported their social cognitions (male-referent descriptive norms and prototypes), self-reliance masculinity ideology, and vaccination intentions. In Study 2, college men (N = 106; Mage = 19.32; white = 61.3%) were randomly assigned to receive HPV vaccination information from a man or woman physician-avatar. Descriptive norms and favorable prototypes (bs ≥ .337; ps ≤ .016) were associated with higher HPV vaccination intentions. Men with higher self-reliance masculinity had higher HPV vaccination intentions with a man physician and when they perceived greater vaccination among men (ps ≤ .035). Men with higher self-reliance masculinity are more sensitive to gendered social-contextual effects in HPV vaccination decision-making. Gendered social-contextual factors should be integrated into public health interventions to increase college men's HPV vaccination uptake.

The CHAOS-7 geomagnetic field model and observed changes in the South Atlantic Anomaly.

We present the CHAOS-7 model of the time-dependent near-Earth geomagnetic field between 1999 and 2020 based on magnetic field observations collected by the low-Earth orbit satellites Swarm, CryoSat-2, CHAMP, SAC-C and Ørsted, and on annual differences of monthly means of ground observatory measurements. The CHAOS-7 model consists of a time-dependent internal field up to spherical harmonic degree 20, a static internal field which merges to the LCS-1 lithospheric field model above degree 25, a model of the magnetospheric field and its induced counterpart, estimates of Euler angles describing the alignment of satellite vector magnetometers, and magnetometer calibration parameters for CryoSat-2. Only data from dark regions satisfying strict geomagnetic quiet-time criteria (including conditions on IMF B z and B y at all latitudes) were used in the field estimation. Model parameters were estimated using an iteratively reweighted regularized least-squares procedure; regularization of the time-dependent internal field was relaxed at high spherical harmonic degree compared with previous versions of the CHAOS model. We use CHAOS-7 to investigate recent changes in the geomagnetic field, studying the evolution of the South Atlantic weak field anomaly and rapid field changes in the Pacific region since 2014. At Earth's surface a secondary minimum of the South Atlantic Anomaly is now evident to the south west of Africa. Green's functions relating the core-mantle boundary radial field to the surface intensity show this feature is connected with the movement and evolution of a reversed flux feature under South Africa. The continuing growth in size and weakening of the main anomaly is linked to the westward motion and gathering of reversed flux under South America. In the Pacific region at Earth's surface between 2015 and 2018 a sign change has occurred in the second time derivative (acceleration) of the radial component of the field. This acceleration change took the form of a localized, east-west oriented, dipole. It was clearly recorded on ground, for example at the magnetic observatory at Honolulu, and was seen in Swarm observations over an extended region in the central and western Pacific. Downward continuing to the core-mantle boundary, we find this event originated in field acceleration changes at low latitudes beneath the central and western Pacific in 2017.

Development and Validation of the Pediatric Resuscitation and Escalation of Care Self-Efficacy Scale.

OBJECTIVES: To validate a scale to assess pediatric providers' resuscitation and escalation of care self-efficacy and assess which provider characteristics and experiences may contribute to self-efficacy. METHODS: Cross-sectional cohort study performed at an academic children's hospital. Pediatric nurses, respiratory therapists, and residents completed the Generalized Self-Efficacy Scale (GSES) and Pediatric Resuscitation Self-Efficacy Scale (PRSES) as well as a survey assessing their experiences with pediatric escalation of care. RESULTS: Four hundred participants completed the GSES and PRSES. A total of 338 completed the survey, including 262 nurses, 51 respiratory therapists, and 25 residents. Cronbach α for the PRSES was 0.905. A factor analysis revealed 2 factors within the scale, with items grouped on the basis of expertise required. Multiple logistic regression analyses controlling for GSES score, number of code blue events participated, number of code blue events activated, number of rapid response team events participated, number of rapid response team response events called, performance on a knowledge assessment of appropriate escalation of care, and years of experience demonstrated that PRSES performance was significantly associated with GSES scores and number of escalation of care events (code blue and rapid response) previously participated in (R 2 = 0.29, P < .001). CONCLUSIONS: The PRSES can be used to assess pediatric providers' pediatric resuscitation self-efficacy and could be used to evaluate pediatric escalation of care interventions. Pediatric resuscitation self-efficacy is significantly associated with number of previous escalation of care experiences. In future studies, researchers should focus on assessing the impact of increased exposures to escalation of care, potentially via mock codes, to accelerate the acquisition of resuscitation self-efficacy.

Mice deficient in AKAP13 (BRX) develop compulsive-like behavior and increased body weight.

OBJECTIVE: Hormonal contributions to the sex-dependent development of both obsessive-compulsive disorder (OCD) and obesity have been described, but the underlying mechanisms are incompletely understood. A-kinase anchoring protein 13 (AKAP13) significantly augments ligand-dependent activation of estrogen receptors alpha and beta. The hypothalamus and pituitary gland are implicated in the development and exacerbation of OCD and obesity and have strong AKAP13 expression. The AKAP13 localization pattern observed in these key brain regions together with its effects on sex steroid action suggest a potential role for AKAP13 in compulsive-like behaviors. Here we tested the role of AKAP13 in compulsive-like behavior and body weight using an Akap13 haploinsufficient murine model. MATERIALS AND METHODS: Targeted deletion of the Akap13 gene generated haploinsufficient (Akap13+/-) mice in a C57BL6/J genetic background. Established behavioral assays were conducted, video recorded, and scored blindly to assess compulsive-like behavior based on genotype and gender. Tests included: marble-burying, grooming, open- field and elevated plus-maze. Brain and body weights were also obtained. Mean levels of test outcomes were compared using multi-way ANOVA to test for genotype, sex, genotype*sex, and genotype*sex*age interaction effects with Bonferroni adjustment for multiple comparisons, to further explain any significant interactions. RESULTS: The marble-burying and grooming assays revealed significant sex-dependent increases in perseverative, compulsive-like behaviors in female Akap13 haploinsufficient mice compared to female wild type (WT) mice by demonstrating increased marble-burying activity (p = .0025) and a trend towards increased grooming behavior (p = .06). Male Akap13 haploinsufficient mice exhibited no behavioral changes (p > 0.05). Elevated plus-maze and open-field test results showed no overt anxiety-like behavior in Akap13 haploinsufficient mice irrespective of sex (p > 0.05, both). No differences in brain weight were found in Akap13 haploinsufficient mice compared to WT mice (p > 0.05). However, female Akap13 haploinsufficient mice weighed more than female WT mice in the 4 to <7 months age range (p = .0051). Male Akap13 haploinsufficient mice showed no differences in weight compared to male WT mice (p = >0.05) at any age range examined. CONCLUSION: Akap13 haploinsufficiency led to sex-dependent, compulsive-like behavioral changes in a murine model. Interestingly, Akap13 haploinsufficiency also led to a sex-dependent increase in body weight. These results revealed a requirement for AKAP13 in murine behavior, particularly in female mice, and is the first report of AKAP13 involvement in murine behavior. Future studies may examine the involvement of AKAP13 in the pathophysiology of OCD in female humans and may contribute to a better understanding of the role of AKAP13 and sex hormones in the development and exacerbation of OCD.

A Comprehensive Model of Earth's Magnetic Field Determined From 4 Years of Swarm Satellite Observations.

The European Space Agency's three-satellite constellation Swarm, launched in November 2013, has provided unprecedented monitoring of Earth's magnetic field via a unique set of gradiometric and multi-satellite measurements from low Earth orbit. In order to exploit these measurements, an advanced "Comprehensive Inversion" (CI) algorithm has been developed to optimally separate the various major magnetic field sources in the near-Earth regime. The CI algorithm is used to determine Swarm Level-2 (L2) magnetic field data products that include the core, lithospheric, ionospheric, magnetospheric, and associated induced sources. In addition, it has become apparent that the CI is capable of extracting the magnetic signal associated with the oceanic principal lunar semi-diurnal tidal constituent M 2 to such an extent that it has been added to the L2 data product line. This paper presents the parent model of the Swarm L2 CI products derived with measurements from the first four years of the Swarm mission and from ground observatories, denoted as "CIY4", including the new product describing the magnetic signal of the M 2 oceanic tide.

Satellite tidal magnetic signals constrain oceanic lithosphere-asthenosphere boundary.

The tidal flow of electrically conductive oceans through the geomagnetic field results in the generation of secondary magnetic signals, which provide information on the subsurface structure. Data from the new generation of satellites were shown to contain magnetic signals due to tidal flow; however, there are no reports that these signals have been used to infer subsurface structure. We use satellite-detected tidal magnetic fields to image the global electrical structure of the oceanic lithosphere and upper mantle down to a depth of about 250 km. The model derived from more than 12 years of satellite data reveals a ≈72-km-thick upper resistive layer followed by a sharp increase in electrical conductivity likely associated with the lithosphere-asthenosphere boundary, which separates colder rigid oceanic plates from the ductile and hotter asthenosphere.

Measuring the opportunity loss of time spent boarding admitted patients in the emergency department: a multihospital analysis.

Emergency department (ED) crowding is an international crisis affecting the timeliness and quality of patient care. Boarding of admitted patients in the ED is recognized as a major contributor to ED crowding. The opportunity loss of this time is the benefit or value it could produce if it were used for something else. In crowded EDs, the typical alternative use of this time is to treat patients waiting to be seen. Various ED performance benchmarks related to inpatient boarding have been proposed, but they are not commonly reported and have yet to be evaluated to determine whether they correlate with the opportunity loss of time used for boarding. This study quantified several measures of ED boarding in a variety of hospital settings and looked for correlations between them and the opportunity loss of the time spent on boarding. In particular, average boarding time per admission was found to be easy to measure. Results revealed that it had a near-perfect linear correlation with opportunity loss. The opportunity loss of every 30 minutes of average boarding time equaled the time required to see 3.5 percent of the ED's daily census. For busy hospitals, the opportunity loss allowed sufficient time for staff to be able to see up to 36 additional patients per day. This correlation suggests that average boarding time per admission may be useful in evaluating efforts to reduce ED crowding and improve patient care.

Emergency department patient flow: the influence of hospital census variables on emergency department length of stay.

OBJECTIVES: The objective was to evaluate the association between hospital census variables and emergency department (ED) length of stay (LOS). This may give insights into future strategies to relieve ED crowding. METHODS: This multicenter cohort study captured ED LOS and disposition for all ED patients in five hospitals during five 1-week study periods. A stepwise multiple regression analysis was used to examine associations between ED LOS and various hospital census parameters. RESULTS: Data were analyzed on 27,325 patients on 161 study days. A significant positive relationship was demonstrated between median ED LOS and intensive care unit (ICU) census, cardiac telemetry census, and the percentage of ED patients admitted each day. There was no relationship in this cohort between ED LOS and ED volume, total hospital occupancy rate, or the number of scheduled cardiac or surgical procedures. CONCLUSIONS: In multiple hospital settings, ED LOS is correlated with the number of admissions and census of the higher acuity nursing units, more so than the number of ED patients each day, particularly in larger hospitals with busier EDs. Streamlining ED admissions and improving availability of inpatient critical care beds may reduce ED LOS.

Heat flux anomalies in Antarctica revealed by satellite magnetic data.

The geothermal heat flux is an important factor in the dynamics of ice sheets; it affects the occurrence of subglacial lakes, the onset of ice streams, and mass losses from the ice sheet base. Because direct heat flux measurements in ice-covered regions are difficult to obtain, we developed a method that uses satellite magnetic data to estimate the heat flux underneath the Antarctic ice sheet. We found that the heat flux underneath the ice sheet varies from 40 to 185 megawatts per square meter and that areas of high heat flux coincide with known current volcanism and some areas known to have ice streams.

Small-scale structure of the geodynamo inferred from Oersted and Magsat satellite data.

The 'geodynamo' in the Earth's liquid outer core produces a magnetic field that dominates the large and medium length scales of the magnetic field observed at the Earth's surface. Here we use data from the currently operating Danish Oersted satellite, and from the US Magsat satellite that operated in 1979/80, to identify and interpret variations in the magnetic field over the past 20 years, down to length scales previously inaccessible. Projected down to the surface of the Earth's core, we found these variations to be small below the Pacific Ocean, and large at polar latitudes and in a region centred below southern Africa. The flow pattern at the surface of the core that we calculate to account for these changes is characterized by a westward flow concentrated in retrograde polar vortices and an asymmetric ring where prograde vortices are correlated with highs (and retrograde vortices with lows) in the historical (400-year average) magnetic field. This pattern is analogous to those seen in a large class of numerical dynamo simulations, except for its longitudinal asymmetry. If this asymmetric state was reached often in the past, it might account for several persistent patterns observed in the palaeomagnetic field. We postulate that it might also be a state in which the geodynamo operates before reversing.