Risk-adjusted analysis of perioperative outcomes after the Sistrunk procedure.

Objectives: Thyroglossal duct cyst (TGDC) is the most common pediatric congenital neck mass. The Sistrunk procedure is the standard method of excision and is associated with low rates of recurrence. This study aimed to review our institution's outcomes following the Sistrunk procedure, specifically the rates of wound complications and cyst recurrence. Methods: This was a retrospective case series of pediatric patients undergoing the Sistrunk procedure from June 2009 to April 2021. Results: A total of 273 patients were included. Of these, 139 (53%) patients were male and 181 (66%) were white. The average age at the time of surgery was 7.1 years. The overall cyst recurrence rate was 11%. The most common wound complications were seroma (14%) and surgical site infections (SSIs) (12%). Wound complications were associated with prior history of cyst infection (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.07-3.60, z-test 2.2, p = .03). Pediatric surgery was associated with fewer wound complications (OR 0.18; 95% CI 0.05-0.6, z-test -2.78, p = .005). However, pediatric surgery operated on fewer patients with a history of cyst infection (36% vs. 55%, p = .012). Drain placement and postoperative antibiotics did not affect rates of wound complications. Conclusions: Prior cyst infection is associated with increased rates of postoperative wound complications. Postoperative antibiotics and drain placement did not significantly affect complication rates. Level of Evidence: 4.

Characteristics and Outcomes of Surgical Treatment for Bronchial Anomalies.

OBJECTIVES: Bronchial anomalies are rare but challenging conditions to treat in children, encompassing a variety of structural abnormalities that could compromise airway patency. This includes complete rings, absent cartilage, traumatic avulsions, bronchoesophageal fistulas, and cartilaginous sleeves. The objective of this study is to describe the characteristics and outcomes of a series of pediatric cases of bronchial anomalies that were treated by slide tracheobronchoplasty. METHODS: This is a single-institution retrospective case series of pediatric patients with bronchial anomalies who underwent surgical treatment between February 2004 and April 2020. Data extracted from electronic medical records included patient demographics, comorbidities, and surgical outcomes. RESULTS: There were a total of 29 patients included in the study, of which 14 had complete bronchial rings, 8 had absent bronchial rings, 4 had traumatic bronchial avulsions, 2 had bronchoesophageal fistulas, and one had a cartilaginous sleeve. Median follow-up time was 13 months (with a range of 0.5-213 months). The overall mortality rate was 17.2% (5 patients), all of whom had complete bronchial rings. Patients with complete bronchial rings also had a higher rate of not only cardiac (85.7%) and pulmonary comorbidities (85.7%) but also secondary airway lesions (78.6%). CONCLUSION: This is the largest series to date describing surgical treatment for bronchial anomalies. Complete bronchial rings were the most common anomaly treated, followed by absent rings and trauma. Surgical treatment can be successful but mortality rates are higher in patients with complete bronchial rings, possibly due to higher rates of pulmonary and cardiac comorbidities. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:3334-3340, 2023.

Sense of control and conspiracy perceptions: Generative directions on a well-worn path.

We review recent research on the well-established relationship between sense of control and conspiracy perceptions, identifying challenges and promising new directions. First, we examine recent efforts to distinguish sense of control from adjacent but confounding psychological constructs (including uncertainty, threat, and powerlessness). Second, we discuss the limitations of experimentally manipulating sense of control and the trend toward natural experiments. Finally, we consider boundary conditions that moderate the relationship and clarify the types of conspiracy perceptions that sense of control predicts. By integrating past findings to more precisely define sense of control and its effects on cognition, we hope to identify productive avenues for future research.

Mitigating and managing COVID-19 conspiratorial beliefs.

BACKGROUND/AIM: Belief in COVID-19 related conspiracy theories is a widespread and consequential problem that healthcare leaders need to confront. In this article, we draw on insights from social psychology and organisational behaviour to offer evidence-based advice that healthcare leaders can use to reduce the spread of conspiratorial beliefs and ameliorate their negative effects, both during the current pandemic and beyond. CONCLUSION: Leaders can effectively combat conspiratorial beliefs by intervening early and bolstering people's sense of control. Leaders can also address some of the problematic behaviours that result from conspiratorial beliefs by introducing incentives and mandates (e.g., vaccine mandates). However, because of the limitations of incentives and mandates, we suggest that leaders complement these techniques with interventions that leverage the power of social norms and increase people's connections to others.

Managing my shame: Examining the effects of parental identity threat and emotional stability on work productivity and investment in parenting.

We identify parental identity threat as a blended work-family experience (i.e., when the family domain becomes a salient aspect of the work domain) that prompts working parents to attend to their parenting identities while at work. By integrating theoretical arguments related to role identities, self-conscious emotions, and identity maintenance, we propose that parental identity threat provokes working parents' shame, which then results in disparate cross-domain outcomes in the form of reduced work productivity and enhanced investment in parenting. We further explain that emotional stability serves as a first-stage moderator of the proposed mediated relationships. Specifically, working parents with higher (vs. lower) emotional stability respond to parental identity threat with weaker shame reactions that then lessen the effects onto work productivity and investment in parenting. We tested our predictions across three studies: an experiment, a multisource field study involving working parent-spouse dyads, and a time-lagged experience sampling study across 15 days also using working parent-spouse dyads. Altogether, our findings generally support our predictions. Theoretical and practical implications and future direction are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Racial Influences on Pediatric Tracheostomy Outcomes.

OBJECTIVES/HYPOTHESIS: To determine the impact of race on outcomes after pediatric tracheostomy. STUDY DESIGN: Retrospective case series. METHODS: A case series of tracheostomies at an urban, tertiary care children's hospital between 2014 and 2019 was conducted. Children were grouped by race to compare neurocognition, mortality, and decannulation rate. RESULTS: A total of 445 children with a median age at tracheostomy of 0.46 (interquartile range [IQR]: 0.97) years were studied. The cohort was 32% Hispanic, 31% White, 30% Black, 2.9% Asian, and 4.3% other race. Black compared to White children had a lower median birth weight (2,022 vs. 2,449 g, P = .005), were more often extremely premature (≤28 weeks gestation: 62% vs. 57%, P = .007), and more frequently had bronchopulmonary dysplasia (BPD) (35% vs. 17%, P = .002). Hispanic compared to Black children had higher median birth weight (2,529 g, P < .001), less extreme prematurity (44%, P < .001), and less BPD (21%, P = .04). The proportion of Black children was higher (30% vs. 19%, P < .001), while the proportion of Hispanic children with a tracheostomy was lower (32% vs. 42%, P = .003) compared to the racial distribution of all pediatric admissions. Racial differences were not seen for rates of severe neurocognitive disability (P = .51), decannulation (P = .17), or death (P = .92) after controlling for age, sex, prematurity, and ventilator dependence. CONCLUSION: Black children disproportionately underwent tracheostomy and had a higher comorbidity burden than White or Hispanic children. Hispanic children had proportionally fewer tracheostomies. Neurocognitive ability, decannulation, and mortality were similar for all races implying that health disparities by race may not change long-term outcomes after pediatric tracheostomy. Laryngoscope, 132:1118-1124, 2022.

The COVID-19 pandemic and the search for structure: Social media and conspiracy theories.

The study outlines a model for how the COVID-19 pandemic has uniquely exacerbated the propagation of conspiracy beliefs and subsequent harmful behaviors. The pandemic has led to widespread disruption of cognitive and social structures. As people face these disruptions they turn online seeking alternative cognitive and social structures. Once there, social media radicalizes beliefs, increasing contagion (rapid spread) and stickiness (resistance to change) of conspiracy theories. As conspiracy theories are reinforced in online communities, social norms develop, translating conspiracy beliefs into real-world action. These real-world exchanges are then posted back on social media, where they are further reinforced and amplified, and the cycle continues. In the broader population, this process draws attention to conspiracy theories and those who confidently espouse them. This attention can drive perceptions that conspiracy beliefs are less fringe and more popular, potentially normalizing such beliefs for the mainstream. We conclude by considering interventions and future research to address this seemingly intractable problem.

Culture and Patterns of Reciprocity: The Role of Exchange Type, Regulatory Focus, and Emotions.

Reciprocity is a fundamental mechanism for sustained social relationships. Escalation-based theories suggest that reciprocity intensifies over time. In contrast, equity-based theories propose that people reciprocate behaviors in kind. We reconcile these conflicting perspectives by examining social exchanges across different cultural contexts. Using three complementary experiments, we investigate when, how, and why individuals in East Asian settings and those in North American settings differentially reciprocate positive versus negative behaviors over time. Study 1 demonstrated that in positively framed exchanges (i.e., giving) Americans escalated their reciprocity, but Singaporeans reciprocated in kind. However, in negatively framed exchanges (i.e., taking), Singaporeans escalated their reciprocity, but Americans reciprocated in kind. Study 2 replicated the results using Hong Kongers and showed that cultural differences in regulatory focus were associated with specific emotions (i.e., anxiety and happiness), which then escalated reciprocity. To establish causality, Study 3 manipulated regulatory focus within one culture and replicated the pattern of results.

A Longitudinal Analysis of Outcomes in Tracheostomy Placement Among Preterm Infants.

OBJECTIVES: To study a case series of preterm and extremely preterm infants, comparing their decannulation and survival rates after tracheostomy. METHODS: We performed a single-institution longitudinal study of preterm infants with a tracheostomy. Infants were categorized as premature (born > 28 weeks and < 37 weeks) and extremely premature (born ≤ 28 weeks). Decannulation and survival rates were determined using the Kaplan-Meier method. Neurocognitive quality of life (QOL) was reported as normal, mild/moderately, and severely impaired. Statistical significance was set at P < .05. RESULTS: This study included 240 patients. Of those, 111 were premature and 129 were extremely preterm. The median age (interquartile range) at tracheostomy was 4.8 months (0.4). Premature infants were more likely than extremely preterm to have airway obstruction (54% vs. 32%, P < .001); whereas extremely preterm infants were more likely to have bronchopulmonary dysplasia (68% vs. 15%, P < .001) and to be ventilation-dependent (68% vs. 54%, P < .001). The 5-year decannulation rate for premature infants was 46% and for extremely preterm was 64%. The 5-year survival rate post-tracheostomy for preterm was 79% and for extremely preterm was 73%. The log-rank test of equality showed that decannulation and survival were similar (P > .05) for both groups, even after controlling for potentially confounding factors like race, age, gender, birth weight, and age at tracheostomy. For neurocognitive QOL, 47% of patients survived with severely impaired QOL after tracheostomy. Preterm had 56% with severely impaired QOL and extremely preterm had 40% with severely impaired QOL (P = .03). CONCLUSION: This study demonstrated that the time to decannulation and the likelihood of survival did not vary among premature and extremely premature infants even when controlling for other confounding variables. LEVEL OF EVIDENCE: 3b Laryngoscope, 131:417-422, 2021.

Palatine Tonsilloliths and Actinomyces: A Multi-institutional Study of Adult Patients Undergoing Tonsillectomy.

OBJECTIVE: To better characterize associations between Actinomyces and tonsillolith versus nontonsillolith tonsillectomy specimens. STUDY DESIGN: Bi-institutional retrospective case-case study. SETTING: University and county hospital. SUBJECTS AND METHODS: Adult patients with a clinical history of tonsilloliths who underwent tonsillectomy from January 2006 to December 2018 were included. Patients undergoing tonsillectomy for tonsillar hypertrophy and chronic tonsillitis were identified as comparative cases. Similarly, patients with ipsilateral oropharyngeal cancer (OPC) who underwent contralateral tonsillectomy of a normal-appearing tonsil for prophylaxis against a second primary cancer were also included as comparative cases. RESULTS: The study population comprised 134 patients who underwent tonsillectomy: 62 tonsillolith and 72 nontonsillolith (tonsillar hypertrophy, n = 30; chronic tonsillitis, n = 30; normal-appearing contralateral tonsil in patients with ipsilateral OPC, n = 12). Actinomyces was reported in 11% of the patients with tonsilloliths on initial pathology reports but in 95% after re-evaluation (n = 54 of 57). Actinomyces prevalence was significantly higher in patients with tonsilloliths as compared with patients with recurrent tonsillitis (73%, n = 22 of 30, P < .001) and normal-appearing contralateral tonsils in patients with ipsilateral OPC (58%, n = 7 of 12, P < .001). Actinomyces prevalence was not significantly different between patients with tonsilloliths and tonsillar hypertrophy (83%, n = 25 of 30, P = .11). CONCLUSION: The prevalence of Actinomyces in tonsillolith tonsil specimens is high; however, Actinomyces routinely colonizes nontonsillolith tonsil specimens. Therefore, Actinomyces is unlikely to be the primary driver of tonsillolith pathogenesis, and Actinomyces-targeted treatment of tonsilloliths may not be effective. Treatment strategies addressing tonsilloliths should be further investigated.

Tracheostomy in Extremely Preterm Neonates in the United States: A Cross-Sectional Analysis.

OBJECTIVES/HYPOTHESIS: Bronchopulmonary dysplasia (BPD) and invasive respiratory support is increasing among extremely preterm neonates. Yet, it is unclear if there is a corresponding increase in tracheostomies. We hypothesize that in extremely preterm neonates with BPD, the incidence of tracheostomy has increased. STUDY DESIGN: Retrospective cross-sectional analysis. METHODS: We analyzed the 2006 to 2012 Kids' Inpatient Databases (KID) for hospital discharges of nonextremely preterm neonates (gestational age >28 weeks and <37 weeks or birth weight >1,500 g) and extremely preterm neonates (gestational age ≤28 weeks or birth weight ≤1,500 g). We studied tracheostomy placement trends in these two populations to see if they are increasing among extremely preterm neonates, especially those with BPD. RESULTS: The study included 1,418,681 preterm neonates (52% male, 50% white, 19% black, 20% Hispanic, 4.2% Asian), of whom 118,676 (8.4%) were extremely preterm. A total of 2,029 tracheostomies were performed, of which 803 (0.68%) were in extremely preterm neonates. The estimated percent change of occurrence of extremely preterm neonates with BPD increased 17% between 2006 and 2012, and tracheostomy placement increased 31%. Amongst all who received tracheostomies, mortality rate was higher in extremely preterm neonates compared to nonextremely preterm neonates (18% vs. 14%, P = .05). However, in extremely preterm neonates, those with tracheostomies had a lower mortality rate compared to those without (18% vs. 24%, P = .002). CONCLUSIONS: Extremely preterm neonates, compared to nonextremely preterm neonates, experienced a marked increase in tracheostomies placed from 2006 to 2012 as well as an increased incidence of BPD, confirming our primary study hypothesis. LEVEL OF EVIDENCE: 4 Laryngoscope, 130: 2056-2062, 2020.

An eye for an eye? A meta-analysis of negative reciprocity in organizations.

Most models of negative workplace behaviors (NWB) are individual in nature, focusing on individual attitudes (e.g., satisfaction) and general workplace perceptions (e.g., procedural justice) that motivate NWB. Less commonly considered are explorations of relationally based negative workplace behaviors-how NWB from Party A is related to reciprocation of NWB from Party B. Based on 2 competing conceptualizations in the literature, that behavior is reciprocated "in-kind" in an eye for an eye exchange or that behavior tends to escalate or spiral over time, we develop a framework for negative reciprocity that considers NWB in terms of severity, activity, and target. This framework addresses (a) whether Party A's NWB is associated with behavior of a similar or greater level (i.e., activity and severity) from Party B; and (b) whether Party B's reciprocating behavior is directed back at Party A (i.e., direct) or transferred onto others (i.e., displaced). We meta-analytically test these relationships with 246 independent samples (N = 96,930) and find strongest support for relationships indicating that NWB from Party A is largely returned in-kind, followed closely by relationships indicative of escalation. We also found that as the frequency of Party A's NWB increases, so too does the frequency of reciprocity behavior of equal levels. Surprisingly, differences related to the target of the behavior as well as differences based on whether the data were cross-sectional or longitudinal were generally negligible. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Regulatory Focus and Conspiratorial Perceptions: The Importance of Personal Control.

We examine when and why people subscribe to conspiratorial beliefs, suggesting that promotion focus reduces conspiratorial perceptions by activating a sense of personal control. Study 1 established that individuals primed with promotion focus are less likely to perceive conspiracies than those in a baseline condition. However, individuals primed with prevention focus and those in a baseline condition did not differ in their levels of conspiratorial beliefs. Study 2 demonstrated that soldiers higher in promotion focus were less likely to endorse conspiracy theories because of their heightened sense of control; this relationship did not emerge for soldiers higher in prevention focus. Study 3 found that conspiratorial beliefs increased when individuals primed with promotion focus recalled personal control loss, whereas those primed with prevention focus were unaffected by personal control loss. Using measures and manipulations of regulatory focus and personal control, we establish when and why promotion focus reduces conspiracy theories.

Why sabotage customers who mistreat you? Activated hostility and subsequent devaluation of targets as a moral disengagement mechanism.

We utilize the social intuitionist approach to moral judgment and moral disengagement theory to understand why and when employees sabotage customers. We contend that when customers mistreat employees (i.e., customer mistreatment), employees experience intuitive emotional reactions in the form of hostility, which automatically activates devaluation of targets, a specific facet of moral disengagement. In turn, employees become unencumbered by moral self-regulation and sabotage customers who mistreat them (i.e., customer-directed sabotage). We further argue that our serially mediated model is moderated by employees' perceptions of the organization's ethical climate. When ethical climates are perceived as being low, employees' hostile reactions toward misbehaving customers produce a positive relationship with devaluation of targets, and devaluation of targets results in a positive relationship with customer-directed sabotage. These positive relationships do not hold when ethical climate is perceived as being high. We test our theoretical model using a field sample of customer service employees and an experimental study to establish causality. Our results provide general support for our hypotheses. We discuss theoretical and practical implications and opportunities for future research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Cultural Boundaries of Perspective-Taking: When and Why Perspective-Taking Reduces Stereotyping.

Research conducted in Western cultures indicates that perspective-taking is an effective social strategy for reducing stereotyping. The current article explores whether and why the effects of perspective-taking on stereotyping differ across cultures. Studies 1 and 2 established that perspective-taking reduces stereotyping in Western but not in East Asian cultures. Using a socioecological framework, Studies 2 and 3 found that relational mobility, that is, the extent to which individuals' social environments provide them opportunities to choose new relationships and terminate old ones, explained our effect: Perspective-taking was negatively associated with stereotyping in relationally mobile (Western) but not in relationally stable (East Asian) environments. Finally, Study 4 examined the proximal psychological mechanism underlying the socioecological effect: Individuals in relationally mobile environments are more motivated to develop new relationships than those in relationally stable environments. Subsequently, when this motivation is high, perspective-taking increases self-target group overlap, which then decreases stereotyping.

Sinusitis in patients on tumor necrosis factor alpha inhibitors.

BACKGROUND: Tumor necrosis factor alpha (TNF-α) inhibitors have revolutionized treatment of many inflammatory diseases. Sinusitis after initiation of TNF-α inhibitors has been observed, but has not been well described in the literature. We aim to characterize the clinical features of sinusitis in patients on anti-TNF-α therapy. METHODS: This is a retrospective chart review of 28 patients on a TNF-α inhibitor diagnosed with sinusitis by otolaryngologists at Duke University. Patient demographics, sinusitis characteristics, and treatment course were studied by chart review. RESULTS: The prevalence of sinusitis diagnosed and treated by an otolaryngologist was less than 1%. Of the 28 patients studied, 12 (42.9%) had a history of preexisting sinusitis and 16 (57.1%) had new-onset sinusitis. 71.4% were diagnosed with chronic rhinosinusitis without polyps (CRSsNP), with disease mainly involving the maxillary and ethmoid sinuses. No patients had major extrasinus complications or required hospital admission or intravenous (IV) antibiotics. 35.7% (n = 10), including 44% (7/16) of new-onset patients required a surgical intervention after initiating anti-TNF therapy. 14.3% (n = 4) of the cohort had improvement in sinonasal symptoms after stopping, changing, or holding doses of the TNF-α inhibitor. CONCLUSION: Anti-TNF-α therapy can be associated with new-onset sinusitis, mainly CRSsNP. Overall, the percentage of patients on a TNF-α inhibitor seeking consultation from an otolaryngologist is low. While some patients with new-onset sinusitis will require surgery, modification of anti-TNF-α therapy should be considered as an option in the medical management of these patients.

Perspective-taking increases willingness to engage in intergroup contact.

The current research explored whether perspective-taking increases willingness to engage in contact with stereotyped outgroup members. Across three studies, we find that perspective-taking increases willingness to engage in contact with negatively-stereotyped targets. In Study 1, perspective-takers sat closer to, whereas stereotype suppressors sat further from, a hooligan compared to control participants. In Study 2, individual differences in perspective-taking tendencies predicted individuals' willingness to engage in contact with a hooligan, having effects above and beyond those of empathic concern. Finally, Study 3 demonstrated that perspective-taking's effects on intergroup contact extend to the target's group (i.e., another homeless man), but not to other outgroups (i.e., a man of African descent). Consistent with other perspective-taking research, our findings show that perspective-taking facilitates the creation of social bonds by increasing contact with stereotyped outgroup members.

The reappropriation of stigmatizing labels: the reciprocal relationship between power and self-labeling.

We present a theoretical model of reappropriation--taking possession of a slur previously used exclusively by dominant groups to reinforce another group's lesser status. Ten experiments tested this model and established a reciprocal relationship between power and self-labeling with a derogatory group term. We first investigated precursors to self-labeling: Group, but not individual, power increased participants' willingness to label themselves with a derogatory term for their group. We then examined the consequences of such self-labeling for both the self and observers. Self-labelers felt more powerful after self-labeling, and observers perceived them and their group as more powerful. Finally, these labels were evaluated less negatively after self-labeling, and this attenuation of stigma was mediated by perceived power. These effects occurred only for derogatory terms (e.g., queer, bitch), and not for descriptive (e.g., woman) or majority-group (e.g., straight) labels. These results suggest that self-labeling with a derogatory label can weaken the label's stigmatizing force.

The cultural dynamics of rewarding honesty and punishing deception.

Recent research suggests that individuals reward honesty more than they punish deception. Five experiments showed that different patterns of rewards and punishments emerge for North American and East Asian cultures. Experiment 1 demonstrated that Americans rewarded more than they punished, whereas East Asians rewarded and punished in equivalent amounts. Experiments 2 and 3 revealed that these divergent patterns by culture could be explained by greater social mobility experienced by Americans. Experiments 4 and 5 examined how certain consequences of social mobility, approach-avoidance behavioral motivations and trust and felt obligation, can lead to disparate reward and punishment decisions within the two cultures. Moreover, Experiment 4 revealed that Americans exhibited stronger evaluative reactions toward deception but stronger behavioral intentions toward honesty; East Asians did not exhibit this evaluative-behavioral asymmetry. The cross-cultural implications for understanding rewards and punishments in an increasingly globalized world are discussed.