Comparison of dynamic versus static ultrasound to confirm endotracheal tube depth.

INTRODUCTION: After endotracheal intubation is performed, the location of the endotracheal tube (ETT) is confirmed followed by assessment of ETT depth. Physical examination can be unreliable and chest radiographs can lead to delayed recognition. Ultrasound may facilitate rapid determination of ETT depth at the bedside; however, the ideal technique is unknown. METHODS: This was a randomized trial comparing the static versus dynamic technique for ETT depth assessment using a cadaver model. The ETT was randomized to correct versus deep placement. Seven physicians blinded to ETT location assessed the location using static (direct visualization of an inflated cuff) versus dynamic (active inflation of the ETT cuff) visualization. Outcomes included diagnostic accuracy, time to identification, and operator confidence with subgroup analyses by physician ultrasound experience. RESULTS: 420 total assessments were performed. The static technique was 99.1% (95% CI 94.8%-100%) sensitive and 97.1% (95% CI 91.9%-99.4%) specific. The dynamic technique was 100% (95% CI 96.7%-100%) sensitive and 100% (95% CI 96.7%-100%) specific. Time to identification was faster for the static technique (6.6 s; 95% CI 5.9-7.4 s) versus the dynamic technique (8.7 s; 95% CI 8.0-9.5 s). Operator confidence was lower for the static technique (4.4/5.0; 95% CI 4.3-4.5) versus the dynamic technique (4.7/5.0; 95% CI 4.6-4.8). There were no differences in the findings when assessed among expert or non-expert sonographers. CONCLUSION: There was no statistically significant difference in the accuracy of ETT depth identification between the static or dynamic technique. However, utilizing the dynamic technique showed a statistically significant improvement in sonographer confidence and a concomitant increase in time to identification.

"I just check 'other'": Evidence to support expanding the measurement inclusivity and equity of ethnicity/race and cultural identifications of U.S. adolescents.

OBJECTIVE: In nationally funded research in the U.S., ethnicity and race are measured with checkbox questions, the limited categories of which may yield significant missing data and low salience to available categories, particularly among adults of color. How adolescent-generated data compare to these limited categories, and how adolescents, not just those of color, describe their culture are understudied. In our sample, we asked the following: (a) how do adolescents' ethnicity/race and culture identifications compare?, (b) how do adolescents' open-ended ethnicity/race and checkbox ethnicity/race labels compare?, and (c) how do adolescents' ethnicity/race labels compare to available categories for identification on the National Institutes of Health's (NIH's) demographic form? METHOD: Data from 76 adolescents (64.5% female, Mage = 15.78 years) were qualitatively and quantitatively analyzed. RESULTS: White adolescents were as likely as adolescents of color to identify with cultural labels, and most adolescents described culture differently than race/ethnicity. White adolescents' open-ended and checkbox labels overlapped more (38.8%) than adolescents of colors' (22.5%). Only 17% of adolescents' open-ended race/ethnicity identification labels and 54% of their checkbox identifications were available on the NIH's demographic form. CONCLUSIONS: As measurement of demographic data is reduced to few options that favor privileged identities, innovative methods to measure individuals' identities are warranted. Using tools that do not reflect individuals' identity labels may increase error and reflects structural problems of research inequity. Our findings provide initial evidence of this methodological issue in a sample of adolescents. Building inclusive demographic tools from individuals' self-descriptors that remain feasible and practical for use can diminish inequity associated with describing "diverse" populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Ultrasound for the diagnosis of necrotizing fasciitis: A systematic review of the literature.

BACKGROUND: Necrotizing fasciitis (NF) is a deadly disorder that can be challenging to diagnose on history and examination alone. Point-of-care ultrasound (POCUS) is widely available and has been increasingly used for diagnosing skin and soft tissue infections. We performed a systematic review to determine the accuracy of POCUS for diagnosing NF with subgroup analyses of the accuracy of specific POCUS examination components. METHODS: PubMed, Scopus, CINAHL, LILACS, the Cochrane databases, Google Scholar, and bibliographies of selected articles were assessed for all retrospective, prospective, and randomized control trials evaluating the accuracy of POCUS for diagnosing NF. Data were dual extracted into a predefined worksheet and quality analysis was performed with the QUADAS-2 tool. Data were summarized and an overall summary was completed. RESULTS: We identified three papers (n = 221 patients; 33% NF) that met our inclusion criteria. The overall sensitivity ranged from 85.4%-100% while the specificity ranged from 44.7% to 98.2%. Fluid accumulation along the fascial plane was the most sensitive (85.4%; 95% CI 72.2% - 93.9%), while subcutaneous emphysema was the most specific (100%; 95% CI 92.5% - 100%). CONCLUSIONS: POCUS has good sensitivity and specificity for the diagnosis of NF. POCUS should be considered as an adjunct to the initial clinical decision making for the diagnosis of NF.

Diagnostic accuracy of ultrasound to confirm endotracheal tube depth.

INTRODUCTION: Endotracheal intubation is commonly performed in the Emergency Department. Traditional measures for estimating and confirming the endotracheal tube (ETT) depth may be inaccurate or lead to delayed recognition. Ultrasound may offer a rapid tool to confirm ETT depth at the bedside. METHODS: This was a randomized trial assessing the diagnostic accuracy of ultrasound to confirm ETT depth. Three cadavers were intubated in a random sequence with the ETT placed high (directly below the vocal cords), middle (2 cm above the carina), or deep (ETT at the carina). Seven blinded sonographers assessed the depth of the ETT using ultrasound. Outcomes included diagnostic accuracy of sonographer identification, time to identification, and operator confidence based upon ETT location. A subgroup analysis was performed to assess diagnostic accuracy by operator confidence. RESULTS: 441 total assessments were performed (154 high, 154 middle, and 133 deep ETT placements). Overall accuracy was 84.8% (95% CI 81.1% to 88.0%). When placed high, ultrasound was 82.5% sensitive (95% CI 75.5% to 88.1%) and 92.3% specific (95% CI 88.6% to 95.1%) with a mean time to identification of 15.3 s (95% CI 13.6-17.0) and a mean operator confidence of 3.9/5.0 (95% CI 3.7-4.1). When the ETT was placed in the middle, ultrasound was 83.8% sensitive (95% CI 77.0% to 89.2%) and 92.3% specific (95% CI 88.6% to 95.1%) with a mean time to identification of 16.7 s (95% CI 14.6-18.8) and a mean operator confidence of 3.7/5.0 (95% CI 3.5-3.9). When the ETT was placed deep, ultrasound was 88.0% sensitive (95% CI 81.2% to 93.0%) and 92.2% specific (95% CI 88.6% to 94.6%) with a mean time to identification of 19.0 s (95% CI 17.3-20.7) and a mean operator confidence of 3.4/5.0 (95% CI 3.2-3.6). Sonographers were significantly more accurate when they reported a higher confidence score. CONCLUSION: Ultrasound was moderately accurate for identifying the ETT location in a cadaveric model and was more accurate when sonographers felt confident with their visualization. Future research should determine the accuracy of combining transtracheal ultrasound with lung sliding and other modifications to improve the accuracy.

Xenophobia and discrimination: Consequences for latinx immigrants and pathways to restoration & healing.

The United States is often conceptualized as a country of immigrants, with an origin story of multicultural, multilingual, diverse foreign-born populations coming together to create the fabric of the nation. This narrative emerges through many domains of American society, frequently depicting an image of opportunity for all. Yet historically and contemporarily, immigration has been racialized and wrought with oppressive practices and policies. Research has shown that white Americans tend to define "American" as synonymous with "white" and subsequently perceive those who appear phenotypically not white (e.g., darker skin tones) as "less American." This phenomenon is reflected in immigration policy and lived experiences of minoritized immigrants. Vast theoretical and empirical literature documents the deleterious consequences of discrimination across domains of physical (e.g., hypertension, compromised immune functioning) and psychological health (e.g., ethno-racial trauma, depression). While it is critical to highlight the harmful effects of racism and xenophobia on immigrant well-being, the intent of this article is to also explore how indigenous, restorative healing practices may help communities and individuals heal from xenophobia and discrimination. Thus, the aim of this piece is twofold; (1) briefly discuss and contextualize the systems of oppression impacting immigrants, specifically Latinx communities in the United States, and (2) provide a framework for restoration and radical healing for Latinx immigrants.

Covered or uncovered: A randomized control trial of Tegaderm versus no Tegaderm for ocular ultrasound.

BACKGROUND: Studies on ocular point-of-care ultrasound vary on whether gel should be directly applied to the eye or on top of an adhesive membrane (i.e., Tegaderm™). However, there are currently no data regarding which approach has better image quality and the impact of patient preference. In this study, we sought to address this gap by assessing the difference in image quality and patient preference between Tegaderm™ versus no Tegaderm™ for ocular ultrasound in the emergency department. METHODS: Patients were randomized to have a Tegaderm™ placed on either their right or left eye. The other eye served as a comparator with no Tegaderm™. Ultrasound was performed on the right eye followed by the left eye in all instances. After performing each ultrasound, the sonographer asked the patient to rate their maximal discomfort from the ultrasound of that eye using a Likert scale (0 = no discomfort; 10 = severe discomfort). The sonographer then asked the patient which side (Tegaderm™ vs no Tegaderm™) they preferred. Finally, images were reviewed by an experienced ultrasound fellowship-trained sonographer blinded to allocation and rated from 1 to 5. Continuous data were analyzed using descriptive statistics with mean and standard deviation. A paired samples t-test was performed to assess for differences between groups. Categorical data were presented as frequency and percentage. RESULTS: The mean image score was significantly worse with Tegaderm™ compared with no Tegaderm™ (mean difference: 0.94/5.00; 95% CI 0.79-1.08; p < 0.001). This was consistent in both the transverse and the sagittal plane subgroups. The percentage of acceptable images was also higher in the no Tegaderm™ group compared with the Tegaderm™ group (97.8% versus 82.8%). There was no statistically significant difference in patient discomfort with the Tegaderm™ versus no Tegaderm™ group. When asked to compare the two approaches, 54.4% of patients preferred Tegaderm™, 30.0% preferred no Tegaderm™, and 15.6% had no preference. CONCLUSIONS: Tegaderm™ was associated with reduced image quality and no significant difference in patient discomfort when utilized for ocular ultrasound. This study suggests that ocular ultrasound may be better performed without the use of Tegaderm™. Future research should evaluate the impact of Tegaderm™ vs. no Tegaderm™ among more novice users.

Impact of the COVID-19 Pandemic on Fecal Immunochemical Testing, Colonoscopy Services, and Colorectal Neoplasia Detection in a Large United States Community-based Population.

BACKGROUND & AIMS: The COVID-19 pandemic has affected clinical services globally, including colorectal cancer (CRC) screening and diagnostic testing. We investigated the pandemic's impact on fecal immunochemical test (FIT) screening, colonoscopy utilization, and colorectal neoplasia detection across 21 medical centers in a large integrated health care organization. METHODS: We performed a retrospective cohort study in Kaiser Permanente Northern California patients ages 18 to 89 years in 2019 and 2020 and measured changes in the numbers of mailed, completed, and positive FITs; colonoscopies; and cases of colorectal neoplasia detected by colonoscopy in 2020 vs 2019. RESULTS: FIT kit mailings ceased in mid-March through April 2020 but then rebounded and there was an 8.7% increase in kits mailed compared with 2019. With the later mailing of FIT kits, there were 9.0% fewer FITs completed and 10.1% fewer positive tests in 2020 vs 2019. Colonoscopy volumes declined 79.4% in April 2020 compared with April 2019 but recovered to near pre-pandemic volumes in September through December, resulting in a 26.9% decline in total colonoscopies performed in 2020. The number of patients diagnosed by colonoscopy with CRC and advanced adenoma declined by 8.7% and 26.9%, respectively, in 2020 vs 2019. CONCLUSIONS: The pandemic led to fewer FIT screenings and colonoscopies in 2020 vs 2019; however, after the lifting of shelter-in-place orders, FIT screenings exceeded, and colonoscopy volumes nearly reached numbers from those same months in 2019. Overall, there was an 8.7% reduction in CRC cases diagnosed by colonoscopy in 2020. These data may help inform the development of strategies for CRC screening and diagnostic testing during future national emergencies.

Coping and its association with psychological adjustment: Differences between first-, second-, and third-plus generation adolescents.

INTRODUCTION: Adolescents with an immigrant background, whether first-generation (born abroad) or second-generation (at least one parent born abroad), face challenges that could compromise their psychological adjustment compared to their third-plus generation peers. Yet, many are developing positively despite the presence of adversity. To understand what contributes to these adolescents' resilience, it can be useful to study the coping strategies they use. METHODS: A total of 1036 Canadian secondary school students participated in this quantitative cross-sectional study (Mage = 12.9; 56% females; 26% first-generation; 34% second generation; 39% third-plus generation). Coping strategies (coping orientation to problems experienced inventory) were assessed and their differentiated associations with self-esteem, anxiety (Screen for Child Anxiety Related Emotional Disorders), and depressive symptoms (Center for Epidemiologic Studies Depression Scale) were analyzed through path analysis and invariance testing. RESULTS: First-generation adolescents reported more acceptance/reinterpretation and substance use than second- and third-plus generation adolescents. First- and second-generation adolescents reported using religion more than third-plus generation adolescents. First-generation adolescents used self-distraction more often than second-generation adolescents, who used it more often than third-plus generation. The use of humor was more prevalent in second-generation adolescents compared with their third-plus generation peers. In addition, some associations between coping strategies and psychological adjustment differed across generations. In first-generation adolescents, behavioral disengagement was significantly associated with fewer anxiety symptoms. The same trend was observed in second-generation adolescents who used self-distraction. These avoidant strategies are generally associated with poor psychological adjustment. CONCLUSIONS: This study adds new knowledge about differences across generations in the coping strategies used by adolescents to deal with stress. Further practical implications are discussed.

Ultrasound for the diagnosis of shoulder dislocation and reduction: A systematic review and meta-analysis.

BACKGROUND: Shoulder dislocations are a common injury prompting presentation to the emergency department. Point-of-care ultrasound (POCUS) is a diagnostic tool for shoulder dislocations, which has the potential to reduce time to diagnosis and reduction, radiation exposure, and health care costs. This systematic review sought to evaluate the diagnostic accuracy of POCUS for diagnosing shoulder dislocations. METHODS: We searched PubMed, Scopus, CINAHL, LILACS, the Cochrane databases, Google Scholar, and bibliographies of selected articles for all prospective and randomized controlled trials evaluating the diagnostic accuracy of POCUS for identifying shoulder dislocations. We dual-extracted data into a predefined worksheet and performed quality analysis using the QUADAS-2 tool. We performed a meta-analysis with subgroup analyses by technique and transducer type. As a secondary outcome, we assessed the diagnostic accuracy of identifying associated fractures. RESULTS: Ten studies met our inclusion criteria, comprising 1,836 assessments with 636 dislocations (34.6%). Overall, POCUS was 100% (95% confidence interval [CI], 85.6%-100%) sensitive and 100% (95% CI, 79.4%-100%) specific for the diagnosis of shoulder dislocation with a LR+ of 11,254.8 (95% CI, 3.9-3.3e7) and a LR- of <0.1 (95% CI, < 0.1-0.2). When compared with the anterior/lateral technique, the posterior technique had greater sensitivity but no difference in specificity. There was no difference between transducer types. POCUS was also 96.8% (95% CI, 92.6%-98.7%) sensitive and 99.7% (95% CI, 92.5%-100%) specific for the diagnosis of associated fractures. CONCLUSIONS: POCUS is a sensitive and specific tool for the rapid identification of shoulder dislocations and reductions, as well as for the detection of associated fractures. POCUS should be considered as an alternate diagnostic tool for the diagnosis and management of shoulder dislocations.

Current Applications of Pediatric Abdominal Point-of-Care Ultrasound.

Point-of-care ultrasound (POCUS) for pediatric abdominal symptoms has expanded in both the inpatient and outpatient settings. POCUS may be used to aid in the diagnosis of appendicitis, hypertrophic pyloric stenosis, and intussusception in the pediatric population. This article reviews the benefits of POCUS for the diagnosis of these pediatric pathologies. This article also provides instruction on how to perform these important examinations. [Pediatr Ann. 2021;50(10):e419-e423.].

Canadian Adolescents' Internalized Symptoms in Pandemic Times: Association with Sociodemographic Characteristics, Confinement Habits, and Support.

Adolescence is a time of increased risk for developing symptoms of anxiety and depression, especially for girls. The stress and social isolation experienced during confinement add new threats to already vulnerable adolescents' daily lives. This study is aimed at determining which sociodemographic characteristics (age, family composition, achievement), confinement habits (schedule, new hobby, sleep duration, cellphone and computer use, sports, schoolwork), and sources of support (parents and teachers) are associated with more or less internalized symptoms in Canadian adolescents. Differences between boys and girls are also investigated. Between April 8 and 30 (2020) and through an online survey, 895 Canadian adolescents (74% girls) aged between 12 and 17 years (M = 14.7) were recruited. Path analysis was performed to identify significant associations between sociodemographic characteristics, confinement habits, support variables, and internalized symptoms. Independent samples t-tests and invariance tests were conducted to compare boys and girls. Results suggest that certain confinement habits (time spent using cellphones, doing sports and schoolwork, finding a new hobby) and support variables (parents working outside the home) were significantly and negatively associated with internalized symptoms. Regarding the sex differences, girls used their cellphones more and invariance test results showed that all associations between predictors and symptoms were statistically similar for boys and girls. This study's results help understand better adolescents' experience in confinement. It sheds light on the habits likely to characterize those who are less at risk of experiencing distress, making it possible to better support adolescents during this challenging period.

Risk and Resilience in Minority Youth Populations.

This review presents current theory and empirical research that address the interplay between risk and resilience processes among minority youth in the United States. To move the clinical sciences forward in their research and treatment approaches to solving minority-majority health and well-being disparities, ecological, intersectional, and emic (within-group) approaches must be adopted. We discuss the consequences of systematic oppression and marginalization for children in the United States, focusing primarily on research regarding xenophobia, discrimination, and racism. Lastly, we provide examples of recent interventions that take emic approaches to closing minority-majority gaps in developmental outcomes.

Body Image, Assimilation, and Weight of Immigrant Adolescents in the United States: A Person-Centered Analysis.

Adolescence is a critical developmental period as youth explore their body image and work to establish an identity. The stress of identity and body image development can be exacerbated by acculturative stress faced by immigrant adolescents. Using a person-centered analysis, we investigated immigrant adolescents' (n = 57) profiles based on assimilation to the United States (US), weight, and body image dissatisfaction. Analyses included an exploratory two-step clustering technique using maximum likelihood estimation procedures to assign class membership. Follow-up analyses then examined latent class membership by adolescent age, gender, culture of origin, and immigration generation. Results indicated several meaningful latent groups of adolescents based on their BID, acculturation, and BMI. These profiles included one in which adolescents who were underweight and more assimilated to US culture also reported more satisfaction with their body image. A second profile emerged of adolescents who were normal weight or overweight and less assimilated, who also reported higher levels of body image dissatisfaction, with a desire to be thinner. The third cluster profile included adolescents who were of normal weight, but were higher on assimilation and were among the most dissatisfied with their body image. Our findings suggest that immigrant adolescents at all levels of acculturation are internalizing the thin body ideal prominent in the US, with a variety of implications for their sense of body image and BMI. Implications for mental and physical health care for immigrant adolescents are discussed.

PERSISTENT CONCERNS: QUESTIONS FOR RESEARCH ON ETHNIC-RACIAL IDENTITY DEVELOPMENT.

Research on ethnic-racial identity (ERI) and its development has increased exponentially over the past decade. In this paper we discuss five questions that the Lifespan ERI Study Group grappled with in our effort propose a lifespan model of ERI: (1) When does ERI development begin and end? (2) How do we account for age-dependent and contextually-initiated factors in ERI? (3) Should there be a reference point for healthy ERI, and if so, what is it? (4) How do the multiplicities of identity (intersectionality, multiracialism, whiteness) figure into our conceptualization of ERI? (5) How do we understand the role of ERI in pursuit of equity, diversity, and social justice? We note that these are persistent questions in ERI research, and thus our goal is to present our collective reckoning with these issues as well as our ponderings about why they persist. We conclude with recommendations forthe kinds of research questions, designs, and methods that developmental science, in particular, needs to pursue.

APPLYING THE LIFESPAN MODEL OF ETHNIC-RACIAL IDENTITY: EXPLORING AFFECT, BEHAVIOR, AND COGNITION TO PROMOTE WELL-BEING.

This paper presents an application of the Lifespan Model of Ethnic-Racial Identity (ERI) Development (see Williams, et al., in press). Using a tripartite approach, we present the affective, behavioral, and cognitive aspects of ERI in a framework that can be adapted for group and individual psychosocial interventions across the lifespan. These A-B-C anchors are presented in developmental contexts as well as the larger social contexts of systemic oppression and current and historical sociopolitical climates. It is ultimately the aspiration of this identity work that individuals will engage in ERI meaning-making, drawing from the implicit and explicit aspects of their A-B-Cs, to support a healthy and positive sense of themselves and others as members of ethnic-racial social groups.

A Lifespan Model of Ethnic-Racial Identity.

The current paper presents a lifespan model of ethnic-racial identity (ERI) from infancy into adulthood. We conceptualize that ethnic-racial priming during infancy prompts nascent awareness of ethnicity/race that becomes differentiated across childhood and through adulthood. We propose that the components of ERI that have been tested to date fall within five dimensions across the lifespan: ethnic-racial awareness, affiliation, attitudes, behaviors, and knowledge. Further, ERI evolves in a bidirectional process informed by an interplay of influencers (i.e., contextual, individual, and developmental factors, as well as meaning-making and identity-relevant experiences). It is our goal that the lifespan model of ERI will provide important future direction to theory, research, and interventions.

Index colonoscopy-related risk factors for postcolonoscopy colorectal cancers.

BACKGROUND AND AIMS: Postcolonoscopy colorectal cancers (PCCRCs) are defined as those detected ≤10 years after an index colonoscopy negative for cancer, but modifiable risk factors are not well established in large, community-based populations. METHODS: We evaluated risk factors from the index colonoscopy for PCCRCs diagnosed 1 to 10 years after an index colonoscopy using a case-control design. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for potential confounders. RESULTS: A proximal polyp ≥10 mm (OR, 8.18; 95% CI, 4.59-14.60), distal polyp ≥10 mm (OR, 3.30; 95% CI, 1.65-6.58), adenoma with (OR, 3.23; 95% CI, 1.83-5.68) and without advanced histology (OR, 1.87; 95% CI, 1.37-2.55), and an incomplete colonoscopy (OR, 5.52; 95% CI, 2.98-10.21) were associated with PCCRC. Risk factors for early versus late cancers (12-36 months vs >36 months to 10 years after examination) included incomplete polyp excision in the colonic segment of the subsequent cancer (OR, 4.76; 95% CI, 2.35-9.65); failure to examine the segment (OR, 2.42; 95% CI, 1.27-4.60); and a polyp ≥10 mm in the segment (OR, 2.38; 95% CI, 1.53-3.70). A total of 559 of 1206 patients with PCCRC (46.4%) had 1 or more risk factors that were significant for PCCRC (incomplete examination, large polyp, or any adenoma). CONCLUSIONS: In a large community-based study with comprehensive capture of PCCRCs, almost half of PCCRCs had potentially modifiable factors related to polyp surveillance or removal and examination completeness. These represent potential high-yield targets to further increase the effectiveness of colorectal cancer screening.

An integrative risk and resilience model for understanding the adaptation of immigrant-origin children and youth.

We propose an integrative model for the adaptation of immigrant-origin children and youth that combines ecological with risk and resilience frameworks. Immigrant-origin children and youth are now, and will continue to be, a diverse and demographically important segment of all postindustrial nations' populations. Synthesizing evidence across psychological, educational, and sociological disciplines produced since the seminal publication of García Coll et al.'s (1996) model, along with significant events such as a global refugee crisis, a sociopolitical "deportation nation" climate, and heightened xenophobia, we provide a model for understanding the current conditions immigrant-origin children and youth encounter as they develop. This new integrative conceptual model for addressing positive frameworks for adaptation provides a culturally relevant approach for understanding both the risks and resilience of this population. The model was designed to inform practice and future research in the service of immigrant-origin children and youth. (PsycINFO Database Record