Psychologists aspiring to leadership positions in public sector health care.

Psychologists are well-positioned to take on leadership roles in health care systems as a result of the broad-based skills included in doctoral level, professional training programs. These include knowledge of evidence-based practice, extensive training in applied research and clinical practice, emphasis on critical thinking in scientific methods and hypothesis testing, teaching, supervision, team consultation, and continuous learning (APA Presidential Task Force on Evidence-Based Practice, 2006; Korman, 1974; McFall, 2007). Formal opportunities to learn how to apply these skills in leadership and organizational management roles are, however, limited during graduate training. There have been recent efforts within the American Psychological Association to foster interest and readiness for leadership roles among psychologists. These efforts have included a leadership development fellowship, on-demand webinars, and online learning for continuing education (American Psychological Association, 2023). The content of these training opportunities is typically general in nature so that it can be applied to all types of organizational settings. Psychologists interested in leadership positions within public sector health care organizations are likely to benefit from information that aligns more specifically with the mission and organizational structures of such systems. This article presents a conceptual framework to prepare psychologists aspiring to leadership positions in public sector health care. Leadership theories and models from organizational management science are outlined which capture the context and organizational goals of such programs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Auditory brainstem response findings in autism spectrum disorder speech delay population.

OBJECTIVES: Evaluate pediatric auditory brainstem response (ABR) findings in children with Autism Spectrum Disorder (ASD) after the 2013 DSM-5 update. STUDY DESIGN: This was an IRB-approved, six-year retrospective chart review evaluating ABR results from pediatric patients with speech delay. Diagnosis of ASD and other neurodevelopmental abnormalities were collected for patient stratification. METHODS: From 2017 to 2023, 148 pediatric patients with speech delay were identified through diagnosis of speech delay and underwent ABR testing. Patients were then separated into two groups: Neurotypical (N = 79) and ASD (N = 69). ABR results were obtained through chart review and waveform and interpeak latency (IPL) results were recorded. Differences in waveform and IPL results were determined via Pearson's chi-square test, with multivariate analysis accounting for race, sex, and age. RESULTS: 28 patients with ASD (40.6 %) had at least one waveform/IPL prolongation. Analysis showed an increased incidence of waveform III (p = 0.028) and IPL III-V (p = 0.03) prolongation in the ASD group compared to their neurotypical counterparts. Waveform III prolongation was noted more in females with ASD (p = 0.001) than in males. No statistically significant difference when comparing race and age was found, except in the 2-3 age range (p = 0.003). CONCLUSIONS: There were higher percentages of prolongation for all waveforms and IPLs in the ASD group versus neurotypical, though not as high as previously reported. Race and age did not appear to be factors in ABR findings though more data is needed to make clinical associations.

Management of Dog-Related Penetrating Laryngotracheal Trauma in a Pediatric Patient.

Dog-bite-related laryngotracheal injuries are rare but can be life-threatening. We present a case of penetrating laryngotracheal trauma in a six-year-old male and the management, considerations, and outcomes. The patient suffered extensive laryngotracheal trauma, including near complete tracheal transection, complete thyroid cartilage fracture, crush injury to the cricoid, and multiple tracheal perforations after a dog attack. We review initial management, subsequent airway interventions, multi-disciplinary approach, and airway outcomes. We present one of the few reports describing extensive dog-related penetrating laryngotracheal trauma in a pediatric patient, with successful airway management.

Validation of a three-dimensional printed pediatric middle ear model for endoscopic surgery training.

Objective: The purpose of this study is to assess the anatomical appropriateness of a three-dimensional (3D) printed pediatric middle ear model with a replaceable middle ear unit as an endoscopic ear surgery (EES) simulator. Methods: Single-blinded, prospective, proof-of-concept study conducted in a simulation operative suite. A simulator was developed through segmentation of source images and multi-material 3D printing. Subjects were asked to point to seven anatomical sites before and after a short anatomy presentation of a human middle ear photograph. They also filled out a survey about the feasibility of the model. Outcome variables included survey scores, pre-anatomy lesson (PreAL) and post-anatomy lesson (PostAL) quiz scores. Results: There were 24 participants (19 residents, 1 fellow, and 4 attendings), none with self-reported proficiency in EES. The PreAL mean score was 4.42 and PostAL quiz mean score was 5.32 (average improvement of 43% [CI = 17%-70%]; p = .003). The higher the level of training, the higher the PreAL scores (0.55 points per year of training; p = .004). The subspecialty (otology, other, in-training) was also associated with the PreAL scores (p = .004). Total survey score means were 22.8 (out of 30). Conclusion: The results of our study suggest that our model has adequate anatomical high fidelity to mimic a real, pediatric temporal bone for EES. As 3D printing technologies continue to advance, the quality of ear models has the potential to provide improved surgical training for pediatric EES. Level of Evidence: 4.

Depression in the Pediatric Otolaryngology Clinic Setting.

OBJECTIVES/HYPOTHESIS: For most pediatric specialty clinics, mental health is not the primary presenting complaint, yet can portend unrecognized morbidity. We describe rates and risk factors of depression and suicidal ideation in adolescents seen at a pediatric specialty clinic and examine changes during COVID-19. STUDY DESIGN: Retrospective database review. METHODS: Outpatient pediatric otolaryngology clinic encounters of patients aged 12-19 years at a tertiary academic medical center were identified from October 2018 to July 2020. Demographic characteristics, ICD-10 primary diagnosis, Patient Health Questionnaire (PHQ)-2 score, and PHQ-9 score (if administered) were obtained. Multivariable regression examined risk factors for PHQ-9 administration, PHQ-9 scores ≥10, and suicidal ideation. Patient characteristics and PHQ scores were compared before and after March 23, 2020 (California COVID-19 Stay-at-Home order). RESULTS: Three thousand six hundred nine encounters with PHQ-2 data were identified. Of these, 223 (6.2%) scored ≥3 and underwent PHQ-9 assessment, of which 121 (3.4% of 3,609) scored ≥10 on the PHQ-9 and 53 (1.5%) endorsed suicidal ideation. Factors associated with PHQ-9 administration were female gender (odds ratio [OR] 1.58, P = .001), obesity (OR 1.48, P = .043), and neck mass/neoplasm/cancer diagnosis (OR 1.99, P = .013). Female gender was also associated with suicidality (OR 2.47, P = .008). Comparison of pre-COVID-19 versus during COVID-19 showed no differences in depression or suicidality. However, subgroup analysis revealed some significant findings. CONCLUSIONS: We demonstrate substantial prevalence of positive depression screening and suicidal ideation among adolescent pediatric otolaryngology clinic encounters. Depression rates were similar to pre-COVID-19 and during COVID-19, yet barriers to screening during this time were substantial. Pediatric specialty providers must remain vigilant for mental health issues in their patients. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:1104-1111, 2022.

A Protocol for Imaging of Cochlear Implantation.

OBJECTIVES: Correct electrode placement is a challenge of cochlear implant surgery, which occurs because electrode position cannot be directly visualized. This work aims to 1) develop a protocol for a practical, consistent, single view plain radiograph able to be used to confirm cochlear implantation, 2) confirm its usefulness on patients, and 3) confirm its usefulness for identifying misplaced electrodes in cadaveric ears. STUDY DESIGN: Imaging procedure and quality improvement initiative. SETTING: Tertiary academic hospital. PATIENTS: Cadaveric ears, and patients undergoing cochlear implantation. INTERVENTIONS: An intraoperative imaging protocol was developed specifying patient head position, machine position, and exposure setting. This was tested to confirm proper cochlear implantation in patients, including one revision case. This technique allowed the electrode placement to be reliably identified in patients of all ages. Its usefulness for identifying maligned electrodes (partial insertion, and insertion into the vestibule or hypotympanum) was confirmed using four cadaveric hemi-heads. MAIN OUTCOME MEASURES: Ability to accurately identify correct or incorrect electrode insertion based on radiographic images. RESULTS: After adjusting radiographic exposure to account for the embalming process of the cadaveric heads, this new protocol was confirmed to be able to identify incorrect placement. This was also successfully used to confirm proper placement of cochlear implants in patients. CONCLUSIONS: Following a standardized radiographic protocol for cochlear implantation is a quick and easy method for checking electrode position.Supplemental Digital Content, http://links.lww.com/MAO/B253.

Patterns of Obstruction on DISE in Adults With Obstructive Sleep Apnea Change With BMI.

OBJECTIVES: We describe drug-induced sleep endoscopy (DISE) obstruction patterns in adults with obstructive sleep apnea (OSA) based on body mass index (BMI). We also evaluate subgroups of patients with clinically significant obstruction patterns at the velopharynx and oropharynx. STUDY DESIGN: Retrospective chart review. METHODS: Single-institution, retrospective chart review of adults with OSA who underwent DISE with dexmedetomidine sedation from 2016 to 2018. Endoscopic findings were graded using VOTE (Velum, Oropharynx, Tongue base, Epiglottis) classification. Oropharyngeal obstruction was additionally graded with the modifier T when due to palatine tonsil tissue. Findings in patients who had BMI < 25, 25 ≤ BMI < 30, and BMI ≥ 30 were compared. RESULTS: One hundred and eleven patients (1 underweight, 23 normal weight, 56 overweight, and 31 obese) were reviewed. Patients with lower BMI were more likely to have more severe obstruction at the level of the tongue base (χ2 = 11.52, P = .021) and epiglottis (χ 2 = 10.56, P = .032). Conversely, patients with higher BMI were more likely to have complete concentric (grade 2C) velum obstruction (χ 2 = 16.04, P < .001) and more severe oropharyngeal obstruction (χ 2 = 9.65, P = .046). Patients with grade 2 oropharyngeal obstruction without tonsil obstruction had more severe concurrent velum obstruction compared to subjects with grade 2 T oropharyngeal obstruction (P = .009). CONCLUSION: In adults with OSA, BMI categories have significantly distinct obstruction patterns at all airway levels on DISE, and there appear to be distinct subgroups associated with certain velum and oropharynx collapse patterns. These findings may have important implications for positive airway pressure-alternative treatment. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:224-229, 2021.

Nurturing the Prepared Mind: Research During Level II Fieldwork.

IMPORTANCE: Level II fieldwork is one of the last opportunities for students to learn from clinicians modeling how to gather practice-based data for research before independent practice. OBJECTIVE: To identify options for incorporating active research opportunities in the Level II fieldwork experience and the barriers that preclude these opportunities. DESIGN: Approximately 575 electronic surveys (QuestionPro), consisting of 31 questions, distributed to fieldwork sites. PARTICIPANTS: A convenience sample of fieldwork educators and clinical fieldwork coordinators recruited from sites in several states. OUTCOMES AND MEASURES: We hypothesized that the main obstacles to providing Level II fieldwork students with research experience were a lack of time resulting from productivity pressures and fieldwork educators' belief that Level II fieldwork should primarily focus on mastering clinical skills. RESULTS: One hundred thirteen surveys were started, and 95 were completed. Most respondents reported that Level II fieldwork students would benefit from participation in research. However, only two fieldwork sites with occupational therapists involved in research intentionally coordinated Level II fieldwork students in an active research opportunity. Clinical responsibilities and the lack of current experienced investigators at the fieldwork site were the most significant barriers to these opportunities. CONCLUSIONS AND RELEVANCE: Fieldwork educators identify ways for Level II fieldwork students to participate in research but typically do not have time or resources to eliminate identified barriers to research participation. Lost opportunities to participate in research in Level II fieldwork must be addressed to promote greater research inquiry in the future occupational therapy clinical workforce. WHAT THIS ARTICLE ADDS: The article adds to the literature describing the barriers to student participation in research activity during Level II Fieldwork and the types of research activity occupational therapy students participated in during a 12-wk rotation.

Effects of selective auditory-nerve damage on the behavioral audiogram and temporal integration in the budgerigar.

Auditory-nerve fibers are lost steadily with age and as a possible consequence of noise-induced glutamate excitotoxicity. Auditory-nerve loss in the absence of other cochlear pathologies is thought to be undetectable with a pure-tone audiogram while degrading real-world speech perception (hidden hearing loss). Perceptual deficits remain unclear, however, due in part to the limited behavioral capacity of existing rodent models to discriminate complex sounds. The budgerigar is an avian vocal learner with human-like behavioral sensitivity to many simple and complex sounds and the capacity to mimic speech. Previous studies in this species show that intracochlear kainic-acid infusion reduces wave 1 of the auditory brainstem response by 40-70%, consistent with substantial excitotoxic auditory-nerve damage. The present study used operant-conditioning procedures in trained budgerigars to quantify kainic-acid effects on tone detection across frequency (0.25-8 kHz; the audiogram) and as a function of duration (20-160 ms; temporal integration). Tone thresholds in control animals were lowest from 1 to 4 kHz and decreased with increasing duration as in previous studies of the budgerigar. Behavioral results in kainic-acid-exposed animals were as sensitive as in controls, suggesting preservation of the audiogram and temporal integration despite auditory-nerve loss associated with up to 70% wave 1 reduction. Distortion-product otoacoustic emissions were also preserved in kainic-acid exposed animals, consistent with normal hair-cell function. These results highlight considerable perceptual resistance of tone-detection performance with selective auditory-nerve loss. Future behavioral studies in budgerigars with auditory-nerve damage can use complex speech-like stimuli to help clarify aspects of auditory perception impacted by this common cochlear pathology.

Management of pediatric orbital cellulitis: A systematic review.

OBJECTIVES: Orbital complications account for 74-85% of all complications from acute sinusitis, more often affect the pediatric population, and can result in devastating consequences. Therefore these patients require prompt diagnosis and proper management. We review and summarize the current literature to determine the appropriate management of each stage of pediatric orbital cellulitis and offer a new comprehensive literature-based algorithm. METHODS: Data sources were PubMed/MEDLINE, and Google Scholar. Studies relevant to the management of each subcategory of the Chandler criteria in the pediatric population, limited to the period 1997 through Jan 2018, were compiled and interpreted. Seventy-one studies were reviewed in total. RESULTS: Pre-septal and post-septal cellulitis can generally be managed non-surgically, while orbital abscess and cavernous sinus thrombosis are managed surgically. For subperiosteal abscess, non-surgical medical management has been successful in certain patients. Results of the literature review were summarized, and subsequently developed into a comprehensive algorithm for management, including criteria for age, location, and volume of abscess on imaging. CONCLUSIONS: Orbital cellulitis, particularly subperiosteal abscesses, in children is not an absolute indication for immediate surgical intervention. Conservative measures can be safe and effective if appropriately used, depending on patient characteristics, clinical course, and imaging.

Predicting help-seeking behavior: The impact of knowing someone close who has sought help.

OBJECTIVES: This study sought to replicate and extend research on social facilitators of college student's help seeking for psychological problems. PARTICIPANTS: We collected data on 420 ethnically diverse college students at a large public university (September 2008-May 2010). METHODS: Students completed a cross-sectional online survey. RESULTS: We found that students who were aware of close others' (eg, family, friends) help seeking were two times more likely to have sought formal (eg, psychologist) and informal (eg, clergy) help themselves. Tests of moderation revealed the incremental effect (ie, controlling for help-seeking attitudes, internalizing symptoms, cultural demographics) of close others' formal help seeking was strong and significant for men (R2 = 0.112), while it was negligible and nonsignificant for women (R2 = .002). CONCLUSIONS: We discuss the importance for students-particularly men-to learn about close others' help seeking for facilitating their own help seeking during times of distress.

A "Wii" bit of fun: the effects of adding Nintendo Wii(®) Bowling to a standard exercise regimen for residents of long-term care with upper extremity dysfunction.

The aims of this randomized, single-blind crossover trial were to investigate the effect of adding a simulated bowling video game via the Nintendo Wii(®) gaming system to the standard exercise regimen of cognitively intact residents of long-term care (LTC) with upper extremity dysfunction and to identify individual characteristics that might predict improvement. Residents (n=34) were recruited through two LTC facilities in southwestern Ontario and were randomized into a standard exercise (SG) or standard exercise plus Wii bowling (Wii) arm. After 4 weeks of intervention, the groups were crossed over to the opposite arm. Outcomes included measures of pain intensity and bothersomeness, physical activity enjoyment, and a six-item measure of functional capacity designed specifically for residents of LTC. Results suggest that subjects improved on all outcomes from pre- to postintervention but that only enjoyment of activity showed a significant difference between the SG and Wii groups. Effect sizes (Cohen's d) ranged from small (0.30 for bothersomeness) to large (1.77 for functional capacity). Responders, defined as those subjects who reported any degree of improvement following the Wii intervention, were less likely to complain of stiffness or shoulder symptoms and were more likely to complain of hand symptoms than non-responders. Limitations in interpretation and recommendations for future research are presented.