Effects of system-sanctioned framing on climate awareness and environmental action in the United States and beyond.

Despite growing scientific alarm about anthropogenic climate change, the world is not on track to solve the crisis. Inaction may be partially explained by skepticism about climate change and resistance to proenvironmental policies from people who are motivated to maintain the status quo (i.e., conservative-rightists). Therefore, practical interventions are needed. In the present research program, we tested an experimental manipulation derived from system justification theory in which proenvironmental initiatives were framed as patriotic and necessary to maintain the American "way of life." In a large, nationally representative U.S. sample, we found that the system-sanctioned change intervention successfully increased liberal-leftists' as well as conservative-rightists' belief in climate change; support for proenvironmental policies; and willingness to share climate information on social media. Similar messages were effective in an aggregated analysis involving 63 countries, although the overall effect sizes were small. More granular exploratory analyses at the country level revealed that while the intervention was moderately successful in some countries (e.g., Brazil, France, Israel), it backfired in others (Germany, Belgium, Russia). Across the three outcome variables, the effects of the intervention were consistent and pronounced in the United States, in support of the hypothesis that system justification motivation can be harnessed on behalf of social change. Potential explanations for divergent country-level effects are discussed. The system-sanctioned change intervention holds considerable promise for policymakers and communicators seeking to increase climate awareness and action.

A Pilot Survey on the Perceptions of Pediatric Subspecialty Fellows and Program Directors on Virtual Compared with In-Person Interview Experiences.

Pediatric fellowship programs have conducted virtual interviews since the start of the COVID-19 pandemic in 2020. In this national survey of fellowship program directors and fellows interviewed in-person and virtually, fellowship program directors and fellows formed accurate impressions, regardless of format, but our data did not clearly support one interview format over another.

Seesaw Precarity: Journaling Anxious Hope on a Chinese University Campus During Covid-19.

In this article, we examine the Covid-19 experiences of a group of Chinese university students studying in the city of Guangzhou. We draw on journal entries that Chinese students submitted to the Pandemic Journaling Project between March and May 2022, along with follow-up responses in July and December 2022, to argue that these students spent most of their undergraduate years living in a state of "seesaw precarity." We define seesaw precarity as a protracted period during which many Chinese were unable to predict from one day to the next whether they would be free to engage in the quotidian activities of everyday life. We trace student reactions and adaptations as they struggled to attend class, buy food, and see friends and family in the midst of unpredictable swings between openness and closedness. The seesaw nature of restrictions spurred considerable anxiety among the students we followed, but also produced an optimistic mindset we refer to as "anxious hope." Participants accepted the necessity of Covid controls and felt it was incumbent upon them as individuals to adjust to this reality. They saw themselves as responsible for actively cultivating a positive mindset. Our findings suggest that the promotion of emotional self-care and anxious hope during the pandemic may have supported the viability of long-term controls as well as the acceptability of their sudden abandonment, while muting the possibility of resistance.

Introduction: Student Experiences of COVID-19 Around the Globe: Insights from the Pandemic Journaling Project.

The COVID-19 crisis has taken a significant toll on the mental health of many students around the globe. In addition to the traumatic effects of loss of life and livelihood within students' families, students have faced other challenges, including disruptions to learning and work; decreased access to health care services; emotional struggles associated with loneliness and social isolation; and difficulties exercising essential rights, such as rights to civic engagement, housing, and protection from violence. Such disruptions negatively impact students' developmental, emotional, and behavioral health and wellbeing and also become overlaid upon existing inequities to generate intersectional effects. With these findings in mind, this special issue investigates how COVID-19 has affected the mental health and wellbeing of high school and college students in diverse locations around the world, including the United States, Mexico, Brazil, China, and South Africa. The contributions collected here analyze data collected through the Pandemic Journaling Project, a combined research study and online journaling platform that ran on a weekly basis from May 2020 through May 2022, along with complementary projects and using additional research methods, such as semi-structured interviews and autobiographical writing by students. The collection offers a nuanced, comparative window onto the diverse struggles that students and educators experienced at the height of the pandemic and considers potential solutions for addressing the long-term impacts of COVID-19. It also suggests a potential role for journaling in promoting mental wellbeing among youth, particularly in the Global South.

"You would think she would hug me": Micropractices of Care Between First-Generation College Students and Their Parents During Covid-19.

The Covid-19 pandemic has greatly disrupted the education of first-generation college students (first-gens)-those whose parents did not complete a college degree. With campuses closed, activities canceled, and support services curtailed, many first-gens have increasingly relied on their parents for mental, emotional, and logistical support. At the same time, their parents face compounding stresses and challenges stemming from the prolonged effects of the Covid pandemic. We examined the role that relational dynamics between first-gens and their parents played in how they weathered the first 2 years of the Covid pandemic together. We draw upon journals submitted by self-identified first-gens and parents of first-gens to the Pandemic Journaling Project between October 2021 and May 2022 as part of a pilot study of first-gen family experiences of Covid-19, along with a series of interviews conducted with three student-parent dyads. We argue that what we term the micropractices of care-the "little things," like a kind word, small gift, or car ride, that were regularly exchanged between parents and students-played a key role in mental wellness and educational persistence. We find that when there is synchrony between practices offered by one dyad member and their reception by the other, mental wellbeing is preserved. When there is asynchrony, mental health is destabilized. These findings reflect the strategies on which first-gen families have creatively relied to maintain shared mental wellness and student success during a time of crisis. We show how everyday mental wellness is forged in the intersubjective space between two people engaged in achieving shared life goals.

Epidemiologizing Culture: Scaling Chineseness through Narratives of Stigma in New York City.

Drawing on 18 months of participation on an epidemiological research team and close analysis of in-depth interviews the team conducted with 30 Chinese immigrants to New York City, this article traces a process I call epidemiologizing culture. In producing qualitative interview data from Chinese immigrants at risk for HIV, team members smoothed over individual variation to extract elements thought to be relevant to population-level experiences of "Chinese culture." Relevance was determined based on how closely the experiences of participants mirrored the behavior of a Chinese ideal type. Interviewer and interviewee collaborated in articulating and reproducing homophobic and HIV-phobic discourses associated with Chinese culture while erasing details of lived experience, and conflating race and culture. I conclude that differing epistemic virtues make an epidemiological embrace of contemporary anthropological understandings of culture difficult. A model of "parallel play" may be an alternative approach to interdisciplinary synthesis.

Burnout in Pediatric Critical Care Medicine Fellows.

OBJECTIVES: Assess the overall level of burnout in pediatric critical care medicine fellows and examine factors that may contribute to or protect against its development. DESIGN: Cross-sectional observational study. SETTING: Accreditation Council for Graduate Medical Education-accredited pediatric critical care medicine fellowship programs across the United States. SUBJECTS: Pediatric critical care medicine fellows and program directors. INTERVENTIONS: Web-based survey that assessed burnout via the Maslach Burnout Inventory, as well as other measures that elicited demographics, sleepiness, social support, perceptions about prior training, relationships with colleagues, and environmental burnout. MEASUREMENTS AND MAIN RESULTS: One-hundred eighty-seven fellows and 47 program directors participated. Fellows from 30% of programs were excluded due to lack of program director participation. Average values on each burnout domain for fellows were higher than published values for other medical professionals. Personal accomplishment was greater (lower burnout) among fellows more satisfied with their career choice (ß 9.319; p ≤ 0.0001), spiritual fellows (ß 1.651; p = 0.0286), those with a stress outlet (ß 3.981; p = 0.0226), those comfortable discussing educational topics with faculty (ß 3.078; p = 0.0197), and those comfortable seeking support from their co-fellows (ß 3.762; p = 0.0006). Depersonalization was higher for second year fellows (ß 2.034; p = 0.0482), those with less educational debt (ß -2.920; p = 0.0115), those neutral/dissatisfied with their career choice (ß -6.995; p = 0.0031), those with nursing conflict (ß -3.527; p = 0.0067), those who perceived burnout among co-fellows (ß 1.803; p = 0.0352), and those from ICUs with an increased number of patient beds (ß 5.729; p ≤ 0.0001). Emotional exhaustion was higher among women (ß 2.933; p = 0.0237), those neutral/dissatisfied with their career choice (ß -7.986; p = 0.0353), and those who perceived burnout among co-fellows (ß 5.698; p ≤ 0.0001). Greater sleepiness correlated with higher burnout by means of lower personal accomplishment (r = -1.64; p = 0.0255) and higher emotional exhaustion (r = 0.246; p = 0.0007). Except for tangible support, all other forms of social support showed a small to moderate correlation with lower burnout. CONCLUSIONS: Pediatric critical care medicine fellows in the United States are experiencing high levels of burnout, which appears to be influenced by demographics, fellow perceptions of their work environment, and satisfaction with career choice. The exclusion of fellows at 30% of the programs may have over or underestimated the actual level of burnout in these trainees.

When the Ghosts Live in the Nursery: Postpartum Depression and the Grandmother-Mother-Baby Triad in Luzhou, China.

In Luzhou, China, where grandmothers often serve as primary caregivers for infants, the past and the future haunt new mothers suffering from postpartum depression. In this article, I draw upon longitudinal interviews conducted with ten families in Luzhou as part of a larger multi-sited ethnography of postpartum depression and anxiety. I argue that the grandmother-mother-baby triad model of infant care in interior urban China accentuates the pain of depressed postpartum mothers by making it difficult for them to rid their homes of the ghosts of past trauma and lost futures. Mothers resent and fear grandmothers even as they rely on them to care for their babies. Memories of trauma, perceived displacement by the grandmother as the mother figure for their babies, and lack of control over their households and children characterize postpartum mothers' experiences. Mothers primarily blame their mothers-in-law for their unhappiness even as they depend on themselves to "self-adjust."

Assessing Competence in Central Venous Catheter Placement by Pediatric Critical Care Fellows: A National Survey Study.

OBJECTIVES: To describe the current approach to initial training, ongoing skill maintenance, and assessment of competence in central venous catheter placement by pediatric critical care medicine fellows, a subset of trainees in whom this skill is required. DESIGN: Cross-sectional internet-based survey with deliberate sampling. SETTING: United States pediatric critical care medicine fellowship programs. SUBJECTS: Pediatric critical care medicine program directors of Accreditation Council for Graduate Medical Education-accredited fellowship programs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A working group of the Education in Pediatric Intensive Care Investigators research collaborative conducted a national study to assess the degree of standardization of training and competence assessment of central venous catheter placement across pediatric critical care medicine fellowship programs. After piloting, the survey was sent to all program directors (n = 67) of Accreditation Council for Graduate Medical Education-accredited pediatric critical care medicine programs between July 2017 and September 2017. The response rate was 85% (57/67). Although 98% of programs provide formalized central venous catheter placement training for first-year fellows, only 42% of programs provide ongoing maintenance training as part of fellowship. Over half (55%) of programs use a global assessment tool and 33% use a checklist-based tool when evaluating fellow central venous catheter placement competence under direct supervision. Only two programs (4%) currently use an assessment tool previously published and validated by the Education in Pediatric Intensive Care group. A majority (82%) of responding program directors believe that a standardized approach to assessment of central venous catheter competency across programs is important. CONCLUSIONS: Despite national mandates for skill competence by many accrediting bodies, no standardized system currently exists across programs for assessing central venous catheter placement. Most pediatric critical care medicine programs use a global assessment and decisions around the ability of a fellow to place a central venous catheter under indirect supervision are largely based upon subjective assessment of performance. Further investigation is needed to determine if this finding is consistent in other specialties/subspecialties, if utilization of standardized assessment methods can improve program directors' abilities to ensure trainee competence in central venous catheter insertion in the setting of variable training approaches, and if these findings are consistent with other procedures across critical care medicine training programs, adult and pediatric.

Quantitative care: Caring for the aggregate in US academic population health sciences.

Academic quantitative population health scientists (AQPHS) in the US care for populations with an ostensibly apolitical set of quantitative methods. This quantitative care has three interconnected components: AQPHS care about populations, they care for their data sets and models, and they care with these models' outputs. In the process their ideals of objectivity compete with, and enable, a moral ideal of political advocacy. Slipping between knowledge and intervention, the "real" and the imagined, and individuals and populations, AQPHS produce knowledge that they hope will change public narratives about marginalized populations. In doing so they draw on ideal types, converting quantitative findings about populations into speculation about individual behavior. AQPHS' ideal types both precede and tautologically reemerge from their science.

H1N1 Is Not a Chinese Virus: the Racialization of People and Viruses in Post-SARS China.

In this article, I trace how the race-making of people, viruses, and the places they share became a powerful means by which Chinese public health professionals made sense of two major infectious outbreaks that threatened to stall or interrupt China's development: the SARS outbreak of 2003 and the H1N1 influenza pandemic of 2009. By inscribing geographical stability onto infected bodies in motion through the languages of race and genetics, Chinese public health professionals sought to constrain the mobility of infection and, in doing so, to contain the symbolic and material threats to China's modernity and development that flu-like infections, and the people who carried and spread them, had come to represent. While SARS in this imaginary became a "Chinese" or "Cantonese" disease, H1N1 became a EuroAmerican disease that, when it reached inside China, adhered more easily to those Chinese who did not quite belong. In constructing this imaginary, public health professionals' racialization of certain groups thought to be infectious joined with the racialization of the infections themselves. H1N1 could not easily infect most Chinese because both the virus and its hosts were racially alien.

Fatalities above 30,000 feet: characterizing pediatric deaths on commercial airline flights worldwide.

OBJECTIVES: We conducted this study to characterize in-flight pediatric fatalities onboard commercial airline flights worldwide and identify patterns that would have been unnoticed through single case analysis of these relative rare events. DESIGN: Retrospective cohort study of pediatric in-flight medical emergencies resulting in fatalities between January 2010 and June 2013. SETTING: A ground-based medical support center providing remote medical support to commercial airlines worldwide. PATIENTS: Children (age 0-18 yr) who experienced a medical emergency resulting in death during a commercial airline flight. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were a total of 7,573 in-flight medical emergencies involving children reported to the ground-based medical support center, resulting in 10 deaths (0.13% of all pediatric in-flight emergencies). The median subject age was 3.5 months with 90% being younger than 2 years, the age until which children are allowed to travel sharing a seat with an adult passenger, also known as lap infants. Six patients had no previous medical history, with one suffering cardiorespiratory arrest after developing acute respiratory distress during flight and five found asystolic (including four lap infants). Four subjects had preflight medical conditions, including two children traveling for the purpose of accessing advanced medical care. CONCLUSIONS: Pediatric in-flight fatalities are rare, but death occurs most commonly in infants and in subjects with a preexisting medical condition. The number of fatalities involving seemingly previously healthy children under the age of 2 years (lap infants) is intriguing and could indicate a vulnerable population at increased risk of death related to in-flight environmental factors, sleeping arrangements, or yet another unrecognized factor.

Assessment of Exercise Capacity in Home Healthcare: Differences in Three Self-Paced Tests.

Submaximal functional tests of endurance are ubiquitous in clinical practice. This investigation compared cardiovascular responses, perceived exertion, and performance measures following the completion of three self-paced, 2-minute, functional tests of endurance. A pilot prospective, observational, cross-sectional design with 16 community-dwelling older participants compared heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), rating of perceived exertion (RPE), and performance measures following the completion of three randomly allocated self-paced activities. The three activities included 2 minutes of stepping in standing (2MSTD), 2 minutes of seated stepping (2MSIT), and a 2-minute walk test (2MWT). A within-subjects repeated measures ANOVA analyzed differences in change scores for cardiovascular and RPE responses. Pearson's correlations assessed associations in performance measures between the three tests. Standing stepping compared to seated stepping produced statistically higher change scores in HR, SBP, DBP, and RPE (p < .05). Further, 2MSTD revealed statistically higher SBP and RPE scores compared to 2MWT (p < .05). Large and moderate correlations were observed between number of steps completed in sitting and standing (r = 0.83, p < .01) and between standing steps and distance walked (r = 0.56, p = .02), respectively. This pilot investigation informs home care physical therapists that 2 minutes of self-paced stepping in standing produced the greatest change scores in all cardiovascular and perceived exertion responses. No significant differences were noted in HR between self-paced walking and standing stepping, and between standing and seated stepping. For patients unable to walk or step in standing, self-paced seated stepping may be a viable alternative.

Are pediatric critical care medicine fellowships teaching and evaluating communication and professionalism?

OBJECTIVES: To describe the teaching and evaluation modalities used by pediatric critical care medicine training programs in the areas of professionalism and communication. DESIGN: Cross-sectional national survey. SETTING: Pediatric critical care medicine fellowship programs. SUBJECTS: Pediatric critical care medicine program directors. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Survey response rate was 67% of program directors in the United States, representing educators for 73% of current pediatric critical care medicine fellows. Respondents had a median of 4 years experience, with a median of seven fellows and 12 teaching faculty in their program. Faculty role modeling or direct observation with feedback were the most common modalities used to teach communication. However, six of the eight (75%) required elements of communication evaluated were not specifically taught by all programs. Faculty role modeling was the most commonly used technique to teach professionalism in 44% of the content areas evaluated, and didactics was the technique used in 44% of other professionalism content areas. Thirteen of the 16 required elements of professionalism (81%) were not taught by all programs. Evaluations by members of the healthcare team were used for assessment for both competencies. The use of a specific teaching technique was not related to program size, program director experience, or training in medical education. CONCLUSIONS: A wide range of techniques are currently used within pediatric critical care medicine to teach communication and professionalism, but there are a number of required elements that are not specifically taught by fellowship programs. These areas of deficiency represent opportunities for future investigation and improved education in the important competencies of communication and professionalism.

Unintentional Cannabis Ingestions and Supervisory Neglect.

Unintentional pediatric ingestions of substances can lead to serious and even fatal consequences in children1 and raises concern for supervisory neglect. Supervisory neglect occurs when a caregiver's supervisory decisions or behaviors place a child in their care at significant risk for physical, emotional or psychological harm.2 A caregiver who is taking prescription medication or who uses recreational or therapeutic substances, such as cannabis, must protect children in their care from accessing these potentially harmful drugs. Studies have demonstrated that unintentional cannabis ingestions by children has increased in states that have legalized medical and recreational cannabis.3 Given the changing laws surrounding cannabis in Rhode Island, this study aims to provide a conceptual framework to diagnose, manage and understand supervisory neglect when children present to care with a cannabis ingestion. Additionally, this paper provides guidance for providers to help prevent unintentional cannabis ingestions.

"It's Overwhelming With the Grief" A Qualitative Study of Families' Experiences When a Young Relative Dies of Sudden Cardiac Death.

BACKGROUND: Sudden cardiac death (SCD) in younger individuals is frequently caused by heritable cardiac conditions. The unexpected nature of SCD leaves families with many unanswered questions and an insufficient understanding of the cause of death and their own risk for heritable disease. We explored the experiences of families of young SCD victims upon learning about their relative's cause of death and how they perceive their own risk for heritable cardiac conditions. METHODS: We conducted a qualitative descriptive study, by interviewing families of young (ages 12-45) SCD victims, who died between 2014 and 2018 from a heritable cardiac condition and were investigated by the Office of the Chief Coroner of Ontario, Canada. We used thematic analysis to analyze the transcripts. RESULTS: Between 2018 and 2020, we interviewed 19 family members, of which 10 were males and 9 were females, ages ranging from 21 to 65 (average 46.2±13.1). Four main themes were revealed, each representing a distinct time period that families experience along a trajectory: (1) interactions between bereaved family and others, in particular coroners, shaped their search for answers about their relative's cause of death, with the types, formats, and timing of communication varying by case; (2) searching for answers and processing the cause of death; (3) incidental implications of the SCD event, such as financial strain and lifestyle changes contributed to cumulative stress; (4) receiving answers (or not) and moving forward. CONCLUSIONS: Families rely on communication with others, yet the type, formats, and timing of information received varies, which can influence families' experiences of processing the death (and its cause), their perceived risk and their decision to pursue cascade screening. These results may provide key insights for the interprofessional health care team responsible for the delivery and communication of the cause of death to families of SCD victims.

Blenders, Hammers, and Knives: Postpartum Intrusive Thoughts and Unthinkable Motherhood.

"Intrusive thoughts" are common symptoms of perinatal mood and anxiety disorders such as postpartum obsessive-compulsive disorder. These thoughts can include horrific flashes of violence involving one's baby and frequently lead to shame and fear on the mother's part, but rarely result in real-world violence. Clinicians tend to downplay the importance of these images' content and calm women by reminding them that they will not act on their impulses. This article leans into the dark nature of intrusive thoughts. I intersperse theoretical and ethnographic reflections with vivid fragments of narratives about intrusive thoughts collected from several years of ethnographic research conducted with postpartum women in the United States. I explore the fear, rage, and repulsion that characterize the thoughts themselves and the racism, classism, and sexism involved in clinical, institutional, and interpersonal responses to them. I suggest that dwelling on the "unthinkable" images contained within intrusive thoughts may be important for understanding and accepting the realities of mother love.

New life, new feelings of loss: Journaling new motherhood during Covid-19.

In this article we analyze the longitudinal journals of 32 Pandemic Journaling Project (PJP) participants who were pregnant, planned a pregnancy, or gave birth between January 2020 and July 2021. Employing a grounded theory approach, we coded journals in NVivo for emerging themes related to the influence of the Covid-19 pandemic on perinatal experiences in North America and Europe. In the paper we first provide some brief background on perinatal mental health and on the particular conditions for pregnancy and birth during Covid-19, before introducing major themes that emerged from the data, along with three in-depth case studies. We argue that the new mothers and prospective mothers in our sample associated new life with new feelings of loss during Covid-19. New motherhood during Covid-19 has meant for PJP participants a loss of seemingly irretrievable opportunities and moments that they see as necessary for establishing themselves as mothers and integrating their babies into their families through a process of "kinning" (Howell, 2003). Feelings of loss associated with disruptions to kinning may be partially responsible for the increase in perinatal mental distress observed during the pandemic.

Multidisciplinary Health Care Professionals' Perceptions About Pediatric End of Life Discussions: A Cross-Sectional Survey and Needs Analysis.

BACKGROUND: Pediatric end of life (EOL) care involves complex coordination of providers from multiple disciplines. Many of these providers' experiences have not been completely described. AIM: This study aims to explicate the alignment and divergence of health care professionals' perceptions of the training, timelines, comfort, and effectiveness of pediatric EOL discussions as well as identify methods to improve medical education training. DESIGN: A cross-sectional survey was conducted. Analyses included Fisher's exact and post-hoc tests for all pairwise comparisons. SETTING/PARTICIPANTS: A total of 160 of 508 eligible participants at a single academic Department of Pediatrics completed the survey (response rate 31%). Participants included attending physicians, fellows, residents, mid-level providers, nurses, and social workers. RESULTS: Sixty percent thought EOL discussions occurred late and 70% thought discussions should occur earlier. Attending physicians were more likely to think discussions occurred late and should occur earlier (P <.01). Residents and fellows were more likely to think participating in and leading discussions was stressful (P <.02 and P <.01, respectively). Respondents that were female, younger than forty years old, had been in their provider role less than five years, or were residents and fellows were more likely to agree that these discussions led to changes in plan of patient care (P <.05). CONCLUSIONS: The majority of multidisciplinary pediatric health care professionals believe pediatric EOL discussions are stressful, occur too late, and should occur earlier. Future efforts in medical education should prioritize curriculum development focusing on workshops and simulations.

Introduction: Journaling and Mental Health during COVID-19: Insights from the Pandemic Journaling Project.

In this article, we introduce the SSM-MH Special Issue "Journaling and Mental Health during COVID-19: Insights from the Pandemic Journaling Project," which presents findings from the Pandemic Journaling Project (PJP). PJP is an online journaling platform and mixed-methods research study created in May 2020 to provide ordinary people around the world an opportunity to chronicle the impact of the COVID-19 pandemic in their lives-for themselves and for posterity. The essays in this collection demonstrate how journaling via an online platform can help illuminate experiences of mental wellbeing and distress, with important implications for both research and clinical practice. We begin by introducing the Pandemic Journaling Project and describing our procedures for generating the data subsets analyzed in the papers collected here. We then outline the principal interventions of the special issue as a whole, introduce the papers, and identify a number of cross-cutting themes and broader contributions. Finally, we point toward key questions for future research and therapeutic practice by highlighting the three-fold value of online journaling as a research method, a therapeutic strategy, and a tool for advancing social justice. We focus in particular on how this innovative methodological approach holds promise as both a modality for psychotherapeutic intervention and a form of grassroots collaborative ethnography. We suggest that our methods create new opportunities for confronting the impact of pandemics and other large-scale events that generate radical social change and affect population-level mental health.