Relational Victimization, Characterological Self-Blame, and Adjustment in Young Children.

The associations between relational victimization, self-blame attributions, and internalizing problems in early childhood has not previously been examined. Using a sample of 116 preschool children, average age 44.05 months (SD = 4.23), multiple informants, multiple methods, and a longitudinal design, path analyses were conducted to explore the associations between relational victimization, self-blame attributions (Characterological Self-Blame[CSB] and Behavioral Self-Blame[BSB]), and maladjustment in early childhood. Concurrent significant associations were found between relational victimization and internalizing problems. The initial longitudinal models revealed some significant effects that were consistent with predictions. Importantly, follow-up tests decomposing internalizing problems, indicated that anxiety at Time 1 was positively and significantly associated with CSB at Time 2. Depression at Time 1 was negatively and significantly associated with CSB at Time 2. Implications of this work are discussed.

The development of forms and functions of aggression during early childhood: A temperament-based approach.

This study used a short-term longitudinal design with theoretically derived preregistered hypotheses and analyses to examine the role of temperament in the development of forms (i.e., physical and relational) and functions (i.e., proactive and reactive) of aggressive behavior in early childhood (N = 300, M age = 44.70 months, SD = 4.38, 44% girls). Temperament was measured via behavioral reports of emotional dysregulation, fearlessness/daring, and rule internalization/empathy and, in a subsample that completed a physiological assessment, via skin conductance and respiratory sinus arrhythmia. Emotion dysregulation generally served as a risk factor for all subtypes of aggression, with evidence of stronger associations with reactive as compared to proactive functions of relational aggression for girls. Daring predicted increases in physical aggression, especially among boys, and rule internalization predicted decreases in relational aggression, especially among girls. Rule internalization mediated longitudinal associations between daring and proactive relational aggression for girls. Some evidence also emerged supporting associations between adaptive functioning (i.e., high empathy, high respiratory sinus arrhythmia) and proactive functions of aggression. Findings highlight distinct temperamental risk factors for physical versus relational aggression and provide partial support for gender-linked theories of the development of aggression.

Autonomic nervous system reactivity and preschoolers' social dominance.

The purpose of this study was to investigate the role of skin conductance level reactivity (SCLR) and respiratory sinus arrhythmia reactivity (RSAR) in preschoolers' social dominance, as well as potential gender differences in these associations. Reactivity was assessed in response to viewing videos of social exclusion and a post-aggression discussion. In a community sample of 94 preschool children followed over one calendar year, reactivity to the post-aggression discussion, but not exclusion, video was related to social dominance. Specifically, increased RSAR to the post-aggression discussion video was positively associated with concurrent social dominance for both boys and girls. Longitudinally, for boys only, coactivation (i.e., increases in SCLR accompanied by increases in RSAR) to the post-aggression discussion video, which may reflect dysregulated, emotionally labile reactions to stress, was associated with relatively low levels of social dominance across the course of the year. Overall, findings contribute to a growing literature documenting the role of autonomic reactivity in preschoolers' social adjustment and extend this work to their capacity to achieve and maintain socially dominant positions with peers.

Best Practices for the Implementation and Sustainment of Virtual Health Information System Training: Qualitative Study.

BACKGROUND: The COVID-19 pandemic has necessitated the adoption and implementation of digital technologies to help transform the educational ecosystem and the delivery of care. OBJECTIVE: We sought to understand instructors' and learners' perceptions of the challenges and opportunities faced in implementing health information system virtual training amid the COVID-19 pandemic. METHODS: Semistructured interviews were conducted with education specialists and health care staff who provided or had taken part in a virtual instructor-led training at a large Canadian academic health sciences center. Guided by the Technology Acceptance Model and the Community of Inquiry framework, we analyzed interview transcript themes deductively and inductively. RESULTS: Of the 18 individuals participating in the study, 9 were education specialists, 5 were learners, 3 were program coordinators, and 1 was a senior manager at the Centre for Learning, Innovation, and Simulation. We found 3 predominant themes: adopting a learner-centered approach for a meaningful learning experience, embracing the advances in educational technologies to maximize the transfer of learning, and enhancing the virtual user experience. CONCLUSIONS: This study adds to the literature on designing and implementing virtual training in health care organizations by highlighting the importance of recognizing learners' needs and maximizing the transfer of learning. Findings from this study can be used to help inform the design and development of training strategies to support learners across an organization during the current climate and to ensure changes are sustainable.

Measurement of aggressive behavior in early childhood: A critical analysis using five informants.

Measurement of aggressive behavior in early childhood is unique given that relational aggression is just developing, physical aggression is still prevalent, and both forms of aggression are relatively overt or direct. The current study had three aims. The first aim was to examine the internal reliability, validity, and correspondence of five different assessments of aggressive behavior in early childhood: parent report, teacher report, observer report, child report, and naturalistic school-based observations. The second aim was to test a one- and two-factor model of early childhood aggression using confirmatory factor analysis. The final aim of the study was to investigate gender differences among different reports of aggression. Observations, teacher report, and observer (research assistant) report were collected in the children's school, and parent report and child report were collected in a lab session at one time point (N = 300; 56% male; Mage = 44.86 months, SD = 5.55). Observations were collected using a focal child sampling with continuous recording approach, and previously validated measures were used for the remaining four informants. Results demonstrated that all measures were reliable with the exception of child report of relational aggression, and there was small to strong correspondence among the various informants. In addition, a two-factor structure of aggression provided the best fit to the data, providing evidence for divergence among relational and physical aggression. Finally, there were robust gender differences in physical aggression, but gender differences in relational aggression varied by method. The implications of different types of measurement are discussed.

An Education Framework for Effective Implementation of a Health Information System: Scoping Review.

BACKGROUND: To optimize their use of a new Health Information System (HIS), supporting health care providers require effective HIS education. Failure to provide this education can significantly hinder an organization's HIS implementation and sustainability efforts. OBJECTIVE: The aim of this review is to understand the most effective educational strategies and approaches to enable health care providers to optimally use an HIS. METHODS: Ovid MEDLINE, Ovid Embase, EBSCO Cumulative Index to Nursing and Allied Health Literature, and EBSCO Education Resources Information Center were searched to identify relevant papers. Relevant studies were systematically reviewed and analyzed using a qualitative thematic analysis approach. RESULTS: Of the 3539 studies screened, 17 were included for data extraction. The literature on the most effective approaches to enable health care providers to optimally use an HIS emphasized the importance of investing in engaging and understanding learners in the clinical context, maximizing the transfer of learning to care, and designing continuous and agile evaluation to meet the emerging demands of the clinical environment. CONCLUSIONS: This review supports the advancement of a new HIS learning framework that organizational leaders and educators can use to guide HIS education design and development. Future research should examine how this framework can be translated into practice.

Fatty acid specific δ13C values reveal earliest Mediterranean cheese production 7,200 years ago.

The earliest evidence for cheese production in the Mediterranean is revealed by stable carbon isotope analyses of individual fatty acids in pottery residues from the Dalmatian coast of Croatia. Lipid residue data indicate the presence of milk in the earliest pottery, Impressed Ware, by 5700 cal. BCE (7700 BP). In contrast, by 5200 cal BCE (7200 BP), milk was common in refined Figulina pottery, meat was mostly associated with Danilo ware, cheese occurred in Rhyta, and sieves contained fermented dairy, representing strong links between specific function and stylistically distinctive pottery vessels. Genetic data indicate the prevalence of lactose intolerance among early farming populations. However, young children are lactase persistent until after weaning and could consume milk as a relatively pathogen-free and nutrient rich food source, enhancing their chances of survival into adulthood. Fermentation of milk into yogurt and cheese decreases lactose content. The evidence for fermented dairy products by 5200 cal BCE indicates a larger proportion of the population was able to consume dairy products and benefit from their significant nutritional advantages. We suggest that milk and cheese production among Europe's early farmers reduced infant mortality and helped stimulate demographic shifts that propelled farming communities to expand to northern latitudes.

Core Content for Wilderness Medicine Training: Development of a Wilderness Medicine Track Within an Emergency Medicine Residency.

Wilderness medicine training has become increasingly popular among medical professionals with numerous educational opportunities nationwide. Curricula for fellowship programs and for medical student education have previously been developed and published, but a specific curriculum for wilderness medicine education during emergency medicine (EM) residency has not. The objective of this study is to create a longitudinal wilderness medicine curriculum that can be incorporated into an EM residency program. Interest-specific tracks are becoming increasingly common in EM training. We chose this model to develop our curriculum specific to wilderness medicine. Outlined in the article is a 3-year longitudinal course of study that includes a core didactic curriculum and a plan for graduated level of responsibility. The core content is specifically related to the required EM core content for residency training with additions specific to wilderness medicine for the residents who pursue the track. The wilderness medicine curriculum would give residencies a framework that can be used to foster learning for residents interested in wilderness medicine. It would enhance the coverage of wilderness and environmental core content education for all EM residents in the program. It would provide wilderness-specific education and experience for interested residents, allowing them to align their residency program requirements through a focused area of study and enhancing their curriculum vitae at graduation. Finally, given the popularity of wilderness medicine, the presence of a wilderness medicine track may improve recruitment for the residency program.

Examining co-occurring and pure relational and physical victimization in early childhood.

The current study took a novel approach to examining peer victimization experiences on a continuum in early childhood. A bifactor approach was used to examine co-occurring victimization as well as the relative contribution of subtypes of victimization, including both physical and relational victimization. To date, no known research has examined co-occurring victimization in early childhood. The fit of a bifactor model, as well as the utility of the model in testing associations with internalizing problems, was examined. The short-term longitudinal study (N=231; 109 girls; Mage=47.46months, SD=7.35) found support for a hierarchical structure of victimization, including co-occurrence and "pure" victimization dimensions, in early childhood. Regression analyses supported that both co-occurring victimization and relational victimization were associated with internalizing adjustment outcomes. These associations differed by gender. A bifactor model may be a useful statistical technique to address the common finding of co-occurrence of victimization to better understand peer harassment experiences and risk for adjustment problems.

Relational Aggression, Victimization and Self-Concept: Testing Pathways from Middle Childhood to Adolescence.

When studying adolescent development, it is important to consider two key areas that are salient for teens, which are self-concept and peer relations. A secondary analysis of the National Institute of Health and Human Development Study of Early Child Care and Youth Development was conducted to examine the prospective bidirectional associations between self-concept and peer relations. To date, how social development broadly and peer relations in particular (e.g., relational aggression and victimization) affect self-concept domains is not fully understood. Using a large sample (N = 1063; 532 girls; M = 11.14 years; SD = .59) with multiple informants, the present study examined whether fifth grade relational aggression and sixth grade relational victimization was associated with adolescent self-concept in three key domains (i.e., academic, sports, physical appearance). A significant direct effect emerged, such that relational aggression in middle childhood was associated with decreases in academic self-concept and increases in sports self-concept in adolescence. Analyses also revealed that having higher levels of domain specific self-concept led to decreases in relational aggression across the transition to adolescence. The findings highlight the importance of examining bidirectional prospective associations between relational aggression, relational victimization, and domain specific self-concept. Implications for future research and clinical intervention are discussed.

EMS Intubation Improves with King Vision Video Laryngoscopy.

INTRODUCTION: Intubation success by paramedics has historically been variable. The lack of first-pass success (FPS) has been associated with increased adverse events. Various video laryngoscope (VL) devices have been investigated to improve success among paramedics. Conflicting research exists on VL vs. direct laryngoscopy (DL) by paramedics and on the effects of the specific King Vision device on FPS and overall success (OS) in an emergency medical services (EMS) system with low intubation frequency and historically low success rates. OBJECTIVES: To evaluate the effect of an ongoing training program using the King Vision VL on FPS, OS, and success per attempt when compared with DL in one suburban EMS system with low historical intubation success rates. METHODS: We performed a retrospective analysis of electronic patient care reports in a suburban EMS system. We analyzed three metrics of intubation success before DL and after implementation of ongoing training with VL in both cardiac arrest and in all other indications: success per attempt, overall success, and first-pass success. We also performed an intention to treat analysis of these rates to account for protocol violations. RESULTS: During the study period, intubation was attempted on 514 patients. There was no difference between the DL and VL groups in age, weight, gender, or percentage receiving paralytic medications. There was improvement over DL with VL in each of the outcome measures: overall success (64.9 vs. 91.5%, p < 0.01), first-pass success (43.8% vs. 74.2%, p < 0.01), and success per attempt (44.4 vs. 71.2%, p < 0.01). A subgroup analysis by indication for intubation also showed improvement in all metrics for all indications. There were several protocol violations: 11 of 376 attempts that should have used VL (2.9%) but were done with DL. An intention to treat analysis was therefore done. Again, we saw an improvement in all metrics for all indications. CONCLUSION: In this suburban EMS system with historically low intubation success rates and low frequency of intubation, paramedics were able to improve all measures of intubation success using the King Vision video laryngoscope and an ongoing training program when compared with direct laryngoscopy.

Peer victimization and peer rejection during early childhood.

The development and course of the subtypes of peer victimization is a relatively understudied topic despite the association of victimization with important developmental and clinical outcomes. Moreover, understanding potential predictors, such as peer rejection and emotion regulation, in early childhood may be especially important to elucidate possible bidirectional pathways between relational and physical victimization and rejection. The current study (N = 97) was designed to explore several gaps and limitations in the peer victimization and peer rejection literature. In particular, the prospective associations between relational and physical victimization and peer rejection over the course of 3.5 months during early childhood (i.e., 3 to 5 years old) were investigated in an integrated model. The study consisted of 97 (42 girls) preschool children recruited from four early childhood schools in the northeast of the United States. Using observations, research assistant report, and teacher report, relational and physical aggression, relational and physical victimization, peer rejection, and emotion regulation were measured in a short-term longitudinal study. Path analyses were conducted to test the overall hypothesized model. Peer rejection was found to predict increases in relational victimization. In addition, emotion regulation was found to predict decreases in peer rejection and physical victimization. Implications for research and practice are discussed, including teaching coping strategies for peer rejection and emotional distress.

A gender-balanced approach to the study of peer victimization and aggression subtypes in early childhood.

A short-term longitudinal study during early childhood (N = 301; 155 girls; M = 44.76 months old, SD = 8.20) investigated the prospective associations between peer victimization and aggression subtypes. Specifically, observations of relational and physical victimization as well as teacher reports of the forms (i.e., relational and physical) and functions (i.e., proactive and reactive) of aggression were collected at two time points during an academic year. Within- and between-group gender differences were examined as part of the preliminary analyses. In order to address key study questions, both directions of effect between peer victimization and aggression subtypes were examined. We found that teacher-reported proactive relational aggression predicted decreases in observed relational victimization over time, whereas reactive relational aggression predicted increases in observed relational victimization over time. Ways in which these and other findings extend the literature are discussed.

Language delay and behavioral/emotional problems in toddlers: findings from two developmental clinics.

PURPOSE: The association between language delay and behavior problems in toddlers was examined in 2 studies, 1 conducted in a developmental clinic in New Jersey (Study 1; N = 83) and the other conducted in a developmental clinic in New York (Study 2; N = 103). METHOD: In both clinics, parents of 18- to 35-month-olds completed the Language Development Survey (LDS) and the Child Behavior Checklist/1.5-5 (CBCL). In Study 2, the Preschool Language Scale-Fourth Edition (PLS-4) was also administered. Neurodevelopmental delay (ND) and pervasive developmental disorder (PDD) symptoms were also assessed in both studies but were done so using different measures. RESULTS: In Study 1, LDS Vocabulary score and CBCL Total Problems, Internalizing, and Withdrawn scores were significantly correlated. However, when children with ND and/or suspected PDD were excluded, only the correlation between LDS Vocabulary and Withdrawn remained significant. In Study 2, only the correlation between LDS Vocabulary and Withdrawn approached significance. Children delayed in language on the PLS-4 had higher CBCL scores than typically developing toddlers only on the CBCL Withdrawn syndrome. CONCLUSION: Significant associations between language delays and behavior problems were not found in 2 samples of 18- to 35-month-olds when children with ND and PDD were excluded, except that toddlers with language delays appeared to show elevated social withdrawal relative to typically developing toddlers.