The revised Psychosis Attachment Measure: further psychometric evidence.

PURPOSE: Disorganised attachment is a key concept in understanding the development of psychosis. However, existing questionnaires of adult attachment do not adequately measure this construct hindering future research into the psychosocial causes of psychosis. The most widely measure of adult attachment in people experiencing psychosis is the Psychosis Attachment Measure (PAM). The measure has recently been revised to include disorganised attachment items. This study develops previous research by providing a rigorous examination the psychometric properties of the revised questionnaire (PAM-R). METHODS: A total of 407 participants with self-reported experiences of psychosis completed a battery of questionnaires which included the PAM-R and other measures which were conceptually related to the concept of disorganised attachment. RESULTS: Confirmatory factor analysis (CFA) indicated a three-factor solution with factors corresponding to anxious, avoidant, and disorganised attachment. The majority of the fit statistics were acceptable with the exception of the RMSEA statistic. Internal consistency and test-retest reliability were good for all subscales. The disorganised subscale correlated in expected directions with other measures of attachment, dissociation, trauma, and psychotic experiences. CONCLUSION: The PAM-R is a valid and reliable measure of adult attachment. It is a practical assessment tool for clinicians and researchers to measure insecure and disorganised attachment patterns that is acceptable to people experiencing psychosis.

Self-report measures of secure attachment in adulthood: A systematic review.

BACKGROUND: Secure attachment in adulthood is associated with many markers of adaptive functioning. Valid and reliable self-report measures of attachment security could provide a practical tool to help advance strengths-based research and clinical work. Previous reviews have not specifically examined the psychometric properties of self-report instruments with respect to secure attachment or systematically appraised the methodological quality of relevant validation studies. METHOD: A systematic review was completed in accordance with the COSMIN guidelines for reviews of patient-reported outcome measures. The methodological quality of individual studies was evaluated, and results were rated against criteria for good measurement properties. RESULTS: A total of 40 studies were included in the review, which collectively reported on 24 self-report instruments. The methodological quality of individual studies was variable, and no single instrument was identified as having sufficient evidence of a range of psychometric properties. However, the Attachment Style Questionnaire-Short Form (ASQ-SF), the Cartes-Modèles Individuels de Relations (CAMIR), Cartes-Modèles Individuels de Relations-Reduced (CAMIR-R), and the Psychological Treatment Inventory-Attachment Style Scales (PTI-ASS) had the most robust evidence for the properties assessed. CONCLUSION: Existing self-report measures assessing adult secure attachment have limited psychometric support. More methodologically robust studies of content validity, reliability, measurement invariance, and construct validity in particular are needed.

School Choice, Teachers' Work, and Professional Identity.

Teacher professional identity, or what it means to be a teacher, informs the types of schools teachers seek for work. With the marketization of schools in the US and abroad, teachers' professional identities are changing. However, we know little about how teachers negotiate-and renegotiate-their professional identities during the job search in contexts with school choice, such as charter schools. This study uses qualitative interview data from 46 teachers in San Antonio, Texas, where over 25% of students attend charter schools. Our findings illuminate the job search as a critical juncture where teachers evaluate their professional identity as they make choices about the sector-charter or traditional public school-and/or school organization they prefer. In particular, the choice context legitimated flexibility and fluidity in teachers' professional identity as teachers moved between sectors to find jobs, even if the school did not align with their personal or professional values. We also found that employability and teachers' perception of the job market played an important role in how teachers strategically presented their professional identity on the job search. Findings offer implications for teacher education and teacher workforce policies.

La identidad profesional docente, o lo que significa ser docente, informa los tipos de escuelas que los docentes buscan para trabajar. Con la mercantilización de las escuelas en los EEUU y en el extranjero, las identidades profesionales de los docentes están cambiando. Sin embargo, sabemos poco acerca de cómo los docentes negocian y renegocian sus identidades profesionales durante la búsqueda de empleo en contextos de elección de escuela, como las escuelas chárter. Este estudio utiliza datos de entrevistas cualitativas de 46 maestros en San Antonio, Texas, donde más del 25 % de los estudiantes asisten a escuelas chárter. Nuestros hallazgos iluminan la búsqueda de empleo como un momento crítico en el que los docentes evalúan su identidad profesional al tomar decisiones sobre el sector (escuela pública autónoma o tradicional) y/o la organización escolar que prefieren. En particular, el contexto de elección legitimó la flexibilidad y la fluidez en la identidad profesional de los docentes a medida que los docentes se movían entre sectores para encontrar trabajo, incluso si la escuela no se alineaba con sus valores personales o profesionales. También encontramos que la empleabilidad y la percepción de los docentes sobre el mercado laboral jugaron un papel importante en la forma en que los docentes presentaron estratégicamente su identidad profesional en la búsqueda de empleo. Los hallazgos ofrecen implicaciones para la formación docente y las políticas de fuerza laboral docente.

A identidade profissional do professor, ou o que significa ser professor, informa os tipos de escolas que os professores procuram para trabalhar. Com o marketing das escolas nos EUA e no exterior, as identidades profissionais dos professores estão mudando. No entanto, sabemos pouco sobre como os professores negociam ­ e renegociam ­ suas identidades profissionais durante a busca de emprego em contextos de escolha escolar, como as escolas charter. Este estudo usa dados de entrevistas qualitativas de 46 professores em San Antonio, Texas, onde mais de 25% dos alunos frequentam escolas charter. Nossas descobertas iluminam a busca de emprego como um momento crítico em que os professores avaliam sua identidade profissional ao fazerem escolhas sobre o setor ­ escola charter ou escola pública tradicional ­ e/ou organização escolar de sua preferência. Em particular, o contexto de escolha legitimou flexibilidade e fluidez na identidade profissional dos professores à medida que os professores se desloc avam entre os setores para encontrar emprego, mesmo que a escola não se alinhasse com seus valores pessoais ou profissionais. Constatamos também que a empregabilidade e a percepção dos professores sobre o mercado de trabalho desempenharam um papel importante na forma como os professores apresentaram estrategicamente sua identidade profissional na busca de emprego. Os resultados oferecem implicações para as políticas de formação de professores e força de trabalho de professores.

Enteral Nutrition Improves Vital Signs in Children With Bronchiolitis on Noninvasive Ventilation.

OBJECTIVES: In children hospitalized for bronchiolitis, enteral nutrition (EN) practices during noninvasive ventilation (NIV) vary widely. We sought to assess the potential impact of EN by observing changes in physiometric indices (heart rate [HR] and respiratory rate [RR]) before and after EN initiation. METHODS: We performed a retrospective cohort study in children <2 years of age hospitalized for bronchiolitis receiving NIV from 2017 to 2019 in a quaternary ICU. The primary outcome was patient HR and RR before and after EN initiation. Descriptive data included demographics, anthropometrics, comorbidities, NIV parameters, EN characteristics, and general hospital outcomes. Analyses included paired comparative and descriptive statistics. RESULTS: Of the 124 children studied, 85 (69%) were permitted EN at a median of 12 (interquartile range [IQR]: 7 to 29) hours. The route was oral (76.5%), nasogastric (15.3%), or postpyloric (8.2%) and was predominantly started during high-flow nasal cannula (71%) at flow rates of 1 (IQR: 0.7 to 1.4) L/kg per minute. After EN initiation, reductions in the median RR (percentage change: -11 [IQR: -23 to 3]; P < .01) and HR (percentage change: -5 [IQR: -12 to 1]; P < .01) were noted. Those permitted EN were younger (5 [IQR: 2 to 11] vs 11 [IQR: 3 to 17] months; P < .01) and more likely to have bronchopulmonary dysplasia (19% vs 5%; P = .04). Malnutrition rates, comorbidities, admission timing, flow rates, length of stay, and NIV duration did not differ for those provided or not provided EN. No aspiration events were observed. CONCLUSIONS: Reductions between pre- and postprandial RR after EN initiation among children hospitalized for bronchiolitis on NIV were observed without clinically significant aspiration. These findings support existing data that suggest that EN is safe during NIV and may lessen distress in some patients.

Physiometric Response to High-Flow Nasal Cannula Support in Acute Bronchiolitis.

OBJECTIVES: To describe the rate of high-flow nasal cannula (HFNC) nonresponse and paired physiometric responses (changes [∆] in heart rate [HR] and respiratory rate [RR]) before and after HFNC initiation in hospitalized children with bronchiolitis. METHODS: We performed a single-center, prospective descriptive study in a PICU within a quaternary referral center, assessing children aged ≤2 years admitted for bronchiolitis on HFNC from November 2017 to March 2020. We excluded for cystic fibrosis, airway anomalies, pulmonary hypertension, tracheostomy, neuromuscular disease, congenital heart disease, or preadmission intubation. Primary outcomes were paired ∆ and %∆ in HR and RR before and after HFNC initiation. Secondary outcomes were HFNC nonresponse rate (ie, intubation or transition to noninvasive positive pressure ventilation). Analyses included χ2, Student's t, Wilcoxon rank, and paired testing. RESULTS: Of the 172 children studied, 56 (32.6%) experienced HFNC nonresponse at a median of 14.4 (interquartile range: 4.8-36) hours and 11 (6.4%) were intubated. Nonresponders had a greater frequency of bacterial pneumonia, but otherwise no major differences in demographics, comorbidities, or viral pathogens were noted. Responders experienced reductions in both %ΔRR (-17.1% ± 15.8% vs +5.3% ± 22.3%) and %ΔHR (-6.5% ± 10.5% vs 0% ± 10.9%) compared with nonresponders. CONCLUSIONS: In this prospective, observational cohort study, we provide baseline data describing expected physiologic changes after initiation of HFNC for children admitted to the PICU for bronchiolitis. In our descriptive analysis, patients with comorbid bacterial pneumonia appear to be at additional risk for subsequent HFNC nonresponse.