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The minimal group effect, in which people prefer ingroup members to outgroup members even when group membership is trivially constructed, has been studied extensively in psychological science. Despite a large body of literature on this phenomenon, concerns persist regarding previous developmental research populations that are small and lack racial/ethnic diversity. In addition, it remains unclear what role holding membership within and interacting with specific racial/ethnic groups plays in the development of children's group attitudes. Using a collaborative multi-site study approach, we measured 4- to 6-year-old children's (N = 716 across five regions in the United States; 47.1% girls; 40.5% White, 13.3% Black, 12.6% Asian, 24.6% Latine, 9.2% multiracial) minimal group attitudes and preference for real-world racial/ethnic ingroups and outgroups. We found that, as a whole, the minimal group effect was observed in the total sample, and no significant differences were found between racial/ethnic groups; yet exploratory analyses revealed that the minimal group effect was most strongly displayed among older children compared with younger children and, when considered separately, was more clearly present in some racial/ethnic groups (White) but not so in others (Black). In addition, there was no relationship between children's minimal group attitudes and racial group preferences, suggesting that factors other than ingroup/outgroup thinking may influence young children's racial bias. Taken together, results highlight the continued need for large and racially diverse samples to inform and test the generalizability of existing influential psychological theories., (Copyright © 2024 Elsevier Inc. All rights reserved.)

When adult men are made to feel gender-atypical, they often lash out with aggression, particularly when they are pressured (vs. autonomously motivated) to be gender-typical. Here, we examined the development of this phenomenon. Specifically, we provided a first experimental test of whether threatening adolescent boys' perceived gender typicality elicits aggression as a function of their pressured (vs. autonomous) motivation to be gender-typical. We also investigated whether this causal link emerges as a function of boys' chronological age versus pubertal development. Participants were a geographically diverse sample of 207 adolescent US boys (ages 10-14; 23.2% boys of color) and one of their parents. Boys played a "game" and received randomly-assigned feedback that their score was atypical versus typical of their gender. For boys in mid-to-late puberty (but not before), feedback that they are gender-atypical predicted an aggressive reaction, particularly among boys whose motivation to be gender-typical was pressured (vs. autonomous). Next, we explored which aspects of boys' social environments predicted their pressured motivation to be gender-typical. Boys' pressured motivation was positively correlated with their perceptions that their parents and peers would be "upset" if they deviated from gender norms, as well as with their parents' endorsement of so-called hegemonic beliefs about masculinity (i.e., that men should hold power over women). Parents with these beliefs resided in more conservative areas, had less formal education, and had lower incomes. Our results inform theorizing on gender identity development and lay the foundation for mitigating the harmful effects of gender typicality threat among adult men. RESEARCH HIGHLIGHTS: Similar to young adult men, adolescent boys in mid-to-late puberty (but not before) responded with aggression to perceived threats to their gender typicality. Aggression was heightened among boys whose motivation to be gender-typical was pressured (i.e., driven by social expectations) rather than autonomous. Which boys showed pressured motivation? Those whose parents endorsed hegemonic beliefs about masculinity (e.g., that men should have more power than people of other genders). Hegemonic beliefs about masculinity were strongest among parents who resided in more conservative US counties, had less formal education, and had lower incomes., (© 2024 John Wiley & Sons Ltd.)

Objective: Teleneonatology, the use of telemedicine for newborn resuscitation and care, can connect experienced care providers with high-risk deliveries. In a simulated resuscitation, we hypothesized that teleneonatal resuscitation, compared to usual resuscitation, would reduce the no-flow fraction., Study Design: This was a single-center, randomized simulation trial in which pediatric residents were randomized to teleneonatal or routine resuscitation. The primary outcome was no-flow fraction defined as time without chest compressions divided by the time during which the heart rate was <60. Secondary outcomes included corrective modifications of bag-mask ventilation and times to intubation and epinephrine administration., Results: Fifty-one residents completed the scenario. The no-flow fraction (median [IQR]) was significantly better in the teleneonatal group (0.06[0.05]) compared to the routine resuscitation group (0.07[0.82]); effect (95% CI): -16 (-43 to 0). Participants in the teleneonatal resuscitation group more frequently performed corrective modifications to bag-mask ventilation (60% vs 15%; p < 0.001). Time to intubation (214 s vs 230 s; p = 0.58) and epinephrine (395 s vs 444 s; p = 0.21) were comparable between groups., Conclusions: In this randomized simulation trial of neonatal resuscitation, teleneonatal resuscitation reduced adverse delivery outcomes compared to routine care. Further in hospital evaluation of teleneonatology may substantiate this technology's impact on delivery outcomes., Gov Id: NCT04258722 IMPACT: Whereas telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings, unique challenges include the need for real-time, high-fidelity audio-video communication with a low failure rate. The no-flow fraction, which evaluates the quality of chest compressions when indicated, has been associated with survival in other clinical contexts. We report a reduction in no-flow fraction in neonatal resuscitations supported with telemedicine, in addition to improvements in the quality of neonatal resuscitation. Telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings without direct access to neonatologists., (© 2024. The Author(s).)

Background: Regionalization of pediatric care in the United States was developed to improve care by directing patients to hospitals with optimal pediatric resources and experience, leading to less pediatric-trained providers in medically underserved areas. Children with emergencies, however, continue to present to local general emergency departments (GEDs), where pediatric emergencies are low-frequency, high-risk events., Objective: The goals of this project were to: increase exposure of GEDs in the southeast United States to pediatric emergencies through simulation, assess pediatric emergency clinical care processes with simulation, describe factors associated with readiness including volume of pediatric patients and ED location (urban/rural), and compare these findings to the 2013 National Pediatric Readiness Project., Methods: This prospective in situ simulation study evaluated GED readiness using the Emergency Medical Services for Children Pediatric Readiness Score (PRS) and team performance in caring for 4 simulated pediatric emergencies. Comparisons between GED and pediatric ED (PED) performance and PRS, GED performance, and PRS based on pediatric patient volume and hospital location were evaluated. A Composite Quality Score (CQS) was calculated for each ED., Results: Seventy-five teams from 40 EDs participated (39 GED; 1 PED). The PED had a significantly higher volume of pediatric patients (73,000 vs 4492; P = 0.003). The PRS for GEDs was significantly lower (57% [SD, 17] vs 98%; P = 0.022). The CQSs for all GEDs were significantly lower than the PED (55% vs 87%; P < 0.004). Among GEDs, there was no statistically significant difference in PRS or CQS based on pediatric patient volume, but urban GEDs had significantly higher CQSs versus rural GEDs (59.8% vs 50.6%, P = 0.001)., Conclusions: This study shows a significant disparity in the performance and readiness of GEDs versus a PED in a medically underserved area. More education and better access to resources is needed in these areas to adequately care for critically ill pediatric patients., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Academic Abstract: Manhood is a precarious social status. Under perceived gender identity threat, men are disproportionately likely to enact certain stereotype-consistent responses such as aggression to maintain their gender status. Yet less is known regarding individual variation in men's threat responsiveness-that is, the psychological conditions under which one's masculine identity is more or less "fragile." We propose a novel model of masculine identity whereby masculine norm expectancy generates discrepancy within the self to the extent that rigid norms are internalized as obligational (actual-ought discrepancy) versus aspirational (actual-ideal discrepancy), which predict extrinsic versus intrinsic motivations to reduce these discrepancies, respectively. Under threat, then, extrinsic motivations predict externalized responses (e.g., aggression), and intrinsic motivations elicit internalized responses (e.g., anxiety, shame, self-harm). We also consider the conditions under which masculinity may be less fragile-for example, in contexts with less rigid expectations and among men who reject expectations-as pathways to mitigate adverse masculinity threat-related outcomes., Public Abstract: In many cultures, men prove their manhood by engaging in behaviors that harm themselves and others (e.g., violence, sexism, homophobia), particularly people from marginalized groups. Yet less is known about why some men are more likely than others to enact these masculinity-proving behaviors. The goal of our model is to specify certain conditions under which masculinities become "fragile" and elicit these responses when under threat. We start by describing the rigid expectations men experience-for example, that they are strong and tough. We propose that these expectations cause men to experience different forms of discrepancy within themselves that produce corresponding motivations to reduce these discrepancies. Under threat, motivations driven by others' expectations elicit outward attempts to restore masculine status (e.g., aggression), whereas motivations driven by self-ideals cause internalized responses (e.g., shame, self-harm). We conclude by discussing how to reduce these discrepancies, such as mitigating the rigidity of and encouraging men's resistance to masculinity expectations., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To describe the quality of pediatric resuscitative care in general emergency departments (GEDs) and to determine hospital-level factors associated with higher quality., Methods: Prospective observational study of resuscitative care provided to 3 in situ simulated patients (infant seizure, infant sepsis, and child cardiac arrest) by interprofessional GED teams. A composite quality score (CQS) was measured and the association of this score with modifiable and nonmodifiable hospital-level factors was explored., Results: A median CQS of 62.8 of 100 (interquartile range 50.5-71.1) was noted for 287 resuscitation teams from 175 emergency departments. In the unadjusted analyses, a higher score was associated with the modifiable factor of an affiliation with a pediatric academic medical center (PAMC) and the nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. In the adjusted analyses, a higher CQS was associated with modifiable factors of an affiliation with a PAMC and the designation of both a nurse and physician pediatric emergency care coordinator, and nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. A weak correlation was noted between quality and pediatric readiness scores., Conclusions: A low quality of pediatric resuscitative care, measured using simulation, was noted across a cohort of GEDs. Hospital factors associated with higher quality included: an affiliation with a PAMC, designation of a pediatric emergency care coordinator, higher pediatric volume, and geographic location. A weak correlation was noted between quality and pediatric readiness scores., (Copyright © 2023 by the American Academy of Pediatrics.)

The past generation has seen a dramatic rise in multiracial populations and a consequent increase in exposure to individuals who challenge monolithic racial categories. We examine and compare two potential outcomes of the multiracial population growth that may impact people's racial categorization experience: (a) exposure to racially ambiguous faces that visually challenge the existing categories, and (b) a category that conceptually challenges existing categories (including "biracial" as an option in addition to the monolithic "Black" and "White" categories). Across four studies ( N = 1,810), we found that multiple exposures to faces that are racially ambiguous directly lower essentialist views of race. Moreover, we found that when people consider a category that blurs the line between racial categories (i.e., "biracial"), they become less certain in their racial categorization, which is associated with less race essentialism, as well. Importantly, we found that these two effects happen independently from one another and represent two distinct cognitive processes.

Threatening a man's manhood-but not a woman's womanhood-elicits aggression. In two studies, we found evidence that this aggression is related to the social pressure men experience to "be a man." In Study 1a, we conducted an exploratory factor analysis to isolate participants' ( N = 195; M age = 19.92) differential motivations for conforming to gender norms. Study 1b then showed that pressure to be masculine moderates the relationship between gender identity threat and aggressive cognition for men. In Study 2a, we conducted a confirmatory factor analysis to validate the aforementioned scales with an age-diverse sample of men ( N = 33.16, range = 18-56 years). Study 2b replicated Study 1b, most notably with younger men. In all, these findings reveal one pathway-the pressure men experience to be stereotypically masculine-that elicits aggressive cognition when under threat in a U.S. context.M age = 33.16, range = 18-56 years). Study 2b replicated Study 1b, most notably with younger men. In all, these findings reveal one pathway-the pressure men experience to be stereotypically masculine-that elicits aggressive cognition when under threat in a U.S. context.

Native American/American Indian (NA/AI) and Multiracial people (those who claim multiple racial identities) report notably high alcohol use compared to other racial groups in the United States. Nearly half of the NA/AI population is also Multiracial, yet NA/AI and Multiracial college students report different motivations for drinking alcohol. Therefore, it remains unclear if NA/AI individuals who are also Multiracial are at different risk for alcohol use and negative alcohol-related consequences, and if there are distinct patterns of risk factors in these understudied populations. Because college-aged students are at risk for high levels of alcohol use, this exploratory study used the AlcoholEdu for College™ survey to compare the association between initial drinking age, college location (urban vs. rural), and alcohol use motivations and consequences between monoracial NA/AI (N = 2,363) and Multiracial NA/AI college-aged students (N = 6,172). Monoracial NA/AI students reported higher incidences of alcohol use and alcohol-related problems such as blacking out and missing class, compared to Multiracial NA/AI students. Risk factors like earlier age of drinking onset were more strongly associated with negative consequences for monoracial NA/AI students compared to Multiracial NA/AI students. Despite similar levels of Internal Coping motivations for drinking (e.g., to feel more confident or sure of yourself), monoracial NA/AI students reported drinking more than Multiracial students and experienced more negative drinking-related outcomes. These results suggest Multiracial NA/AI students may draw on protective factors not accessible to monoracial NA/AI students, highlighting the need for interventions tailored to students at highest risk. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objectives: Coaches improve cardiopulmonary (CPR) outcomes in real-world and simulated settings. To explore verbal feedback that targets CPR quality, we used natural language processing (NLP) methodologies on transcripts from a published pediatric randomized trial (coach vs. no coach in simulated CPR). Study objectives included determining any differences by trial arm in (1) overall communication and (2) metrics over minutes of CPR and (3) exploring overall frequencies and temporal patterns according to degrees of CPR excellence., Methods: A human-generated transcription service produced 40 team transcripts. Automated text search with manual review assigned semantic category; word count; and presence of verbal cues for general CPR, compression depth or rate, or positive feedback to transcript utterances. Resulting cue counts per minute (CPM) were corresponded to CPR quality based on compression rate and depth per minute. CPMs were compared across trial arms and over the 18 min of CPR. Adaptation to excellence was analyzed across four patterns of CPR excellence determined by k-shape methods., Results: Overall coached teams experienced more rate-directive, depth-directive, and positive verbal cues compared with noncoached teams. The frequency of coaches' depth cues changed over minutes of CPR, indicating adaptation. In coached teams, the number of depth-directive cues differed among the four patterns of CPR excellence. Noncoached teams experienced fewer utterances by type, with no adaptation over time or to CPR performance., Conclusion: NLP extracted verbal metrics and their patterns in resuscitation sessions provides insight into communication patterns and skills used by CPR coaches and other team members. This could help to further optimize CPR training, feedback, excellence, and outcomes., Competing Interests: The authors have no potential conflicts to disclose., (© 2021 by the Society for Academic Emergency Medicine.)

Objective: Accumulating evidence suggests that the prevalence of eating disorders among Chinese women is a public health concern. Prior studies have drawn linkages between conflicting cultural values, identity confusion, and eating disorder symptomatology, which may be relevant for understanding the rise of eating disorders amidst China's rapid economic and sociocultural transformation. Here, we explore how women's experiences with traditional eating norms and modernizing norms of femininity may shape their food and body attitudes., Method: Chinese young adult women (N = 34; aged 18-22 years) participated in semi-structured interviews focusing on experiences with norms surrounding eating and ideal feminine appearance, perceived conflict between these norms, and their responses to perceived conflict. Interviews were conducted via email (n = 27) or via Skype (n = 7). Participants were not asked about past or present diagnoses of eating disorders. Analysis of responses was guided by the principles of thematic analysis., Results: Women reported encounters with cultural eating norms and feminine appearance norms, and described factors that motivated continued or discontinued adherence to these norms. Women reported strategies of conflict resolution, which resulted in different emotional and behavioral outcomes including eating disorder symptoms., Discussion: Women's experiences with norms surrounding eating and appearance indicate the centrality of these encounters in the formation of individual and interpersonal values. Our findings suggest the importance for clinicians to assist clients in exploring the meanings behind internalized attitudes toward food and body, and to help clients balance interpersonal and individual needs., (© 2020 Wiley Periodicals LLC.)

Objectives: Paediatric cardiopulmonary arrest resuscitation is a critically important skill but infrequently used in clinical practice. Therefore, resuscitation knowledge relies heavily on formal training which is vulnerable to rapid knowledge decay. We evaluate knowledge and skill retention post-training using rapid cycle deliberate practice (RCDP)., Design: Pilot, non-blinded, single-arm study., Setting: Pediatric Simulation Center at Children's of Alabama., Participants: 42 paediatric residents at a large, tertiary care, academic children's hospital were enrolled in this simulation-based resuscitation study., Interventions: Each participant led a 7 min preintervention arrest scenario as a baseline test. After testing, participants were trained individually in the paediatric advanced life support (PALS) skills necessary for resuscitation of a patient in pulseless electrical activity and ventricular fibrillation using RCDP-a simulation method using frequent expert feedback and repeated opportunities for the learner to incorporate new learning. Immediately post-training, participants were retested as leaders of a different paediatric arrest scenario. 3 months post-training participants returned to complete a final simulation scenario., Main Outcome Measures: To evaluate knowledge and skill retention following PALS training., Results: Preintervention data demonstrated poor baseline resident performance with an average PALS score of 52%. Performance improved to 94% immediately post-training and this improvement largely persisted at 3 months, with an average performance of 81%. In addition to improvements in performance, individual skills improved including communication, recognition of rhythms, early chest compressions and rapid administration of epinephrine or defibrillation., Conclusions: RCDP training was associated with significant improvements in resident performance during simulated paediatric resuscitation and high retention of those improvements., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Delayed or inadequate cardiopulmonary resuscitation during cardiopulmonary arrest is associated with adverse resuscitation outcomes in pediatric patients. Therefore, a "First Five Minutes" program was developed to train all inpatient acute care nurses in resuscitation skills. The program focused on steps to take during the first 5 minutes., Objective: To improve response of bedside personnel in the first few minutes of a cardiopulmonary emergency., Methods: A simulation-based in situ educational program was developed that focused on the components of the American Heart Association's "Get With the Guidelines" recommendations. The program was implemented in several phases to improve instruction and focus on necessary skills., Results: The program garnered positive feedback from participants and was deemed helpful in preparing nurses and other staff members to respond to a patient in cardiopulmonary arrest. Time to chest compressions improved after training, and postintervention responses to questions regarding future code performance indicated participant recognition of the priority of the interventions addressed, such as backboard use, timely initiation of chest compressions, and timely administration of medications. Preliminary data show staff improvements in mock code performance., Conclusions: The First Five Minutes program has proved to be a successful educational initiative and is expected to be continued indefinitely, with additional phases incorporated as needed. A rigorous study on best teaching methods for the program is planned., (Copyright© 2020 American Association of Critical-Care Nurses.)

Stereotypes often guide our perceptions of members of social groups. However, research has yet to document what stereotypes may exist for the fastest growing youth demographic in the United States-biracial individuals. Across seven studies ( N = 1,104), we investigate what stereotypes are attributed to various biracial groups, whether biracial individuals are stereotyped as more similar to their lower status monoracial parent group (trait hypodescent), and whether contact moderates these stereotypes. Results provide evidence of some universal biracial stereotypes that are applied to all biracial groups: attractive and not fitting in or belonging. We also find that all biracial groups are attributed a number of unique stereotypes (i.e., which are not associated with their monoracial parent groups). However, across all studies, we find little evidence of trait hypodescent and no evidence that the tendency to engage in trait hypodescent varies as a function of contact.

Competing Interests: Competing interests: None declared.

Early recognition of and prompt intervention for the deteriorating pediatric patient remains paramount in preventing cardiac arrests from occurring outside intensive care units. To decrease these events, we developed a three-part simulation-based blended learning course consisting of a computer-based training module, a simulation scenario, and follow-up in situ scenarios for inpatient nurses. After initiation of the course, our facility has seen a decrease in the number of codes outside critical care areas.