Neural representations of vicarious rewards are linked to interoception and prosocial behaviour.

Every day we constantly observe other people receiving rewards. Theoretical accounts posit that vicarious reward processing might be linked to people's sensitivity to internal body states (interoception) and facilitates a tendency to act prosocially. However, the neural processes underlying the links between vicarious reward processing, interoception, and prosocial behaviour are poorly understood. Previous research has linked vicarious reward processing to the anterior cingulate gyrus (ACCg) and the anterior insula (AI). Can we predict someone's propensity to be prosocial or to be aware of interoceptive signals from variability in how the ACCg and AI process rewards? Here, participants monitored rewards being delivered to themselves or a stranger during functional magnetic resonance imaging. Later, they performed a task measuring their willingness to exert effort to obtain rewards for others, and a task measuring their propensity to be aware and use interoceptive respiratory signals. Using multivariate similarity analysis, we show that people's willingness to be prosocial is predicted by greater similarity between self and other representations in the ACCg. Moreover, greater dissimilarity in self-other representations in the AI is linked to interoceptive propensity. These findings highlight that vicarious reward is linked to bodily signals in AI, and foster prosocial tendencies through the ACCg.

Coherence and divergence in autonomic-subjective affective space.

A central tenet of many theories of emotion is that emotional states are accompanied by distinct patterns of autonomic activity. However, experimental studies of coherence between subjective and autonomic responses during emotional states provide little evidence of coherence. Crucially, previous studies investigating coherence have either adopted univariate approaches or made limited use of multivariate analytic approaches by investigating subjective and autonomic responses separately. The current study addressed this question using a multivariate dimensional approach to build a common autonomic-subjective affective space incorporating subjective responses and three different autonomic signals (heart rate, skin conductance response, and pupil diameter), measured during an emotion-inducing task, in 51 participants. Results showed that autonomic and subjective responses could be adequately described in a two-dimensional affective space. The first dimension included contributions from subjective and autonomic responses, indicating coherence, while contributions to the second dimension were almost exclusively of autonomic covariance. Thus, while there was a degree of coherence between autonomic and subjective emotional responses, there was substantial structure in autonomic responses that did not covary with subjective emotional experience. This study, therefore, contributes new insights into the relationship between subjective and autonomic emotional responses, and provides a framework for future multimodal emotion research, enabling both hypothesis- and data-driven testing.

Mirror neuron brain regions contribute to identifying actions, but not intentions.

Previous studies have struggled to determine the relationship between mirror neuron brain regions and two distinct "action understanding" processes: identifying actions and identifying the intentions underlying those actions. This may be because the identification of intentions from others' actions requires an initial action identification process. Disruptive transcranial magnetic stimulation was administered to left inferior frontal gyrus (lIFG) during a novel cognitive task to determine which of these "action understanding" processes is subserved by mirror neuron brain regions. Participants identified either the actions performed by observed hand actions or the intentions underlying those actions. The extent to which intention identification was disrupted by lIFG (vs. control site) stimulation was dependent on the level of disruption to action identification. We subsequently performed functional magnetic resonance imaging during the same task. During action identification, responses were widespread within mirror neuron areas including lIFG and inferior parietal lobule. However, no independent responses were found in mirror neuron brain regions during intention identification. Instead, responses occurred in brain regions associated with two distinct mentalizing localizer tasks. This supports an account in which mirror neuron brain regions are involved in an initial action identification process, but the subsequent identification of intentions requires additional processing in mentalizing brain regions.

Equivalent own name bias in autism: An EEG study of the Attentional Blink.

The "Attentional Blink" refers to difficulty in detecting the second of two target stimuli presented in rapid temporal succession. Studies have shown that salient target stimuli, such as one's own name, reduce the magnitude of this effect. Given indications that self-related processing is altered in autism, it is an open question whether this attentional self-bias is reduced in autism. To investigate this, in the current study we utilised an Attentional Blink paradigm involving one's own and others' names, in a group of 24 autistic adults, and 22 neurotypical adults, while measuring EEG. In line with previous studies, the Attentional Blink was reduced when the participant's own name was the second target, with no differences between autistic and neurotypical participants. ERP results show that the effect on the Attentional Blink of one's own name was reflected in increased N2 and P3 amplitudes, for both autistic and nonautistic individuals. This is the first event-related potential study of own-name processing in the context of the Attentional Blink. The results provide evidence of an intact attentional self-bias in autism, both at the behavioural and neural level.

Investigating the sense of agency and its relation to subclinical traits using a novel task.

Tasks measuring the sense of agency often manipulate the predictability of action outcomes by introducing spatial deviation. However, the extent to which spatial predictability of an outcome influences the sense of agency when spatial deviation is controlled for remains untested. We used a novel task to investigate the effect of several factors (action-outcome contingency, spatial deviation, and spatial predictability when controlling for spatial deviation of action outcomes) on the sense of agency. We also investigated trait predictors of metacognition of agency-the degree to which participants' confidence in their agency judgements corresponds to the accuracy of those judgements. Initial and replication samples completed contingency, deviation, and predictability versions of the task. Across samples, participants' sense of agency was impacted by action-outcome contingency and spatial deviation of action outcomes. Manipulation of the spatial predictability of action outcomes did not reliably impact the sense of agency. Metacognition of agency was related to alexithymic traits-higher alexithymia scores were associated with reduced metacognition of agency.

The role of interoception in the overlap between eating disorders and autism: Methodological considerations.

Significant comorbidity has been demonstrated between feeding and eating disorders and autism. Atypical interoception (perception of bodily signals) may, at least in part, be responsible for this association, as it has been implicated in the aetiology of both conditions. However, significant methodological limitations are impeding progress in this area. This paper provides a brief overview of how interoception has been linked to autism and feeding and eating disorders in both adolescent and adult populations before identifying several issues with current measures of interoception. We suggest that methodological issues may be contributing to the inconsistency in the empirical literature, and provide suggestions for future research.

Validation of Gazepoint low-cost eye-tracking and psychophysiology bundle.

Eye-tracking and recording of physiological signals are increasingly used in research within cognitive science and human-computer interaction. For example, gaze position and measures of autonomic arousal, including pupil dilation, skin conductance (SC), and heart rate (HR), provide an indicator of cognitive and physiological processes. The growing popularity of these techniques is partially driven by the emergence of low-cost recording equipment and the proliferation of open-source software for data collection and analysis of such signals. However, the use of new technology requires investigation of its reliability and validation with respect to real-world usage and against established technologies. Accordingly, in two experiments (total N = 69), we assessed the Gazepoint GP3-HD eye-tracker and Gazepoint Biometrics (GPB) system from Gazepoint. We show that the accuracy, precision, and robustness of the eye-tracker are comparable to competing systems. While fixation and saccade events can be reliably extracted, the study of saccade kinematics is affected by the low sampling rate. The GP3-HD is also able to capture psychological effects on pupil dilation in addition to the well-defined pupillary light reflex. Finally, moderate-to-strong correlations between physiological recordings and derived metrics of SC and HR between the GPB and the well-established BIOPAC MP160 support its validity. However, low amplitude of the SC signal obtained from the GPB may reduce sensitivity when separating phasic and tonic components. Similarly, data loss in pulse monitoring may pose difficulties for certain HR variability analyses.

The Oxford Face Matching Test: A non-biased test of the full range of individual differences in face perception.

Tests of face processing are typically designed to identify individuals performing outside of the typical range; either prosopagnosic individuals who exhibit poor face processing ability, or super recognisers, who have superior face processing abilities. Here we describe the development of the Oxford Face Matching Test (OFMT), designed to identify individual differences in face processing across the full range of performance, from prosopagnosia, through the range of typical performance, to super recognisers. Such a test requires items of varying difficulty, but establishing difficulty is problematic when particular populations (e.g., prosopagnosics, individuals with autism spectrum disorder) may use atypical strategies to process faces. If item difficulty is calibrated on neurotypical individuals, then the test may be poorly calibrated for atypical groups, and vice versa. To obtain items of varying difficulty, we used facial recognition algorithms to obtain face pair similarity ratings that are not biased towards specific populations. These face pairs were used as stimuli in the OFMT, and participants were required to judge whether the face images depicted the same individual or different individuals. Across five studies the OFMT was shown to be sensitive to individual differences in the typical population, and in groups of both prosopagnosic individuals and super recognisers. The test-retest reliability of the task was at least equivalent to the Cambridge Face Memory Test and the Glasgow Face Matching Test. Furthermore, results reveal, at least at the group level, that both face perception and face memory are poor in those with prosopagnosia, and are good in super recognisers.

Socio-cognitive processing in people with eating disorders: Computerized tests of mentalizing, empathy and imitation skills.

OBJECTIVE: Eating disorders are psychiatric illnesses characterized by extreme eating behaviors, such as sustained food restriction or loss of control over eating. Symptoms are thought to be maintained by a variety of mechanisms, one of which may be the socio-cognitive impairments associated with eating disorders. While some previous work has addressed socio-cognitive impairments in eating disorders, this work has relied mostly on self-report data. METHOD: Here we employed computerized tests of (a) mentalizing (ability to infer the mental states of others); (b) empathy (the degree to which the emotional states of others can be identified and the degree to which the states of others impact one's own emotional state); and (c) imitation (the degree to which observation of another's actions prompts the performance of those actions); in a group of 78 women with an eating disorder and a matched control group of 66 healthy women. RESULTS: People with eating disorders showed both hyper- and hypo-mentalizing and reduced accuracy of emotional and cognitive mental state inference. They displayed less imitation of observed actions, but no differences in empathy compared to healthy controls. Although anxiety and depressive symptoms had significant effects on mentalizing, most of the observed inter-group differences persisted. DISCUSSION: Women with eating disorders have difficulties mentalizing and imitating observed actions despite intact non-social automatic imitation, compared to healthy controls. These findings provide an indication that intervention modules to strengthen specific areas of social cognition might be helpful to improve patients' social skills.

Predicting and Surviving Prolonged Critical Illness After Congenital Heart Surgery.

OBJECTIVES: Prolonged critical illness after congenital heart surgery disproportionately harms patients and the healthcare system, yet much remains unknown. We aimed to define prolonged critical illness, delineate between nonmodifiable and potentially preventable predictors of prolonged critical illness and prolonged critical illness mortality, and understand the interhospital variation in prolonged critical illness. DESIGN: Observational analysis. SETTING: Pediatric Cardiac Critical Care Consortium clinical registry. PATIENTS: All patients, stratified into neonates (≤28 d) and nonneonates (29 d to 18 yr), admitted to the pediatric cardiac ICU after congenital heart surgery at Pediatric Cardiac Critical Care Consortium hospitals. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 2,419 neonates and 10,687 nonneonates from 22 hospitals. The prolonged critical illness cutoff (90th percentile length of stay) was greater than or equal to 35 and greater than or equal to 10 days for neonates and nonneonates, respectively. Cardiac ICU prolonged critical illness mortality was 24% in neonates and 8% in nonneonates (vs 5% and 0.4%, respectively, in nonprolonged critical illness patients). Multivariable logistic regression identified 10 neonatal and 19 nonneonatal prolonged critical illness predictors within strata and eight predictors of mortality. Only mechanical ventilation days and acute renal failure requiring renal replacement therapy predicted prolonged critical illness and prolonged critical illness mortality in both strata. Approximately 40% of the prolonged critical illness predictors were nonmodifiable (preoperative/patient and operative factors), whereas only one of eight prolonged critical illness mortality predictors was nonmodifiable. The remainders were potentially preventable (postoperative critical care delivery variables and complications). Case-mix-adjusted prolonged critical illness rates were compared across hospitals; six hospitals each had lower- and higher-than-expected prolonged critical illness frequency. CONCLUSIONS: Although many prolonged critical illness predictors are nonmodifiable, we identified several predictors to target for improvement. Furthermore, we observed that complications and prolonged critical care therapy drive prolonged critical illness mortality. Wide variation of prolonged critical illness frequency suggests that identifying practices at hospitals with lower-than-expected prolonged critical illness could lead to broader quality improvement initiatives.

Hemodynamic Impact of Oxygen Desaturation During Tracheal Intubation Among Critically Ill Children With Cyanotic and Noncyanotic Heart Disease.

OBJECTIVES: To determine a level of oxygen desaturation from baseline that is associated with increased risk of tracheal intubation associated events in children with cyanotic and noncyanotic heart disease. DESIGN: Retrospective analysis of prospectively collected data from the National Emergency Airway Registry for Children, an international multicenter quality improvement collaborative for airway management in critically ill children. SETTING: Thirty-eight PICUs from July 2012 to December 2016. PATIENTS: Children with cyanotic and noncyanotic heart disease who underwent tracheal intubation in a pediatric or cardiac ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our exposure of interest was oxygen desaturation measured by a fall in pulse oximetry from baseline after preoxygenation. Primary outcome was the occurrence of hemodynamic tracheal intubation associated events defined as cardiac arrest, hypotension or dysrhythmia. One-thousand nine-hundred ten children (cyanotic, 999; noncyanotic, 911) were included. Patients with cyanotic heart disease who underwent tracheal intubations were younger (p < 0.001) with higher Pediatric Index of Mortality 2 scores (p < 0.001), more likely to have a cardiac surgical diagnosis (p < 0.001), and less likely to have hemodynamic instability (p = 0.009) or neurologic failure as an indication (p = 0.008). Oxygen desaturation was observed more often in children with cyanotic versus noncyanotic heart disease (desaturation of 15% to < 30%: 23% vs 16%, desaturation ≥ 30%: 23% vs 17%; p < 0.001), with no significant difference in occurrence of hemodynamic tracheal intubation associated events (7.5% vs 6.9%; p = 0.618). After adjusting for confounders, oxygen desaturation by 30% or more is associated with increased odds for adverse hemodynamic events (odds ratio, 4.03; 95% CI, 2.12-7.67) for children with cyanotic heart disease and (odds ratio, 3.80; 95% CI, 1.96-7.37) for children with noncyanotic heart disease. CONCLUSIONS: Oxygen desaturation was more commonly observed during tracheal intubation in children with cyanotic versus noncyanotic heart disease. However, hemodynamic tracheal intubation associated event rates were similar. In both groups, oxygen desaturation greater than or equal to 30% was significantly associated with increased occurrence of hemodynamic tracheal intubation associated events.

Crossmodal Classification of Mu Rhythm Activity during Action Observation and Execution Suggests Specificity to Somatosensory Features of Actions.

The alpha mu rhythm (8-13 Hz) has been considered to reflect mirror neuron activity because it is attenuated by both action observation and action execution. The putative link between mirror neuron system activity and the mu rhythm has been used to study the involvement of the mirror system in a wide range of socio-cognitive processes and clinical disorders. However, previous research has failed to convincingly demonstrate the specificity of the mu rhythm, meaning that it is unclear whether the mu rhythm reflects mirror neuron activity. It also remains unclear whether mu rhythm suppression during action observation reflects the processing of motor or tactile information. In an attempt to assess the validity of the mu rhythm as a measure of mirror neuron activity, we used crossmodal pattern classification to assess the specificity of EEG mu rhythm response to action varying in terms of action type (whole-hand or precision grip), concurrent tactile stimulation (stimulation or no stimulation), or object use (transitive or intransitive actions) in 20 human participants. The main results reveal that above-chance crossmodal classification of mu rhythm activity was obtained in the central channels for tactile stimulation and action transitivity but not for action type. Furthermore, traditional univariate analyses applied to the same data were insensitive to differences between conditions. By calling into question the relationship between mirror system activity and the mu rhythm, these results have important implications for the use and interpretation of mu rhythm activity.SIGNIFICANCE STATEMENT The central alpha mu rhythm oscillation is a widely used measure of the human mirror neuron system that has been used to make important claims concerning cognitive functioning in health and in disease. Here, we used a novel multivariate analytical approach to show that crossmodal EEG mu rhythm responses primarily index the somatosensory features of actions, suggesting that the mu rhythm is not a valid measure of mirror neuron activity. Results may lead to the revision of the conclusions of many previous studies using this measure, and to the transition toward a theory of mu rhythm function that is more consistent with current models of sensory processing in the self and in others.

The influence of action-outcome contingency on motivation from control.

The sense of agency is defined as one's sense of control over one's actions and their consequences. A recent theory, the control-based response selection framework (Karsh and Eitam, Motivation from control: a response selection framework. The sense of agency, Oxford University Press, New York, 2015a), suggests that actions associated with a high sense of agency are intrinsically rewarding and thus motivate response selection. Previous studies support this theory by demonstrating that factors impacting on sense of agency (e.g. probability of an outcome following an action) also motivate selection of actions. Here we report a novel test of the control-based response selection framework in the domain of action-outcome contingency. The contingency between actions and their outcome has previously been demonstrated to impact the sense of agency, but its impact on the motivation to perform actions has not yet been examined. Participants were asked to press one of four buttons as randomly as possible. Each of the buttons was assigned a different probability of causing an outcome when pressed. Additionally, a contingency manipulation was employed where the probability of an outcome occurring in the absence of a button press was also varied in blocks throughout the experiment. Results demonstrated a significant influence of contingency on response speed, and a significant effect of probability on response selection, consistent with predictions from the control-based response selection framework. Furthermore, some evidence was observed for a positive correlation between influence of contingency and autistic traits, with individuals with higher autistic traits showing a greater influence of contingency on reaction times. The current findings support the idea that actions associated with an increased sense of agency are intrinsically rewarding, and identify how individual differences may impact on this process.

The Structure of Social Cognition: In(ter)dependence of Sociocognitive Processes.

Social cognition is a topic of enormous interest and much research, but we are far from having an agreed taxonomy or factor structure of relevant processes. The aim of this review is to outline briefly what is known about the structure of social cognition and to suggest how further progress can be made to delineate the in(ter)dependence of core sociocognitive processes. We focus in particular on several processes that have been discussed and tested together in typical and atypical (notably autism spectrum disorder) groups: imitation, biological motion, empathy, and theory of mind. We consider the domain specificity/generality of core processes in social learning, reward, and attention, and we highlight the potential relevance of dual-process theories that distinguish systems for fast/automatic and slow/effortful processing. We conclude with methodological and conceptual suggestions for future progress in uncovering the structure of social cognition.

Quantifying compliance and acceptance through public and private social conformity.

Social conformity is a class of social influence whereby exposure to the attitudes and beliefs of a group causes an individual to alter their own attitudes and beliefs towards those of the group. Compliance and acceptance are varieties of social influence distinguished on the basis of the attitude change brought about. Compliance involves public, but not private conformity, while acceptance occurs when group norms are internalised and conformity is demonstrated both in public and in private. Most contemporary paradigms measuring conformity conflate compliance and acceptance, while the few studies to have addressed this issue have done so using between-subjects designs, decreasing their sensitivity. Here we present a novel task which measures compliance and acceptance on a within-subjects basis. Data from a small sample reveal that compliance and acceptance can co-occur, that compliance is increased with an increasing majority, and demonstrate the usefulness of the task for future studies of conformity.

Frequency of Desaturation and Association With Hemodynamic Adverse Events During Tracheal Intubations in PICUs.

OBJECTIVES: Oxygen desaturation during tracheal intubation is known to be associated with adverse ICU outcomes in critically ill children. We aimed to determine the occurrence and severity of desaturation during tracheal intubations and the association with adverse hemodynamic tracheal intubation-associated events. DESIGN: Retrospective cohort study as a part of the National Emergency Airway Registry for Children Network's quality improvement project from January 2012 to December 2014. SETTING: International PICUs. PATIENTS: Critically ill children younger than 18 years undergoing primary tracheal intubations in the ICUs. INTERVENTIONS: tracheal intubation processes of care and outcomes were prospectively collected using standardized operational definitions. We defined moderate desaturation as oxygen saturation less than 80% and severe desaturation as oxygen saturation less than 70% during tracheal intubation procedures in children with initial oxygen saturation greater than 90% after preoxygenation. Adverse hemodynamic tracheal intubation-associated event was defined as cardiac arrests, hypo or hypertension requiring intervention, and dysrhythmia. MEASUREMENTS AND MAIN RESULTS: A total of 5,498 primary tracheal intubations from 31 ICUs were reported. Moderate desaturation was observed in 19.3% associated with adverse hemodynamic tracheal intubation-associated events (9.8% among children with moderate desaturation vs 4.4% without desaturation; p < 0.001). Severe desaturation was observed in 12.9% of tracheal intubations, also significantly associated with hemodynamic tracheal intubation-associated events. After adjusting for patient, provider, and practice factors, the occurrence of moderate desaturation was independently associated with hemodynamic tracheal intubation-associated events: adjusted odds ratio 1.83 (95% CI, 1.34-2.51; p < 0.001). The occurrence of severe desaturation was also independently associated with hemodynamic tracheal intubation-associated events: adjusted odds ratio 2.16 (95% CI, 1.54-3.04; p < 0.001). Number of tracheal intubation attempts was also significantly associated with the frequency of moderate and severe desaturations (p < 0.001). CONCLUSIONS: In this large tracheal intubation quality improvement database, we found moderate and severe desaturation are reported among 19% and 13% of all tracheal intubation encounters. Moderate and severe desaturations were independently associated with the occurrence of adverse hemodynamic events. Future quality improvement interventions may focus to reduce desaturation events.

Effect of Location on Tracheal Intubation Safety in Cardiac Disease-Are Cardiac ICUs Safer?

OBJECTIVES: Evaluate differences in tracheal intubation-associated events and process variances (i.e., multiple intubation attempts and oxygen desaturation) between pediatric cardiac ICUs and noncardiac PICUs in children with underlying cardiac disease. DESIGN: Retrospective cohort study using a multicenter tracheal intubation quality improvement database (National Emergency Airway Registry for Children). SETTING: Thirty-six PICUs (five cardiac ICUs, 31 noncardiac ICUs) from July 2012 to March 2016. PATIENTS: Children with medical or surgical cardiac disease who underwent intubation in an ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our primary outcome was the rate of any adverse tracheal intubation-associated event. Secondary outcomes were severe tracheal intubation-associated events, multiple tracheal intubation attempt rates, and oxygen desaturation. There were 1,502 tracheal intubations in children with underlying cardiac disease (751 in cardiac ICUs, 751 in noncardiac ICUs) reported. Cardiac ICUs and noncardiac ICUs had similar proportions of patients with surgical cardiac disease. Patients undergoing intubation in cardiac ICUs were younger (median age, 1 mo [interquartile range, 0-6 mo]) compared with noncardiac ICUs (median 3 mo [interquartile range, 1-11 mo]; p < 0.001). Tracheal intubation-associated event rates were not different between cardiac ICUs and noncardiac ICUs (16% vs 19%; adjusted odds ratio, 0.74; 95% CI, 0.54-1.02; p = 0.069). However, in a sensitivity analysis comparing cardiac ICUs with mixed ICUs (i.e., ICUs caring for children with either general pediatric or cardiac diseases), cardiac ICUs had decreased odds of adverse events (adjusted odds ratio, 0.71; 95% CI, 0.52-0.97; p = 0.033). Rates of severe tracheal intubation-associated events and multiple attempts were similar. Desaturations occurred more often during intubation in cardiac ICUs (adjusted odds ratio, 1.61; 95% CI, 1.04-1.15; p = 0.002). CONCLUSIONS: In children with underlying cardiac disease, rates of adverse tracheal intubation-associated events were not lower in cardiac ICUs as compared to noncardiac ICUs, even after adjusting for differences in patient characteristics and care models.

Safety of tracheal intubation in the presence of cardiac disease in paediatric ICUs.

IntroductionChildren with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.Materials and methodsWe sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation. RESULTS: A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease. CONCLUSIONS: The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.

Attentional processes, not implicit mentalizing, mediate performance in a perspective-taking task: Evidence from stimulation of the temporoparietal junction.

Mentalizing is a fundamental process underpinning human social interaction. Claims of the existence of 'implicit mentalizing' represent a fundamental shift in our understanding of this important skill, suggesting that preverbal infants and even animals may be capable of mentalizing. One of the most influential tasks supporting such claims in adults is the dot perspective-taking task, but demonstrations of similar performance on this task for mentalistic and non-mentalistic stimuli have led to the suggestion that this task in fact measures domain-general processes, rather than implicit mentalizing. A mentalizing explanation was supported by fMRI data claiming to show greater activation of brain areas involved in mentalizing, including right temporoparietal junction (rTPJ), when participants made self-perspective judgements in a mentalistic, but not in a non-mentalistic condition, an interpretation subsequently challenged. Here we provide the first causal test of the mentalizing claim using disruptive transcranial magnetic stimulation of rTPJ during self-perspective judgements. We found no evidence for a distinction between mentalistic and non-mentalistic stimuli: stimulation of rTPJ impaired performance on all self-perspective trials, regardless of the mentalistic/non-mentalistic nature of the stimulus. Our data support a domain-general attentional interpretation of performance on the dot perspective-taking task, a role which is subserved by the rTPJ.

Relationship Between Adverse Tracheal Intubation Associated Events and PICU Outcomes.

OBJECTIVE: Tracheal intubation in PICUs is a common procedure often associated with adverse events. The aim of this study is to evaluate the association between immediate events such as tracheal intubation associated events or desaturation and ICU outcomes: length of stay, duration of mechanical ventilation, and mortality. STUDY DESIGN: Prospective cohort study with 35 PICUs using a multicenter tracheal intubation quality improvement database (National Emergency Airway Registry for Children: NEAR4KIDS) from January 2013 to June 2015. Desaturation defined as Spo2 less than 80%. SETTING: PICUs participating in NEAR4KIDS. PATIENTS: All patients less than18 years of age undergoing primary tracheal intubations with ICU outcome data were analyzed. MEASUREMENTS AND MAIN RESULTS: Five thousand five hundred four tracheal intubation encounters with median 108 (interquartile range, 58-229) tracheal intubations per site. At least one tracheal intubation associated event was reported in 892 (16%), with 364 (6.6%) severe tracheal intubation associated events. Infants had a higher frequency of tracheal intubation associated event or desaturation than older patients (48% infants vs 34% for 1-7 yr and 18% for 8-17 yr). In univariate analysis, the occurrence of tracheal intubation associated event or desaturation was associated with a longer mechanical ventilation (5 vs 3 d; p < 0.001) and longer PICU stay (14 vs 11 d; p < 0.001) but not with PICU mortality. The occurrence of severe tracheal intubation associated events was associated with longer mechanical ventilation (5 vs 4 d; p < 0.003), longer PICU stay (15 vs 12 d; p < 0.035), and PICU mortality (19.9% vs 9.6%; p < 0.0001). In multivariable analyses, the occurrence of tracheal intubation associated event or desaturation was significantly associated with longer mechanical ventilation (+12%; 95% CI, 4-21%; p = 0.004), and severe tracheal intubation associated events were independently associated with increased PICU mortality (OR = 1.80; 95% CI, 1.24-2.60; p = 0.002), after adjusted for patient confounders. CONCLUSIONS: Adverse tracheal intubation associated events and desaturations are common and associated with longer mechanical ventilation in critically ill children. Severe tracheal intubation associated events are associated with higher ICU mortality. Potential interventions to decrease tracheal intubation associated events and oxygen desaturation, such as tracheal intubation checklist, use of apneic oxygenation, and video laryngoscopy, may need to be considered to improve ICU outcomes.