Temperature Management for Comatose Adult Survivors of Cardiac Arrest: A Science Advisory From the American Heart Association.

Targeted temperature management has been a cornerstone of post-cardiac arrest care for patients remaining unresponsive after return of spontaneous circulation since the initial trials in 2002 found that mild therapeutic hypothermia improves neurological outcome. The suggested temperature range expanded in 2015 in response to a large trial finding that outcomes were not better with treatment at 33° C compared with 36° C. In 2021, another large trial was published in which outcomes with temperature control at 33° C were not better than those of patients treated with a strategy of strict normothermia. On the basis of these new data, the International Liaison Committee on Resuscitation and other organizations have altered their treatment recommendations for temperature management after cardiac arrest. The new American Heart Association guidelines on this topic will be introduced in a 2023 focused update. To provide guidance to clinicians while this focused update is forthcoming, the American Heart Association's Emergency Cardiovascular Care Committee convened a writing group to review the TTM2 trial (Hypothermia Versus Normothermia After Out-of-Hospital Cardiac Arrest) in the context of other recent evidence and to present an opinion on how this trial may influence clinical practice. This science advisory was informed by review of the TTM2 trial, consideration of other recent influential studies, and discussion between cardiac arrest experts in the fields of cardiology, critical care, emergency medicine, and neurology. Conclusions presented in this advisory statement do not replace current guidelines but are intended to provide an expert opinion on novel literature that will be incorporated into future guidelines and suggest the opportunity for reassessment of current clinical practice.

From guidelines to clinical practice in care for ischaemic stroke patients: A systematic review and expert opinion.

BACKGROUND AND PURPOSE: Guidelines help physicians to provide optimal care for stroke patients, but implementation is challenging due to the quantity of recommendations. Therefore a practical overview related to applicability of recommendations can be of assistance. METHODS: A systematic review was performed on ischaemic stroke guidelines published in scientific journals, covering the whole acute care process for patients with ischaemic stroke. After data extraction, experts rated the recommendations on dimensions of applicability, that is, actionability, feasibility and validity, on a 9-point Likert scale. Agreement was defined as a score of ≥8 by ≥80% of the experts. RESULTS: Eighteen articles were identified and 48 recommendations were ultimately extracted. Papers were included only if they described the whole acute care process for patients with ischaemic stroke. Data extraction and analysis revealed variation in terms of both content and comprehensiveness of this description. Experts reached agreement on 34 of 48 (70.8%) recommendations in the dimension actionability, for 16 (33.3%) in feasibility and for 15 (31.3%) in validity. Agreement on all three dimensions was reached for seven (14.6%) recommendations: use of a stroke unit, exclusion of intracerebral haemorrhage as differential diagnosis, administration of intravenous thrombolysis, performance of electrocardiography/cardiac evaluation, non-invasive vascular examination, deep venous thrombosis prophylaxis and administration of statins if needed. DISCUSSION AND CONCLUSION: Substantial variation in agreement was revealed on the three dimensions of the applicability of recommendations. This overview can guide stroke physicians in improving the care process and removing barriers where implementation may be hampered by validity and feasibility.

Pharmacotherapy for behavioural manifestations in frontotemporal dementia: An expert consensus from the European Reference Network for Rare Neurological Diseases (ERN-RND).

BACKGROUND AND PURPOSE: Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by pervasive personality and behavioural disturbances with severe impact on patients and caregivers. In current clinical practice, treatment is based on nonpharmacological and pharmacological approaches. Unfortunately, trial-based evidence supporting symptomatic pharmacological treatment for the behavioural disturbances in FTD is scarce despite the significant burden this poses on the patients and caregivers. METHOD: The study examined drug management decisions for several behavioural disturbances in patients with FTD by 21 experts across European expert centres affiliated with the European Reference Network for Rare Neurological Diseases (ERN-RND). RESULTS: The study revealed the highest consensus on drug treatments for physical and verbal aggression, impulsivity and obsessive delusions. Antipsychotics (primarily quetiapine) were recommended for behaviours posing safety risks to both patients and caregivers (aggression, self-injury and self-harm) and nightly unrest. Selective serotonin reuptake inhibitors were recommended for perseverative somatic complaints, rigidity of thought, hyperphagia, loss of empathy and for impulsivity. Trazodone was specifically recommended for motor unrest, mirtazapine for nightly unrest, and bupropion and methylphenidate for apathy. Additionally, bupropion was strongly advised against in 10 out of the 14 behavioural symptoms, emphasizing a clear recommendation against its use in the majority of cases. CONCLUSIONS: The survey data can provide expert guidance that is helpful for healthcare professionals involved in the treatment of behavioural symptoms. Additionally, they offer insights that may inform prioritization and design of therapeutic studies, particularly for existing drugs targeting behavioural disturbances in FTD.

When is it appropriate to ask a question? The role of age, social context, and personality.

How do children decide when it is appropriate to ask a question? In Study 1 (preregistered), 50 4- and 5-year-olds, 50 7- and 8-year-olds, and 100 adults watched vignettes featuring a child who had a question, and participants indicated whether they thought the child should ask the question "right now." Both adults and children endorsed more question-asking to a well-known informant than to an acquaintance and to someone doing nothing than to someone busy working or busy socializing. However, younger children endorsed asking questions to someone who was busy more often than older children and adults. In addition, Big Five personality traits predicted endorsement of question-asking. In Study 2 (preregistered, N = 500), mothers' self-reports showed that children's actual question-asking varied with age, informant activity, and informant familiarity in ways that paralleled the results of Study 1. In Study 3 (N = 100), we examined mothers' responses to their children's question-asking and found that mothers' responses to their children's question-asking varied based on the mother's activity. In addition, mothers high in authoritarianism were less likely to answer their children's questions when they were busy than mothers low in authoritarianism. In sum, across three studies, we found evidence that the age-related decline in children's question-asking to their parents reflects a change in children's reasoning about when it is appropriate to ask a question.

The effect of mood on shaping belief and recollection following false feedback.

The current study examined how mood affects the impact of false feedback on belief and recollection. In a three-session experiment, participants first watched 40 neutral mini videos, which were accompanied by music to induce either a positive or negative mood, or no music. Following a recognition test, they received false feedback to reduce belief in the occurrence of the events displayed in some of the videos (Session 2). This was followed by an immediate memory test and a delayed memory assessment one week later (Session 3). The results revealed that participants in negative mood reported higher belief scores compared to those in positive moods, despite an overall decline in belief scores for all groups following the false feedback. Notably, individuals in negative moods exhibited less reduction in their belief scores after encountering challenges, thereby maintaining a higher accuracy in their testimonies. Over time, a reduction in the clarity of participants' memory recall was observed, which correspondingly reduced their testimony accuracy. This study thus indicates that mood states play a role in shaping belief and memory recall under the influence of false feedback.

An exploration of Italian laypeople's belief in how human memory works.

We present the first study to measure the beliefs held by Italian laypeople about how human memory works, using a newly developed tool: the Italian Memory Belief Questionnaire (IMBQ). Research conducted in other countries has demonstrated that beliefs about memory vary widely between different professional and non-professional groups, indicating that limitations exist regarding the dissemination of empirically researched scientific knowledge. To ascertain what Italian people understand about memory-related topics, including eyewitness testimony, repression of traumatic memories and factors influencing memory recall, 301 native Italian participants completed the IMBQ in Study 1. In Study 2, 346 additional participants completed the IMBQ, alongside various additional measures, to examine the construct validity of our new instrument and investigate socio-demographic predictors of memory beliefs. Exploratory factor analysis in Study 1 identified three distinct belief factors that were present in the dataset: eyewitness and memory reliability, trauma and remembering and aspects that improve remembering. Study 2 partially confirmed this factor structure and found IMBQ scores to correlate with existing memory belief questionnaires. Correlations were also found between the IMBQ subscales and measures of fantasy proneness, but not dissociation. In both studies, many Italian laypeople strongly endorsed the notion that controversial topics (i.e., repression) are possible. Contrastingly, Italian laypeople do appear to understand the conceivable inaccuracies of memory in eyewitness settings. Sex, age and education were shown to predict beliefs about memory. Findings are discussed in relation to the importance of addressing misinformation about memory, especially in clinical and forensic settings.

Clinical perspectives on sampling and processing approaches for the management of infection in diabetic foot ulceration: A qualitative study.

Diabetic foot ulcers (DFUs) often become infected and are treated with antimicrobials, with samples collected to inform care. Swab samples are easier than tissue sampling but report fewer organisms. Compared with culture and sensitivity (C&S) methods, molecular microbiology identifies more organisms. Clinician perspectives on sampling and processing are unknown. We explored clinician perspectives on DFU sampling-tissue samples/wound swabs-and on processing techniques, culture and sensitivity or molecular techniques. The latter provides information on organisms which have not survived transport to the laboratory for culture. We solicited feedback on molecular microbiology reports. Qualitative study using semi-structured interview, with analysis using a Framework approach. CODIFI2 clinicians from UK DFU clinics. Seven consultants agreed to take part. They reported, overall, a preference for tissue samples over swabbing. Clinicians were not confident replacing C&S with molecular microbiology as the approach to reporting was unfamiliar. The study was small and did not recruit any podiatrists or nurses, who may have discipline-specific attitudes or perspectives on DFU care. Both sampling approaches appear to be used by clinicians. Molecular microbiology reports would not be, at present, suitable for replacement of traditional culture and sensitivity.

If you express it in the form of a negation, you can expect an effect similar to misinformation.

The primary goal of the presented research was to investigate how processing post-event information affects memory of details in an event viewed on video. We used two forms of post-event information: classic misinformation (changing or implanting new information into memory) and a new form that involves a correct explicit or implicit negation of the existence of an object in the video. We followed the three-step procedure used in studies on the misinformation effect, with a final memory test that was either immediate or delayed by a week and consisted in indicating which objects appeared in the video. We replicated the misinformation effect. More importantly, in the delayed test condition, both explicitly and implicitly negated objects were falsely recalled more often than unmentioned objects. These results indicate that it is possible to induce negation-related false memories; they also show that memory is impaired by negated post-event information or misleading post-event information.

["Thanks to all this good care, we progressed quickly"]. / « Grâce à tous ces bons soins, nous avons vite progressé ¼.

Sohane and Sélenn are twins and will soon be 6 years old. They had a birth journey often described as unusual, because they were born far too early, at 31 weeks of amenorrhea. Through the pen of their father, they share their testimony with us, looking back on this complicated period of which they were able to keep memories thanks to the photographs and stories of their parents.

In the presence and absence of conflicting testimony, children's selective trust in the in-group informant in moral judgment and knowledge access.

In this study, we assessed whether the trust model formed by children in a moral judgment context with an inaccurate in-group informant affected their corresponding trust model in the knowledge access context and whether conditions (the presence of conflicting testimony: an inaccurate in-group informant paired with an accurate out-group informant; the absence of conflicting testimony: only an inaccurate in-group informant) influenced the trust model. Children aged 3 to 6 years (N = 215; 108 girls) in blue T-shirts as in-group members completed selective trust tasks in the moral judgment and knowledge access contexts. Results for moral judgment showed that children under both conditions were more likely to trust informants based on accurate judgments and gave less consideration to group identity. Results for knowledge access showed that in the presence of conflicting testimony, 3- and 4-year-olds trusted the in-group informant at chance, but 5- and 6-year-olds trusted the accurate informant. In the absence of conflicting testimony, 3- and 4-year-olds agreed more with the inaccurate in-group informant, but 5- and 6-year-olds trusted the in-group informant at chance. The results indicated that older children considered the accuracy of the informant's previous moral judgment for selective trust in the context of knowledge access while ignoring group identity, but that younger children were affected by in-group identity. The study found that 3- to 6-year-olds' trust in inaccurate in-group informants was conditional and that their trust choices appeared to be experimentally conditioned, domain specific, and age differentiated.

Miraculous, magical, or mundane? The development of beliefs about stories with divine, magical, or realistic causation.

Children's naïve theories about causal regularities enable them to differentiate factual narratives describing real events and characters from fictional narratives describing made-up events and characters (Corriveau, Kim, Schwalen, & Harris, Cognition 113 (2): 213-225, 2009). But what happens when children are consistently presented with accounts of miraculous and causally impossible events as real occurrences? Previous research has shown that preschoolers with consistent exposure to religious teaching tend to systematically judge characters involved in fantastical or religious events as real (Corriveau et al., Cognitive Science, 39 (2), 353-382, 2015; Davoodi et al., Developmental Psychology, 52 (2), 221, 2016). In the current study, we extended this line of work by asking about the scope of the impact of religious exposure on children's reality judgments. Specifically, we asked whether this effect is  domain-general or domain-specific. We tested children in Iran, where regular exposure to uniform religious beliefs might influence children's reasoning about possibility in non-religious domains, in addition to the domain of religion. Children with no or minimal schooling (5- to 6-year-olds) and older elementary school students (9- to 10-year-olds) judged the reality status of different kinds of stories, notably realistic, unusual (but nonetheless realistic), religious, and magical stories. We found that while younger children were not systematic in their judgments, older children often judged religious stories as real but rarely judged magical stories as real. This developmental pattern suggests that the impact of religious exposure on children's reality judgments does not extend beyond their reasoning about divine intervention. Children's justifications for their reality judgments provided further support for this domain-specific influence of religious teaching.

Moral expertise revisited.

In recent years, there has been a lively (bio-)ethical debate on the nature of moral expertise and the concept of moral experts. However, there is currently no common ground concerning most issues. Against this background, this paper has two main goals. First, in more general terms, it examines some of the problems concerning moral expertise and experts, with a special focus on moral advice and testimony. Second, it applies the results in the context of medical ethics, especially in the clinical setting. By situating the debate in the clinical setting, one arrives at some important conclusions to better understand the relevant concepts and vital problems in the general discussion on moral expertise and the requirements of who counts as a moral expert.

It is not real until it feels real: Testing a new method for simulation of eyewitness experience with virtual reality technology and equipment.

Laboratory research in the psychology of witness testimony is often criticized for its lack of ecological validity, including the use of unrealistic artificial stimuli to test memory performance. The purpose of our study is to present a method that can provide an intermediary between laboratory research and field studies or naturalistic experiments that are difficult to control and administer. It uses Video-360° technology and virtual reality (VR) equipment, which cuts subjects off from external stimuli and gives them control over the visual field. This can potentially increase the realism of the eyewitness's experience. To test the method, we conducted an experiment comparing the immersion effect, emotional response, and memory performance between subjects who watched a video presenting a mock crime on a head-mounted display (VR goggles; n = 57) and a screen (n = 50). The results suggest that, compared to those who watched the video on a screen, the VR group had a deeper sense of immersion, that is, of being part of the scene presented. At the same time, they were not distracted or cognitively overloaded by the more complex virtual environment, and remembered just as much detail about the crime as those viewing it on the screen. Additionally, we noted significant differences between subjects in ratings of emotions felt during the video. This may suggest that the two formats evoke different types of discrete emotions. Overall, the results confirm the usefulness of the proposed method in witness research.

"The Timeless Explosion of Fantasy's Dream": How State Courts Have Ignored the Supreme Court's Decision in Panetti v. Quarterman.

Multiple states have enacted statutes to govern procedures when a state seeks to execute a person who may be incompetent to understand why s/he is being so punished, an area of the law that has always been riddled with confusion. The Supreme Court, in Panetti v. Quarterman, sought to clarify matters, ruling that a mentally ill defendant had a constitutional right to make a showing that his mental illness "obstruct[ed] a rational understanding of the State's reason for his execution."However, the first empirical studies of how Panetti has been interpreted in federal courts painted a dismal picture. Only a handful of defendants have ever been successful in federal courts in seeking to enforce the Panetti ruling, and the authors of this abstract have characterized the relief ostensibly offered by that case as nothing more than an "illusion" or a "mirage" in a federal context. The issues of believability of experts, allegations of malingering, and "synthetic competency" dominate these decisions.In this paper, we seek to expand this inquiry to determine (1) how defendants in state courts seeking to assert Panetti claims have fared, and (2) the extent to which state statutes have made any meaningful difference in the way such cases have been decided. We also investigate the significance of the fact that the caselaw in this area has totally ignored the teachings of the school of legal thought known as therapeutic jurisprudence and offer some conclusions and recommendations (based on therapeutic jurisprudence principles) that, if implemented, can (at least partially) ameliorate this situation.

Rational transformative decision-making.

According to L. A. Paul (2014), transformative experiences pose a challenge for decision theory, as their subjective value is not epistemically accessible. However, several authors propose that the subjective values of options are often irrelevant to their ranking; in many cases, all we need for rational transformative decision-making are the known non-subjective values. This stance is in conflict with Paul's argument that the subjective value can always swamp the non-subjective value. The approach presented in this paper takes Paul's argument into account and shows how potential swamping can be controlled given that one desires the transformative outcome: If one knows from previous decisions that desired transformative outcomes are associated with positive subjective value and if, in addition, testimony confirms this association for the current decision situation, one can infer that a desired outcome's expected subjective value has a positive valence. Accordingly, one can rationally choose the desired transformative option if its non-subjective value is no lower than the overall value of any other option.

Williamson on conditionals and testimony.

In Suppose and Tell, Williamson makes a new case for the material conditional account. He tries to explain away apparently countervailing data by arguing that these have been misinterpreted because researchers have overlooked the role of heuristics in the processing of conditionals. Cases involving the receipt of apparently conflicting conditionals play an important dialectical role in Williamson's book: they are supposed to provide evidence for the material conditional account as well as for the defeasibility of a key procedure underlying our everyday assessments of conditionals. We argue that they can serve neither of these purposes and that Williamson overestimates the reach of heuristics. We specifically challenge Williamson's assumption that, in the kind of cases centrally at issue in his book, the recipient of conflicting conditionals will typically accept those at face value, even granting Williamson that conditionals can be freely passed among speakers under normal conditions of testimony.

Philosophical producers, philosophical consumers, and the metaphilosophical value of original texts.

In recent years, two competing methodological frameworks have developed in the study of the epistemology of philosophy. The traditional camp, led by experimental philosophy and its allies, has made inferences about the epistemology of philosophy based on the reactions, or intuitions, people have to works of philosophy. In contrast, multiple authors have followed the lead of Deutsch and Cappelen by setting aside experimental data in favor of inferences based on careful examination of the text of notable works of philosophy. In other words, the debate is split between authors focusing on philosophy's consumption and those focusing on philosophy's production. This paper examines the motivation for focusing on original texts and other evidence of philosophy's production and finds it lacking. Drawing upon Hills' distinction between propagation and transmission, I argue that the social epistemology of philosophy does not justify the recent focus on original texts of philosophy. Because the philosophical knowledge of consumers of philosophy is likely inspired by producers of philosophy, as opposed to epistemically grounded in the producers' epistemic states, experimental philosophy had it right all along-if we want to know the epistemic standing of philosophy, we need to look to philosophy's consumers.

[« I believe that children should know how they were conceived ¼]. / « J'ai la conviction que les enfants doivent connaître leur mode de conception ¼.

The decision to become a donor is an altruistic one. It allows infertile couples wishing to have a child to realize their dream. Although there have been developments in recent years concerning the lifting of donor anonymity, there is still progress to be made. Joseph Geantet is one of the people who have chosen to donate sperm. He shares his experience.

[« I was moved by an absolute urgency: I had to know what had always been kept from me ¼]. / « J'étais mû par une urgence absolue: je devais savoir ce qui m'avait toujours été tu ¼.

In certain family configurations, the secrecy of origins is fiercely maintained. The revelation can then occur suddenly, causing a radical upheaval for the person concerned. This is what happened to Alexandre Mercier, who agreed to share his experience with us.

[The search for the origins of the person entrusted to the adoption]. / La quête des origines chez la personne confiée à l'adoption.

This text offers the testimony of a reality sometimes very complex to conceive, that of a person entrusted to adoption who goes in search of his origins. The process seems simple, but it covers many intertwined aspects, which make the quest perilous. The adopted person, his adoptive parents as well as the original ones, will all find themselves embarked on a new page of their history, full of emotions. They will have to tame the result and continue their journey with this new personal baggage.