A Bedside Method for Measuring Effects of a Sedative Drug on Cerebral Function in Newborn Infants.

BACKGROUND: Data on the cerebral effects of analgesic and sedative drugs are needed for the development of safe and effective treatments during neonatal intensive care. Electroencephalography (EEG) is an objective, but interpreter-dependent method for monitoring cortical activity. Quantitative computerized analyses might reveal EEG changes otherwise not detectable. METHODS: EEG registrations were retrospectively collected from 21 infants (mean 38.7 gestational weeks; range 27-42) who received dexmedetomidine during neonatal care. The registrations were transformed into computational features and analyzed visually, and with two computational measures quantifying relative and absolute changes in power (range EEG; rEEG) and cortico-cortical synchrony (activation synchrony index; ASI), respectively. RESULTS: The visual assessment did not reveal any drug effects. In rEEG analyses, a negative correlation was found between the baseline and the referential frontal (rho = 0.612, p = 0.006) and parietal (rho = -0.489, p = 0.035) derivations. The change in ASI was negatively correlated to baseline values in the interhemispheric (rho = -0.753; p = 0.001) and frontal comparisons (rho = -0.496; p = 0.038). CONCLUSION: Cerebral effects of dexmedetomidine as determined by EEG in newborn infants are related to cortical activity prior to DEX administration, indicating that higher brain activity levels (higher rEEG) during baseline links to a more pronounced reduction by DEX. The computational measurements indicate drug effects on both overall cortical activity and cortico-cortical communication. These effects were not evident in visual analysis.

Working Under the Gun: A Theoretical Analysis of Stressors Associated With the Re-negotiation of Norms and Control of Work Tasks During COVID-19.

The COVID-19 pandemic has led many of the world's nations to impose numerous preventive and mitigative measures to increase social distance, including various forms of home isolation and quarantine. A central premise for the current paper is that the COVID-19 situation is likely to constitute a massive re-negotiation of social and organizational norms, which may lead to psychological distress at the individual, family and interpersonal level. Virtually overnight, people have to re-define what is expected and deemed appropriate by a given group member in a certain social setting. This goes for all kinds of general social interaction, such as societal, even multinational medical demands on social distancing. Simultaneously it also goes for a sudden, gargantuan re-division of labor in a complex global system. We provide a theoretical analysis of the potential consequences of re-negotiation of norms from the perspective of four sets of psychological theory: Theory of professions; organizational strategic crisis responses; the job-demands-resources model; and theories addressing the interplay between norm violations and psychological distance. From these theories we derive three suggestions that the discussion centers around: (1) The COVID-19 situation leads to a massive re-negotiation of norms related to work, (2) The COVID-19 situation diffuses the demarcation between the various professional arenas and the private sphere, and this diffusion enhances the stress associated with norm conflict, and (3) Norm conflicts are enhanced by digitalization. Our discussion centers on potential stressors associated with the renegotiation of norms, and also includes a few suggestions for practice. For each theoretical suggestion, we give examples of how the suggestion may manifest itself with respect to (a) the work task, (b) the individual's relationship to their leader and/or organization, and (c) interpersonal relationships. We finally point to some theoretical and applied implications.

The use and reporting of neonatal pain scales: a systematic review of randomized trials.

ABSTRACT: The burden of pain in newborn infants has been investigated in numerous studies, but little is known about the appropriateness of the use of pain scales according to the specific type of pain or infant condition. This systematic review aimed to evaluate the reporting of neonatal pain scales in randomized trials. A systematic search up to March 2019 was performed in Embase, PubMed, PsycINFO, CINAHL, Cochrane Library, Scopus, and Luxid. Randomized and quasirandomized trials reporting neonatal pain scales were included. Screening of the studies for inclusion, data extraction, and quality assessment was performed independently by 2 researchers. Of 3718 trials found, 352 with 29,137 infants and 22 published pain scales were included. Most studies (92%) concerned procedural pain, where the most frequently used pain scales were the Premature Infant Pain Profile or Premature Infant Pain Profile-Revised (48%), followed by the Neonatal Infant Pain Scale (23%). Although the Neonatal Infant Pain Scale is validated only for acute pain, it was also the second most used scale for ongoing and postoperative pain (21%). Only in a third of the trials, blinding for those performing the pain assessment was described. In 55 studies (16%), pain scales that were used lacked validation for the specific neonatal population or type of pain. Six validated pain scales were used in 90% of all trials, although not always in the correct population or type of pain. Depending on the type of pain and population of infants included in a study, appropriate scales should be selected. The inappropriate use raises serious concerns about research ethics and use of resources.

Opioids and alpha-2-agonists for analgesia and sedation in newborn infants: protocol of a systematic review.

BACKGROUND: Hospitalized newborn infants may require analgesia and sedation either for the management of procedural pain, during or after surgery, and other painful conditions. The benefits and harms of opioids administered at different doses and routes of administration have been reported in numerous trials and systematic reviews. The use of alpha-2-agonists such as clonidine and dexmedetomidine in newborn infants is more recent, and they might be prescribed to reduce the total amount of opioids which are thought to have more side effects. Moreover, alpha-2-agonists might play an important role in the management of agitation and discomfort. METHODS: We will conduct a systematic review and meta-analysis on the use of opioids, alpha-2-agonists, or the combination of both drugs. We will include randomized controlled trials to assess benefits and harms and observational studies to assess adverse events and pharmacokinetics; preterm and term infants; studies on any opioids or alpha-2-agonists administered for any indication and by any route except spinal, intraosseous, or administration for nerve blocks and wound infusions. The use of opioids or alpha-2-agonists will be compared to no intervention; placebo with normal saline or other non-sedative, non-analgesic drug; control with oral sugar solution or non-pharmacological intervention; same drug of different dose or route; or a different drug (not limiting to opioids and alpha-2-agonists) or combinations of such drugs. The primary outcomes for this review will be all-cause mortality during initial hospitalization and hypotension requiring medical therapy. We will conduct a search in the following databases: The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE, Embase, and CINAHL. Two review authors will independently screen records for inclusion, undertake data abstraction using a data extraction form and assess the risk of bias of all included trials using the Cochrane "Risk of bias" tool. DISCUSSION: This systematic review will summarize and update our knowledge about neonatal analgesia and sedation including pharmacokinetics/pharmacodynamics, and provide a platform for developing evidence-based guidelines that we can immediately apply to our clinical practice. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2020 CRD42020170852.

Why Metacognition Is Not Always Helpful.

In many situations, actively engaging in metacognition may improve cognitive achievement and subjective well-being. However, the potential disadvantages of metacognitive engagement are only rarely communicated in metacognition research. In this paper, I outline three ways in which metacognition may reduce cognitive achievement and psychological well-being. First, metacognition may sometimes actively interfere with task performance. Second, the costs of engaging in metacognitive strategies may under certain circumstances outweigh its benefits. Third, metacognitive judgments or feelings involving a negative self-evaluation may detract from psychological well-being. The main contribution of this paper is to integrate findings from different research traditions in order to illustrate the three suggested ways in which metacognition may be unhelpful. An implication of this overview is that although metacognition is most often beneficial to cognitive achievement and subjective well-being, one should bear in mind that it may also have the opposite effect. It is important for researchers and practitioners to take this potential downside of metacognition into account. Practitioners might find it useful to consider the following three questions that relate to my aforementioned claims: Is the nature of the task such that metacognition could interfere with performance? Is the cognitive demand required by the metacognitive strategy disproportionally large compared to its potential usefulness to cognitive achievement? Does metacognition lead to an unhelpful comparison of oneself to others? The same considerations should be kept in mind when researchers and practitioners communicate the potential implications of research findings in metacognition research to audiences within and beyond the research community.

Clonidine for pain in non-ventilated infants.

BACKGROUND: Critically ill newborn infants undergo a variety of painful procedures or experience a variety of painful conditions during their early life in the neonatal unit. In the critically ill paediatric and neonatal population, clonidine is prescribed as an adjunct to opioids or benzodiazepines aiming to reduce the doses of these drugs that are required for analgesia or sedation, or to facilitate weaning from mechanical ventilation. It has been shown that clonidine premedication might have a positive effect on postoperative pain in children. OBJECTIVES: To assess the benefit and harms of clonidine for the prevention or treatment of procedural pain; postoperative pain; or pain associated with clinical conditions in non-ventilated neonates. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the CENTRAL, MEDLINE via PubMed, Embase, and CINAHL to December 2018. We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. We ran an updated search from 1 January 2018 to 11 March 2020 in CENTRAL via CRS Web, MEDLINE via Ovid, and CINAHL via EBSCOhost. SELECTION CRITERIA: Randomised controlled trials, quasi-randomised controlled trials, and cluster trials comparing clonidine to placebo or no treatment, opioids, paracetamol, dexmedetomidine, or non-pharmacological pain-reducing interventions for the management of procedural pain, postoperative pain, and pain associated with clinical conditions in preterm and term newborns. DATA COLLECTION AND ANALYSIS: Two review authors independently planned to extract data (e.g. number of participants, birth weight, gestational age, modality of administration, and dose of clonidine) and assess the risk of bias (e.g. adequacy of randomisation, blinding, completeness of follow-up). The primary outcome considered was pain: for procedural pain, the mean values of each analgesia scale assessed during the procedure and at one to two hours after the procedure; for postoperative pain and for pain associated with clinical conditions, the mean values of each analgesia scale assessed at 30 minutes, three hours, and 12 hours after the administration of the intervention. We planned to use the GRADE approach to assess the quality of evidence. MAIN RESULTS: Our search strategy yielded 3383 references. Two review authors independently assessed all references for inclusion. We did not find any completed studies for inclusion. We excluded three trials where clonidine was administered for spinal anaesthesia. AUTHORS' CONCLUSIONS: We did not find any studies that met our inclusion criteria and hence there is no evidence to recommend or refute the use of clonidine for the prevention or treatment of procedural or postoperative pain, or pain associated with clinical conditions in neonates.

Improved infrastructure and support needed for paediatric clinical trials in Sweden.

AIM: There is a lack of authorised medicines for paediatric patients and improved drug development is necessary. The aim of this study was to evaluate the need for infrastructure and support for paediatric clinical trials in Sweden. METHODS: A web-based survey was sent to doctors and nurses involved in the care of neonates, children and adolescents assessing the current situation and future needs for paediatric clinical trials in Sweden. Questions regarding premises, competence, organisation, support for paediatric clinical trials and Good Clinical Practice Training were addressed. RESULTS: In total, 137 individuals responded to the survey (109 doctors and 28 nurses). Overall, 61% of the respondents had previous experience of paediatric clinical trials. Some respondents had access to trial units, but only 34% had used the trial unit for support. Half of the responders were interested in recurrent paediatric Good Clinical Practice training. Doctors responded that clinical work often had to be prioritised and emphasised the need for research time. CONCLUSION: This study clearly shows the commitment for clinical trials among doctors and nurses involved in paediatric care in Sweden, but also that administrative, logistic and economic support in a sustainable setting and an expanded national collaboration are needed.

You Must Be Joking! Benign Violations, Power Asymmetry, and Humor in a Broader Social Context.

Violated expectations can indeed be funny, as is acknowledged by incongruity theories of humor. According to the Benign Violation Theory (BVT), something is perceived as humorous when it hits the "sweet spot," where there is not only a violation, but where the violation is also perceived as benign. The BVT specifies how psychological distance plays a central role in determining whether a certain event, joke, or other stimulus is perceived as benign or malign. In line with the aims of this research topic, we specifically address how this "sweet spot" may be influenced by social distance. This form of psychological distance has so far received less attention in the BVT than other forms of distance. First, we argue that the BVT needs to distinguish between different perspectives in a given situation, i.e., between the joke-teller and the joke-listener, and needs to account for the social distance between the two parties as well as between each of them and the joke. Second, we argue that the BVT needs to acknowledge possible power asymmetries between the two parties, and how asymmetries might influence the social distance between the joke-teller and joke-listener, as well as between each of these and the joke. Based on the assumption that power influences social distance, we argue that power asymmetry may explain certain disagreements over whether something is funny. Third, we suggest that cultural differences might influence shared perspectives on what is benign vs. malign, as well as power balance. Thus, cultural differences might have both a direct and an indirect influence on what is perceived as humorous. Finally, we discuss potential implications beyond humor, to other social situations with border zones. Close to the border, there is often disagreement concerning attempted violations of expectations and norms, and concerning their nature as benign or malign. This can for instance occur in sexual harassment, #MeToo, bullying, aggression, abusive supervision, destructive leadership, counterproductive work behavior, organizational citizenship behavior, parenting, and family relations. New understanding of border zones may thus be gained from BVT along with our proposed systematically mismatched judgments which parties could make about attempted benign violations.

Individual variations in fentanyl pharmacokinetics and pharmacodynamics in preterm infants.

AIM: Fentanyl pharmacokinetics and pharmacodynamics are lacking in preterm infants. Our aim was to study these and their relation with a new formulation of fentanyl 5 µg/mL for procedural pain. METHODS: Preterm infants were given 0.5 (n = 20, median gestational age 26.5; range 23.3-34.1 weeks) and 2 µg/kg (n = 8, 27.4; 25.3-30.7 weeks) fentanyl, respectively, before skin-breaking procedures or tracheal intubation. Blood samples were collected after ten minutes, two, four, eight and 24 hours. Physiologic parameters were monitored and pain scores assessed. RESULTS: The median fentanyl concentrations were 0.18, 0.15, 0.15 and 0.57, 0.37, 0.35 ng/mL at 15-31 minutes, two and four hours and the half-lives were 1.6 to 20.5 or 4.1 to 32.6 hours for the low- and high-dose groups, respectively. A significant correlation was seen between weight at study inclusion and half-life (Spearman's r = -0.9, p < 0.001), volume of distribution (r = -0.8, p < 0.01) and clearance (r = -0.9, p < 0.01) in the low-dose group (n = 9). Pain assessment results were not correlated to pharmacokinetic variables. Fentanyl was well tolerated. CONCLUSION: The inter-individual variation of fentanyl pharmacokinetics is large in preterm infants, and the dose of 0.5 µg/kg seems not effective for skin-breaking procedures.

Swedish consensus reached on recording, interpretation and reporting of neonatal continuous simplified electroencephalography that is supported by amplitude-integrated trend analysis.

Continuous monitoring of electroencephalography (EEG), with a focus on amplitude-integrated EEG (aEEG), has been used in neonatal intensive care for decades. A number of systems have been suggested for describing and quantifying aEEG patterns. Extensive full-montage EEG monitoring is used in specialised intensive care units. The American Clinical Neurophysiology Society published recommendations for defining and reporting EEG findings in critically ill adults and infants. Swedish neonatologists and clinical neurophysiologists collaborated to optimise simplified neonatal continuous aEEG and EEG recordings based on these American documents. CONCLUSION: This paper describes the Swedish consensus document produced by those meetings.

Clonidine for sedation and analgesia for neonates receiving mechanical ventilation.

BACKGROUND: Although routine administration of pharmacologic sedation or analgesia during mechanical ventilation in preterm neonates is not recommended, its use in clinical practice remains common. Alpha-2 agonists, mainly clonidine and dexmedetomidine, are used as adjunctive (or alternative) sedative agents alongside opioids and benzodiazepines. Clonidine has not been systematically assessed for use in neonatal sedation during ventilation. OBJECTIVES: To assess whether clonidine administered to term and preterm newborn infants receiving mechanical ventilation reduces morbidity and mortality rates. To compare the intervention versus placebo, no treatment, and dexmedetomidine; and to assess the safety of clonidine infusion for potential harms.To perform subgroup analyses according to gestational age; birth weight; administration method (infusion or bolus therapy); dose, duration, and route of clonidine administration; and pharmacologic sedation as a co-intervention. SEARCH METHODS: We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 12) in the Cochrane Library, MEDLINE via PubMed (1966 to January 10, 2017), Embase (1980 to January 10, 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to January 10, 2017). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. SELECTION CRITERIA: We searched for randomized controlled trials, quasi-randomized controlled trials, and cluster trials comparing clonidine versus placebo, no treatment, or dexmedetomidine administered to term and preterm newborns receiving mechanical ventilation via an endotracheal tube. DATA COLLECTION AND ANALYSIS: For the included trial, two review authors independently extracted data (e.g. number of participants, birth weight, gestational age, all-cause death during initial hospitalization, duration of respiratory support, sedation scale, duration of hospital stay) and assessed risk of bias (e.g. adequacy of randomization, blinding, completeness of follow-up). This review considered primary outcomes of all-cause neonatal death, all-cause death during initial hospitalization, and duration of mechanical ventilation in days. MAIN RESULTS: One trial, which included 112 infants, met the inclusion criteria for this review. Term newborn infants on mechanical ventilation with the need for continuous analgesia and sedation with fentanyl and midazolam were eligible for enrollment during the first 96 hours of ventilation. Study authors administered clonidine 1 µg/kg/h or placebo on day 4 after intubation.We found no differences between the two groups in all-cause death during hospitalization (risk ratio [RR] 0.69, 95% confidence interval [CI] 0.12 to 3.98). The quality of the evidence supporting these findings is low owing to imprecision of the estimates (one study; few events). The median (interquartile range) duration of mechanical ventilation was 7.1 days (5.7 to 9.1 days) in the clonidine group and 5.8 days (4.9 to 7.9 days) in the placebo group, respectively (P = 0.070). Among secondary outcomes, we found no differences in terms of duration of stay in the intensive care unit. Sedation scale values (COMFORT) and analgesia scores (Hartwig) during the first 72 hours of infusion of study medication were lower in the clonidine group than in the placebo group. AUTHORS' CONCLUSIONS: At present, evidence is insufficient to show the efficacy and safety of clonidine for sedation and analgesia in term and preterm newborn infants receiving mechanical ventilation.

Metacognition and Mindfulness: the Role of Fringe Consciousness.

The involvement of metacognition in mindfulness is already acknowledged in recent mindfulness models. The focus of the current paper is on how mindfulness may be seen to involve a particular subcategory of metacognitive feeling referred to as fringe consciousness. Fringe feelings are in themselves consciously experienced but have been demonstrated to reflect nonconscious context information and are assumed to play a functional role in metacognitive monitoring and behavioral control. I first address ways in which metaexperiences during mindfulness may be seen as a variety of fringe consciousness. I then turn to how mindfulness practice may change a person's attitude to fringe feelings, which in turn may influence the ease with which currently unconscious cognitive content may be retrieved. Finally, I specifically discuss how feelings of novelty, described by many as characteristic of a mindful state, may be understood within the fringe consciousness framework. I propose that fringe consciousness may be a useful framework for understanding the relationship between cognition and certain forms of subjective feelings during mindfulness.

Intuitive Feelings of Warmth and Confidence in Insight and Noninsight Problem Solving of Magic Tricks.

The focus of the current study is on intuitive feelings of insight during problem solving and the extent to which such feelings are predictive of successful problem solving. We report the results from an experiment (N = 51) that applied a procedure where the to-be-solved problems were 32 short (15 s) video recordings of magic tricks. The procedure included metacognitive ratings similar to the "warmth ratings" previously used by Metcalfe and colleagues, as well as confidence ratings. At regular intervals during problem solving, participants indicated the perceived closeness to the correct solution. Participants also indicated directly whether each problem was solved by insight or not. Problems that people claimed were solved by insight were characterized by higher accuracy and higher confidence than noninsight solutions. There was no difference between the two types of solution in warmth ratings, however. Confidence ratings were more strongly associated with solution accuracy for noninsight than insight trials. Moreover, for insight trials the participants were more likely to repeat their incorrect solutions on a subsequent recognition test. The results have implications for understanding people's metacognitive awareness of the cognitive processes involved in problem solving. They also have general implications for our understanding of how intuition and insight are related.

The Relationship between Feelings-of-Knowing and Partial Knowledge for General Knowledge Questions.

Feelings of knowing (FoK) are introspective self-report ratings of the felt likelihood that one will be able to recognize a currently unrecallable memory target. Previous studies have shown that FoKs are influenced by retrieved fragment knowledge related to the target, which is compatible with the accessibility hypothesis that FoK is partly based on currently activated partial knowledge about the memory target. However, previous results have been inconsistent as to whether or not FoKs are influenced by the accuracy of such information. In our study (N = 26), we used a recall-judge-recognize procedure where stimuli were general knowledge questions. The measure of partial knowledge was wider than those applied previously, and FoK was measured before rather than after partial knowledge. The accuracy of reported partial knowledge was positively related to subsequent recognition accuracy, and FoK only predicted recognition on trials where there was correct partial knowledge. Importantly, FoK was positively related to the amount of correct partial knowledge, but did not show a similar incremental relation with incorrect knowledge.

Studying Different Tasks of Implicit Learning across Multiple Test Sessions Conducted on the Web.

Implicit learning is usually studied through individual performance on a single task, with the most common tasks being the Serial Reaction Time (SRT) task, the Dynamic System Control (DSC) task, and Artificial Grammar Learning (AGL). Few attempts have been made to compare performance across different implicit learning tasks within the same study. The current study was designed to explore the relationship between performance on the DSC Sugar factory task and the Alternating Serial Reaction Time (ASRT) task. We also addressed another limitation of traditional implicit learning experiments, namely that implicit learning is usually studied in laboratory settings over a restricted time span lasting for less than an hour. In everyday situations, implicit learning is assumed to involve a gradual accumulation of knowledge across several learning episodes over a longer time span. One way to increase the ecological validity of implicit learning experiments could be to present the learning material repeatedly across shorter test sessions. This can most easily be done by using a web-based setup in which participants can access the material from home. We therefore created an online web-based system for measuring implicit learning that could be administered in either single or multiple sessions. Participants (n = 66) were assigned to either a single session or a multiple session condition. Learning occurred on both tasks, and awareness measures suggested that acquired knowledge was not fully conscious on either of the tasks. Learning and the degree of conscious awareness of the learned regularities were compared across conditions and tasks. On the DSC task, performance was not affected by whether learning had taken place in one or over multiple sessions. On the ASRT task, RT improvement across blocks was larger in the multiple-session condition. Learning in the two tasks was not related.

The relationship between strategic control and conscious structural knowledge in artificial grammar learning.

We address Jacoby's (1991) proposal that strategic control over knowledge requires conscious awareness of that knowledge. In a two-grammar artificial grammar learning experiment all participants were trained on two grammars, consisting of a regularity in letter sequences, while two other dimensions (colours and fonts) varied randomly. Strategic control was measured as the ability to selectively apply the grammars during classification. For each classification, participants also made a combined judgement of (a) decision strategy and (b) relevant stimulus dimension. Strategic control was found for all types of decision strategy, including trials where participants claimed to lack conscious structural knowledge. However, strong evidence of strategic control only occurred when participants knew or guessed that the letter dimension was relevant, suggesting that strategic control might be associated with - or even causally requires - global awareness of the nature of the rules even though it does not require detailed knowledge of their content.

The Concept of "Metaemotion": What is There to Learn From Research on Metacognition?

We first present a selection of vignette examples from empirical psychological research to illustrate how the phenomenon of metaemotion (Gottman, Katz, & Hooven, 1996; Mendonça, 2013) is studied within different domains of psychology. We then present a theoretical distinction which has been made between three facets of metacognition, namely metacognitive experiences, metacognitive knowledge, and metacognitive strategies (e.g., Efklides, 2008; Flavell, 1979). Referring back to the vignette examples from metaemotion research, we argue that a similar distinction can be drawn between three facets of metaemotion, namely metaemotional experiences, metaemotional knowledge, and metaemotional strategies. We argue that this distinction clarifies some of the unresolved issues in metaemotion research, and therefore has important implications for the study of metaemotion, both methodologically and theoretically.

Genetic Predisposition to Poor Opioid Response in Preterm Infants: Impact of KCNJ6 and COMT Polymorphisms on Pain Relief After Endotracheal Intubation.

BACKGROUND: Single-nucleotide polymorphisms in genes involved in pain control might predispose to exaggerated sensitivity or difference in opioid analgesic effect. The relevance of the KCNJ6 -1250G>A (rs6517442, c.-1787G>A) and the catecholamine-O-methyltransferase (COMT) c.472G>A (rs4680, ValMet) single-nucleotide polymorphisms were studied in preterm infants needing intubation and randomized to a premedication strategy including remifentanil (n = 17) or morphine (n = 17). METHODS: Pain was scored with Astrid Lindgren and Lund Children's Hospital Pain Assessment Scale every 30 minutes for 6 hours. The pain relief provided by the opioids was compared between the different KCNJ6 and COMT genotypes. RESULTS: Infants homozygous for the KCNJ6 -1250A allele had an increased duration after intubation to achieve a score indicating no pain compared with infants with the A/G or G/G genotypes (182 ± 30, 109 ± 29, and 60 ± 21 minutes, respectively; Logrank = 7.5, P = 0.006). Similarly, the duration was increased in individuals with the COMT Val/Val alleles compared with Val/Met and Met/Met (285 ± 37, 137 ± 25, and 63 ± 15 minutes, respectively; Logrank = 14.4, P = 0.0021). Cox proportional hazards analysis confirmed that the variation in both genes was independently associated with susceptibility to respond to therapy. CONCLUSION: We conclude that the KCNJ6 -1250A and COMT Val alleles are predisposing preterm newborns to diminished opioid-induced pain relief.

Perceived Mortality and Perceived Morality: Perceptions of Value-Orientation Are More Likely When a Decision Is Preceded by a Mortality Reminder.

The questions addressed in this paper are whether and how reported mortality reminders can function as an indication of sincerity when communicating ambiguously motivated decisions. In two experiments, participants were exposed to a fictitious CEO who announced a decision to implement new organizational measures that were both environmentally and financially beneficial. In the experimental condition, the CEO attributed her new ideas to a recent mortality reminder. In the active control condition, the CEO attributed her decision to a non-lethal dentistry health scare, and in the passive control condition the CEO did not give any account of events preceding her decision. When a CEO implemented new corporate initiatives after a mortality reminder, her motivation for doing so was perceived as somewhat more motivated by intrinsic values, and significantly less motivated by financial gains. This change in attribution patterns was demonstrated to be indirectly related to a positive evaluation of the CEO, as well as an increased willingness to pay for the organization's services. The second experiment further demonstrated that the reduced attribution to financial motivation associated with mortality awareness persisted even when the CEO in question was known for placing a high personal priority on financial goal attainment. The findings underscore the importance of perceived value-oriented motivation when communicating climate change mitigating policies, and the role of mortality awareness as one of many ways to induce such attributions.

Measuring strategic control in implicit learning: how and why?

Several methods have been developed for measuring the extent to which implicitly learned knowledge can be applied in a strategic, flexible manner. Examples include generation exclusion tasks in Serial Reaction Time (SRT) learning (Goschke, 1998; Destrebecqz and Cleeremans, 2001) and 2-grammar classification tasks in Artificial Grammar Learning (AGL; Dienes et al., 1995; Norman et al., 2011). Strategic control has traditionally been used as a criterion for determining whether acquired knowledge is conscious or unconscious, or which properties of knowledge are consciously available. In this paper I first summarize existing methods that have been developed for measuring strategic control in the SRT and AGL tasks. I then address some methodological and theoretical questions. Methodological questions concern choice of task, whether the measurement reflects inhibitory control or task switching, and whether or not strategic control should be measured on a trial-by-trial basis. Theoretical questions concern the rationale for including measurement of strategic control, what form of knowledge is strategically controlled, and how strategic control can be combined with subjective awareness measures.