Children's developing ability to recognize deceptive use of true information.

The strategic use of deliberate omissions, conveying true but selective information for deceptive purposes, is a prevalent and pernicious disinformation tactic. Crucially, its recognition requires engaging in a sophisticated, multi-part social cognitive reasoning process. In two preregistered studies, we investigated the development of children's ability to engage in this process and successfully recognize this form of deception, finding that children even as young as 5 years are capable of doing so, but only with sufficient scaffolding. This work highlights the key role that social cognition plays in the ability to recognize the manipulation techniques that underpin disinformation. It suggests that the interrelated development of pragmatic competence and epistemic vigilance can be harnessed in the design of tools and strategies to help bolster psychological resistance against disinformation in even our youngest citizens-children at the outset of formal education.

Factors Associated With Improved Pediatric Resuscitative Care in General Emergency Departments.

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

Trauma-informed and family-centered paediatric resuscitation: Defining domains and practices.

Aim: For paediatric patients and families, resuscitation can be an extremely stressful experience with significant medical and psychological consequences. Psychological sequelae may be reduced when healthcare teams apply patient- and family-centered care and trauma-informed care, yet there are few specific instructions for effective family-centered or trauma-informed behaviours that are observable and teachable. We aimed to develop a framework and tools to address this gap. Methods: We reviewed relevant policy statements, guidelines, and research to define core domains of family-centered and trauma-informed care, and identified observable evidence-based practices in each domain. We refined this list of practices via review of provider/team behaviours in simulated paediatric resuscitation scenarios, then developed and piloted an observational checklist. Results: Six domains were identified: (1) Sharing information with patient and family; (2) Promoting family involvement in care and decisions; (3) Addressing family needs and distress; (4) Addressing child distress; (5) Promoting effective emotional support for child; (6) Practicing developmental and cultural competence. A 71-item observational checklist assessing these domains was feasible for use during video review of paediatric resuscitation. Conclusion: This framework can guide future research and provide tools for training and implementation efforts to improve patient outcomes through patient- and family-centered and trauma-informed care.

Claims of wrongdoing by outgroup members heighten children's ingroup biases.

Little is known about how group bias may impact children's acceptance of unsubstantiated claims. Most children view cheating as unfair. However, in competitive situations, when ambiguity surrounds the potential intention to cheat, group affiliation may lead children to support claims of cheating based solely on the team affiliation of the claimant, even when those claims are not clearly substantiated. Therefore, it may be particularly important to consider the role ingroup bias may play in children's accusations of cheating in a competitive intergroup context. The current study investigated 4-10 year old children's (N = 137, MAge = 6.71 years, SDAge = 1.49; 47 % female) evaluations of ambiguous acts and unverified claims about those acts in a competitive, intergroup context. Results showed that children initially viewed an ambiguous act similarly, regardless of team affiliation, but demonstrated increasing ingroup biases after claims of wrongdoing were introduced. Implications for how unsubstantiated claims may impact intergroup interactions more broadly will be discussed.

Look Again: Pedagogical Demonstration Facilitates Children's Use of Counterevidence.

In learning about the world children must not only make inferences based on minimal evidence, but must deal with conflicting evidence and question those initial inferences when they appear to be wrong. Four experiments (N = 144) found that young children were significantly more likely to revise their initial inferences when conflicting evidence was explicitly demonstrated for them. Four- and five-year-old children saw deterministic evidence about which objects had causal powers, and then saw counterevidence conflicting with that initial pattern. Critically, the conflicting evidence was either demonstrated communicatively and pedagogically, or produced in an intentional but nonpedagogical manner. Only when evidence was explicitly demonstrated for them did children revise their initial hypothesis and use a subtle clue to infer the correct rule.

The Impact of Telemedicine on Teamwork and Workload in Pediatric Resuscitation: A Simulation-Based, Randomized Controlled Study.

BACKGROUND: Telemedicine provides access to specialty care to critically ill patients from a geographic distance. The effects of using telemedicine on (1) teamwork and communication (TC), (2) task workload during resuscitation, and (3) the processes of critical care have not been well described. OBJECTIVES: To evaluate the impact of telemedicine on (1) TC, (2) task workload during a resuscitation, and (3) the processes of critical care during a simulated pediatric resuscitation. METHODS: Prospective single-center randomized trial. Teams of two physicians (senior and junior resident) and two standardized confederate nurses were randomized to either telemedicine (telepresent senior physician team leader) or usual care (both physicians in the room) during a simulated infant resuscitation. Simulations were video recorded and assessed for teamwork, workload, and processes of care using the Simulated Team Assessment Tool (STAT), the NASA Task Load Index (NASA-TLX) tool, and time between onset of ventricular fibrillation and defibrillation, respectively. RESULTS: Twenty teams participated. There was no difference in teamwork between the groups (mean STAT score 72% vs. 69%; p = 0.383); however, there was a significantly greater workload in the telemedicine group (mean TLX score 56% vs. 48%, p = 0.020). Using linear regression, no difference was found in time-to-defibrillation between groups (p = 0.671), but higher teamwork scores predicted faster time to defibrillation (p = 0.020). CONCLUSIONS: In this simulation-based study, a telepresent team leader was associated with increased team workload compared to usual care. However, no differences were noted in teamwork and processes of care metrics.

Children's evaluation of verified and unverified claims.

Critical to children's learning is the ability to judiciously select what information to accept-to use as the basis for learning and inference-and what information to reject. This becomes especially difficult in a world increasingly inundated with information, where children must carefully reason about the process by which claims are made in order to acquire accurate knowledge. In two experiments, we investigated whether 3- to 7-year-old children (N = 120) understand that factual claims based on verified evidence are more acceptable than claims that have not been sufficiently verified. We found that even at preschool age, children evaluated verified claims as more acceptable than insufficiently verified claims, and that the extent to which they did so was related to their explicit understanding, as evident in their explanations of why those claims were more or less acceptable. These experiments lay the groundwork for an important line of research studying the roots and development of this foundational critical thinking skill.

What Do Clinicians Caring for Children Need to Know about Pediatric Medical Traumatic Stress and the Ethics of Trauma-Informed Approaches?

Medical experiences can be frightening and traumatic for children. Ill and injured children can experience pediatric medical traumatic stress-psychological and physiological distress responses related to their medical event and subsequent medical treatment experiences-which can lead to symptoms of posttraumatic stress disorder (PTSD) and suboptimal health outcomes. Trauma-informed care provides a framework for acknowledging, addressing, and mitigating the risks of psychological trauma associated with medical treatment experiences and is congruent with the ethical principles of respect for autonomy, beneficence, nonmaleficence, and justice. Health care systems and professionals are encouraged to apply the principles of trauma-informed care to address the effects of pediatric medical traumatic stress.

Young Children See a Single Action and Infer a Social Norm.

Human social life depends heavily on social norms that prescribe and proscribe specific actions. Typically, young children learn social norms from adult instruction. In the work reported here, we showed that this is not the whole story: Three-year-old children are promiscuous normativists. In other words, they spontaneously inferred the presence of social norms even when an adult had done nothing to indicate such a norm in either language or behavior. And children of this age even went so far as to enforce these self-inferred norms when third parties "broke" them. These results suggest that children do not just passively acquire social norms from adult behavior and instruction; rather, they have a natural and proactive tendency to go from "is" to "ought." That is, children go from observed actions to prescribed actions and do not perceive them simply as guidelines for their own behavior but rather as objective normative rules applying to everyone equally.

Two- and 3-year-olds integrate linguistic and pedagogical cues in guiding inductive generalization and exploration.

Young children can in principle make generic inferences (e.g., "doffels are magnetic") on the basis of their own individual experience. Recent evidence, however, shows that by 4 years of age children make strong generic inferences on the basis of a single pedagogical demonstration with an individual (e.g., an adult demonstrates for the child that a single "doffel" is magnetic). In the current experiments, we extended this to look at younger children, investigating how the mechanisms underlying this phenomenon are integrated with other aspects of inductive inference during early development. We found that both 2- and 3-year-olds used pedagogical cues to guide such generic inferences, but only so long as the "doffel" was linguistically labeled. In a follow-up study, 3-year-olds, but not 2-year-olds, continued to make this generic inference even if the word "doffel" was uttered incidentally and non-referentially in a context preceding the pedagogical demonstration, thereby simply marking the opportunity to learn about a culturally important category. By 3 years of age, then, young children show a remarkable ability to flexibly combine different sources of culturally relevant information (e.g., linguistic labeling, pedagogy) to make the kinds of generic inferences so central in human cultural learning.

Young children use pedagogical cues to modulate the strength of normative inferences.

Young children understand pedagogical demonstrations as conveying generic, kind-relevant information. But, in some contexts, they also see almost any confident, intentional action on a novel artefact as normative and thus generic, regardless of whether this action was pedagogically demonstrated for them. Thus, although pedagogy may not be necessary for inferences to the generic, it may nevertheless be sufficient to produce inductive inferences on which the child relies more strongly. This study addresses this tension by bridging the literature on normative reasoning with that on social learning and inductive inference. Three-year-old children learned about a novel artefact from either a pedagogical or non-pedagogical demonstration, and then, a series of new actors acted on that artefact in novel ways. Although children protested normatively in both conditions (e.g., 'No, not like that'), they persisted longer in enforcing the learned norms in the face of repeated non-conformity by the new actors. This finding suggests that not all generic, normative inferences are created equal, but rather they depend - at least for their strength - on the nature of the acquisition process.

Preschoolers use pedagogical cues to guide radical reorganization of category knowledge.

In constructing a conceptual understanding of the world, children must actively evaluate what information is idiosyncratic or superficial, and what represents essential, defining information about kinds and categories. Preschoolers observed identical evidence about a novel object's function (magnetism) produced in subtly different manners: accidentally, intentionally, or demonstrated communicatively and pedagogically. Only when evidence was explicitly demonstrated for their benefit did children reliably go beyond salient perceptual features (color or shape), to infer function to be a defining property on which to base judgments about category membership. Children did not show this pattern when reasoning about a novel perceptual property, suggesting that a pedagogical communicative context may be especially important for children's learning about artifact functions. Observing functional evidence in a pedagogical context helps children construct fundamentally different conceptions of novel categories as defined not by superficial appearances but by deeper, functional properties.

The opportunity to collaborate increases preschoolers' motivation for challenging tasks.

Collaborating on challenging endeavors is a foundation of human society. Recent research suggests that young children are not only motivated to cooperate with others-for instance, to help others accomplish their goals-but may also be motivated to collaborate with others-to pursue shared goals. However, a primary reason why collaboration is so important is because opportunities to collaborate can bring people together to work hard to overcome challenges. Two studies (N=70) tested whether the collaborative nature of an activity itself can cause preschoolers to enjoy challenging tasks more and to persist longer on them. To isolate the psychological feeling of collaboration, we tested this hypothesis by manipulating purely psychological cues of collaboration; in all cases, children worked while physically alone. Both studies found that such cues substantially increased preschoolers' motivation on a challenging puzzle, including their persistence on and liking for the puzzle, relative to two non-collaborative control conditions. We suggest that an early emerging drive to engage in shared collaborative activities leads children to find collaborative activities to be intrinsically motivating. This may represent an important basis of motivation as children embark on formal schooling.

Preschoolers use intentional and pedagogical cues to guide inductive inferences and exploration.

Children are judicious social learners. They may be particularly sensitive to communicative actions done pedagogically for their benefit, as such actions may mark important, generalizable information. Three experiments (N = 224) found striking differences in preschoolers' inductive generalization and exploration of a novel functional property, depending on whether identical evidence for the property was produced accidentally, intentionally, or pedagogically and communicatively. Results also revealed that although 4-year-olds reserved strong generalizations for a property that is pedagogically demonstrated, 3-year-olds made such inferences when it was produced either intentionally or pedagogically. These findings suggest that by age 4 children assess whether evidence is produced for their benefit in gauging generalizability, giving them a powerful tool for acquiring important kind-relevant, generic knowledge.

Toddlers' referential understanding of pictures.

Pictures are referential in that they can represent objects in the real world. Here we explore the emergence of understanding of the referential potential of pictures during the second year of life. In Study 1, 15-, 18-, and 24-month-olds learned a word for a picture of a novel object (e.g., "blicket") in the context of a picture book interaction. Later they were presented with the picture of a blicket along with the real object it depicted and asked to indicate the blicket. Many of the 24-, 18-, and even 15-month-olds indicated the real object as an instance of a blicket, consistent with an understanding of the referential relation between pictures and objects. In Study 2, children were tested with an exemplar object that differed in color from the depicted object to determine whether they would extend the label they had learned for the depicted object to a slightly different category member. The 15-, 18-, and 24-month-old participants failed to make a consistent referential response. The results are discussed in terms of whether pictorial understanding at this age is associative or symbolic.

Proteomic-based detection of a protein cluster dysregulated during cardiovascular development identifies biomarkers of congenital heart defects.

BACKGROUND: Cardiovascular development is vital for embryonic survival and growth. Early gestation embryo loss or malformation has been linked to yolk sac vasculopathy and congenital heart defects (CHDs). However, the molecular pathways that underlie these structural defects in humans remain largely unknown hindering the development of molecular-based diagnostic tools and novel therapies. METHODOLOGY/PRINCIPAL FINDINGS: Murine embryos were exposed to high glucose, a condition known to induce cardiovascular defects in both animal models and humans. We further employed a mass spectrometry-based proteomics approach to identify proteins differentially expressed in embryos with defects from those with normal cardiovascular development. The proteins detected by mass spectrometry (WNT16, ST14, Pcsk1, Jumonji, Morca2a, TRPC5, and others) were validated by Western blotting and immunoflorescent staining of the yolk sac and heart. The proteins within the proteomic dataset clustered to adhesion/migration, differentiation, transport, and insulin signaling pathways. A functional role for several proteins (WNT16, ADAM15 and NOGO-A/B) was demonstrated in an ex vivo model of heart development. Additionally, a successful application of a cluster of protein biomarkers (WNT16, ST14 and Pcsk1) as a prenatal screen for CHDs was confirmed in a study of human amniotic fluid (AF) samples from women carrying normal fetuses and those with CHDs. CONCLUSIONS/SIGNIFICANCE: The novel finding that WNT16, ST14 and Pcsk1 protein levels increase in fetuses with CHDs suggests that these proteins may play a role in the etiology of human CHDs. The information gained through this bed-side to bench translational approach contributes to a more complete understanding of the protein pathways dysregulated during cardiovascular development and provides novel avenues for diagnostic and therapeutic interventions, beneficial to fetuses at risk for CHDs.