Search

Real world search behaviour often involves limb movements, either during search or following search. Here we investigated whether movement-related costs influence search behaviour in two kinds of search tasks. In our visual search tasks, participants made saccades to find a target object among distractors and then moved a cursor, controlled by the handle of a robotic manipulandum, to the target. In our manual search tasks, participants moved the cursor to perform the search, placing it onto objects to reveal their identity as either a target or a distractor. In all tasks, there were multiple targets. Across experiments, we manipulated either the effort or time costs associated with movement such that these costs varied across the search space. We varied effort by applying different resistive forces to the handle and we varied time costs by altering the speed of the cursor. Our analysis of cursor and eye movements during manual and visual search, respectively, showed that effort influenced manual search but did not influence visual search. In contrast, time costs influenced both visual and manual search. Our results demonstrate that, in addition to perceptual and cognitive factors, movement-related costs can also influence search behaviour.

This retrospective study included children aged ≤18 years who had durable ventricular assist devices (VADs) as a bridge to transplantation from the United Network Organ Sharing (UNOS) database between 2011 and 2020. We evaluated 90-day waitlist mortality and 1-year posttransplant mortality after VAD implantation in children stratified by race/ethnicity: Black, White, and Others. The VAD was used in a higher proportion of Black children listed for heart transplantation (HT) (26%) versus Other (25%) versus White (22%); p0.01. Black children had Medicaid health insurance coverage (67%) predominantly at the time of listing for HT. There was no significant overall difference in waitlist survival among the three groups supported with VAD at the time of listing (log-rank p = 0.4). On the other hand, the 90-day waitlist mortality after the VAD implantation at listing and while listed was the lowest among Black (6%) compared with White (13%) and Other (14%) (p0.01). The multivariate regression analysis showed that Other race (hazard ratio [HR], 2.29; p0.01), Black race (HR, 2.13; p0.01), use of mechanical ventilation (HR, 1.72; p = 0.01), and Medicaid insurance (HR, 1.54; p = 0.04) were independently associated with increased 1-year posttransplant mortality. In conclusion, Black children had more access to durable VAD support than White children. The 90-day waitlist mortality was significantly lower in Black children compared with White and Other after VAD implantation. However, Black and Other racial/ethnic children with VAD at transplant had higher 1-year posttransplant mortality than White children. Future studies to elucidate the reasons for these disparities are needed.

We report a case of thyroid storm precipitated by SARS-CoV-2 infection in an adolescent girl with a history of Graves disease and dilated cardiomyopathy. This case highlights that SARS-CoV-2 infection can potentially trigger a thyrotoxicosis crisis and acute decompensated heart failure in a patient with underlying thyroid disease and myocardial dysfunction even in the absence of multi-system inflammatory syndrome in children. We systematically reviewed the thyrotoxicosis cases with SARS-CoV-2 infection and described its impact on pre-existing dilated cardiomyopathy.

We aimed to study the disparity in the clinical profile and outcomes of hospitalized Multisystem Inflammatory Syndrome in Children (MIS-C) patients at our center. The second goal was to examine the temporal association with preceding SARS-CoV-2 infection by race/ethnicity in our community in Mississippi. We found the racial disparity in the prevalence of MIS-C exceeded its temporal association with SARS-CoV-2 infections. We included 51 consecutive MIS-C patients hospitalized, whose median age was 9 (interquartile range [IQR] 5-12) years, 58% were male, 71% were black, 25% were white, and 4% belonged to other groups. We found a delay between onset of symptoms and hospitalization in black patients compared with white patients with a median of 2 (IQR 0-7) vs median of 0 (0-5) urgent care visits ( P = .022), respectively. Black patients were hospitalized longer (median 8, IQR 2-39 days) than whites (median 5, IQR 3-14 days), P = .047. A total of 38.9% of blacks and 23.1% of whites were admitted to intensive care unit ( P = .498); 36.1% of blacks had severe cardiac involvement vs 23.1% of white patients, P = .531. Future studies of MIS-C are required to improve health equity for children.

Prior research suggests that the implicit biases of physicians are negatively associated with quality of medical care and patient satisfaction among minority patients. However, relatively little is known about how physicians express these subtle forms of bias in patient interactions. This study examined the implicit and explicit anti-Hispanic biases of 53 resident physicians and the relationship between anti-Hispanic bias and language use during outpatient medical appointments with 291 Hispanic patients. Physician implicit bias was positively associated with use of interrogatives and work-related words and negatively associated with the use of prepositions and relativity-related words (e.g., words related to time and the future). These findings contribute to the growing body of evidence suggesting that, in addition to nonverbal and paraverbal behaviors, providers may communicate implicit bias to patients through the words they use during a clinical visit.

Previous research has shown that perceivers spontaneously form trait inferences from others' behaviors received at a single point in time. The present work examined the persistence of spontaneous trait inferences (STIs) in the presence of trait-inconsistent information about others. We hypothesized that STIs should be resistant to change over time and in the presence of new trait-inconsistent information due to perceivers forming and storing multiple STIs independently in memory. Consistently, Experiments 1a and 1b showed that initial STIs were not affected by new trait-inconsistent information. Experiments 2 and 3 revealed that STIs were persistent over 48 hours. Two experiments also tested memory reconsolidation as a possible mechanism of updating first impressions. While STIs were not substantially affected, spontaneous goal inferences (SGIs) were elevated among those with a better explicit memory of behaviors after learning trait-inconsistent information following a memory reactivation procedure. Implications of these findings on impression formation and updating processes are discussed.

Real world search behaviour often involves limb movements, either during search or following search. Here we investigated whether movement-related costs influence search behaviour in two kinds of search tasks. In our visual search tasks, participants made saccades to find a target object among distractors and then moved a cursor, controlled by the handle of a robotic manipulandum, to the target. In our manual search tasks, participants moved the cursor to perform the search, placing it onto objects to reveal their identity as either a target or a distractor. Across experiments, we manipulated either the effort or time costs associated with movement such that these costs varied across the search space. We varied effort by applying different resistive forces to the handle and we varied time costs by altering the speed of the cursor. Our analysis of cursor and eye movements during manual and visual search, respectively, showed that effort influenced manual search but did not influence visual search. In contrast, time costs influenced both visual and manual search. Our results demonstrate that, in addition to perceptual and cognitive factors, movement-related costs can also influence search behaviour.Public Significance StatementMany of the tasks we perform on a daily basis involve searching for targets. Numerous studies have investigated perceptual and cognitive factors that influence decisions about where to search. However, few studies have examined how search is influenced by movement-related costs associated with manual search (e.g., opening drawers to find a corkscrew) or acting on an object once it has been located (e.g., reaching for a particular bottle of wine once it has been spied in a rack). We show that movement effort and time costs associated with manual search, and time costs associated with moving after visual search, can influence decision-making about where to search over time.

The use of telehealth technology to connect with patients has expanded significantly over the past several years, particularly in response to the global coronavirus disease 2019 pandemic. This technical report describes the present state of telehealth and its current and potential applications. Telehealth has the potential to transform the way care is delivered to pediatric patients, expanding access to pediatric care across geographic distances, leveraging the pediatric workforce for care delivery, and improving disparities in access to care. However, implementation will require significant efforts to address the digital divide to ensure that telehealth does not inadvertently exacerbate inequities in care. The medical home model will continue to evolve to use telehealth to provide high-quality care for children, particularly for children and youth with special health care needs, in accordance with current and evolving quality standards. Research and metric development are critical for the development of evidence-based best practices and policies in these new models of care. Finally, as pediatric care transitions from traditional fee-for-service payment to alternative payment methods, telehealth offers unique opportunities to establish value-based population health models that are financed in a sustainable manner.

Contains fulltext : 236625.pdf (Publisher’s version ) (Open Access) Spontaneous (i.e., heuristic, fast, effortless, and associative) processing has clear advantages for human cognition, but it can also elicit undesirable outcomes such as stereotyping and other biases. In the current article, we argue that biased judgements and behaviour that result from spontaneous processing can be reduced by activating various flexibility mindsets. These mindsets are characterised by the consideration of alternatives beyond one's spontaneous thoughts and behaviours and could, thus, contribute to bias reduction. Research has demonstrated that eliciting flexibility mindsets via goal and cognitive conflicts, counterfactual thinking,, recalling own past flexible thoughts or behaviour, and adopting a promotion focus reduces biases in judgements and behaviour. We summarise evidence for the effectiveness of flexibility mindsets across a wide variety of important phenomena - including creative performance, stereotyping and prejudice, interpersonal behaviour, and decision-making. Finally, we discuss the underlying processes and potential boundary conditions. 43 p.

Behavior is a reflection of the intentions, attitudes, goals, beliefs, and desires of a person. These intra-individual factors are coordinated with what opportunities the situation affords and the perceived constraints placed on the person by their context and the norms of the culture they are in. Further, the intentions, attitudes, goals, beliefs, and desires of a person are often not known to them in any given moment, and because they reside within the mind of that person they are almost always not known to the people who are perceiving that person. To know anything about other people we must observe and identify/classify their behavior and then attribute to the observed behavior inferences and judgments about the internal states of that person serving as the motivating force behind their behavior. This entry explores this process of attribution. Heider described attribution as the process that determines “how one person thinks and feels about another person, how he perceives him and what he does to him, what he expects him to do or think, how he reacts to the actions of the other.” The entry explores the rules that people follow in order to make sense of behavior, and the rational versus non-rational nature of the procedure. Even when highly motivated to think rationally, this process can be biased, and flaws can appear in the attribution process, such as from chronic differences among perceivers due to culture, experience, or personality. How the process would unfold if accurate and purely rational is contrasted with how it unfolds when biased. How we feel, and how we choose to act, are derived from how we make sense of the world. Thus, attribution processes are foundational for understanding how we feel, for establishing expectations, and planning how to act in turn.

All children and adolescents deserve access to quality health care regardless of their race/ethnicity, health conditions, financial resources, or geographic location. Despite improvements over the past decades, severe disparities in the availability and access to high-quality health care for children and adolescents continue to exist throughout the United States. Economic and racial factors, geographic maldistribution of primary care pediatricians, and limited availability of pediatric medical subspecialists and pediatric surgical specialists all contribute to inequitable access to pediatric care. Robust, comprehensive telehealth coverage is critical to improving pediatric access and quality of care and services, particularly for under-resourced populations.

This is a cross-sectional study of 29 published cases of acute myopericarditis following COVID-19 mRNA vaccination. The most common presentation was chest pain within 1–5 days after the second dose of mRNA COVID-19 vaccination. All patients had an elevated troponin. Cardiac magnetic resonance imaging revealed late gadolinium enhancement consistent with myocarditis in 69% of cases. All patients recovered clinically rapidly within 1–3 weeks. Most patients were treated with non-steroidal anti-inflammatory drugs for symptomatic relief, and 4 received intravenous immune globulin and corticosteroids. We speculate a possible causal relationship between vaccine administration and myocarditis. The data from our analysis confirms that all myocarditis and pericarditis cases are mild and resolve within a few days to few weeks. The bottom line is that the risk of cardiac complications among children and adults due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection far exceeds the minimal and rare risks of vaccination-related transient myocardial or pericardial inflammation.

It is well-established that people can factor into account the distribution of their errors in motor performance so as to optimize reward. Here we asked whether, in the context of motor learning where errors decrease across trials, people take into account their future, improved performance so as to make optimal decisions to maximize reward. One group of participants performed a virtual throwing task in which, periodically, they were given the opportunity to select from a set of smaller targets of increasing value. A second group of participants performed a reaching task under a visuomotor rotation in which, after performing a initial set of trials, they selected a reward structure (ratio of points for target hits and misses) for different exploitation horizons (i.e., numbers of trials they might be asked to perform). Because movement errors decreased exponentially across trials in both learning tasks, optimal target selection (task 1) and optimal reward structure selection (task 2) required taking into account future performance. The results from both tasks indicate that people anticipate their future motor performance so as to make decisions that will improve their expected future reward., Author summary A hallmark of motor learning is the reduction of performance errors with practice, which can have important ramifications for decision making. For example, when purchasing a new surfboard, our choice should anticipate our improvement with practice so that we select an appropriate board. In this paper we asked whether, in the context of two different motor learning tasks, people take into account their future, improved performance so as to make optimal decisions to maximize reward. In the throwing task, which involved learning the dynamics of the thrown object, participants were periodically given the opportunity to select from a set of smaller targets of increasing value. In the reaching task, which involved adapting to a visuomotor rotation, participants—after performing an initial block of trials—selected a reward structure (ratio of points for target hits and misses) for different exploitation horizons (i.e., numbers of trials they might be asked to perform). Performance errors decreased across trials in both tasks and therefore optimal target selection (task 1) and optimal reward structure selection (task 2) required taking into account future performance. In both tasks, participants anticipated their future motor performance so as to make decisions that improved their expected future reward.

The pathogenesis of postural orthostatic tachycardia syndrome (POTS) is incompletely understood. This study aimed to identify different theories of possible POTS pathogenesis and to formulate evidence-based pathogenesis that correlates with different clinical pictures. Five databases were searched systematically using predefined key words. Inclusion criteria for studies were comparing POTS patients to a normal population regarding different forms of pathogenesis. Predefined exclusion criteria for studies were: animal subjects–non-POTS–case reports AND review articles. Selected studies were categorized into theories according to the studied parameter(s) in each manuscript. Cochrane risk of bias was calculated for each study. A qualitative narrative synthesis of the evidence was performed to critically appraise different theories. Sixty-two studies were identified as POTS pathogenesis. Studies were categorized under ten theories: sympathetic/baroreceptor, flow, neuroendocrine, age/gender, nitric oxide, collagenic, autoimmune, genetic, isolated regional neuropathy and hypovolemia. Isolated regional neuropathy and hypovolemia theories were rejected. Collagenic, autoimmune and genetic theories were accepted as predisposing factors rather than the primary POTS pathogenesis. Angiotensin II receptor subtype AT1/AT2 imbalance could integrate neuro-hormonal, flow, baroreceptor and nitric oxide theories and consequently explains different POTS patients' profiles. Our study was registered in the International Prospective Register of Systematic Review (PROSPERO # CRD42015016769).

Objective To update pediatric subspecialty workforce data to support evidence-based legislation and public policy decisions by replicating the American Academy of Pediatrics' 1998 Future of Pediatric Education (FOPE II) workforce survey. Methods A descriptive and comparative analysis of survey responses from 9950 US pediatric subspecialists who completed an electronic survey. Results Pediatric subspecialists are working fewer hours and spending less of their time in direct patient care than they did in 1998 but the mean hours worked differs significantly according to subspecialty. Most subspecialists continue to be board-certified, white, non-Hispanic men, although the percentage who are women and from minority groups has increased. The proportion of subspecialists practicing in an academic medical center has increased since 1998. Thirty percent of pediatric subspecialists reported appointment wait times of >2 weeks and pediatric subspecialists in developmental pediatrics, endocrinology, and neurology identified much longer wait times than other subspecialists. Conclusion The demographic and practice characteristics of pediatric subspecialists have changed since the FOPE II survey and access to subspecialty care in a family's community remains a challenge. However, pediatric subspecialties are not monolithic and solutions to workforce shortages will need to take into account these differences to improve access to subspecialty care.

Objectives Examine how the subtype “black athletes” differs from that of black men. More centrally, to illustrate that the category black athletes can be triggered and lead to implicit bias. This bias is implicit and impacts a perceiver's evaluation outside conscious awareness. Design and method Participants were white residents of the United States. Experiment one assessed familiarity with three qualities comprising the cultural stereotype of black athletes. Experiment two explored implicit bias from the stereotype using a within subjects design. Participants read a series of quotes and rated how strongly they implied these stereotypical qualities. Each participant rated such quotes from a black athlete, white athlete, black salesman, and a white salesman. Results Implicit bias was revealed in the type of ratings provided of black athletes. The ratings for the black athletes along these two stereotypical dimensions significantly differed from the ratings made to the same quotes when uttered by other men. Conclusions The stereotype guided how participants viewed the person's actions/words. The stereotype of black athletes is distinct from black men generally. Participants did not rate men negatively along the stereotypic dimensions when they were black salesmen, only when they were black athletes. Additionally, although the quality “athletic,” which is part of the global stereotype of black men, has a positive connotation, the stereotype that is built around this quality is not positive. It is a stereotype that this group has natural athletic ability that leads to an arrogance and lack of work ethic (since one is naturally gifted).

In 4 studies, we show that two behavioral dimensions specified in Kelley’s (1967) model of attribution, consistency and distinctiveness of behaviors, determine perceivers’ likelihood to explain others’ behaviors in terms of their goals versus traits. Participants tended to attribute the cause of others’ behaviors to their goals (vs. traits and other characteristics) when behaviors were characterized by high distinctiveness (Study 1A & 1B) or low consistency (Study 2). On the other hand, traits were ascribed as predominant causal explanations when behaviors had low distinctiveness or high consistency. Study 3 investigated the combined effect of those behavioral dimensions on causal attributions and showed that behaviors with high distinctiveness and consistency as well as low distinctiveness and consistency trigger goal attributions. We discuss the implications of the present research in terms of going beyond the dominant approach of trait-situation dichotomy in attribution research. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Background: Limited therapeutic options are available for Fontan patients with dysfunctional or failing single ventricle physiology. This study describes the evaluation of an alternative, non-invasive, at-home therapeutic compression treatment for Fontan patients. Our hypothesis is that routinely administered, externally applied compression treatments to the lower extremities will augment systemic venous return, improve ventricular preload, and thus enhance cardiac output in Fontan patients. Methods: To initially evaluate this hypothesis, we employed the NormaTec pneumatic compression device (PCD) in a pilot clinical study (n=2). This device is composed of inflatable trouser compartments that facilitate circumferentially and uniformly applied pressure to a patient’s lower extremities. Following an initial health screening, test subjects were pre-evaluated with a modified-Bruce treadmill exercise stress test, and baseline data on cardiorespiratory health was collected. After training, test subjects conducted 6 days of external compression therapy at-home. Subjects were then re-evaluated with a final treadmill stress test and data acquisition of new cardiorespiratory parameters. Results: Both subjects demonstrated improvement in exercise duration time, peak oxygen volume, and ventilator threshold, as compared to the baseline evaluation. Conclusions: These findings are promising and provide the foundation for future studies that will focus on increasing study participation (sample size) to better assess the clinical benefit of compression therapy for Fontan patients.

The increasing number of part-time physicians in pediatrics and other specialties has major implications for state medical boards. This study examines the demographic and practice characteristics of part-time pediatricians compared to full-time pediatricians and the implications of these characteristics on licensure requirements. An electronic survey on workforce topics was developed by the American Academy of Pediatrics' Committee on Pediatric Workforce. The survey responses of part-time pediatricians were compared to the responses of pediatricians working full-time. Approximately 31% of the part-time pediatricians plan to continue to work part-time for > 10 years. A small cohort of part-time pediatricians (4.7%) were working < 11 hours per week. The demographic and practice characteristics of part-time pediatricians differ significantly from full-time pediatricians but there was no difference in reported appointment availability between part-time and full-time pediatricians. These findings have implications for the regulatory community regarding the number of hours a physician must work to provide quality patient care and be considered an active physician in good standing. They also have important implications for projecting the number of pediatricians needed to ensure that all children have access to care in the United States.

The last decade has seen a rush to address the causes and consequences of bias in applied contexts across the world. When and why might these initiatives promote attitudes and behavior that align with egalitarian goals? A common assumption is that increasing awareness of bias can motivate control over prejudiced responding. However, learning that one's actions are biased is threatening, and often motivates a range of self-protective responses to buffer that threat. In the current research, we tested a strategy for reducing such defensive responding and increasing the kind of awareness central to contemporary theories of prejudice regulation and egalitarian behavior. Four experiments (N > 2500) and a mini meta-analysis demonstrate that interventions that (a) decrease perceived moral blameworthiness for having bias and (b) increase the perceived ability to control bias, can reduce defensive responding and increase awareness both in the short-term and approximately 6 months later. Interventions that minimize threat and facilitate efficacy can motivate increased bias awareness and commitment to egalitarian values.

3549 Background: Strategies to detect and prevent young-onset colorectal cancer (YOCRC, diagnosed under age 50) are critical. Established high-risk screening guidelines (SGs) aim to detect/prevent YOCRCs arising from hereditary syndromes. For non-hereditary YOCRCs, average-risk screening is being considered at an earlier age, but family history (FH)-based increased-risk screening has been poorly studied. We aimed to define the proportion of non-hereditary YOCRC with a FH, and to determine whether existing SGs could have detected/prevented these cases. Methods: 394 consecutive YOCRC patients presenting for surgical resection were reviewed for tumor MMR status, pedigree and genetic testing. Those with known/suspected hereditary syndrome (by phenotype, MMR status, and/or germline mutation) were excluded (N = 65). Pedigrees (N = 329) were analyzed for first- or second-degree relatives (FDR, SDR) with CRC and the ages of diagnosis. The gap between the recommended age for FH-based CRC screening and the age of YOCRC diagnosis was calculated. Results: 89 (27%) non-hereditary YOCRC patients had a FH of CRC. The median age of diagnosis was 45; the tumors were mostly from the distal colon (22%) and rectum (60%), and stage III (48%) and IV (27%). Twenty-one (24%) patients had 22 FDRs with CRCs diagnosed at age 64 (median); and 71 (80%) patients had 92 SDRs with CRCs diagnosed at age 65 (median). Thirteen (15%) had a FH of YOCRC. The existing SGs consider 39 patients (44%) at increased-risk, and the remaining, average-risk (Table). Screening would have begun prior to the YOCRC diagnoses in 28 (31% [or 46, 52%]) patients. But YOCRC diagnosis preceded the recommended screening age in the remaining 61(69% [or 43, 48%]) patients by a median of 5.3 [or 3.9] years (Table). Conclusions: FH is found in 27% of the non-hereditary YOCRC patients; 15% has a FH of YOCRC. In nearly half of the patients, YOCRC was diagnosed several years earlier than the recommended age for FH-based screening, even assuming perfect SG adoption and starting average risk screening at age 45. Refining existing FH-based SGs can potentially be impactful.[Table: see text]

This review discusses the potential drug and device therapies for pediatric heart failure (HF) due to reduced systolic function. It is important to realize that most drugs that are used in pediatric HF are extrapolated from adult cardiology practices or consensus guidelines based on expert opinion rather than on evidence from controlled clinical trials. It is difficult to conclude whether the drugs that are well established in adult HF trials are also beneficial for children because of tremendous heterogeneity in the mechanism of HF in children and variations in the pharmacokinetics and pharmacodynamics of drugs from birth to adolescence. The lessons learned from adult trials can guide pediatric cardiologists to design clinical trials of the newer drugs that are in the pipeline to study their efficacy and safety in children with HF. This paper’s focus is that the reader should specifically think through the pathophysiological mechanism of HF and the mode of action of drugs for the selection of appropriate pharmacotherapy. We review the drug and device trials in adults with HF to highlight the knowledge gap that exists in the pediatric HF population.

Attempts at idea generation often produce outputs that are marked by restricted creativity. This lack of originality is often due to responses being tethered to recently activated knowledge and salient examples. The current research tested the hypothesis that implicitly priming creativity results in more creativity (i.e., flexibility). Experiment 1 addressed the potential underlying mechanisms that might lead to such an effect and demonstrated that creativity priming leads to the activation of remote, as opposed to close, associations to a target item. Experiments 2a, 2b , 3 , and 4 showed that priming creativity (using two different procedures) leads to more original ideas in a generative task as well as better performance in the remote association task (RAT). These effects occurred independently of the conscious intention to be creative as well as motivational and mood states. Across these studies, the activation of a creative mindset undermined the sources of inflexible and uncreative responding.

A large body of work has shown that perceivers form spontaneous inferences about others' characteristics (e.g., mean, bad) as soon as they observe their behaviors. However, a question that has not been addressed by previous research is the integration of contingencies of those actions (e.g., perceivers' ultimate goals) that are typically learned over time into the initial spontaneous impressions of those others. Three experiments examined updating of spontaneously formed trait inferences (STIs) and evaluative inferences (SEIs) as a function of the contingency information that alters the meaning of the initial information. All three studies showed that perceivers update their SEIs (both positive and negative) immediately after learning about the contingencies (i.e., transforming information). STIs, however, were not updated, even when the contingency information was provided immediately after the initial behavior information (Experiment 3). Instead, in all three experiments participants formed multiple STIs; one from the behavior information before and one from the information after the contingency. It was only when participants had the opportunity to elaborate on their trait judgments within explicit measures that they revised their judgments and aligned them with the contingency information. The results and the implications of the findings are discussed in light of the theoretical models suggesting separate mechanisms of semantic and evaluative processing in person perception. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

When people learn about or observe the behaviors of others, they tend to make implicit inferences from these behaviors (e.g., Uleman, Saribay, & Gonzalez, 2008). Such inferences are an essential part of a person's ability to understand his/her environment and to prepare appropriate behavior within that environment. In the present paper, we review the conditions under which people are more likely to make implicit goal inferences versus implicit trait inferences. The distinction between these two ways of understanding the behavior we observe has important consequences for how we make predictions about future behavior, set expectations for our interaction partners, and how we choose to behave. It can determine when we stereotype. However, until now, the literature has focused on trait inference as the dominant way perceivers make sense of their environment, with little discussion of inferences concerning a person's goals.

The use of telemedicine technologies by primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists (henceforth referred to as “pediatric physicians”) has the potential to transform the practice of pediatrics. The purpose of this policy statement is to describe the expected and potential impact that telemedicine will have on pediatric physicians’ efforts to improve access and physician workforce shortages. The policy statement also describes how the American Academy of Pediatrics can advocate for its members and their patients to best use telemedicine technologies to improve access to care, provide more patient- and family-centered care, increase efficiencies in practice, enhance the quality of care, and address projected shortages in the clinical workforce. As the use of telemedicine increases, it is likely to impact health care access, quality, and education and costs of care. Telemedicine technologies, applied to the medical home and its collaborating providers, have the potential to improve current models of care by increasing communication among clinicians, resulting in more efficient, higher quality, and less expensive care. Such a model can serve as a platform for providing more continuous care, linking primary and specialty care to support management of the needs of complex patients. In addition, telemedicine technologies can be used to efficiently provide pediatric physicians working in remote locations with ongoing medical education, increasing their ability to care for more complex patients in their community, reducing the burdens of travel on patients and families, and supporting the medical home. On the other hand, telemedicine technologies used for episodic care by nonmedical home providers have the potential to disrupt continuity of care and to create redundancy and imprudent use of health care resources. Fragmentation should be avoided, and telemedicine, like all primary and specialty services, should be coordinated through the medical home.

Single ventricle anomalies are a challenging set of congenital heart defects that require lifelong clinical management due to progressive decline of cardiovascular function. Few therapeutic devices are available for these patients, and conventional blood pumps are not designed for the unique anatomy of the single ventricle physiology. To address this unmet need, we are developing an axial flow blood pump with a protective cage or stent for Fontan patients. This study investigates the 3-D particle image velocimetry measurements of two cage designs being deployed in a patient-specific Fontan anatomy. We considered a control case without a pump, impeller placed in the inferior vena cava, and two cases where the impeller has two protective stents with unique geometric characteristics. The experiments were evaluated at a cardiac output of 3 L/min, a fixed vena caval flow split of 40%/60%, a fixed pulmonary arterial flow split of 50%/50%, and for operating speeds of 1000-4000 rpm. The introduction of the cardiovascular stents had a substantial impact on the flow conditions leaving the pump and entering the cavopulmonary circulation. The findings indicated that rotational speeds above 4000 rpm for this pump could result in irregular flows in this specific circulatory condition. Although retrograde flow into the superior vena cava was not measured, the risk of this occurrence increases with higher pump speeds. The against-with stent geometry outperformed the other configurations by generating higher pressures and more energetic flows. These results provide further support for the viability of mechanical cavopulmonary assistance as a therapeutic treatment strategy for Fontan patients.

Limited treatment options for patients having dysfunctional single ventricle physiology motivate the necessity for alternative therapeutic options. To address this unmet need, we are developing a collapsible axial flow blood pump. This study investigated the impact of geometric simplicity to facilitate percutaneous placement and maintain optimal performance. Three new pump designs were numerically evaluated. A transient simulation explored the impact of respiration on blood flow conditions over the entire respiratory cycle. Prototype testing of the top performing pump design was completed. The top performing Rec design generated the highest pressure rise range of 2–38 mm Hg for flow rates of 1–4 L/min at 4000–7000 RPM, exceeding the performance of the other two configurations by more than 26%. The blood damage indices for the new pump designs were determined to be below 0.5% and predicted hemolysis levels remained low at less than 7 × 10−5 g/100 L. Prototype testing of the Rec design confirmed numerical predictions to within an average of approximately 22%. These findings demonstrate that the pumps are reasonably versatile in operational ability, meet pressure-flow requirements to support Fontan patients, and are expected to have low levels of blood trauma.

The implementation of simultaneous mechanical cavopulmonary assistance having blood pumps located in both of the vena cavae is investigated as an approach to treating patients with an ailing Fontan physiology. Identical intravascular blood pumps are employed to model the hemodynamic support of a patient-specific Fontan. Pressure flow characteristics, energy gain calculations, and blood damage analyses are assessed for each model. The performance of the dual-support scenario is compared to conditions of mechanical support in the inferior vena cava only and to a nonsupported cavopulmonary circuit. The blood pump in the superior vena cava generates pressures ranging from 1 to 22 mm Hg for flow rates of 1-4 L/min at operating speeds of 1250-2500 rpm. The blood pump in the inferior vena cava produces pressures at levels approximately 20% lower. The blood pumps positively augment the hydraulic energy in the total cavopulmonary connection circuit as a function of flow rate and rotational speed. Scalar stress levels and fluid residence times are at acceptable levels. Damage indices for the dual-support case, however, are elevated slightly above 3.5%. These results suggest that concurrent, mechanical assistance of the inferior vena cava and superior vena cava in Fontan patients has the potential to be beneficial, but additional studies are needed to further explore this approach.

Background Cardiac asthma describes symptoms of airflow obstruction due to heart failure. Chronic heart failure is associated with decreased FEV 1 , and FEV 1 improves after heart transplantation. Fibrotic remodeling of the heart and airways is mediated, in part, through transforming growth factor (TGF)-β. Blood TGF-β 1 concentration correlates with ventricular remodeling in cardiac disease, and TGF-β decreases after repair. Methods We established a coculture of normal human bronchial epithelial (NHBE) cells differentiated at air-liquid interface with submerged basal cardiomyoblasts. Airway cells were immunostained with cytokeratin, actin, and involucrin. TGF-β synthesis was assayed using enzyme-linked immunosorbent assay. Phosphorylation of Smad in NHBE cells was determined by Western blotting. Mice given doxorubicin developed cardiac failure, and their airways were histologically examined. Results Coculture induced involucrin-positive squamous metaplasia of NHBE cells, and this was attenuated by TGF-β antibody. Total TGF-β 1 was increased in coculture conditioned medium ( P 1 , there was squamous transformation of NHBE cells. One week after removing cardiomyoblasts from culture, squamous metaplasia resolved into normal ciliated epithelia. Smad was phosphorylated in NHBE cells with cardiomyoblasts or with recombinant TGF-β 1 exposure. The airways of mice with heart failure also demonstrated involucrin-positive squamous transformation. Conclusions TGF-β from cardiomyoblasts or from the failing heart can cause airway squamous metaplasia via Smad signaling, and this is blocked by anti-TGF-β antibody and reversed when cardiac cells are removed from culture. This appears to be an important mechanism for airflow obstruction with heart failure, sometimes described as cardiac asthma.

This numerical study examined the performance of an intravascular axial flow blood pump for mechanical hemodynamic support of patients in the setting of Fontan failure, which presently has few treatment options. Three anatomically accurate geometries of the total cavopulmonary connection (TCPC) were generated using patients' magnetic resonance imaging data. These patient-specific geometries, as well as an idealized version with cylindrical vessels, were computationally analyzed with and without a pump in the inferior vena cava. Pressure flow characteristics, energy gain calculations, and blood damage analyses were performed for each model. The pump produced pressures of 1-14 mm Hg for 1500-4000 revolutions per minute, flow rates of 1-4 L/min, and pulmonary artery pressures of 8-24 mm Hg. Comparison of pump performance among the four models showed minimal intermodel differences (