Evidence for a multidimensional account of cognitive and affective theory of mind: A state-trace analysis.

Theory of mind (ToM) has been argued to be a multidimensional construct, with ToM inferences depending on distinct processes across affective and cognitive ToM tasks and across first-order cognitive and second-order cognitive ToM tasks. Behavioural evidence for a multidimensional account has primarily depended on dissociations identified via analysis of variance, a statistical approach insufficient for assessing dimensionality. Instead, state-trace analysis (STA) is a more appropriate statistical technique to uncover dimensionality. The current study first applied STA to two summary datasets that had previously identified key dissociations between cognitive and affective ToM; these reanalyses did not support a multidimensional account of ToM. Next, STA was applied to a more detailed dataset to reveal whether ToM is based on multiple processes in a sample of 115 older adults aged 60-85 years (M = 68.5, SD = 5.92, 61.7% female) with higher or lower emotion perception ability. Participants made ToM judgements about different social exchanges (e.g., sarcasm or lying). STA results supported a multidimensional account of ToM across first-order cognitive, second-order cognitive, and affective ToM subdomains. These results lay a more rigorous foundation for subsequent studies to further examine the dimensionality of ToM and to apply formal modelling, progressing the field's understanding and measurement of the cognitive processes driving ToM judgements.

Emotional empathy across adulthood: A meta-analytic review.

Emotional empathy is a congruent emotional response stemming from another's emotional state and has mixed evidence for its association with age. We sought to synthesize existing data to investigate cross-sectional changes in emotional empathy across adulthood using random-effects meta-analyses. Embase, APA PsycInfo, Medline, and Scopus databases were systematically searched until October 2022. Thirty-three studies assessed age categorically by comparing older (M = 68.42, SD = 4.95) with younger (M = 27.55, SD = 6.82) adults and demonstrated higher emotional empathy in older adults (g = 0.10, p = .039). Seven studies examined age continuously (18-100 years), resulting in a positive correlation with age (zr = .08, p = .033). Subgroup analyses identified age effects differed based on the emotional empathy measure but not on measure type (state vs. trait) or gender ratio (73% women and 27% men). Cross-sectional results indicate emotional empathy may increase across adulthood. These results clarify the previously mixed reports of typical emotional empathy functioning in later life. Age effects varying due to the emotional empathy measure examined indicate that these measures' convergent validity should be reexamined. Further research should employ older, population-based, non-western, educated, industrialized, rich, and democratic samples and longitudinal designs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluating a novice driver and pre-driver road safety intervention.

Intervention or evaluation studies represent a small proportion of traffic psychology research. The current study evaluated the effectiveness of a road safety intervention by measuring attitudes toward unsafe driving behaviors and risk perception. A sample of high school students (n=133) participated in a road safety intervention program focusing on attitudes and risk perceptions of young people as novice drivers, pre-drivers, and passengers. This sample was compared with a matched sample of students who did not take the program (n=172) on their attitudes and perceived risk toward unsafe driving, both prior to the program (T1), immediately after the program (T2), and at 6-week follow-up (T3). While no changes in attitudes toward unsafe driving were found for the control group, the intervention group reported riskier attitudes toward unsafe driving behaviors from T1 to T2 and T3. No differences were found from T1 to T3 in perceived risk toward unsafe driving for either the intervention or control groups. Implications of the study include encouraging a higher rate of road safety program evaluations, leading to better understanding of the effectiveness of road safety intervention programs and how they may be designed and delivered to ensure lower engagement in unsafe driving behaviors by young drivers.

The impact of antiplatelet therapy on pelvic fracture outcomes.

INTRODUCTION: Despite increasing use of antiplatelet agents (APA), little is known regarding the effect of these agents on the orthopedic trauma patient. This study reviews clinical outcomes of patients with pelvic fractures (Pfx) who were using pre-injury APA. Specifically, we focused on the influence of APA on postinjury bleeding, transfusions, and outcomes after Pfx. METHODS: Patients with Pfx admitted during a 37-month period beginning January 2006 were divided into APA and non-APA groups. Pelvic injuries were graded using pelvic fracture severity score (PFSS)-a combination of Young-Burgess (pelvic ring), Letournel-Judet (acetabular), and Denis (sacral fracture) classifications. Other clinical data included demographics, co-morbid conditions, medications, injury severity score (ISS), associated injuries, morbidity/mortality, hemoglobin trends, blood product use, imaging studies, procedures, and resource utilization. Multivariate analyses for predictors of early/late transfusions, pelvic surgery, and mortality were performed. RESULTS: A total of 109 patients >45 years with Pfx were identified, with 37 using preinjury APA (29 on aspirin [ASA], 8 on clopidogrel, 5 on high-dose/scheduled non-steroidal anti-inflammatory agents [NSAID], and 8 using >1 APAs). Patients in the APA groups were older than patients in the non-APA group (70 vs. 63 years, P < 0.01). The two groups were similar in gender distribution, PFSS and ISS. Patients in the APA group had more comorbidities, lower hemoglobin levels at 24 h, and received more packed red blood cell (PRBC) transfusions during the first 24 h of hospitalization (all, P < 0.05). There were no differences in platelet or late (>24 h) PRBC transfusions, blood loss/transfusions during pelvic surgery, lengths of stay, post-ED/discharge disposition, or mortality. In multivariate analysis, predictors of early PRBC transfusion included higher ISS/PFSS, pre-injury ASA use, and lower admission hemoglobin (all, P < 0.03). Predictors of late PRBC transfusion included the number of complications, gender, PFSS, and any APA use (all, P < 0.05). Mortality was associated with pelvic hematoma/contrast extravasation on imaging, number of complications, and higher PFSS/ISS (all, P < 0.04). CONCLUSIONS: Results of this study support the contention that preinjury use of APA does not independently affect morbidity or mortality in trauma patients with Pfx. Despite no clinically significant difference in early postinjury blood loss, pre-injury use of APA was associated with increased likelihood of receiving PRBC transfusion within 24 h of admission. Furthermore, multivariate analyses demonstrated that among different APA, only preinjury ASA (vs. clopidogrel or NSAID) was associated with early PRBC transfusions. Late transfusion was associated with the use of any APA, complications, higher PFSS, and need for pelvic surgery.

Pre-injury polypharmacy as a predictor of outcomes in trauma patients.

BACKGROUND: One of the hallmarks of modern medicine is the improving management of chronic health conditions. Long-term control of chronic disease entails increasing utilization of multiple medications and resultant polypharmacy. The goal of this study is to improve our understanding of the impact of polypharmacy on outcomes in trauma patients 45 years and older. MATERIALS AND METHODS: Patients of age ≥45 years were identified from a Level I trauma center institutional registry. Detailed review of patient records included the following variables: Home medications, comorbid conditions, injury severity score (ISS), Glasgow coma scale (GCS), morbidity, mortality, hospital length of stay (LOS), intensive care unit (ICU) LOS, functional outcome measures (FOM), and discharge destination. Polypharmacy was defined by the number of medications: 0-4 (minor), 5-9 (major), or ≥10 (severe). Age- and ISS-adjusted analysis of variance and multivariate analyses were performed for these groups. Comorbidity-polypharmacy score (CPS) was defined as the number of pre-admission medications plus comorbidities. Statistical significance was set at alpha = 0.05. RESULTS: A total of 323 patients were examined (mean age 62.3 years, 56.1% males, median ISS 9). Study patients were using an average of 4.74 pre-injury medications, with the number of medications per patient increasing from 3.39 for the 45-54 years age group to 5.68 for the 75+ year age group. Age- and ISS-adjusted mortality was similar in the three polypharmacy groups. In multivariate analysis only age and ISS were independently predictive of mortality. Increasing polypharmacy was associated with more comorbidities, lower arrival GCS, more complications, and lower FOM scores for self-feeding and expression-communication. In addition, hospital and ICU LOS were longer for patients with severe polypharmacy. Multivariate analysis shows age, female gender, total number of injuries, number of complications, and CPS are independently associated with discharge to a facility (all, P < 0.02). CONCLUSION: Over 40% of trauma patients 45 years and older were receiving 5 or more medications at the time of their injury. Although these patients do not appear to have higher mortality, they are at increased risk for complications, lower functional outcomes, and longer hospital and intensive care stays. CPS may be useful when quantifying the severity of associated comorbid conditions in the context of traumatic injury and warrants further investigation.

Tree stands, not guns, are the midwestern hunter's most dangerous weapon.

Although the prevailing stereotype is that most hunting injuries are gunshot wounds inflicted by intoxicated hunting buddies, our experience led us to hypothesize that falls comprise a significant proportion of hunting related injuries. Trauma databases of two Level I trauma centers in central Ohio were queried for all hunting related injuries during a 10-year period. One hundred and thirty patients were identified (90% male, mean age 41.0 years, range 17-76). Fifty per cent of injuries resulted from falls, whereas gunshot wounds accounted for 29 per cent. Most hunters were hunting deer and 92 per cent of falls were from tree stands. Alcohol was involved in only 2.3 per cent, and drugs of abuse in 4.6 per cent. Of gunshots, 58 per cent were self-inflicted, and 42 per cent were shot by another hunter. Tree stand falls were highly morbid, with 59 per cent of fall victims suffering spinal fractures, 47 per cent lower extremity fractures, 18 per cent upper extremity fractures, and 18 per cent closed head injuries. Surgery was required for 81 per cent of fall-related injuries, and 8.2 per cent of fall victims had permanent neurological deficits. In contrast to prevailing beliefs, in our geographic area tree-stand falls are the most common mechanism of hunting related injury requiring admission to a Level 1 trauma center.

Complications related to endoscopic retrograde cholangiopancreatography: a comprehensive clinical review.

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most commonly performed endoscopic procedures. It provides the treating physician with both diagnostic and therapeutic options. The recent shift towards interventional uses of ERCP is largely due to the emergence of advanced imaging techniques, including magnetic resonance cholangiopancreatography and ultrasonography. With over 500,000 ERCP procedures performed yearly in the United States alone, it is important that all medical and surgical practitioners be well versed in indications, contraindications, potential complications, benefits, and alternatives to ERCP. The authors present an in-depth review of ERCP-related complications (pancreatitis, bleeding, perforation, etc) as well as special topics related to ERCP (periprocedural antibiotic use, performance of intraoperative ERCP, performance of ERCP during pregnancy, etc).