Prospective correlates of early (30 day) readmissions on a Cardiothoracic Surgery Service

Known to vary widely among hospitals for unclear reasons, early readmissions are associated with higher mortality and are suspected to frequently be due to inadequate discharge preparation/planning. It has been previously documented that the strongest and most consistent predictor of early readmissions in CHF patients is chronic cognitive impairment, and compensatory assistance with adherence on discharge improves early readmission rates. Prospective observational study. The present investigation examined multiple putative perioperative predictors of early readmission in a hospitalized Cardiothoracic Surgery Service. A subtest of the Mini-Cog, Short Term Memory, was the strongestunivariate predictor of early readmissions (p < .001), but the overall Mini-Cog (p = .024), Age (p = .045), Number of Admissions over the Preceding Year (p = .036), an Anxiety Scale (p = .035), Years of Education (p = .055) and a Depression Scale (p = .056) also demonstrated covariation. In a Logistic Regression, only Short Term Memory survived as a predictor variable (p = .007), correctly classifying 76% of patients. Chronic cognitive impairment is a predictor of early readmissions in Cardiothoracic patients. A brief bedside exam interpreted in medical context may permit identification of patients requiring familial assistance for adherence on discharge.     

The Determinants of Subjective Well-Being of Young Adults in Europe

Applied Research in Quality of Life - Subjective well-being (SWB) is a desirable goal for the society as a whole and in particular for young adults (i.e., those aged 18–34) who are a crucial...     

Time processing in children with Tourette’s syndrome

Background

Tourette syndrome (TS) is characterized by dysfunctional connectivity between prefrontal cortex and sub-cortical structures, and altered meso-cortical and/or meso-striatal dopamine release. Since time processing is also regulated by fronto-striatal circuits and modulated by dopaminergic transmission, we hypothesized that time processing is abnormal in TS.

Methods

We compared time processing abilities between nine children with TS-only (i.e. without major psychiatric comorbidities) and 10 age-matched healthy children, employing a time reproduction task in which subjects actively reproduce different temporal intervals, and a time comparison task in which subjects judge whether a test interval is longer or shorter than a reference interval. IQ, sustained and divided attention, and working memory were assessed in both groups using the Leiter International Performance Scale-Revised, and the Digit Span sub-test of the WISC-R.

Results

Children with TS-only reproduced in an overestimated fashion over-second, but not sub-second, time intervals. The precision of over-second intervals reproduction correlated with tic severity, in that the lower the tic severity, the closer the reproduction of over-second time intervals to their real duration. Time reproduction performance did not significantly correlate with IQ, attention and working memory measures in both groups. No differences between groups were documented in the time comparison task.

Conclusions

The improvement of time processing in children with TS-only seems specific for the over-second range of intervals, consistent with an enhancement in the ‘cognitively controlled’ timing system, which mainly processes longer duration intervals, and depends upon dysfunctional connectivity between the basal ganglia and the dorso-lateral prefrontal cortex. The absence of between-group differences on time comparison, moreover, suggests that TS patients manifest a selective improvement of ‘motor’ timing abilities, rather than of perceptual time abilities. Our data also support an enhancement of cognitive control processes in TS children, probably facilitated by effortful tic suppression.     

Man,You Might Look Like a Woman—If a Child Is Next to You

Gender categorization seems prone to a pervasive bias: Persons about whom null or ambiguous gender information is available are more often considered male than female. Our study assessed whether such a male-bias is present in non-binary choice tasks and whether it can be altered by social contextual information. Participants were asked to report their perception of an adult figure’s gender in three context conditions: (1) alone, (2) passively besides a child, or (3) actively helping a child (n = 10 pictures each). The response options male, female and I don’t know were provided. As a result, participants attributed male gender to most figures and rarely used the I don’t know option in all conditions, but were more likely to attribute female gender to the same adult figure if it was shown with a child. If such social contextual information was provided in the first rather than the second block of the experiment, subsequent female gender attributions increased for adult figures shown alone. Additionally, female gender attributions for actively helping relative to passive adults were made more often. Thus, we provide strong evidence that gender categorization can be altered by social context even if the subject of gender categorization remains identical.     

Connections between Family Centered Care and Medical Homes of Children with Neurodevelopmental Disabilities: Experiences of Diverse Families

Cultural issues tied to race/ethnicity are important aspects in delivering medical home services to children with neurodevelopmental disabilities and their families. To better understand family satisfaction with family centered care (FCC) in medical homes of children with disabilities, this study investigated whether family race/ethnicity, in addition to parent and child characteristics, significantly influenced family perceptions of FCC in three areas: family-provider partnership, care setting practices and policies, and community coordination and follow-up. Based on the life course theory for optimizing children's developmental trajectories, examining connections between family race/ethnicity and satisfaction with health care allows for identification of strengths and weaknesses in medical home services delivery, and offers opportunities for family support and improvement in outcomes for children with disabilities. This study developed an original empirical survey using a structured questionnaire developed by Family Voices, a national advocacy organization dedicated to promoting the well-being of children with disabilities and their families. The study collected data for 122 families in a large urban area in the northeastern United States. Multivariate analyses revealed that family race/ethnicity significantly contributed to the prediction of parental satisfaction with medical homes of children with disabilities, and to families' perceptions of FCC in care setting practices and policies, and community coordination and followup, but not to family provider partnership. Non-White families reported significantly lower satisfaction. Discussion emphasizes that health care providers need to become more vigilant in providing culturally sensitive care. To enhance FCC practices and policies, the study advances a checklist of ten essential areas that promote culturally sensitive interactions between families of children with disabilities and their medical and non-medical health care providers.     

Motor imagery effectiveness for mirror reversed movements

Physical practice is known to enhance motor adaptation skills, which refer to the individual ability to compensate for environmental changes. So far, it is still unknown whether a similar effect can be observed following motor imagery (MI). Thirty-nine participants were tested during a joystick tracking task under both normal and mirror conditions (i.e., the inductive direction of the joystick was reversed), before and after a physical practice or MI training phase. Eye movements and electromyographic activity were recorded during MI. Motor performance was also evaluated after a 6 h interval during daytime. As compared to the control group, the results revealed that both MI and physical practice improved motor performance in the mirror condition, during the post-training test. Furthermore, the time to complete the task was further reduced after 6 hours, both in the normal and mirror conditions. These results demonstrate the effectiveness of MI for learning mirror-reversed movements, and for the consolidation process that follows motor adaptation.     

Contributors

Abstract

The profound psychic differences between the two human sexes are also reflected in their diverse psychopathology, even though the basic clinical forms remain common for both. In this study the problem of the psychoanalytic difference between the two sexes is discussed within the framework of psychotic situations; in intrapsychic relationships with the mother and the father, and between the patient and the therapist and with his sex. The problem of masculine and feminine psychosexuality is furthermore seen in a different light, in accordance with its pre- or postoedipal configuration.     

The structure of psychosomatic symptoms

1. According to our findings, a psychosomatic structure is not an alternative to neurosis. The syndrome of alexithymia appears to be, in our cases, a transitional phase, the dynamics of which can be understood and treated by psychotherapy. In the course of psychotherapeutic treatment, alexithymia always disappears. 2. However, a special psychotherapeutic technique is advisable, one different from that applied in classical neurosis. 3. For this reason the term psychosomatic structure can be used as a way of expressing a variation of neurosis. 4. Modern concepts of psychosomatic disease describe pathological personalities that are different from the classic pseudoneurotic type because of their narcissistic and pregenital structures. These structures can be concealed underneath a facade of genital and psychoneurotic defense. 5. The old relationship between psychosomatosis and psychosis can be better understood on the basis of our findings, which reveal a borderline structure and splitting mechanisms in many psychosomatic patients. 6. Psychosomatic pathology can be better understood today by relating it to the structure of the psychosomatic family. 7. It appears that if, on the one hand, psychosomatic diseases of a more hysterical picture are frequent among preindustrial cultures and in low-income classes, on the other hand psychosomatic syndromes of a narcissistic and borderline type are characteristic for our civilization.     

An anomalous brightness differentiation

The two adjacent regions of a homogeneous surface divided by a thin line may appear different in brightness. The phenomenon is weak, but can be obtained and systematically studied under certain experimental conditions. Data suggest that the effect is influenced by both the spatial position and the relative size of the two regions. The phenomenon is worthy of further examination because it challenges current theories of brightness perception.