498 research outputs found

    Characteristics and Outcomes of Patients Discharged Directly Home From the Pediatric Intensive Care Unit

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    Introduction: Patients admitted to the pediatric intensive care unit (PICU) typically transfer to an acute care floor prior to discharge (ACD). Various circumstances, including rapid clinical improvement, technology dependence, or capacity constraints, may lead to discharge directly to home from a PICU (DDH). This practice has been studied in adult intensive care units, but research is lacking for PICU patients. Methods: We aimed to describe characteristics and outcomes of patients requiring PICU admission who experienced DDH versus ACD. We conducted a retrospective cohort study of patients ≀18 years old admitted to our academic, tertiary care PICU between 1/1/15 and 12/31/20. Patients who died or were transferred to another facility were excluded. Baseline characteristics (including home ventilator dependence) and markers of illness severity, specifically the need for vasoactive infusion or new mechanical ventilation, were compared between groups. Admission diagnoses were categorized using the Pediatric Clinical Classification System (PECCS). Our primary outcome was hospital readmission within 30 days. Results: Of 4042 PICU admissions during the study period, 768 (19%) were DDH. Baseline demographic characteristics were similar, although DDH patients were more likely to have a tracheostomy (30% vs 5%, P < .01) and require a home ventilator at discharge (24% vs 1%, P < .01). DDH was associated with being less likely to have required a vasoactive infusion (7% vs 11%, P < .01), shorter median length of stay (LOS) (2.1 days vs 5.9 days, P < .01) and increased rate of readmission within 30 days of discharge (17% vs 14%, P < .05). However, repeat analysis after removing ventilator-dependent patients at discharge (n = 202) showed no difference in rates of readmission (14% vs 14%, P = .88). Conclusions: Direct discharge home from the PICU is a common practice. DDH and ACD groups had similar 30-day readmission rate when patient admissions with home ventilator dependence were excluded

    Posterior Beta and Anterior Gamma Oscillations Predict Cognitive Insight

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    Pioneering neuroimaging studies on insight have revealed neural correlates of the emotional “Aha!” component of the insight process, but neural substrates of the cognitive component, such as problem restructuring (a key to transformative reasoning), remain a mystery. Here, multivariate electroencephalogram signals were recorded from human participants while they solved verbal puzzles that could create a small-scale experience of cognitive insight. Individuals responded as soon as they reached a solution and provided a rating of subjective insight. For unsolved puzzles, hints were provided after 60 to 90 sec. Spatio-temporal signatures of brain oscillations were analyzed using Morlet wavelet transform followed by exploratory parallel-factor analysis. A consistent reduction in beta power (15–25 Hz) was found over the parieto-occipital and centro-temporal electrode regions on all four conditions—(a) correct (vs. incorrect) solutions, (b) solutions without (vs. with) external hint, (c) successful (vs. unsuccessful) utilization of the external hint, and d) self-reported high (vs. low) insight. Gamma band (30–70 Hz) power was increased in right fronto-central and frontal electrode regions for conditions (a) and (c). The effects occurred several (up to 8) seconds before the behavioral response. Our findings indicate that insight is represented by distinct spectral, spatial, and temporal patterns of neural activity related to presolution cognitive processes that are intrinsic to the problem itself but not exclusively to one's subjective assessment of insight

    False claims about false memory research

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    Pezdek and Lam [Pezdek, K. & Lam, S. (2007). What research paradigms have cognitive psychologists used to study “False memory,” and what are the implications of these choices? Consciousness and Cognition] claim that the majority of research into false memories has been misguided. Specifically, they charge that false memory scientists have been (1) misusing the term “false memory,” (2) relying on the wrong methodologies to study false memories, and (3) misapplying false memory research to real world situations. We review each of these claims and highlight the problems with them. We conclude that several types of false memory research have advanced our knowledge of autobiographical and recovered memories, and that future research will continue to make significant contributions to how we understand memory and memory errors

    A procedurålis emlékezet szerepe a testkép zavaraiban = The role of procedural memory in trouble of body picture

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    Az evĂ©szavarok egyik vezetƑ betegsĂ©gfenntartĂł tĂ©nyezƑje a betegek torzult, diszfunkcionĂĄlis kognĂ­ciĂłja. Ezen belĂŒl is kiemelendƑk a tĂĄplĂĄlĂ©kfelvĂ©teli viselkedĂ©s zavaraival Ă©s a testĂ©lmĂ©nnyel kapcsolatban lĂ©vƑ, a zavarok lĂ©trejöttĂ©ben kulcsszerepet jĂĄtszĂł kognitĂ­v disztorziĂłk, melyek az informĂĄciĂłfeldolgozĂĄsi folyamatokon belĂŒl elsƑsorban a perceptuĂĄlis Ă©lmĂ©nyfeldolgozĂĄst Ă©rintik Ă©s evĂ©szavaros betegeknĂ©l a testkĂ©p speciĂĄlis zavarĂĄban mutatkoznak meg. A kognitĂ­v informĂĄciĂłfeldolgozĂĄst a sĂ©mĂĄk irĂĄnyĂ­tjĂĄk, amelyekben a selfrƑl valĂł komplex tudĂĄs szervezƑdik. A sĂ©mĂĄk procedurĂĄlis ismeretanyagot is hordoznak, Ășgy mint motoros kĂ©szsĂ©geket, szokĂĄsokat, szabĂĄlyokat, cĂ©lkĂ©pzeteket, döntĂ©shozatali stratĂ©giĂĄkat. Ezek alapjĂĄn felmerĂŒl, hogy az evĂ©szavarokra jellemzƑ viselkedĂ©ses rutincselekvĂ©sek, mint pĂ©ldĂĄul a diĂ©tĂĄzĂĄs, falĂĄsroham, önhĂĄnytatĂĄs a testkĂ©p sĂ©mĂĄjĂĄn belĂŒl procedurĂĄlis Ă©lmĂ©nyanyagkĂ©nt kĂłdolĂłdhat Ă©s a munkamemĂłriĂĄban automatikusan a többi explicit tudĂĄssal Ă©s emlĂ©kkel egyĂŒtt aktivĂĄlĂłdik. ElmĂ©leti ĂĄttekintĂ©sĂŒnkben ezeknek a prekognitĂ­v folyamatoknak keressĂŒk a helyĂ©t Ă©s szerepĂ©t az evĂ©szavaros betegekre jellemzƑ kognitĂ­v informĂĄciĂłfeldolgozĂĄsi jellegzetessĂ©gek kialakĂ­tĂĄsĂĄban

    The fallibility of memory in judicial processes: Lessons from the past and their modern consequences

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    The capability of adult and child witnesses to accurately recollect events from the past and provide reliable testimony has been hotly debated for more than one hundred years (Binet, 1900). Prominent legal cases of the 1980s and 1990s sparked lengthy debates and important research questions surrounding the fallibility and general reliability of memory. But what lessons have we learned, some forty years later, about the role of memory in the judicial system? In this review, we focus on what we now know about the consequences of the fallibility of memory for legal proceedings. We present a brief historical overview of false memories that focuses on three critical forensic areas that changed memory research: Children as eyewitnesses, historic sexual abuse, and eyewitness (mis)identification. We revisit some of the prominent trials of the 1980s and 1990s to not only consider the role false memories have played, but also to see how this has helped us understand memory today. Finally, we consider the way in which the research on memory (true and false) has been successfully integrated into some courtroom procedures

    Time perception and the experience of agency in meditation and hypnosis

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    Mindfulness meditation and hypnosis are related in opposing ways to awareness of intentions. The cold control theory of hypnosis proposes that hypnotic responding involves the experience of involuntariness while performing an actually intentional action. Hypnosis therefore relies upon inaccurate metacognition about intentional actions and experiences. Mindfulness meditation centrally involves awareness of intentions and is associated with improved metacognitive access to intentions. Therefore, mindfulness meditators and highly hypnotizable people may lie at opposite ends of a spectrum with regard to metacognitive access to intention‐related information. Here we review the theoretical background and evidence for differences in the metacognition of intentions in these groups, as revealed by chronometric measures of the awareness of voluntary action: the timing of an intention to move (Libet's “W” judgments) and the compressed perception of time between an intentional action and its outcome (“intentional binding”). We review these measures and critically evaluate their proposed connection to the experience of volition and sense of agency

    Small business economics: A perspective from The Netherlands

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    In the analysis of economic phenomena either within or across industries there is room for integrating the role of small business. This contribution can be made by aggregation or generalization of the findings at the meso level, which again are partly based upon analyses at the micro level. The Netherlands has a long history in macro model building. A recent discussion among Dutch macro-economists considered the future of econometric model building at the macro level, and considered how best to improve this model building. The explicit integration of scale effects, however, was not mentioned. I am convinced that improvements in this respect are possible. In particular, I have in mind the role which small businesses play in certain areas such as wage structure, employment or investments. The dissection of macro prognoses into a small business component and a remaining component is a traditional practice in The Netherlands.1 Finally, there is much concern in The Netherlands for the calculation of regulatory effects, decomposed into effects for small and large businesses. If anywhere in the world there is a solid foundation for studying scale effects in both macro and sectoral models, it most certainly has been in The Netherlands. There is a strong tradition of macro-econometric model building; groups of econometricians specialized in small business research exist; Dutch policymakers show concern and the required research apparatus is available
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