Length of hospital stay and postdischarge mortality in patients with pulmonary embolism: a statewide perspective

BACKGROUND: The optimal length of stay (LOS) for patients with pulmonary embolism (PE) is unknown. Although reducing LOS is likely to save costs, the effects on patient safety are unclear. We sought to identify patient and hospital factors associated with LOS and assess whether LOS was associated with postdischarge mortality. METHODS: We evaluated patients discharged with a primary diagnosis of PE from 186 acute care hospitals in Pennsylvania (January 2000 through November 2002). We used discrete survival models to examine the association between (1) patient and hospital factors and the time to discharge and (2) LOS and postdischarge mortality within 30 days of presentation, adjusting for patient and hospital factors. RESULTS: Among 15 531 patient discharges with PE, the median LOS was 6 days, and postdischarge mortality rate was 3.3%. In multivariate analysis, patients from Philadelphia were less likely to be discharged on a given day (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.73-0.93), as were black patients (OR, 0.88; 95% CI, 0.82-0.94).The odds of discharge decreased notably with greater patient severity of illness and in patients without private health insurance. Adjusted postdischarge mortality was significantly higher for patients with an LOS of 4 days or less (OR, 1.55; 95% CI, 1.21-2.00) relative to those with an LOS of 5 to 6 days. CONCLUSIONS: Several hospital and patient factors were independently associated with LOS. Patients with a very short LOS had greater postdischarge mortality relative to patients with a typical LOS, suggesting that physicians may inappropriately select patients with PE for early discharge who are at increased risk of complications

Former eating disorder impairs 3rd person but not 1st person perspective taking. Does dance training help?

The mental ability to take the perspective of another person may depend on one's own bodily awareness and experience. In the present study, the former was defined as having a history of an eating disorder, and the latter variable was defined as formal experience with dance. The study used a 2 × 2 × 2 factorial design in which reaction times in two mental perspective taking tasks were compared between female dancers and non-dancers with and without a former eating disorder. Participants were asked to imagine two perspectives: i) the position of front-facing and back-facing figures (3rd person perspective taking task) and ii) that these same figures are a self reflection in a mirror (1st person perspective taking task). In both tasks, a particular hand was indicated in the presented figures, and the participants had to decide whether the hand represented their own left or right hand. Overall, responses were slower for front-facing than back-facing figures in the 3rd person perspective taking task, and for back-facing than front-facing figures in the 1st person perspective taking task. Importantly, having a former history of an eating disorder related to a decreased performance in the 3rd person perspective taking task, but only in participants without dance experience. Results from an additional control group (a history of exercise but no dance experience) indicated that dance is particularly beneficial for mental bodily perspective taking. Dance experience, more so than exercise in general, can benefit 3rd person or extrapersonal perspective taking, supporting the favourable impact this exercise has on own body processing

Multisensory mechanisms in temporo-parietal cortex support self-location and first-person perspective.

Self-consciousness has mostly been approached by philosophical enquiry and not by empirical neuroscientific study, leading to an overabundance of diverging theories and an absence of data-driven theories. Using robotic technology, we achieved specific bodily conflicts and induced predictable changes in a fundamental aspect of self-consciousness by altering where healthy subjects experienced themselves to be (self-location). Functional magnetic resonance imaging revealed that temporo-parietal junction (TPJ) activity reflected experimental changes in self-location that also depended on the first-person perspective due to visuo-tactile and visuo-vestibular conflicts. Moreover, in a large lesion analysis study of neurological patients with a well-defined state of abnormal self-location, brain damage was also localized at TPJ, providing causal evidence that TPJ encodes self-location. Our findings reveal that multisensory integration at the TPJ reflects one of the most fundamental subjective feelings of humans: the feeling of being an entity localized at a position in space and perceiving the world from this position and perspective.

Validation of the French version of the Hierarchical Personality Inventory for Children (HiPIC): Influence of gender and age on personality traits from 8 to 12 years

The study was designed to investigate the psychometric properties of the French version and the cross-language replicability of the Hierarchical Personality Inventory for Children (HiPIC). The HiPIC is an instrument aimed at assessing the five dimensions of the Five-Factor Model for Children. Subjects were 552 children aged between 8 and 12 years, rated by one or both parents. At the domain level, reliability ranged from .83 to .93 and at the facet level, reliability ranged from .69 to .89. Differences between genders were congruent with those found in the Dutch sample. Girls scored higher on Benevolence and Conscientiousness. Age was negatively correlated with Extraversion and Imagination. For girls, we also observed a decrease of Emotional Stability. A series of exploratory factor analyses confirmed the overall five-factor structure for girls and boys. Targeted factor analyses and congruence coefficients revealed high cross-language replicability at the domain and at the facet levels. The results showed that the French version of the HiPIC is a reliable and valid instrument for assessing personality with children and has a particularly high cross-language replicability.

Primary care at Swiss universities--current state and perspective.

BACKGROUND: There is increasing evidence that a strong primary care is a cornerstone of an efficient health care system. But Switzerland is facing a shortage of primary care physicians (PCPs). This pushed the Federal Council of Switzerland to introduce a multifaceted political programme to strengthen the position of primary care, including its academic role. The aim of this paper is to provide a comprehensive overview of the situation of academic primary care at the five Swiss universities by the end of year 2012. RESULTS: Although primary care teaching activities have a long tradition at the five Swiss universities with activities starting in the beginning of the 1980ies; the academic institutes of primary care were only established in recent years (2005 - 2009). Only one of them has an established chair. Human and financial resources vary substantially. At all universities a broad variety of courses and lectures are offered, including teaching in private primary care practices with 1331 PCPs involved. Regarding research, differences among the institutes are tremendous, mainly caused by entirely different human resources and skills. CONCLUSION: So far, the activities of the existing institutes at the Swiss Universities are mainly focused on teaching. However, for a complete academic institutionalization as well as an increased acceptance and attractiveness, more research activities are needed. In addition to an adequate basic funding of research positions, competitive research grants have to be created to establish a specialty-specific research culture.

Updating the Politics of Experience: Angela Carter's Translation of Charles Perrault's Le Petit Chaperon Rouge.

AbstractThis article seeks to assess the importance of Angela Carter's little-known work as a translator of Perrault's tales in The Fairy Tales of Charles Perrault (1977) through an examination of her "Little Red Riding Hood". Carter is mostly famous today for The Bloody Chamber and Other Stories (1979), a collection of innovative and thought-provoking fairy-tale rewritings infused with feminist concerns, strategies and perspectives. Insofar as Carter was translating Perrault's tales while writing her own "stories about fairy stories", an analysis of her translations reveals them as part of an ongoing dialogue with the work of the French author. While Carter's translations consciously update and adapt the material for children whom she seeks to sensitize to gender issues, she does not so much challenge the sexual politics of her source as recognize the emancipatory potential of Perrault's contes as useful "fables of the politics of experience".RésuméCet article vise à rendre compte de l'activité méconnue de traductrice déployée par l'auteure anglaise Angela Carter conjointement à son oeuvre de fiction, et à en reconnaître l'importance dans sa trajectoire d'écrivain. Une analyse de « Little Red Riding Hood », publié dans The Fairy Tales of Charles Perrault (1977), permet d'éclairer la poétique particulière qu'elle développera dans le recueil qui l'a rendue célèbre, The Bloody Chamber and Other Stories (1979), des « histoires sur des contes de fées » qui reflètent la perspective et les stratégies féministes de l'auteure. Carter a mené de front ses traductions et réécritures, envisagées ici comme deux formes du dialogue très riche et complexe qu'elle engage à cette période avec l'oeuvre de Perrault, plutôt qu'une subversion de celui-ci. Ainsi, sa traduction modernise et simplifie le texte des contes pour de jeunes lecteurs qu'elle cherche à sensibiliser à des problématiques de genre, en leur révélant la portée émancipatrice des contes de Perrault qu'elle envisage comme « des fables utiles sur la politique de l'expérience » plutôt qu'en contestant la politique sexuelle de sa source.