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6 h in patients with an initial misdiagnosis to 5.5 h in patients with the correct initial diagnosis (p less then 0.001). Of all acute type A aortic dissection patients, 49% had a positive Aortic Dissection Detection Risk Score. Of all initial misdiagnosed patients, 41% had a positive score (⩾2). The presence of lumbar pain (p less then 0.001), any paresis (p=0.037) and sweating (p=0.042) was more likely to lead to the correct initial diagnosis. CONCLUSION An early consideration of acute aortic dissection may reduce the delay of surgical care. The suggested Aortic Dissection Detection Risk Score may be a useful tool to improve the preclinical assessment.The narrative of depression as a neurochemical imbalance in the brain or, more precisely, a deficiency of the neurotransmitters serotonin and norepinephrine - largely produced by commercial interests of the international and national pharmaceutical industry and spread globally by international diagnostic systems - has found its way into the offices of mainstream psychiatrists in Kerala. In the clinical encounters, social, economic and existential suffering is thus transformed into a medical condition, treatable with pharmacological means. On the one hand, the setting of a psychiatric outpatient department largely shapes the way depressive patients express their subjectivities. On the other hand, the diagnosis (and explanation) of depression as neurochemical imbalance and the prescription of drugs influences the way patients experience their suffering. Using two ethnographic examples, the aim of this paper is to analyze how subjectivities are construed and shaped in the process of negotiating depression in clinical encounters in mainstream psychiatric institutions in Kerala and how multiple framings and ontologies of affliction are assembled in them. Subjectivities of depression are, it will be argued, less coherent than ambigious and fractured, unstable and fragile. They engage, accentuate and sometimes merge different, often contradictory discourses. They should therefore better be referred to as 'subjunctivities'. The idiom of depression often becomes a rhetorical device to emphasize affiliation to a scientific medical discourse or citizenship and is often a statement to emphasize 'scientific temper' and modernity and to demarcate oneself from backwardness and superstition.Although many facets of social status (i.e., socioeconomic status, gender, race) are fairly stable, limited work has assessed how youths' identification with their status changes over time. [https://www.selleckchem.com/products/azd-5462.html AZD-5462 clinical trial] Subjective social status (SSS) refers to one's perception of standing or rank relative to others, and for youth status is generally in the context of society or school. The current study assessed how adolescents' SSS in American society and in their school changes and predicts health and well-being during and after high school. A total of 336 adolescents (Mage = 16.40 at Wave 1) reported their SSS at up to three time points, each 2 years apart, such that youth provided data between the 10th grade and 3 years following the transition from high school. Piecewise multilevel modeling was used, including discontinuities to assess the importance of the transition from high school. Society SSS decreased across the period, especially among youth with lower family income, youth whose parents reported lower SSS, and youth who did not attend college. School SSS was stable during high school, declined after 12th grade, and remained stable thereafter. Moderation analyses revealed that school SSS declines more consistently among female adolescents than male adolescents and Latinos relative to other ethnic groups. Lower society and school SSS were associated with more depressive symptoms and greater likelihood of obesity, highlighting the relevance of SSS for health during this important developmental transition. Results suggest declines in SSS are especially common among disadvantaged groups as they age, and that lower SSS may indicate risk for poorer health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).The ability to switch efficiently between different tasks underpins cognitive flexibility and is impaired in various psychiatric disorders. Recent research has suggested that the control processes mediating switching can be subject to learning, because "switch readiness" can become associated with, and primed by, specific stimuli. In cued task switching, items that are frequently associated with the need to switch incur a smaller behavioral switch cost than do items associated with a low probability of switching, known as the item-specific switch probability (ISSP) effect (Chiu &amp; Egner, 2017). However, it remains unknown whether ISSP associations modulate the efficiency of only cued switching or also impact people's voluntary choice to switch tasks. Here, we addressed this question by combining an ISSP manipulation with a protocol that mixed 75% standard cued task trials with 25% free choice trials, allowing us to measure the effect of ISSP on voluntary switch rate (VSR). We observed robust ISSP effects on cued trials, replicating previous findings. Crucially, we also found that the VSR was greater for items associated with a high than with a low switch likelihood. We thus demonstrate that associating specific stimuli with frequent switch requirements not only reduces switch costs but also enhances participants' tendency to switch voluntarily. (PsycInfo Database Record (c) 2020 APA, all rights reserved).A typical way to investigate the relationship between spatial attention and the programming of an eye movement is with a dual-task. Here, participants simultaneously make an eye movement in 1 direction and discriminate a target at the same or a different location. Results of these tasks consistently find that performance is best at the goal of an upcoming eye movement. It is less clear, however, the extent to which spatial attention can shift independently of the programmed saccade. In this article, for the first time, we use an evidence accumulation model to examine this longstanding question. Specifically, across 2 studies, we quantify the relative contributions of spatial attention and saccade preparation in a perceptual dual-task. Our results establish that there is a unique and measurable effect of spatial attention away from the saccade goal, and, interestingly, that the relative magnitude of this effect varies by cue type. There is a larger influence of spatial attention when a peripheral rather than a central cue is employed.