The Impact of DRGs on Social Workers in a University-Affiliated, Teaching Hospital System

The impact of DRGs on social workers in four social work departments located in one Northeast State was assessed by interviews with all social work staff and administrators. The impact of DRGs was determined to be substantial. Implications for social work education and practice are considered

Linear theory and violent relaxation in long-range systems: a test case

In this article, several aspects of the dynamics of a toy model for longrange Hamiltonian systems are tackled focusing on linearly unstable unmagnetized (i.e. force-free) cold equilibria states of the Hamiltonian Mean Field (HMF). For special cases, exact finite-N linear growth rates have been exhibited, including, in some spatially inhomogeneous case, finite-N corrections. A random matrix approach is then proposed to estimate the finite-N growth rate for some random initial states. Within the continuous, $N \rightarrow \infty$, approach, the growth rates are finally derived without restricting to spatially homogeneous cases. All the numerical simulations show a very good agreement with the different theoretical predictions. Then, these linear results are used to discuss the large-time nonlinear evolution. A simple criterion is proposed to measure the ability of the system to undergo a violent relaxation that transports it in the vicinity of the equilibrium state within some linear e-folding times

Three different glacier surges at a spot: What satellites observe and what not

In the Karakoram, dozens of glacier surges occurred in the past 2 decades, making the region a global hotspot. Detailed analyses of dense time series from optical and radar satellite images revealed a wide range of surge behaviour in this region: from slow advances longer than a decade at low flow velocities to short, pulse-like advances over 1 or 2 years with high velocities. In this study, we present an analysis of three currently surging glaciers in the central Karakoram: North and South Chongtar Glaciers and an unnamed glacier referred to as NN9. All three glaciers flow towards the same small region but differ strongly in surge behaviour. A full suite of satellites (e.g. Landsat, Sentinel-1 and 2, Planet, TerraSAR-X, ICESat-2) and digital elevation models (DEMs) from different sources (e.g. Shuttle Radar Topography Mission, SRTM; Satellite Pour l'Observation de la Terre, SPOT; High Mountain Asia DEM, HMA DEM) are used to (a) obtain comprehensive information about the evolution of the surges from 2000 to 2021 and (b) to compare and evaluate capabilities and limitations of the different satellite sensors for monitoring surges of relatively small glaciers in steep terrain. A strongly contrasting evolution of advance rates and flow velocities is found, though the elevation change pattern is more similar. For example, South Chongtar Glacier had short-lived advance rates above 10 yr-1, velocities up to 30 d-1, and surface elevations increasing by 170 m. In contrast, the neighbouring and 3-times-smaller North Chongtar Glacier had a slow and near-linear increase in advance rates (up to 500 yr-1), flow velocities below 1 d-1 and elevation increases up to 100 m. The even smaller glacier NN9 changed from a slow advance to a full surge within a year, reaching advance rates higher than 1 yr-1. It seems that, despite a similar climatic setting, different surge mechanisms are at play, and a transition from one mechanism to another can occur during a single surge. The sensor inter-comparison revealed a high agreement across sensors for deriving flow velocities, but limitations are found on small and narrow glaciers in steep terrain, in particular for Sentinel-1. All investigated DEMs have the required accuracy to clearly show the volume changes during the surges, and elevations from ICESat-2 ATL03 data fit neatly to the other DEMs. We conclude that the available satellite data allow for a comprehensive observation of glacier surges from space when combining different sensors to determine the temporal evolution of length, elevation and velocity changes

Improving the turnaround time of molecular profiling for advanced non-small cell lung cancer: Outcome of a new algorithm integrating multiple approaches

BACKGROUND Molecular tumor profiling to identify oncogenic drivers and actionable mutations has a profound impact on how lung cancer is treated. Especially in the subgroup of non-small cell lung cancer (NSCLC), molecular testing for certain mutations is crucial in daily clinical practice and is recommended by international guidelines. To date, a standardized approach to identify druggable genetic alterations are lacking. We have developed and implemented a new diagnostic algorithm to harmonize the molecular testing of NSCLC. PATIENTS AND METHODS In this retrospective analysis, we reviewed 119 patients diagnosed with NSCLC at the University Hospital Zurich. Tumor samples were analyzed using our standardized diagnostic algorithm: After the histological diagnosis was made, tissue samples were further analyzed by immunohistochemical stainings as well as the real-time PCR test Idylla™. Extracted DNA was further utilized for comprehensive genomic profiling (FoundationOne®CDx, F1CDx). RESULTS Out of the 119 patients were included in this study, 100 patients were diagnosed with non-squamous NSCLC (nsqNSCLC) and 19 with squamous NSCLC (sqNSCLC). The samples from the nsqNSCLC patients underwent testing by Idylla™ and were evaluated by immunohistochemistry (IHC). F1CDx analysis was run on 67 samples and 46 potentially actionable genomic alterations were detected. Ten patients received the indicated targeted treatment. The median time to test results was 4 days for the Idylla test, 5 days for IHC and 13 days for the F1CDx. CONCLUSION In patients with NSCLC, the implementation of a standardized molecular testing algorithm provided information on predictive markers for NSCLC within a few working days. The implementation of broader genomic profiling led to the identification of actionable targets, which would otherwise not have been discovered

Epidemic space

The aim of this article is to highlight the importance of 'spatiality' in understanding the materialization of risk society and cultivation of risk sensibilities. More specifically it provides a cultural analysis of pathogen virulence (as a social phenomenon) by means of tracing and mapping the spatial flows that operate in the uncharted zones between the microphysics of infection and the macrophysics of epidemics. It will be argued that epidemic space consists of three types of forces: the vector, the index and the vortex. It will draw on Latour's Actor Network Theory to argue that epidemic space is geared towards instability when the vortex (of expanding associations and concerns) displaces the index (of finding a single cause)

Anthroposophic therapy for chronic depression: a four-year prospective cohort study

BACKGROUND: Depressive disorders are common, cause considerable disability, and do not always respond to standard therapy (psychotherapy, antidepressants). Anthroposophic treatment for depression differs from ordinary treatment in the use of artistic and physical therapies and special medication. We studied clinical outcomes of anthroposophic therapy for depression. METHODS: 97 outpatients from 42 medical practices in Germany participated in a prospective cohort study. Patients were aged 20–69 years and were referred to anthroposophic therapies (art, eurythmy movement exercises, or rhythmical massage) or started physician-provided anthroposophic therapy (counselling, medication) for depression: depressed mood, at least two of six further depressive symptoms, minimum duration six months, Center for Epidemiological Studies Depression Scale, German version (CES-D, range 0–60 points) of at least 24 points. Outcomes were CES-D (primary outcome) and SF-36 after 3, 6, 12, 18, 24, and 48 months. Data were collected from July 1998 to March 2005. RESULTS: Median number of art/eurythmy/massage sessions was 14 (interquartile range 12–22), median therapy duration was 137 (91–212) days. All outcomes improved significantly between baseline and all subsequent follow-ups. Improvements from baseline to 12 months were: CES-D from mean (standard deviation) 34.77 (8.21) to 19.55 (13.12) (p < 0.001), SF-36 Mental Component Summary from 26.11 (7.98) to 39.15 (12.08) (p < 0.001), and SF-36 Physical Component Summary from 43.78 (9.46) to 48.79 (9.00) (p < 0.001). All these improvements were maintained until last follow-up. At 12-month follow-up and later, 52%–56% of evaluable patients (35%–42% of all patients) were improved by at least 50% of baseline CES-D scores. CES-D improved similarly in patients not using antidepressants or psychotherapy during the first six study months (55% of patients). CONCLUSION: In outpatients with chronic depression, anthroposophic therapies were followed by long-term clinical improvement. Although the pre-post design of the present study does not allow for conclusions about comparative effectiveness, study findings suggest that the anthroposophic approach, with its recourse to non-verbal and artistic exercising therapies can be useful for patients motivated for such therapies

Promoting Client Participation and Constructing Decisions in Mental Health Rehabilitation Meetings

The chapter analyzes practices by which support workers promote client participation in mental health rehabilitation meetings at the Clubhouse. While promoting client participation, the support workers also need to ascertain that at least some decisions get constructed during the meetings. This combination of goals—promoting participation and constructing decisions—leads to a series of dilemmatic practices, the dynamics of which the chapter focuses on analyzing. The support workers may treat clients’ turns retrospectively as proposals, even if the status of these turns as such is ambiguous. In the face of a lack of recipient uptake, the support workers may remind the clients about their epistemic access to the content of the proposal or pursue their agreement or commitment to the idea. These practices involve the support workers carrying primary responsibility over the unfolding of interaction, which is argued to compromise the jointness of the decision-making outcome.The chapter analyzes practices by which support workers promote client participation in mental health rehabilitation meetings at the Clubhouse. While promoting client participation, the support workers also need to ascertain that at least some decisions get constructed during the meetings. This combination of goals—promoting participation and constructing decisions—leads to a series of dilemmatic practices, the dynamics of which the chapter focuses on analyzing. The support workers may treat clients’ turns retrospectively as proposals, even if the status of these turns as such is ambiguous. In the face of a lack of recipient uptake, the support workers may remind the clients about their epistemic access to the content of the proposal or pursue their agreement or commitment to the idea. These practices involve the support workers carrying primary responsibility over the unfolding of interaction, which is argued to compromise the jointness of the decision-making outcome.Peer reviewe

A qualitative emancipatory inquiry into relationships between people with mental disorders and health professionals

Introduction: A therapeutic alliance with people is essential for the efficacy of treatments. However, the traditional paternalistic values of the Mediterranean society may be incompatible with patient autonomy. Aim: To explore the therapeutic relationship from the perspective of people diagnosed with mental disorders with health professionals, including nurses. Methods: This emancipatory research was performed through focus groups, with people with mental disorders who had a variety of diagnoses and experiences of acute and community‐based mental health services and other healthcare services. Data were analysed using the content analysis method. Results: Four main themes emerged: stereotypes and prejudice; quality of interactions and treatment; emotional and behavioural impacts; and demands. Discussion: According to the participants' descriptions, health professionals are not exempt from prejudice against persons with psychiatric diagnoses. They reported experiencing abuse of power, malpractice, and overmedication. Thus, in the Mediterranean culture, professional attitudes may represent a barrier for an appropriate therapeutic alliance, and people with mental disorders do not feel involved in making decisions about their health. Implications for practice: Knowing how people with mental disorders perceive their interactions with health professionals and the effects is necessary to move the care model towards more symmetric relationships that facilitate a therapeutic alliance

The benefit of symbols: monkeys show linear, human-like, accuracy when using symbols to represent scalar value

When humans and animals estimate numbers of items, their error rate is proportional to the number. To date, however, only humans show the capacity to represent large numbers symbolically, which endows them with increased precision, especially for large numbers, and with tools for manipulating numbers. This ability depends critically on our capacity to acquire and represent explicit symbols. Here we show that when rhesus monkeys are trained to use an explicit symbol system, they too show more precise, and linear, scaling than they do using a one-to-one corresponding numerosity representation. We also found that when taught two different types of representations for reward amount, the monkeys systematically undervalued the less precise representation. The results indicate that monkeys, like humans, can learn alternative mechanisms for representing a single value scale and that performance variability and relative value depend on the distinguishability of each representation