Dealing with care disruption in High and Intensive Care wards:From difficult patients to difficult situations

High and Intensive Care is a relatively new care model in Dutch mental health care for clinical admissions. One of the goals is to keep the admission short. For some patients, this goal is not realized, which results in a long-term admission. Often, this is experienced as a disruption. Disruptions in care processes are frequently defined in terms of patient characteristics. Yet, it may be that other factors play a role. The aim of this study is to gain better insight into the perceptions of care professionals of what is characteristic for disruptions at High and Intensive Care wards and how professionals can deal with these. Qualitative research was performed by means of semi-structured interviews and a focus group with professionals. Results show that a focus on patient characteristics is too narrow and that other factors also play an important role. These factors include challenges in the relation between professionals and the patient, a divided team, and a lack of collaboration with ambulatory care. In order to deal with these factors, professionals should invest in the relationship with the patient, identify destructive team processes early, and improve communication with ambulatory care. It is recommended to develop a monitoring tool that includes all these factors. Another recommendation is to organize structured reflection on dilemmas experienced in care. In conclusion, this study shows the importance of going beyond patient characteristics in order to better understand, identify, and deal with disruption at High and Intensive Care wards

Clinical auditing as an instrument to improve care for patients with ovarian cancer:The Dutch Gynecological Oncology Audit (DGOA)

Introduction: The Dutch Gynecological Oncology Audit (DGOA) was initiated in 2014 to serve as a nationwide audit, which registers the four most prevalent gynecological malignancies. This study presents the first results of clinical auditing for ovarian cancer in the Netherlands. Methods: The Dutch Gynecological Oncology Audit is facilitated by the Dutch Institute of Clinical Auditing (DICA) and run by a scientific committee. Items are collected through a web-based registration based on a set of predefined quality indicators. Results of quality indicators are shown, and benchmarked information is given back to the user. Data verification was done in 2016. Results: Between January 01, 2014 and December 31, 2018, 6535 patients with ovarian cancer were registered. The case ascertainment was 98.3% in 2016. The number of patients with ovarian cancer who start therapy within 28 days decreased over time from 68.7% in 2014 to 62.7% in 2018 (p < 0.001). The percentage of patients with primary cytoreductive surgery decreased over time (57.8%–39.7%, P < 0.001). However, patients with complete primary cytoreductive surgery improved over time (53.5%–69.1%, P < 0.001). Other quality indicators did not significantly change over time. Conclusion: The Dutch Gynecological Oncology Audit provides valuable data on the quality of care on patients with ovarian cancer in the Netherlands. Data show variation between hospitals with regard to pre-determined quality indicators. Results of ‘best practices’ will be shared with all participants of the clinical audit with the aim of improving quality of care nationwide

Tumor immune escape in acute myeloid leukemia: Class II-associated invariant chain peptide expression as result of deficient antigen presentation

In this overview, we discuss the role of class II-associated invariant chain peptide (CLIP) in acute myeloid leukemia (AML), one of the few tumors expressing HLA class II. The clinical impact, function and regulation of CLIP expression on leukemic cells is addressed, indicating its potential as immunotherapeutic target in AML

Does Migration Make You Happy?:A Longitudinal Study of Internal Migration and Subjective Well-Being

The authors acknowledge financial support from the Economic and Social Research Council (ESRC) (RES-625-28-0001). This project is part of the ESRC Centre for Population Change (CPC). Financial support from the Marie Curie programme under the European Union's Seventh Framework Programme (FP/2007-2013) / Career Integration Grant n. PCIG10-GA-2011-303728 (CIG Grant NBHCHOICE, Neighbourhood choice, neighbourhood sorting, and neighbourhood effects).The majority of quantitative studies on the consequences of internal migration focus almost exclusively on the labour-market outcomes and the material well-being of migrants. We investigate whether individuals who migrate within the UK become happier after the move than they were before, and whether the effect is permanent or transient. Using life-satisfaction responses from twelve waves of the British Household Panel Survey and employing a fixed-effects model, we derive a temporal pattern of migrants’ subjective well-being around the time of the migration event. Our findings make an original contribution by revealing that, on average, migration is preceded by a period when individuals experience a significant decline in happiness for a variety of reasons, including changes in personal living arrangements. Migration itself causes a boost in happiness, and brings people back to their initial levels. The research contributes, therefore, to advancing an understanding of migration in relation to set-point theory. Perhaps surprisingly, long-distance migrants are at least as happy as short-distance migrants despite the higher social and psychological costs involved. The findings of this paper add to the pressure to retheorize migration within a conceptual framework that accounts for social well-being from a life-course perspective.PostprintPeer reviewe

Sputum microbiome profiling in COPD: beyond singular pathogen detection.

Culture-independent microbial sequencing techniques have revealed that the respiratory tract harbours a complex microbiome not detectable by conventional culturing methods. The contribution of the microbiome to chronic obstructive pulmonary disease (COPD) pathobiology and the potential for microbiome-based clinical biomarkers in COPD are still in the early phases of investigation. Sputum is an easily obtainable sample and has provided a wealth of information on COPD pathobiology, and thus has been a preferred sample type for microbiome studies. Although the sputum microbiome likely reflects the respiratory microbiome only in part, there is increasing evidence that microbial community structure and diversity are associated with disease severity and clinical outcomes, both in stable COPD and during the exacerbations. Current evidence has been limited to mainly cross-sectional studies using 16S rRNA gene sequencing, attempting to answer the question 'who is there?' Longitudinal studies using standardised protocols are needed to answer outstanding questions including differences between sputum sampling techniques. Further, with advancing technologies, microbiome studies are shifting beyond the examination of the 16S rRNA gene, to include whole metagenome and metatranscriptome sequencing, as well as metabolome characterisation. Despite being technically more challenging, whole-genome profiling and metabolomics can address the questions 'what can they do?' and 'what are they doing?' This review provides an overview of the basic principles of high-throughput microbiome sequencing techniques, current literature on sputum microbiome profiling in COPD, and a discussion of the associated limitations and future perspectives

Learning from failure

We study decentralized learning in organizations. Decentralization is captured through a symmetry constraint on agents’ strategies. Among such attainable strategies, we solve for optimal and equilibrium strategies. We model the organization as a repeated game with imperfectly observable actions. A fixed but unknown subset of action profiles are successes and all other action profiles are failures. The game is played until either there is a success or the time horizon is reached. For any time horizon, including infinity, we demonstrate existence of optimal attainable strategies and show that they are Nash equilibria. For some time horizons, we can solve explicitly for the optimal attainable strategies and show uniqueness. The solution connects the learning behavior of agents to the fundamentals that characterize the organization: Agents in the organization respond more slowly to failure as the future becomes more important, the size of the organization increases and the probability of success decreases.Game theory

Galactose inhibition of the constitutive transport of hexoses in Saccharomyces cerevisiae

The relationship between the pathways of glucose and galactose utilization in Saccharomyces cerevisiae has been studied. Galactose (which is transported and phosphorylated by inducible systems) is a strong inhibitor of the utilization of glucose, fructose and mannose (which have the same constitutive transport and phosphorylation systems). Conversely, all these three hexoses inhibit the utilization of galactose, though with poor efficiency. These cross-inhibitions only occur in yeast adapted to galactose or in galactose-constitutive mutants. The efficiency of galactose as inhibitor is even greater than the efficiencies of each of the other three hexoses to inhibit the utilization of each other. Phosphorylation is not involved in the inhibition and transport of sugars is the affected step. The cross-inhibitions between galactose and either glucose, fructose or mannose do not implicate utilization of one hexose at the expense of the other, as it occurs in the mutual interactions between the latter three sugars. it seems that, by growing the yeast in galactose, a protein component is synthesized, or alternatively modified, that once bound to either galactose or any one of the other three hexoses (glucose, fructose or mannose), cross-interacts respectively with the constitutive or the inducible transport systems, impairing their function.This work was supported by a grant (PB87-0206) from the DGICYT, Promoción General del Conocimiento.Peer Reviewe

Generation of entangled coherent states via cross phase modulation in a double electromagnetically induced transparency regime

The generation of an entangled coherent state is one of the most important ingredients of quantum information processing using coherent states. Recently, numerous schemes to achieve this task have been proposed. In order to generate travelling-wave entangled coherent states, cross phase modulation, optimized by optical Kerr effect enhancement in a dense medium in an electromagnetically induced transparency (EIT) regime, seems to be very promising. In this scenario, we propose a fully quantized model of a double-EIT scheme recently proposed [D. Petrosyan and G. Kurizki, {\sl Phys. Rev. A} {\bf 65}, 33833 (2002)]: the quantization step is performed adopting a fully Hamiltonian approach. This allows us to write effective equations of motion for two interacting quantum fields of light that show how the dynamics of one field depends on the photon-number operator of the other. The preparation of a Schr\"odinger cat state, which is a superposition of two distinct coherent states, is briefly exposed. This is based on non-linear interaction via double-EIT of two light fields (initially prepared in coherent states) and on a detection step performed using a $50:50$ beam splitter and two photodetectors. In order to show the entanglement of a generated entangled coherent state, we suggest to measure the joint quadrature variance of the field. We show that the entangled coherent states satisfy the sufficient condition for entanglement based on quadrature variance measurement. We also show how robust our scheme is against a low detection efficiency of homodyne detectors.Comment: 15 pages, 9 figures; extensively revised version; added Section