The recovery movement in mental health emphasizes holistic and individualized treatment through many pathways to recovery, though the majority of mental health treatment and existing literature emphasize pharmacotherapy and medication adherence for major mental health conditions. The reimbursement system and research literature are oriented around formal diagnostic categories based in a biomedical perspective of mental health problems, but diagnostic labels also carry stigma and influence how clients perceive themselves and their mental health problems. To investigate the influence of labeling and perception in alternate pathways to recovery, this qualitative study explores the lived experience of diagnostic labeling and self-perception among persons in sustained recovery without ongoing medication use. The study used a grounded theory approach to analyze data from in-depth interviews with 19 participants. Participants had previously received diagnoses of schizophrenia, bipolar disorder, and/or major depression, met criteria for functional recovery, and were no longer taking psychotropic medications for 12 months. The participants identified positive perceptions-externalization of the problem and hope for an external "cure"-and negative perceptions-stigma and powerlessness-following a diagnostic label. Notably, the theme of powerlessness related to the initially positive themes as the diagnosis placed the problem outside their control and some participants experienced treatments as unhelpful. Participants succeeded in overcoming powerlessness by finding internalized solutions and redefining their mental health experience as transformative. Rather than pressing clients to accept their diagnosis or "illness," mental health providers can support multiple pathways to recovery by emphasizing empowerment and personal meaning-making in the recovery process.The risk from naturally occurring radioactive materials (NORM) has been extensively assessed, and this has led to the integration of specific NORM radiation protection requirements within the latest EU Directive 2013/59. Nevertheless, it has been internationally recognised that remaining NORM knowledge gaps and uncertainties now present similarly significant issues in addressing recent regulatory requirements. The multi-tiered nature of environmental impact assessment (EIA) implies per se possibility for uncertainties, but when EIA at radiation exposure sites includes consideration of sites with multiple radiation and contamination sources, different ecosystem transport pathways, effects and risks by applying different parameters and models, level of overall uncertainty increases.  https://www.selleckchem.com/Bcl-2.html  The results of EIA study in the Fen area in Norway, comprised of undisturbed and legacy NORM sites, have been evaluated in this analysis, in order to identify all existing input uncertainties and how they may impact the final conclusions, and thus, influence any subsequent decision-making. The main uncertainties have been identified in the measurement and exposure analysis tier, and were related to the heterogeneous distribution of radionuclides, radionuclide speciation, as well as to generic variability issues in the concepts used for mobility and biota uptake analysis (such as distribution coefficient, transfer factors and concentration ratios) as well as radioecological modelling. The uncertainties in the input values to the calculation of the dose arising from radon exposure in the Fen area led to an overall elevated uncertainty of the magnitude of the radiation exposure dose of humans. It has been concluded that an integrated, ecosystem-based approach with consideration of complexity of prevailing environmental conditions and interconnections must be applied to fully understand possible radiation effects and risks.
  Crohn's disease (CD) is associated with increased postoperative morbidity. Sarcopenia correlates with increased morbidity and mortality in various medical conditions. We assessed correlations of the lean body mass marker and psoas muscle area (PMA), with postoperative outcomes in CD patients undergoing gastrointestinal surgery.
 
  We included patients with CD who underwent gastrointestinal surgery between June 2009 and October 2018 and had CT/MRI scans within 8 weeks preoperatively. PMA was measured bilaterally on perioperative imaging.
 
  Of 121 patients, the mean age was 35.98 ± 15.07 years; 51.2% were male. The mean BMI was 21.56 ± 4 kg/m2. The mean PMA was 95.12 ± 263.2cm
  . Patients with postoperative complications (N = 31, 26%) had significantly lower PMA compared with patients with a normal postoperative recovery (8.5 ± 2.26 cm2 vs. 9.85 ± 2.68 cm2, P = 0.02). A similar finding was noted comparing patients with anastomotic leaks to those without anastomotic leaks (7.48 ± 0.1 cm2 vs. 9.6 ± 2.51 cm2, P = 0.04). PMA correlated with the maximum degree of complications per patient, according to the Clavien-Dindo classification (Spearman's coefficient = -0.26, P = 0.004). Patients with major postoperative complications (Clavien-Dindo ≥ 3) had lower mean PMA (8.12 ± 2.75 cm2 vs. 9.71 ± 2.57 cm2, P = 0.03). Associations were similar when stratifying by gender and operation urgency. On multivariate analysis, PMA (HR = 0.72/cm2, P = 0.02), operation urgency (HR = 3.84, P < 0.01), and higher white blood cell count (HR = 1.14, P = 0.02) were independent predictive factors for postoperative complications.
 
  PMA is an easily measured radiographic parameter associated with postoperative complications in patients with CD undergoing bowel resection.
 PMA is an easily measured radiographic parameter associated with postoperative complications in patients with CD undergoing bowel resection.
  Many primary care practices have adopted Lean techniques to reduce the amount of time spent completing routine tasks. Few studies have evaluated both immediate and sustained impacts of Lean to improve this aspect of primary care work efficiency.
 
  To examine 3-year impacts of Lean implementation on the amount of time taken for physicians to complete common clinical tasks.
 
  Non-randomized stepped wedge with segmented regression and interrupted time series analysis (January 2011-December 2016).
 
  A total of 317 physician-led teams in 46 primary care departments in a large ambulatory care delivery system.
 
  Lean redesign was initiated in one pilot site followed by system-wide spread across all primary care departments. Redesigns included standardization of exam room equipment and supplies, streamlining of call management processes, care team co-location, and team management of the electronic inbox.
 
  Time-stamped EHR tracking of physicians' completion time for 4 common tasks (1) office visit documentation and closure of patient charts; (2) telephone call resolution; (3) prescription refill renewal; and (4) response to electronic patient messages.