Identifying profiles of need among psychiatric inpatients approaching discharge in New York City: a latent class analysis.

PURPOSE: Understanding the needs of individuals transitioning to the community following a psychiatric hospitalization can inform community service planning. This study is among the first to examine the needs of a sample of psychiatric inpatients approaching discharge in a large urban area in the USA. METHODS: Representative data were drawn from 1129 acutely hospitalized psychiatric inpatients from eight New York City hospitals. Descriptive statistics were used to estimate patient needs at discharge across nine domains: housing, employment, income, transportation, education, time use, social support, and help accessing medical and mental health care. Latent class analysis (LCA) was applied to identify subgroups of patients based on needs profiles. Multinomial logistic regression was used to investigate socio-demographic associations with class membership. RESULTS: Respondents were most likely to have needs related to income (50.7%), housing (49.2%), and employment (48.7%). Results from the LCA suggested a five class solution of patient needs: three domain-specific classes whose members endorsed needs for 'housing and employment' (22.5%), 'social support and time use' (15.0%) and 'access to care' (6.4%) and two classes where overall member needs were high ('high needs,'18.4%) or low ('low needs,' 37.7%) across all needs. Compared to the 'low needs' class, members of the 'high needs' class had significantly greater odds of being black or Latino, male, uninsured, and parents of a child under 18 years. CONCLUSION: Patients have unique profiles of need that are significantly associated with the socio-demographic characteristics. These findings may help practitioners and policymakers improve mental health services.

Feasibility Assessment of Using the Complete Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) Item Library.

The patient-reported outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) complements capture of symptomatic adverse events (AEs) by clinicians. Previous trials have typically used a limited subset of relevant symptomatic AEs to reduce patient burden. We aimed to determine the feasibility of administering all 80 AEs included in the PRO-CTCAE library by approaching consecutive patients enrolled in a large academic phase I program at three points in time. Here, we report a preplanned analysis after enrolling the first 20 patients. All items were answered on 51 of 56 potential visits (adherence 91%). Three (5%) additional PRO-CTCAE assessments were partially completed, and two (4%) were missed because of conflicting appointments. No patient withdrew consent or chose not to complete the assessments once enrolled on study. Future trials of experimental drugs that incorporate the PRO-CTCAE should consider using this unselected approach to identify adverse events more completely.

Olympic Recoveries.

In March 2020, Prime Minister Abe Shinzo, the Tokyo Olympic Organising Committee, and the International Olympic Committee postponed the 2020 Tokyo Olympics for one year. The delay is the most prominent consequence of the COVID-19 crisis in Japan thus far. But the "Corona Calamity" (korona ka) is bigger than the Olympics. The totality of the disaster is impossible to capture. The very thing that makes it a calamity are the myriad rhythms of crisis that intersect at COVID-19. If there is a shared theme to be found in these rhythms, it is the question of recovery. When will it happen? What will it look like? And what, exactly, will we recover? In what follows, I share three rhythms of crisis and recovery: national history, the tourism industry, and the parcel delivery industry.

Characterization and outcomes of patients enrolled to multiple phase I cancer trials.

PURPOSE: Some patients who participate in early phase cancer trials enroll to more than one trial. Whether these patients have different characteristics or outcomes than patients who enroll to a single phase I trial is unknown. METHODS: The study included all patients who participated in the solid tumor drug development program of the Princess Margaret Cancer Centre, a specialized academic cancer center, from July 2014 to January 2017. Patients sequentially enrolled to multiple phase I trials were compared to those enrolled in a single trial according to demographics, clinical characteristics, reported toxicities and prognosis. RESULTS: The study cohort included 328 patients, including 61 (19%) enrolled to multiple phase I trials and 267 (81%) enrolled to a single phase I trial. Demographics, comorbidities, performance status, cancer site and time between initial diagnosis and initial enrollment to the phase I program were comparable between both groups. Patients enrolled to multiple phase I trials received more previous non-trial treatment lines (median 3 versus 2, p < 0.001) and had a higher average response rate on phase I trials (18% versus 10%, p = 0.03). Toxicity data, including number of any adverse events (AEs), grade 3/4 AEs, serious AEs and dose-limiting toxicities were comparable between both groups. Time to disease progression and time to last documented follow-up were also comparable between both groups. CONCLUSIONS: Patients enrolled to multiple phase I trials and those enrolled to a single trial had similar toxicity and prognostic profiles. These patients do not introduce bias into early-phase cancer trials results.

The New York City Mental Health Needs Assessment Study (MHNAS): Objectives, design, and methods.

OBJECTIVES: This paper describes the objectives, design, and methods of the Mental Health Needs Assessment Study (MHNAS). The objective of the MHNAS was to assess the needs of individuals transitioning to the community following psychiatric hospitalization and again 3-5 months later to inform community service planning. Needs were defined broadly to include domains like housing, employment, treatment, and social support. METHODS: The MHNAS used a 2-stage clustered sampling approach where the primary sampling units were hospitals and secondary sampling units were patients. The study included an in-person patient interview, an assessment of need from a key hospital worker, and a follow-up telephone interview 3-5 months after discharge. RESULTS: One thousand one hundred twenty-nine patients from 8 randomly selected hospitals participated. The overall response rate was 54.3% with a cooperation rate of 71.8%. The sample was similar to the overall population of psychiatric patients with respect to several key demographics. CONCLUSION: The MHNAS demonstrates the feasibility of conducting a needs assessment with a random sample of psychiatric inpatients in a large urban setting. Results from this study may improve community service planning to better meet individuals' needs, with the ultimate goal of reducing rehospitalization and promoting recovery.

Asymmetrical Integration: Lessons from a Railway Empire.

This article reexamines railway imperialism in Manchuria from the perspective of global network building. Through a case study of the Japanese-owned South Manchuria Railway Company (SMR), I trace how one railway empire used through traffic agreements to integrate Northeast Asian railways into a global network while at the same time installing itself as the necessary intermediary between European and Asian overland traffic. I argue that the SMR's pursuit of global reach and local dominance compels us to reconsider the traditional division of border-crossing railways into international and imperialist types, and instead to examine how border-crossing railways contributed to the uneven or "asymmetrical" integration of the global transportation infrastructure.