Jung's Psychoid Monism

Jung's final psychoid theory of archetypes was an additional attempt to find a solution to the philosophical problem of how to relate mind and matter. In the following essay Jung's solution is summarized by a set of 17 theses, and Jung's philosophy will be called psychoid monism. According to psychoid monism, what ultimately and primarily is, is the psycho-physically neutral domain of instinctual experience. The origin of this view can be traced back to Post-Kantian German Idealism (Schopenhauer, Schelling, Hölderlin), and a systematization of the view requires a dialectic approach and, in particular, contradiction-tolerant dialectic logic.

Characterizing the trophy hunting debate on Twitter

Social media is an arena of debate for contentious political and social topics. One conservation topic debated online is the acceptability of trophy hunting, a debate that has implications for national and international policy. We used a mixed-methods approach (grounded theory and quantitative clustering) to identify themes in the trophy hunting debate on Twitter. We examined commonly co-occurring categories that describe people's stances on trophy hunting. We identified 12 categories and 4 preliminary archetypes opposing trophy hunting-activism, scientific, condemning, and objecting-whose opposition derived from different moral reasoning. Few tweets (22) in our sample of 500 supported trophy hunting, whereas 350 opposed it. The debate was hostile; 7% of tweets in our sample were categorized as abusive. Online debates can be unproductive, and our findings may be important for stakeholders wishing to effectively engage in the trophy hunting debate on Twitter. More generally, we contend that because social media is increasingly influential, it is important to formally contextualize public responses to contentious conservation topics in order to aid communication of conservation evidence and to integrate diverse public perspectives in conservation practice.

Assessing the Role of Systems Thinking for Stocker Cattle Operations

Bovine respiratory disease (BRD) is recognized as a complex multifactorial disease often resulting in significant economic losses for the stocker industry through reduced health and performance of feeder calves. Conventional approaches to manage BRD in stocker production systems can be challenged with a restricted view of the system, most importantly the structure, which drives the behavior of the system and fails to anticipate unintended consequences. The translation and implementation of systems thinking into veterinary medicine can offer an alternative method to problem-solving. Fundamental to the success of the systems thinker is the conceptualization of the Iceberg Diagram intended to identify root causes of complex problems such as BRD. Furthermore, veterinary and animal health professionals are well-positioned to serve as facilitators to establish creative tension, the positive energy necessary to identify high-leverage strategies. The interrelationships and interconnected behaviors of complex stocker systems warrant an understanding of various archetypes. Archetypes provide the systems thinker with a decision-making tool to explore tactics in a nonlinear fashion for the purpose of recognizing short- and long-term outcomes. Developing literacy in the discipline of systems thinking will further equip professionals with the skillset necessary to address the multitude of challenges ingrained in complex stocker cattle systems.

A configurational approach to leadership behavior through archetypal analysis

The behavioral approach to leadership, which has introduced leadership styles, has been of great importance to the leadership field. Despite its importance, scholars have recently argued and demonstrated that these styles have various conceptual, methodological, and empirical limitations that could hamper further development of the leadership field. Consequently, they have called for alternative approaches to study leadership. We argue that taking a configurational or person-oriented approach to leadership behavior, which focuses on ideal-type configurations of leadership behaviors to identify leadership archetypes, offers such an alternative. We demonstrate the potential of such an approach via the use of archetypal analysis, for a dataset of 46 behaviors across 6 leadership styles, including more than 150,000 respondents. Our results offer a clear indication for the existence of archetypes of leadership. We also suggest how the resulting archetypes can get a meaningful interpretation, and discuss implications for future research.

Archetypal Analysis of Injury in Kidney Transplant Biopsies Identifies Two Classes of Early AKI

All transplanted kidneys are subjected to some degree of injury as a result of the donation-implantation process and various post-transplant stresses such as rejection. Because transplants are frequently biopsied, they present an opportunity to explore the full spectrum of kidney response-to-wounding from all causes. Defining parenchymal damage in transplanted organs is important for clinical management because it determines function and survival. In this study, we classified the scenarios associated with parenchymal injury in genome-wide microarray results from 1,526 kidney transplant indication biopsies collected during the INTERCOMEX study. We defined injury groups by using archetypal analysis (AA) of scores for gene sets and classifiers previously identified in various injury states. Six groups and their characteristics were defined in this population: No injury, minor injury, two classes of acute kidney injury ("AKI," AKI1, and AKI2), chronic kidney disease (CKD), and CKD combined with AKI. We compared the two classes of AKI, namely, AKI1 and AKI2. AKI1 had a poor function and increased parenchymal dedifferentiation but minimal response-to-injury and inflammation, instead having increased expression of PARD3, a gene previously characterized as being related to epithelial polarity and adherens junctions. In contrast, AKI2 had a poor function and increased response-to-injury, significant inflammation, and increased macrophage activity. In random forest analysis, the most important predictors of function (estimated glomerular filtration rate) and graft loss were injury-based molecular scores, not rejection scores. AKI1 and AKI2 differed in 3-year graft survival, with better survival in the AKI2 group. Thus, injury archetype analysis of injury-induced gene expression shows new heterogeneity in kidney response-to-wounding, revealing AKI1, a class of early transplants with a poor function but minimal inflammation or response to injury, a deviant response characterized as PC3, and an increased risk of failure. Given the relationship between parenchymal injury and kidney survival, further characterization of the injury phenotypes in kidney transplants will be important for an improved understanding that could have implications for understanding native kidney diseases (ClinicalTrials.gov #NCT01299168).

The Meaning of Life and Death in the Eyes of Frankl: Archetypal and Terror Management Perspectives

This article aims to uncover the meaning of life and death across the lifespan of the extraordinary person, Viktor E. Frankl (1905–1997). Frankl was purposively sampled due to his international acclaim as an Austrian neurologist and psychiatrist, who later became famous as a holocaust survivor and the founder of logotherapy. Through his approach of “healing through meaning,” he became the founder of the meaning-centred school of psychotherapy and published many books on existential and humanistic psychology. The study describes the meaning of life and death through two theoretical approaches: the archetypal analysis based on C.G. Jung’s and C.S. Pearson’s work and a terror management approach based on the melancholic existentialist work of Ernest Becker. The methodology of psychobiography is used to conduct the psycho-historical analysis of the interplay of archetypes and death annihilation anxiety throughout Frankl’s lifespan. The article evaluates how archetypes and death anxiety interacts and how they built meaning in different stages of Frankl’s lifespan. The theories are discussed and illustrated in the light of Viktor E. Frankl’s life.

Four groups of type 2 diabetes contribute to the etiological and clinical heterogeneity in newly diagnosed individuals: An IMI DIRECT study

The presentation and underlying pathophysiology of type 2 diabetes (T2D) is complex and heterogeneous. Recent studies attempted to stratify T2D into distinct subgroups using data-driven approaches, but their clinical utility may be limited if categorical representations of complex phenotypes are suboptimal. We apply a soft-clustering (archetype) method to characterize newly diagnosed T2D based on 32 clinical variables. We assign quantitative clustering scores for individuals and investigate the associations with glycemic deterioration, genetic risk scores, circulating omics biomarkers, and phenotypic stability over 36 months. Four archetype profiles represent dysfunction patterns across combinations of T2D etiological processes and correlate with multiple circulating biomarkers. One archetype associated with obesity, insulin resistance, dyslipidemia, and impaired β cell glucose sensitivity corresponds with the fastest disease progression and highest demand for anti-diabetic treatment. We demonstrate that clinical heterogeneity in T2D can be mapped to heterogeneity in individual etiological processes, providing a potential route to personalized treatments.

Evaluating the Impact of Social and Built Environments on Health-Related Quality of Life among Cancer Survivors

BACKGROUND

With almost 17 million U.S. cancer survivors, understanding multilevel factors impacting health-related quality of life (HRQOL) is critical to improving survivorship outcomes. Few studies have evaluated neighborhood impact on HRQOL among cancer survivors.

METHODS

We combined sociodemographic, clinical, and behavioral data from three registry-based studies in California. Using a three-level mixed linear regression model (participants nested within block groups and study/regions), we examined associations of both independent neighborhood attributes and neighborhood archetypes, which capture interactions inherent among neighborhood attributes, with two HRQOL outcomes, physical (PCS) and mental (MCS) composite scores.

RESULTS

For the 2,477 survivors, 46% were 70+ years, 52% were non-Hispanic White, and 53% had localized disease. In models minimally adjusted for age, stage, and cancer recurrence, HRQOL was associated with neighborhood socioeconomic status (nSES), racial/ethnic composition, population density, street connectivity, restaurant environment index, traffic density, urbanicity, crowding, rental properties, and non-single family units. In fully adjusted models, higher nSES remained associated with better PCS, and restaurant environment index, specifically more unhealthy restaurants, associated with worse MCS. In multivariable-adjusted models of neighborhood archetype, compared with upper middle-class suburb, Hispanic small town and inner city had lower PCS, and high status had higher MCS.

CONCLUSIONS

Among survivors, higher nSES was associated with better HRQOL; more unhealthy restaurants were associated with worse HQROL. As some neighborhood archetypes were associated with HRQOL, they provide an approach to capture how neighborhood attributes interact to impact HRQOL.

IMPACT

Elucidating the pathways through which neighborhood attributes influence HRQOL is important in improving survivorship outcomes.

Coronavirus: does its activation of archetypes of evil cause added psychological suffering?

Fear and grief caused by the pandemic have produced a powerful unconscious narrative in the collective psyche that the coronavirus is driven by an innately evil, and possibly divine, force. The resulting archetypal dimension of fear causes an extra layer of psychological suffering in individuals. This paper discusses how and why this narrative was created and why it is so compelling by looking at 1) the myth‐making nature of the human psyche, 2) the psychodynamics of fear that drive the narrative, 3) the properties of the coronavirus and the pandemic that activate negative poles of some archetypes, in particular, archetypes of evil, and 4) asking how analytical psychology can help ease psychological suffering caused by these negative narratives, where one possibility is to invoke the transcendent function. The author’s personal experiences as both biochemist and analytical psychologist elucidate how the transcendent function can promote healing.

Overwhelmed by Technostress? Sensitive Archetypes and Effects in Times of Forced Digitalization

This paper explores technostress and its dimensions, assessing the relationship with possible negative effects in the individual, social and professional sphere. The study uses a self-reported approach of undergraduate students in Spain (n = 337), forced to follow their academic life by using technology comprehensively because of social distancing, as a public health action necessary to reduce the spread of COVID-19. The analysis, based on the exploration of a system of archetypes of the use of social networks, presents insights into contemporary technostress management as a new approach that can suppose opportunities for the optimization of prevention plans. Pearson's correlation coefficients and structural equation modeling based on partial least squares (SEM-PLS) were the methods used for achieving the goals. The results reveal valid and reliable measures where technostress has a high impact on the individual sphere of students and there is a significant relationship between the type of user and techno-anxiety. The conclusions point to the imperative for developing a deeper understanding of technostress by archetypes, in both a higher education context (as antecedent) and the world of work, in an irreversible move towards a digital economy.

Regulation of Breast Cancer Progression by Noncoding RNAs

BACKGROUND

Breast cancer (BC) is the cardinal cause of cancer-related deaths among women across the globe. Our understanding of the molecular mechanisms underlying BC invasion and metastasis remains insufficient. Recent studies provide compelling evidence on the prospective contribution of noncoding RNAs (ncRNAs) and the association of different interactive mechanisms between these ncRNAs with breast carcinogenesis. MicroRNAs (small ncRNAs) and lncRNAs (long ncRNAs) have been explored extensively as classes of ncRNAs in the pathogenesis of several malignancies, including BC.

OBJECTIVE

In this review, we aim to provide a better understanding of the involvement of miRNAs and lncRNAs and their underlying mechanisms in BC development and progression that may assist the development of monitoring biomarkers and therapeutic strategies to effectively combat BC.

CONCLUSION

These ncRNAs play critical roles in cell growth, cell cycle regulation, epithelialmesenchymal transition (EMT), invasion, migration, and apoptosis among others, and were observed to be highly dysregulated in several cancers. The miRNAs and lncRNAs were observed to interact with each other through several mechanisms that governed the expression of their respective targets and could act either as tumor suppressors or as oncogenes, playing a crucial part in breast carcinogenesis.

Feasibility of Using EN 13606 Clinical Archetypes for Defining Computable Phenotypes

INTRODUCTION

Computable phenotypes are gaining importance as structured and reproducible method of using electronic health data to identify people with certain clinical conditions. A formal standard is not available for defining and formally representing phenotyping algorithms. In this paper, we have tried to build a formal representation of such phenotyping algorithm.

METHODS

We built EN 13606 EHR standard for building clinical archetypes to represent the computable phenotyping algorithm for 'diagnosis of cardiac failure'. As part of this work, we created a set of new clinical archetypes for defining 'cardiac failure diagnosis'. The EN13606 editor called Object Dictionary Client was used which was in-house developed by University College London. We evaluated the ability of EN 13606 to provide clinical archetypes to define EHR phenotyping algorithms using the predefined desiderata for the purpose [Mo et al].

RESULTS

EN 13606 archetypes could represent phenotype components grouped and nested based on their logical meaning. It was possible to build the EHR phenotyping algorithm with the clinical elements and their interrelationships along with hierarchical structure and temporal criteria. But the specific mathematical calculation and temporal relations involved in the algorithm was difficult to incorporate. These will need to be coded and integrated within the clinical information system. These archetypes can be mapped for comparison with the openEHR models. Binding to external clinical terminology is fully supported. However, it does not satisfy all the desiderata defined by Mo et al. A possible way could be an approach using phenotype ontologies and its architectural representation integrated with ISO interoperability.

CONCLUSION

The EN13606 archetypes can be used to define the phenotype algorithm that basically identifies patients by a set of clinical characteristics in their records. Phenotype representations defined in EN 13606 do not satisfy all the desiderata proposed by Mo et al. and thus currently has a limited ability to define the computable phenotyping algorithms. Further work is required to make the EN13606 standard to fully support the objective.

Illuminating nursing's shadow side through a Jungian analysis of the film Fog in August

Fog in August is a German film based on Robert Domes' historical novel of the same name. The film provides a fictionalized account of the institutionalization and eventual killing of children and adults labelled as a burden on the State and unworthy of life. On one level, this is a story of good versus evil, where innocent patients are manipulated by callous doctors and nurses. At a deeper level, however, it is possible to read the characters as more complex and such a reading gives an insight into the paradox of how a genocidal policy was able to be systematically implemented by health care professionals who had previously taken an oath to provide care to all people. Carl Jung argued that powerful stories, told across generations, contain mythical archetypes that help drive the plot and convey beliefs about humanity. The aims of this paper are to explore Jungian ideas within Fog in August that help the historical story it is based on resonate with viewers today, and demonstrate how the application of these insights can help health care professionals more fully understand morally distressing events and, as a result, support and improve the safety of patients.

Ambiguity and contradiction: the outlines of Jung's dialectics

This essay explores Jung's thinking strategies, argumentation patterns, and concept formation processes, and reveals how they distinguish his work from normal present-day science. Jung doesn't much appreciate the law of noncontradiction, which is a cornerstone of classical logic, and he doesn't refrain from using openly ambiguous theoretical terms. It will be pointed out that not only specific archetypes, but the notion of archetype itself, as well as other of Jung's theoretical notions (energy, including libidinal energy, polarity, integration, wholeness, instinct, symbol, and so on), are consciously ambiguous and thus potentially contradictory. It is shown that this kind of dialectic research strategy and related contradiction-tolerant and ambiguity-tolerant methods connect his work to Post-Kantian German Idealism, Schelling's and Schopenhauer's philosophy in particular. However, it was Hegel who, in his Science of Logic, presented a systematic overview of such dialectic principles of reasoning, which were, in the 19^th century, widely applied by German philosophers, theologians, and other scholars. Unfortunately, Jung decided not to study Hegel, but, instead, wrote derogatorily of his work. It will be argued that a Jungian who wants to be conscious of her own argumentation strategies and methods of concept formation should study Hegel's complex and sophisticated dialectical logic. In addition, it is suggested that Jungian depth psychology might help us to amend the phenomenological deficits of Hegel's system by providing it with a primal experiential source. This is needed because Hegel's Geist, due to its intellectual emphasis, is a self-conscious conceptual totality which advances progressively from stage to stage by guiding itself with the help of dialectical reason (Vernunft). It will be shown that if enriched with a proper kind of experiential givenness, which includes the Jungian unconsciousness (with libidinal energy, instincts, and archetypes), Hegelian metaphysics would be able to embrace a seriously aconceptual or preconceptual dimension. Aconceptual experience, which is, for Jung, mainly the instinctual layer of archetypes, remains essentially inaccessible, not only for normal scientific concepts, but for the concepts of any form of dialectics as well.

Overview and recommendations for regionalized life cycle impact assessment

PURPOSE

Regionalized life cycle impact assessment (LCIA) has rapidly developed in the past decade, though its widespread application, robustness, and validity still faces multiple challenges. Under the umbrella of UNEP/SETAC Life Cycle Initiative, a dedicated cross-cutting working group on regionalized LCIA aims to provides an overview of the status of regionalization in LCIA methods. We give guidance and recommendations to harmonize and support regionalization in LCIA for developers of LCIA methods, LCI databases, and LCA software.

METHOD

A survey of current practice among regionalized LCIA method developers was conducted. The survey included questions on chosen method spatial resolution and scale, the spatial resolution of input parameters, choice of native spatial resolution and limitations, operationalization and alignment with life cycle inventory data, methods for spatial aggregation, the assessment of uncertainty from input parameters and model structure, and variability due to spatial aggregation. Recommendations are formulated based on the survey results and extensive discussion by the authors.

RESULTS AND DISCUSSION

Survey results indicate that majority of regionalized LCIA models have global coverage. Native spatial resolutions are generally chosen based on the availability of global input data. Annual modelled or measured elementary flow quantities are mostly used for aggregating characterization factors (CFs) to larger spatial scales, although some use proxies, such as population counts. Aggregated CFs are mostly available at the country level. Although uncertainty due to input parameter, model structure, and spatial aggregation are available for some LCIA methods, they are rarely implemented for LCA studies. So far, there is no agreement if a finer native spatial resolution is the best way to reduce overall uncertainty. When spatially differentiated models CFs are not easily available, archetype models are sometimes developed.

CONCLUSIONS

Regionalized LCIA methods should be provided as a transparent and consistent set of data and metadata using standardized data formats. Regionalized CFs should include both uncertainty and variability. In addition to the native-scale CFs, aggregated CFs should always be provided, and should be calculated as the weighted averages of constituent CFs using annual flow quantities as weights whenever available. This paper is an important step forward for increasing transparency, consistency and robustness in the development and application of regionalized LCIA methods.

Evaluating regional resiliency of coastal wetlands to sea level rise through hypsometry-based modeling

Sea level rise (SLR) threatens coastal wetlands worldwide, yet the fate of individual wetlands will vary based on local topography, wetland morphology, sediment dynamics, hydrologic processes, and plant-mediated feedbacks. Local variability in these factors makes it difficult to predict SLR effects across wetlands or to develop a holistic regional perspective on SLR response for a diversity of wetland types. To improve regional predictions of SLR impacts to coastal wetlands, we developed a model that addresses the scale-dependent factors controlling SLR response and accommodates different levels of data availability. The model quantifies SLR-driven habitat conversion within wetlands across a region by predicting changes in individual wetland hypsometry. This standardized approach can be applied to all wetlands in a region regardless of data availability, making it ideal for modeling SLR response across a range of scales. Our model was applied to 105 wetlands in southern California that spanned a broad range of typology and data availability. Our findings suggest that if wetlands are confined to their current extents, the region will lose 12% of marsh habitats (vegetated marsh and unvegetated flats) with 0.6 m of SLR (projected for 2050) and 48% with 1.7 m of SLR (projected for 2100). Habitat conversion was more drastic in wetlands with larger proportions of marsh habitats relative to subtidal habitats and occurred more rapidly in small lagoons relative to larger sites. Our assessment can inform management of coastal wetland vulnerability, improve understanding of the SLR drivers relevant to individual wetlands, and highlight significant data gaps that impede SLR response modeling across spatial scales. This approach augments regional SLR assessments by considering spatial variability in SLR response drivers, addressing data gaps, and accommodating wetland diversity, which will provide greater insights into regional SLR response that are relevant to coastal management and restoration efforts.

The Geometry of Emotions: Using Chakra Acupuncture and 5-Phase Theory to Describe Personality Archetypes for Clinical Use

Background: The 5-Phase theory of Traditional Chinese Medicine has been an integral part of medical acupuncture for 2000 years. The research of John R. Cross PhD, PhDAc, has resulted in a further evolution of the 5-Phase theory to include the Ayurvedic chakra energy centers. By using chakras, a clinician can appreciate the integration of human organ systems, the neuroendocrine system, and personality attributes (both positive and negative) associated with each chakra. Objective: To create personality archetypes from chakras that have practical clinical value. Design: By assigning chakras to the 5-Phase elements on a pentagon per Dr. Cross, it was possible to connect a series of negative or positive emotions, from one to another, using the familiar Ko cycles and Shen cycles, to form theoretical personality archetypes and then to demonstrate archetype usefulness in a sample clinical case. The patient was being treated with Japanese acupuncture. The main outcome sought was to determine the personality types according to the 5-Phase theory with chakra energy centers included and to demonstrate the application of this system in the clinical case. Results: Fourteen personality archetypes-seven composed of positive emotions and seven composed of negative emotions-were identified. Easy-to-remember names and familiar patterns of emotion that are mapped to the nodes of a pentagon (adapted to chakra acupuncture) were produced. The clinical case showed that the patient's work life conflicts resulted in negative archetype emotional patterns (anger, scarcity, lack of self-esteem) consistent with the presentation of irritable bowel syndrome, insomnia, liver illness, and osteoarthritis. Conclusions: Personality archetypes have clinical value for understanding the emotions associated with illness.

Archaic man meets a marvellous automaton: posthumanism, social robots, archetypes

Posthumanism is associated with critical explorations of how new technologies are rewriting our understanding of what it means to be human and how they might alter human existence itself. Intersections with analytical psychology vary depending on which technologies are held in focus. Social robotics promises to populate everyday settings with entities that have populated the imagination for millennia. A legend of A Marvellous Automaton appears as early as 350 B.C. in a book of Taoist teachings, and is joined by ancient and medieval legends of manmade humanoids coming to life, as well as the familiar robots of modern science fiction. However, while the robotics industry seems to be realizing an archetypal fantasy, the technology creates new social realities that generate distinctive issues of potential relevance for the theory and practice of analytical psychology.

An Interoperable System toward Cardiac Risk Stratification from ECG Monitoring

Many indices have been proposed for cardiovascular risk stratification from electrocardiogram signal processing, still with limited use in clinical practice. We created a system integrating the clinical definition of cardiac risk subdomains from ECGs and the use of diverse signal processing techniques. Three subdomains were defined from the joint analysis of the technical and clinical viewpoints. One subdomain was devoted to demographic and clinical data. The other two subdomains were intended to obtain widely defined risk indices from ECG monitoring: a simple-domain (heart rate turbulence (HRT)), and a complex-domain (heart rate variability (HRV)). Data provided by the three subdomains allowed for the generation of alerts with different intensity and nature, as well as for the grouping and scrutinization of patients according to the established processing and risk-thresholding criteria. The implemented system was tested by connecting data from real-world in-hospital electronic health records and ECG monitoring by considering standards for syntactic (HL7 messages) and semantic interoperability (archetypes based on CEN/ISO EN13606 and SNOMED-CT). The system was able to provide risk indices and to generate alerts in the health records to support decision-making. Overall, the system allows for the agile interaction of research and clinical practice in the Holter-ECG-based cardiac risk domain.

A Comparison of Reimbursement Recommendations by European HTA Agencies: Is There Opportunity for Further Alignment?

Introduction: In Europe and beyond, the rising costs of healthcare and limited healthcare resources have resulted in the implementation of health technology assessment (HTA) to inform health policy and reimbursement decision-making. European legislation has provided a harmonized route for the regulatory process with the European Medicines Agency, but reimbursement decision-making still remains the responsibility of each country. There is a recognized need to move toward a more objective and collaborative reimbursement environment for new medicines in Europe. Therefore, the aim of this study was to objectively assess and compare the national reimbursement recommendations of 9 European jurisdictions following European Medicines Agency (EMA) recommendation for centralized marketing authorization.

Methods: Using publicly available data and newly developed classification tools, this study appraised 9 European reimbursement systems by assessing HTA processes and the relationship between the regulatory, HTA and decision-making organizations. Each national HTA agency was classified according to two novel taxonomies. The System taxonomy, focuses on the position of the HTA agency within the national reimbursement system according to the relationship between the regulator, the HTA-performing agency, and the reimbursement decision-making coverage body. The HTA Process taxonomy distinguishes between the individual HTA agency's approach to economic and therapeutic evaluation and the inclusion of an independent appraisal step. The taxonomic groups were subsequently compared with national HTA recommendations.

Results: This study identified European national reimbursement recommendations for 102 new active substances (NASs) approved by the EMA from 2008 to 2012. These reimbursement recommendations were compared using a novel classification tool and identified alignment between the organizational structure of reimbursement systems (System taxonomy) and HTA recommendations. However, there was less alignment between the HTA processes and recommendations.

Conclusions: In order to move forward to a more harmonized HTA environment within Europe, it is first necessary to understand the variation in HTA practices within Europe. This study has identified alignment between HTA recommendations and the System taxonomy and one of the major implications of this study is that such alignment could support a more collaborative HTA environment in Europe.

Bridging the Gap Between the Social and the Technical: The Enrolment of Socio-Technical Information Architects to Cope with the Two-Level Model of EPR Systems

This is a project proposal derived from an urge to re-define the governance of ICT in healthcare towards regional and national standardization of the patient pathways. The focus is on a two-levelled approach for governing EPR systems where the clinicians' model structured variables and patient pathways. The overall goal is a patient centric EPR portfolio. This paper define and enlighten the need for establishing the socio- technical architect role necessary to obtain the capabilities of a modern structured EPR system. Clinicians are not capable to moderate between the technical and the clinical.

Symbol/Meaning paired-associate recall: an "archetypal memory" advantage?

The theory of the archetypes and the hypothesis of the collective unconscious are two of the central characteristics of analytical psychology. These provoke, however, varying reactions among academic psychologists. Empirical studies which test these hypotheses are rare. Rosen, Smith, Huston and Gonzales proposed a cognitive psychological experimental paradigm to investigate the nature of archetypes and the collective unconscious as archetypal (evolutionary) memory. In this article we report the results of a cross-cultural replication of Rosen et al. conducted in the German-speaking part of Switzerland. In short, this experiment corroborated previous findings by Rosen et al., based on English speakers, and demonstrated a recall advantage for archetypal symbol meaning pairs vs. other symbol/meaning pairings. The fact that the same pattern of results was observed across two different cultures and languages makes it less likely that they are attributable to a specific cultural or linguistic context.

The Dialogical Jung: Otherness within the Self

This paper explores dialogical currents in Jung's analytical psychology, with reference to contemporary theories of the dialogical self. The dialogical self is a notion that has gained increasing currency in psychology since the 1990s, in response to the limitations of traditional notions of the self, based on monological, encapsulated consciousness. Modern dialogical self theory construes the self as irrevocably embedded in a matrix of real and imagined dialogues with others. The theme of dialogical otherness within the self is also taken up in Jung's analytical psychology, both in the practice of active imagination and psychotherapy and in the theory of archetypes, and a dialogical approach to inquiry is evident in Jung's work from the outset. The implications of a dialogical re-conceptualization of analytical psychology and of analytical psychology for dialogical theory are considered in detail.

Validating archetypes for the Multiple Sclerosis Functional Composite

BACKGROUND

Numerous information models for electronic health records, such as openEHR archetypes are available. The quality of such clinical models is important to guarantee standardised semantics and to facilitate their interoperability. However, validation aspects are not regarded sufficiently yet. The objective of this report is to investigate the feasibility of archetype development and its community-based validation process, presuming that this review process is a practical way to ensure high-quality information models amending the formal reference model definitions.

METHODS

A standard archetype development approach was applied on a case set of three clinical tests for multiple sclerosis assessment: After an analysis of the tests, the obtained data elements were organised and structured. The appropriate archetype class was selected and the data elements were implemented in an iterative refinement process. Clinical and information modelling experts validated the models in a structured review process.

RESULTS

Four new archetypes were developed and publicly deployed in the openEHR Clinical Knowledge Manager, an online platform provided by the openEHR Foundation. Afterwards, these four archetypes were validated by domain experts in a team review. The review was a formalised process, organised in the Clinical Knowledge Manager. Both, development and review process turned out to be time-consuming tasks, mostly due to difficult selection processes between alternative modelling approaches. The archetype review was a straightforward team process with the goal to validate archetypes pragmatically.

CONCLUSIONS

The quality of medical information models is crucial to guarantee standardised semantic representation in order to improve interoperability. The validation process is a practical way to better harmonise models that diverge due to necessary flexibility left open by the underlying formal reference model definitions.This case study provides evidence that both community- and tool-enabled review processes, structured in the Clinical Knowledge Manager, ensure archetype quality. It offers a pragmatic but feasible way to reduce variation in the representation of clinical information models towards a more unified and interoperable model.

Dealing with the archetypes development process for a regional EHR system

OBJECTIVES

This paper aims to present the archetype modelling process used for the Health Department of Minas Gerais State, Brazil (SES/MG), to support building its regional EHR system, and the lessons learned during this process.

METHODS

This study was undertaken within the Minas Gerais project. The EHR system architecture was built assuming the reference model from the ISO 13606 norm. The whole archetype development process took about ten months, coordinated by a clinical team co-ordinated by three health professionals and one systems analyst from the SES/MG. They were supported by around 30 health professionals from the internal SES/MG areas, and 5 systems analysts from the PRODEMGE. Based on a bottom-up approach, the project team used technical interviews and brainstorming sessions to conduct the modelling process.

RESULTS

The main steps of the archetype modelling process were identified and described, and 20 archetypes were created.

LESSONS LEARNED

-The set of principles established during the selection of PCS elements helped the clinical team to keep the focus in their objectives;-The initial focus on the archetype structural organization aspects was important;-The data elements identified were subjected to a rigorous analysis aimed at determining the most suitable clinical domain;-Levelling the concepts to accommodate them within the hierarchical levels in the reference model was definitely no easy task, and the use of a mind mapping tool facilitated the modelling process;-Part of the difficulty experienced by the clinical team was related to a view focused on the original forms previously used;-The use of worksheets facilitated the modelling process by health professionals;-It was important to have a health professional that knew about the domain tables and health classifications from the Brazilian Federal Government as member in the clinical team.

CONCLUSION

The archetypes (referencing terminology, domain tables and term lists) provided a favorable condition for the use of a controlled vocabulary between the central repository and the EMR systems and, probably, will increase the chances of preserving the semantics from the knowledge domain. Finally, the reference model from the ISO 13606 norm, along with the archetypes, proved sufficient to meet the specificities for the creation of an EHR system for basic healthcare in a Brazilian state.

Rhinoplasty in the Hispanic patient

In the United States, rhinoplasty has traditionally been performed in Caucasian patients. Ethnic rhinoplasty is often thought of as a procedure done to reshape the nose of a black or Asian patient. Little attention has been paid to rhinoplasty in Hispanic patients. There has been a large increase in the Hispanic population of the United States, and plastic surgeons will see a concomitant rise in requests for rhinoplasty among this population. In an effort to increase our understanding of Hispanic rhinoplasty, a retrospective review of a senior surgeon's experience was performed. A retrospective chart review was done examining the senior author's (S.S.) rhinoplasty practice over the past 10 years. Hispanic patients presenting for aesthetic and corrective rhinoplasty (cleft patients were excluded) were analyzed. The Hispanic nose was divided into three archetypes. Type I is characterized by a high radix and prominent vault; these noses should be corrected by dorsal reduction and resection of caudal septum. Type II is characterized by a dependent tip with inadequate projection; dorsal augmentation with diced cartilage and tip support with cartilage grafts are important. Osteotomies should generally be avoided in this group. Type III noses are characterized by a broad nasal base with thick skin and a wide tip; rhinoplasty in this group requires correction of the dorsum-base disproportion using several techniques including columellar struts, tip grafts, and dorsal augmentation. Hispanics are projected to become the largest minority population within the next 10 years, and rhinoplasty in this population will become more frequent over time. It behooves plastic surgeons to become familiar with the different archetypes of Hispanic noses and appropriate corrective techniques for each.