Is psychiatric residential facility discharge possible and predictable? A multivariate analytical approach applied to a prospective study in Italy.

BACKGROUND: A growing number of severely ill patients require long-term care in non-hospital residential facilities (RFs). Despite the magnitude of this development, longitudinal studies surveying fairly large resident samples and yielding important information on this population have been very few. AIMS: The aims of the study were (1) to describe the socio-demographic, clinical, and treatment-related characteristics of RF patients during an index period in 2010; (2) to identify predictors and characteristics associated with discharge at the 1-year follow-up; (3) to evaluate clinicians' predictions about each patient's likelihood of home discharge (HD). METHODS: A prospective observational cohort study was conducted involving all patients staying in 23 medium-long-term RFs of the St John of God Order with a primary psychiatric diagnosis. A comprehensive set of socio-demographic, clinical, and treatment-related information was gathered and standardized assessments (BPRS, HONOS, PSP, PHI, SLOF, RBANS) were administered to each participant. Logistic regression analyses were run to identify independent discharge predictors. RESULTS: The study involved 403 patients (66.7% male), with a mean age of 49 years (SD = 10). The participants' average illness duration was 23 years; median value for length of stay in the RF was 2.2 years. The most frequent diagnosis was schizophrenia (67.5%). 104 (25.8%) were discharged: 13.6% to home, 8.2% to other RFs, 2.2% to supported housing, and 1.5% to prison. Clinicians' predictions about HD were generally erroneous. CONCLUSIONS: Very few patients were discharged to independent accommodations after 1 year. The main variables associated with a higher HD likelihood were: illness duration of <15 years and effective social support during the previous year. Lower severity of psychopathology and higher working skill levels were also associated with a significantly greater HD likelihood.

Compositional thresholds and anomalies in connection with stiffness transitions in network glasses.

The structural and dynamical properties of amorphous and liquid As(x)Se(1-x) (0.2

Altered Erythropoiesis in Mouse Models of Type 3 Hemochromatosis.

Type 3 haemochromatosis (HFE3) is a rare genetic iron overload disease which ultimately lead to compromised organs functioning. HFE3 is caused by mutations in transferrin receptor 2 (TFR2) gene that codes for two main isoforms (Tfr2α and Tfr2ß). Tfr2α is one of the hepatic regulators of iron inhibitor hepcidin. Tfr2ß is an intracellular isoform of the protein involved in the regulation of iron levels in reticuloendothelial cells. It has been recently demonstrated that Tfr2 is also involved in erythropoiesis. This study aims to further investigate Tfr2 erythropoietic role by evaluating the erythropoiesis of two Tfr2 murine models wherein either one or both of Tfr2 isoforms have been selectively silenced (Tfr2 KI and Tfr2 KO). The evaluations were performed in bone marrow and spleen, in 14 days' and 10 weeks' old mice, to assess erythropoiesis in young versus adult animals. The lack of Tfr2α leads to macrocytosis with low reticulocyte number and increased hemoglobin values, together with an anticipation of adult BM erythropoiesis and an increased splenic erythropoiesis. On the other hand, lack of Tfr2ß (Tfr2 KI mice) causes an increased and immature splenic erythropoiesis. Taken together, these data confirm the role of Tfr2α in modulation of erythropoiesis and of Tfr2ß in favoring iron availability for erythropoiesis.

Spirituality of health workers: a descriptive study.

BACKGROUND: The World Health Organisation defines health as "a state of complete physical, mental and social well-being, not merely the absence of disease or infermity". In May 1984 the spiritual dimension became part of WHO Member States' strategies for health. The WHO defines quality of life as "individuals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns." PURPOSE: To test health workers' quality of life (QOL) with regard to their spirituality. METHODS: The WHOQOL SRPB-domain 6 was used. It denotes an individual's perception of quality of life, as far as spirituality is concerned. The sample was formed by 116 health workers from three wards of three Rehabilitation Hospitals owned by the Brothers of Saint John of God, in Northern Italy. RESULTS: The sample shows means above the mid-point in all facets denoting reasonably good quality of life in the domain of spirituality. The most significative variables are: health conditions (p = .001*), religiousness (p < or = .0005**), personal creed (p < or = .0005**). IMPLICATIONS: The sample's quality of life in the domain of spirituality is reasonably good. Our findings suggest that spirituality is associated with the subjective perception of people's health status.

Ab initio simulation of phase transitions and dissociation of H2S at high pressure

By ab initio constant pressure molecular dynamics, we have identified the structure of phase V and phase VI of H2S at 35 and 65 GPa, respectively. The theoretical IR spectra of both phases are consistent with experimental findings and support our proposed structural models. We find that phase V is characterized by the presence of charged SH+3 and SH- species which are created and destroyed dynamically, whereas phase VI is no longer a molecular phase but consists of sheets of S with the majority of H intercalated between the layers. The stability of the two phases with respect to dissociation into elemental crystalline hydrogen and sulfur is discussed.

Quantitative assessment of histological changes in chronic gastritis after eradication of Helicobacter pylori.

AIMS: To evaluate the effect of 10 day triple treatment on H pylori eradication and associated gastritis. METHODS: Fifty patients with H pylori positive non-ulcer dyspepsia were treated for 10 days with amoxicillin, tinidazole, and bismuth salts. Histological examination of the antral mucosa was performed before (T0), six weeks (T1), and six months (T2) after treatment. The new Sydney classification of gastritis was used, using a score from 0 to 3 to grade degree of inflammation, atrophy, activity (intraepithelial or lamina propria damage) and H pylori. RESULTS: At T0 all patients had chronic active gastritis. Lymphoid follicules were present in 12 cases. At T1 33 patients were H pylori negative: the score showed a decrease of activity (from 2.5 to 0.54). The result was confirmed at T2 (mean score 0.22). Inflammation decreased from 1.8 to 1.4 at T2. Only one case of follicular gastritis was observed. In H pylori positive patients the scores did not show significant modifications. CONCLUSIONS: Ten day triple treatment is effective in eradicating H pylori in 69% of cases, causing a decrease of the total score for gastritis. Activity, defined by polymorph infiltration, was promptly reduced when H pylori was eradicated. There was a trend to a reduction in inflammation, but atrophy was irreversible.

Pre-treatment levels of anti-HCV core IgM antibodies are closely associated with response to alpha interferon therapy in chronic hepatitis C patients.

OBJECTIVES: To investigate the relationship between pre-treatment levels of anti-hepatitis C virus (HCV) immunoglobulin M (IgM) antibodies and the outcome of interferon therapy, and also the relationship with genotypes and quantitative viraemia. PATIENTS: One hundred and four patients with biopsy-proven chronic hepatitis C without cirrhosis, consecutively enrolled in three general hospitals in Turin, Italy, and treated according to the same interferon schedule (3 MU of recombinant alpha-2b interferon three times a week for 6 months). Anti-HCV IgM were measured by a second-generation enzyme-linked immunoassay and results expressed as sample-cutoff ratio. In 30 patients, determination of viraemia by branched DNA (bDNA) and genotyping were performed and the correlation with anti-HCV IgM ratios was assessed. RESULTS: According to univariate analysis, anti-HCV IgM ratios, age, serum gamma-glutamyltranspeptidase (gamma-GT) and ferritin levels were significantly associated with sustained response to therapy. A log-linear model, testing the effect of these variables on response to therapy, showed that anti-HCV IgM ratio was the only independently associated variable (P=0.00057). Anti-HCV IgM were associated with viraemia levels (r=0.57), but not with genotype distribution. Patients with anti-HCV IgM ratio less than 1 were sustained responders to the 'standard therapy' in 65% of cases. By contrast, among patients with a ratio greater than 3, sustained response was achieved in only one patient (3%), while 73% were non-responders; the majority of relapsers were found among patients with a ratio between 1 and 3. CONCLUSION: Anti-HCV IgM antibodies provide an easily accessible and cheap serological marker of active viral replication, and are significantly related to the outcome of interferon therapy in patients with chronic hepatitis C.

Evaluation of support bandaging during measurement of proximal sesamoidean ligament strain in horses by use of a mercury strain gauge.

Liquid mercury strain gauges were implanted in the forelimb proximal sesamoidean ligaments (PSL) of 8 adult horses. The gauges measured PSL strain while horses were standing with or without external support. In 6 of the horses, the gauges also measured PSL strain in horses at a walk, with or without external support. Gauges were enclosed within sliding polypropylene tubes to prevent nonaxial deformation. Each gauge was placed in 1 arm of a low-resistance half-bridge circuit. To provide temperature compensation, a dummy gauge was placed in the adjacent arm of the bridge circuit and was implanted next to the active gauge in the surrounding fascial tissue. External support included fiberglass cast support (CAST), dorsal fetlock splint support (DFS), support wraps of 3 bandage materials (SW1, SW2, and SW3), and support wrap with caudal splint (SW4). The cast was applied, with the fetlock and foot in weightbearing position, from the proximal portion of the metacarpus distal to and including the foot. The DFS was applied by placing the cranial half of the fiberglass cast on the dorsal aspect of the instrumented limb. The SW1, SW2, and SW3 were applied in a figure-8 pattern around the fetlock, using 50% of the linear stretch capacity of the bandage material, with the horse standing squarely on all 4 limbs. The SW4 was applied identically to the other support wraps, with the exception of addition of a flexible caudal splint incorporated in the support wrap. Mean maximal strain while standing (epsilon S) without external support for 8 horses was 6.0% (range, 3.8 to 7.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

Composition and morphologic features of the interosseous muscle in Standardbreds and Thoroughbreds.

Suspensory ligaments (SL) from 32 Thoroughbreds and 32 Standardbreds were collected to evaluate the variation in muscle content with respect to age, breed, sex, limb, and use. Six transverse sections, each 3 to 5 mm thick, were obtained from each SL. Four sections were taken from the body of the SL and 1 from the midportion of each branch. Sections were stained with van Gieson picric acid-fuchsin solution, then photographed, and black-and-white slides were made from the processed negatives. The transverse-sectional area of the SL and the contained muscle were determined by use of a computer with a color monitor and a digitizing device with its associated software. The percentage of muscle was then calculated for each section, for the entire ligament, and for each horse. Results were analyzed by multiple-regression analysis and Duncan multiple-range test, using the General Linear Model of SAS. Standardbreds had 40% more muscle in their SL than did Thoroughbreds. There was no significant difference in the percentage of SL muscle among sex, age, use, individual limb, or forelimb vs hind limb. For Standardbred horses, females had significantly greater muscle area content than intact males. Also, hind limb muscle area content was significantly greater than forelimb muscle content. Thoroughbred horses between 2 and 10 years of age not in training had significantly more muscle content than horses of the same age not in training. The reasons for these differences remain unclear.

Small-colon rupture attributable to granulosa cell tumor in a mare.

A large granulosa cell tumor was believed to be responsible for causing obstruction and subsequent rupture of the small colon in a 10-year-old Quarter Horse mare. Two months earlier, a mass, tentatively diagnosed as granulosa cell tumor of the left ovary, had been identified by means of rectal palpation and ultrasonography. The mare was evaluated for clinical signs of acute, severe, abdominal pain, increased heart rate, cyanotic mucous membranes, clinical dehydration, with high PCV, leukopenia, and extreme abdominal distension. A large soft tissue mass and taut band that constricted the lumen of the small colon were palpable per rectum. Septic peritonitis was diagnosed on the basis of results of abdominocentesis. Exploratory surgery revealed extensive fecal contamination of the abdominal viscera, and the mare was euthanatized because of the resultant poor prognosis. At necropsy, the small colon was occluded by a taut, left broad ligament and the ovarian mass that was proved to be a granulosa cell tumor. The occlusion had caused impaction of the small colon, with subsequent perforation at the level of the broad ligament.

Stress reactions and stress fractures of the proximal palmar aspect of the third metacarpal bone in horses: 58 cases (1980-1990).

The case records, radiographs, and nuclear bone scans of 58 horses with stress reactions or stress fractures of the proximal palmar aspect of the third metacarpal bone (MC3) were reviewed. There were 47 Standardbreds, 4 Quarter Horses, 3 Thoroughbreds, 2 Arabians, 1 Oldenburg, and 1 Pony of America. Fifty-six of the horses were racehorses or performance horses. The mean and median ages of affected horses were 4 and 3 years, respectively. Lameness ranged from mild to severe. Physical findings were usually subtle and included signs of pain on deep palpation of the proximal palmar aspect of MC3 and slight effusion of the middle carpal joint in some cases. Lameness was commonly improved by high palmar and palmar metacarpal nerve blocks or anesthesia of the middle carpal joint. Fifty-three horses had higher than normal radiopharmaceutical uptake in the proximal palmar aspect of MC3 in the left or right limb. The other 5 horses had higher than normal radiopharmaceutical uptake bilaterally. Fifty-six of the 63 limbs with abnormal bone scans also had abnormal radiographs. Treatment consisted of a variable period of rest (1 to 6 months). Healing was best assessed by follow-up bone scans. Of the 45 horses for which follow-up information was adequate, 29 (64%) returned to their previous level of performance.

Incomplete linear tibial fractures in two horses.

Incomplete linear tibial fractures were identified in two horses with the aid of scintigraphy. Both horses were treated successfully by strict stall confinement, and both returned to normal athletic activity. Scintigraphy can be used to facilitate the generally difficult diagnosis of incomplete tibial fractures.

Scapular notch resection for suprascapular nerve decompression in 12 horses.

Supraspinatus and infraspinatus muscle paralysis with atrophy was treated by partial osteotomy of the scapula, deep to the suprascapular nerve. The horses had various gait abnormalities, which were corrected by the surgery, but regeneration of the muscles varied from partial to complete, depending on the duration of the condition and the degree of atrophy before surgery.

Caudal cruciate ligament function and injury in the horse.

The caudal cruciate ligament assists the medial femorotibial ligament in supporting the medial aspect of the femorotibial joint. It also limits the outward rotation of the tibia during weight bearing. In two lame horses tearing of the caudal portion of the femoral attachment of the caudal cruciate ligament was recorded together with cracking and tearing of the medial meniscus. In one case, synovitis and restrictive fibrous periarthritis were the sequelae of secondary stifle sepsis.