A state-wide assessment: marital stability and client outcomes.

This paper presents results of Missouri's first statewide evaluation of alcohol and drug treatment programs. The study utilized a 1-year follow-up sample of 242 respondents to explore the nature and patterns of post-treatment functioning. This paper focuses on the impact of client marital stability on post-treatment substance use. The data supported the expected result that marital status was related to post-treatment relapse. Further analysis suggests that transitional periods between marriage and divorce are especially important in understanding the pattern of relapse after treatment. Multivariate analysis indicates that the marital status effect is important both directly and in interaction with program completion. The data suggest that attention to transitional states and interpersonal functioning should be incorporated into client follow-up.     

The relative effects of three expressive methods upon the speech intelligibility of profoundly deaf speakers

Two studies, conducted over a nine month interval, were designed to evaluate the relative effects of three expressive methods (speech alone, speech and signs, and speech with cues) upon speech intelligibility. Five profoundly deaf adults, who were receiving continuous speech training, were recorded reading lists of individual words under all three expressive modes. Listeners were required to identify through a multiple choice format the target stimuli from auditory presentations only. Study I results indicated that speech with cues produced the highest level of intelligibility, while speech and signs produced the lowest level. Study II, with an expanded set of word stimuli, found that speech alone produced a 65% rate of correct identification by listeners; speech and signs again produced the lowest rate of correct identifications. Implications for the assessment and understanding of speech intelligibility are considered.     

Estimation of Vmax in auxotonic systoles from the rate of relative increase of isovolumic pressure: (dP/dt)kP

High speed oscilloscopic recordings (4000 mm/sec) of left ventricular pressure (micromanometer) and its first derivative were used to calculate contractile element velocity (Vce) during the isovolumic period of auxotonic beats in anesthetized dogs. At 0.5-2.0 msec intervals of isovolumic systole, Vce was derived as (dP/dt)/kP, where k = 24 cm(-1). Plots of Vce and P yielded inverse curves from peak Vce to aortic valve opening pressure which averaged 27 msec in controls, and 11 msec during norepinephrine administration. Extrapolated Vmax, in muscle lengths/second, averaged 3.6 (controls), 3.6 (volume load), and 6.6 (norepinephrine). In each experimental state, Vmax was also determined from force-velocity relations of isovolumic beats (abrupt aortic occlusion) analyzed at 10 msec intervals from conventional pressure recordings. Vmax by both methods correlated well (r = 0.88). While good correlations were also noted between Vmax and maximum dP/dt, (max dP/dt)/integrated isovolumic pressure, (max dP/dt)/peak isovolumic pressure, and (max dP/dt)/kP, only the last two of these successfully distinguished changes between volume load and inotropic stimulation. Thus, assuming an unchanged series elasticity, the contractile state of the auxotonic ventricle may be determined utilizing a single high-fidelity catheter system and high speed recordings of isovolumic pressure.     

An assessment of gait analysis in the rehabilitation of children with walking difficulties

Purpose: To assess the current status of computerized gait analysis techniques in the management of children with cerebral palsy or spina bifida who have significant walking disorders.

Method: Synthesis of available data from a review of the literature, drawing on MEDLINE, EMBASE, PRE-MEDLINE, HealthStar and PsychInfo. Other information was obtained from persons with expertise in computerized gait analysis. Cost data were obtained from Canadian rehabilitation centres and the provincial health ministry.

Results: This technology seems helpful in detecting gait changes. However, available evidence is insufficient to draw conclusions about the influence of computerized gait analysis on treatment outcomes. Part of the rationale for use of the technology is that costs of gait analysis (of the order of $CAN 2,000 per examination) would be offset by a decrease in followup surgical procedures and associated hospital care. There could also be a major influence on children's independence and quality of life. However, there are as yet no convincing data to support these propositions.

Conclusions: Computerized gait analysis is a potentially useful technology in the management of children with walking disabilities, but its efficacy is not established. It should be regarded as a developing technology and its clinical application linked to systematic collection and assessment of outcomes data.     

Volubility of the human infant: Effects of parental interaction (or lack of it)

Although parental volubility, or amount of talk, has received considerable recent attention, infant volubility has received comparatively little attention despite its potential significance for communicative risk status and later linguistic and cognitive outcomes. Volubility of 16 typically developing infants from 2 to 11 months of age was longitudinally investigated in the present study across three social circumstances: parent talking to infant, parent not talking to infant and parent talking to interviewer while the infant was in the room. Results indicated that volubility was least in the Interview circumstance. There were no significant differences in volubility between the parent Talk and No Talk circumstances. Volubility was found to reduce with age. These results suggest that infants vocalise in a variety of circumstances, even when no one talks to or interacts with them. The presence of a stranger or perhaps overhearing adults speaking to each other, however, may significantly reduce infant volubility.     

A Prospective Examination of Clinician and Supervisor Turnover Within the Context of Implementation of Evidence-Based Practices in a Publicly-Funded Mental Health System

Staff turnover rates in publicly-funded mental health settings are high. We investigated staff and organizational predictors of turnover in a sample of individuals working in an urban public mental health system that has engaged in a system-level effort to implement evidence-based practices. Additionally, we interviewed staff to understand reasons for turnover. Greater staff burnout predicted increased turnover, more openness toward new practices predicted retention, and more professional recognition predicted increased turnover. Staff reported leaving their organizations because of personal, organizational, and financial reasons; just over half of staff that left their organization stayed in the public mental health sector. Implications include an imperative to focus on turnover, with a particular emphasis on ameliorating staff burnout.     

Fatal sepsis in a patient with rheumatoid arthritis treated with etanercept

Patients with long-standing, severe, erosive rheumatoid arthritis who have extra-articular manifestations and have undergone joint replacement surgery are at increased risk for serious infection and premature mortality. New therapies, including cytokine antagonists, hold great promise for improving the course of rheumatoid arthritis. However, they have powerful anti-inflammatory effects that may mask symptoms of serious infection. We report a case of fatal pneumococcal sepsis occurring in a 37-year-old woman with rheumatoid arthritis treated with the tumor necrosis factor antagonist etanercept and suggest management strategies for early detection and management of this complication.     

The effect of renal function on the febrile response to bacteremia.

The febrile responses of 73 bacteremic patients were retrospectively studied using peak temperatures and 24-hour areas under the fever curve on the day of the positive cultures. These responses were compared to their respective creatinine clearances calculated with the Nielsen-Hansen nomogram. Patients with clearances greater than or equal to 80 ml/min had a significantly greater febrile response than those with clearances less than or equal to 29 ml/min (P less than .025). Patients with clearances between these groups had responses that were in a mid position but not significantly different from either group. We conclude that patients with impaired renal function do manifest fever in response to infection, but that it is quantitatively less than those with normal renal function. Because of this blunted response, minimal elevations of temperature in such patients warrant a diligent search for the presence of infection.     

IL-22 and IL-20 are key mediators of the epidermal alterations in psoriasis while IL-17 and IFN-γ are not

Psoriasis is a common chronic skin disease with a largely unknown pathogenesis. We demonstrate here that transgenic over-expression of interleukin (IL)-22 in mice resulted in neonatal mortality and psoriasis-like skin alterations including acanthosis and hypogranularity. This cutaneous phenotype may be caused by the direct influence of IL-22 on keratinocytes, since this cytokine did not affect skin fibroblasts, endothelial cells, melanocytes, or adipocytes. The comparison of cytokines with hypothesized roles in psoriasis pathogenesis determined that neither interferon (IFN)-γ nor IL-17, but only IL-22 and, with lower potency, IL-20 caused psoriasis-like morphological changes in a three-dimensional human epidermis model. These changes were associated with inhibited keratinocyte terminal differentiation and with STAT3 upregulation. The IL-22 effect on differentiation-regulating genes was STAT3-dependent. In contrast to IL-22 and IL-20, IFN-γ and IL-17 strongly induced T-cell and neutrophilic granulocyte-attracting chemokines, respectively. Tumor necrosis factor-α potently induced diverse chemokines and additionally enhanced the expression of IL-22 receptor pathway elements and amplified some IL-22 effects. This study suggests that different cytokines are players in the psoriasis pathogenesis although only the IL-10 family members IL-22 and IL-20 directly cause the characteristic epidermal alterations. Kerstin Wolk and Harald S. Haugen equally contributed to this work.