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OBJECTIVE: In order to realize the vision of recovery-orientated mental health services, there is a need for a model and a method of measuring recovery as the concept is described by mental health consumers. A preliminary five-stage model based on consumer accounts was developed in an earlier study by the authors. This next stage of the research program describes the development and initial testing of a stage measure which, when validated, can be used in testing that model. METHOD: Existing measures of recovery were reviewed to assess their concordance with the model, and a new measure, the Stages of Recovery Instrument (STORI) was subsequently developed. A postal survey was conducted of 94 volunteers from the NISAD Schizophrenia Research Register. Participants completed the STORI and measures of mental health, psychological wellbeing, hope, resilience and recovery. RESULTS: The STORI correlated with all of the psychological health variables, and the five stage subscales were found to be internally consistent. An ordinal relationship between the stage subscales was demonstrated by the intercorrelations of the subscale scores and the pattern of correlations between the subscales and the other measures. However, a cluster analysis of items revealed an overlap in measurement of adjacent stages, with only three clear clusters emerging. CONCLUSIONS: The results provide preliminary empirical validation of the STORI as a measure of the consumer definition of recovery. However, refinement of the measure is needed to improve its capacity to discriminate between the stages of the model. The model could then be comprehensively tested using longitudinal methods and the inclusion of objective measures.
1. Sartorius muscles of Rana temporaria, equilibrated at 20 degrees C in Ringer solution buffered with phosphates, were stimulated isometrically for 0.2 up to 0.75 s at lengths varying from 1.03 to 1.48 times rest length, L0. The aerobic recovery heat was measured for 10.5 min after contraction. 2. The recovery heat production had a complex time course, showing a variable delay to maximum, declining thereafter. In most cases, the rate of heat production did not decrease monotonically; attention was focused on the slow exponential decay which only persisted from 1.5-5 min after contraction. This latter part of the time course was considered as strictly aerobic and characterized by the time constant tau s. 3. Increasing the tetanus duration from 0.2 to 0.75 s increased initial heat Qi and recovery heat Qr in proportion, so that the recovery ratio R (Qr/Qi) did not change; it was equal to 1.29 +/- 0.03 (S.E.M.; n = 44) for muscles at about L0. The kinetics of heat production were modified with longer tetani; in particular, tau s was increased from 2.2 to 5.2 min. 4. When muscles were stretched beyond L0, as long as there was no increase of the resting heat rate (stretch response or 'Feng effect'), recovery heat production had a similar evolution to that in muscles at about L0; R was constant and equal to 1.21 +/- 0.03 (n = 46). 5. When muscles were sufficiently stretched to develop a stretch response, R increased proportionally to the stretch response. The effect seemed independent of the contractile machinery, as it vanished concomitantly with the stretch response, while force and Qi remained unchanged for the length considered. The kinetics were also modified--the delay to maximum was no longer detected and tau s most likely increased. 6. Substitution of 60% of the NaCl of the Ringer solution by NaI (mol/mol) produced a significant increase of R, mainly due to the increase of Qr. 7. The results show that neither the time course nor the amount of aerobic recovery heat Qr are strictly determined by the amount of initial heat Qi. The hypothesis is discussed that Qr might include a variable fraction due to processes which are not directly implicated in the actin-myosin interactions, possibly those involving the cytosolic Ca2+ concentration and the rate of resting metabolism.
Redevelopment of isometric force following shortening of skeletal muscle is thought to result from a redistribution of cross-bridge states. We varied the initial force and cross-bridge distribution by applying various length-change protocols to active skinned single fibres from rabbit psoas muscle, and observed the effect on the slowest phase of recovery ('late recovery') that follows transient changes. In response to step releases that reduced force to near zero ( approximately 8 nm (half sarcomere)(-1)) or prolonged shortening at high velocity, late recovery was well described by two exponentials of approximately equal amplitude and rate constants of approximately 2 s(-1) and approximately 9 s(-1) at 5 degrees C. When a large restretch was applied at the end of rapid shortening, recovery was accelerated by (1) the introduction of a slow falling component that truncated the rise in force, and (2) a relative increase in the contribution of the fast exponential component. The rate of the slow fall was similar to that observed after a small isometric step stretch, with a rate of 0.4-0.8 s(-1), and its effects could be reversed by reducing force to near zero immediately after the stretch. Force at the start of late recovery was varied in a series of shortening steps or ramps in order to probe the effect of cross-bridge strain on force redevelopment. The rate constants of the two components fell by 40-50% as initial force was raised to 75-80% of steady isometric force. As initial force increased, the relative contribution of the fast component decreased, and this was associated with a length constant of about 2 nm. The results are consistent with a two-state strain-dependent cross-bridge model. In the model there is a continuous distribution of recovery rate constants, but two-exponential fits show that the fast component results from cross-bridges initially at moderate positive strain and the slow component from cross-bridges at high positive strain.
The haematological recovery time, infection rate and supportive care requirements of patients receiving recovery phase autologous peripheral blood stem cell transplants (APBSCT) (n = 38), autologous bone marrow transplants (autoBMT) (n = 13) and allogeneic bone marrow transplants (alloBMT) (n = 14) were compared with respect to the time post-transplant to reach 0.1, 0.5 and 2.0 x 10(9) neutrophils/l and 50 and 150 x 10(9) platelets/l, the length of hospitalization, fever and antibiotic use, the incidence of documented infection and the number of red cell and platelet transfusions. The APBSCT group had a significantly more rapid recovery of neutrophils and platelets and their supportive care requirements were significantly less than the autoBMT and the alloBMT groups. There was no difference between the latter two groups. The most significant variables contributing to the differences in haematological recovery times were the granulocyte-macrophage progenitor (CFU-GM) dose infused and, to a lesser extent, patient age. The APBSCT group received a higher CFU-GM dose of 87 +/- 12 x 10(4)/kg BW compared with 12 +/- 5 and 17 +/- 3 x 10(4)/kg BW in the autoBMT and the alloBMT groups, respectively (p = 0.0001). Patient age showed a negative correlation with the rate of recovery because the APBSCT group, which recovered faster was also older (48 +/- 2 years, compared with 33 +/- 3 and 31 +/- 2, respectively, p = 0.0001). On multivariate analysis, CFU-GM dose was the only variable to show a significant correlation with all the haematological recovery endpoints studied in these 65 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Although word-finding difficulties have been largely studied from a theoretical and a rehabilitation point of view, recovery mechanisms and especially the fact that patients with similar anomic patterns may exhibit different recovery, are still not fully understood. In the first part of the present study we investigated the word retrieval curve during therapy and the psycholinguistic variables affecting word-finding recovery patterns in three anomic subjects (PG, AH and TM). Despite the fact that all patients had similar anomia at baseline, they presented different recovery patterns during an identical therapy program. The progress during therapy and the number of sessions necessary to reach satisfactory improvement was similar in two patients (AH and TM), but differed in the third patient (PG), who needed more treatment sessions. Moreover, these two different patterns were affected by different psycholinguistic variables: words age of acquisition predicted improvement in AH and TM, whereas phonological neighbourhood predicted improvement in PG. Following the observation that phonological neighbourhood density affected the slower progress during therapy, in the second study we analysed whether this variable also predicts pseudo-word learning in healthy controls and in anomic subjects. Indeed, phonological neighbourhood predicted pseudo-word learning speed in controls and in some anomic patients. We suggest that the analysis of progress during therapy for anomia and the comparison of the variables affecting learning and recovery may provide information about the underlying nature of the anomic deficit that is not available through the simple assessment of performance.
OBJECTIVES: The aim of this study was to determine whether the extent of viability or scar is important in the amount of recovery of left ventricular (LV) function, and to develop a model for predicting recovery after revascularization that could be tested in a randomized trial. BACKGROUND: F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) is used to define viable myocardium in patients with coronary artery disease (CAD) and severe LV dysfunction and to guide revascularization decisions. Whether this approach improves clinical outcomes has not been tested in a randomized trial. Before doing so, an objective model for prediction of recovery is required. METHODS: A total of 82 patients with CAD and an ejection fraction (EF) < or =35% had FDG PET perfusion imaging before revascularization. Complete follow-up was available on 70 patients (86%). Patients had radionuclide angiograms at baseline and three months post-revascularization. RESULTS: Diabetes (p = 0.029), time to operation (p = 0.008), and scar score (p = 0.001) were significant independent predictors of the change in EF. Previous coronary artery bypass graft confounded the effect of age. There was a significant interaction between the perfusion tracer used and mismatch score (p = 0.02). The multivariable prediction model incorporating PET and clinical variables had a goodness of fit with p = 0.001. Across tertiles of scar scores (I, small: 0% to 16%; II, moderate: 16% to 27.5%; III, large: 27.5% to 47%), the changes in EFs were 9.0 +/- 1.9%, 3.7 +/- 1.6%, and 1.3 +/- 1.5% (p = 0.003: I vs. III), respectively. CONCLUSIONS: In patients with severe LV dysfunction, the amount of scar was a significant independent predictor of LV function recovery after revascularization. A combination of PET and clinical parameters predicts the degree of recovery. This model is being applied in a large randomized controlled trial to determine the effectiveness of therapy guided by FDG PET.
BACKGROUND: At present, myocardial recovery with mechanical support for acute myocarditis is a more frequently observed issue. However, predictive parameters of a sustained myocardial recovery are still under investigation. METHODS: Two recent cases of mechanical support for acute lymphocytic myocarditis with two different outcomes are reported. Literature about this disease and predictability of a sustainable myocardial recovery are reviewed. RESULTS: Acute lymphocytic myocarditis is an individual entity whose outcome is associated with the importance of healed cell damage. Unfortunately, there are no available means of quantifying the fibrotic scar and endomyocardial biopsy has a high percentage of false-negative results. Echocardiographic assessment of systolic and diastolic cardiac function is difficult while under mechanical support and its significance is not obvious. Forthcoming development of Doppler could better correlate myocardial contractility and histology to be predictive of a sustained recovery after acute myocarditis under mechanical support. CONCLUSIONS: Long-lasting recovery after mechanical support for acute myocarditis remains unpredictable in our experience. More predictive factors are needed.
OBJECTIVES: To further evaluate the use of the orientation log (O-Log) in an acute rehabilitation program for adults with traumatic brain injury (TBI), specifically focusing on prediction of rehabilitation outcome, possible use of the O-Log to promote recovery, and development of templates of orientation recovery. DESIGN: Stepwise discriminant function analysis was used in one study and ANOVA based on between-groups comparisons in another. Confidence intervals were established in the third study. SETTING: Acute rehabilitation hospital. PATIENTS: Samples were taken from an overall pool of 389 subjects with predominantly severe TBI based on Glasgow Coma Scale score. RESULTS: A combination of initial O-Log performance, time since injury, and number of O-Log assessments correctly predicted resolution of disorientation for 76% of the sample. Individuals attaining orientation before discharge achieved higher discharge scores on functional measures. Administration of the O-Log 3 versus 5 times a week did not result in more rapid resolution of disorientation. A similar pattern of steady improvement in orientation was evident for mild-moderate and severe injury cases across 10 administrations. CONCLUSIONS: Recovery of orientation provides important information about recovery following TBI and is predictive of rehabilitation outcome. More frequent administration of a formal orientation measure does not seem to expedite the recovery of orientation, which on average seems to progress at a steady pace in a rehabilitation setting regardless of the time since injury or severity of injury.
A long work schedule often results in sleep deprivation, sleepiness, impaired performance and fatigue. We investigated the residual effects of slow-release caffeine (SRC) on sleep, sleepiness and cognitive performance during a 42-hour recovery period following a 64-hour continuous wakefulness period in 16 healthy males, according to a double-blind, randomised, placebo-controlled, crossover study. Three hundred milligrams of SRC or placebo was given twice a day at 21:00 and 9:00 during the first 48 h of wakefulness. Recovery sleep was analysed with electroencephalography (EEG) and wrist actigraphy, daytime sleepiness with continuous EEG, sleep latency tests and actigraphy and cognitive functions with computerized tests from the NATO AGARD STRES battery. Both drug groups exhibited almost the same sleep architecture with a rebound of slow-wave sleep during both recovery nights and of REM sleep during the second night. Wakefulness level and cognitive functions were similarly impaired in both groups on the first day of recovery and partially returned to baseline on the second. To conclude, SRC appears to have no unwanted side-effects on recovery sleep, wakefulness and cognitive performance after a long period of sleep deprivation and might therefore be a useful choice over other psychostimulants for a long work schedule.
Despite reductions in atmospheric SO4(2-) deposition and resultant decreases in surface water acidity, widespread biological recovery from acidification has not yet been documented. Temporal trends in crustacean zooplankton species richness (number of species) and composition were examined between 1971-2000 in 46 Killarney Park lakes, Ontario, Canada, to assess the degree of biological recovery in lakes with significant water quality improvements, i.e. pH now > 6, compared to 2 other groups: i) lakes which never acidified; and ii) lakes which are still acidified (pH < 6). Time trends in species richness could not be distinguished among the 3 groups of lakes, nor did changes in species richness indicate recovery. In contrast, the zooplankton community composition of lakes in which the pH increased to above 6, as measured by a multivariate index of species abundances, changed from a "damaged" state to one typical of neutral lakes. Some recovery in composition was also documented for the acidic lakes. While still acidic, the pH levels of these lakes have risen. The extent and pace of recovery in Killarney Provincial Park bodes well for the future of other acidified regions in North America and Europe.
The pars convoluta of the proximal tubule of the rat kidney was studied by light and electron microscopy during the recovery phase from transient ischemia. The left kidney was made ischemic by clamping the aorta just above the left renal artery leaving the blood supply to the right kidney and the intestine intact. The pars convoluta (P1 and P2 segments) of the proximal tubule was examined both immediately after various periods of ischemia (15, 30, 60 and 120 min) and after the same ischemic periods followed by 3, 6, 12 and 24 h of blood reflow (= recovery phase). It was found that ischemia for periods up to 60 min were compatible with cell survival whereas 120 min of ischemia gave rise to irreversible cellular changes. Before regaining a normal conformation during the recovery phase, cells made ischemic for 15 min were characterized by slightly decreased cell height, dispersed nuclear chromatin, mitochondria in orthodox conformation and increased numbers of digestive vacuoles and of lipid droplets (stage A2). Most cells made ischemic for 15 min appeared normal when examined after 24 h of reflow. Cells made ischemic for 30 min were also characterized by stage A2 changes after 3 h of reflow and remained in this stage during all recovery periods studied. Cells made ischemic for 60 min first passed into a stage designated A1 and then later during the recovery phase into stage A2. Stage A1 cells were characterized by decreased height, condensed mitochondria, apparently increased numbers and sizes of secondary lysosomes and slightly dilated rough surfaced endoplasmic reticulum; 120 min of ischemia followed by reflow was not compatible with cell survival. Cells made ischemic for 120 min showed the following alterations denoted as stages C and D: shrunken with pyknotic nuclei, swollen mitochondria with large flocculent densities, and filled with different sized vesicles in the apical portion (stage C). Stage D included cells which had undergone necrosis, i.e., phasma membranes and organelles were fragmented and occurred as debris in the tubule lumens.