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PubMed1990

Recovery from end-stage renal disease.

To evaluate the rate and associated factors for recovery of renal function in patients labeled by their nephrologists as having end-stage renal disease (ESRD), the data base of the Michigan Kidney Registry was used. All patients reported as starting treatment for ESRD between 1976 and 1985 (N = 7,404) were evaluated, excluding patients with acute tubular necrosis (ATN) or transplantation cases. While patients with ESRD due to diabetes and cystic diseases had lower recovery rates than average, patients with glomerulonephritis associated with a systemic illness, vasculopathies, and crescents had threefold to fourfold higher recovery rates. White race, older age, and later year of ESRD were associated with significantly higher recovery rates. Recovery rates did not differ substantially for patients receiving peritoneal dialysis or hemodialysis. Recovery occurred within 6 months of ESRD in approximately 48% of those recovering, 74% within 1 year, and lasted at least 1 year in 75% of the cases. The authors conclude that caution should be applied when the diagnosis of ESRD is made; the possibility of recovery should be sought and assessed, especially when early renal transplantation is considered.

Actuarial Analysis↗

PubMed1999

Effect of calcitriol and age on recovery from hypocalcemia in hemodialysis patients.

Calcitriol is used to treat hyperparathyroidism in hemodialysis patients. Calcitriol treatment, either through a reduction in parathyroid hormone (PTH) levels or direct effect on bone, decreases the osteoblast and osteoclast surface and bone formation rate. Our study of 13 hemodialysis patients was designed to evaluate whether calcitriol treatment changed the rate of spontaneous recovery from hypocalcemia induced by a low-calcium dialysis. Calcitriol treatment decreased basal PTH levels from 614 +/- 84 to 327 +/- 102 pg/mL (P < 0.001) and maximal PTH levels from 1,282 +/- 157 to 789 +/- 161 pg/mL (P < 0.001), but the rate of serum ionized calcium recovery from hypocalcemia did not change. When the 13 patients were separated based on the median age of 64 years, the predialysis serum ionized calcium level was less in the younger (group I, 44 +/- 6 years; n = 6) than older (group II, 68 +/- 1 years; n = 7) patients (1.05 +/- 0.03 v 1.22 +/- 0.03 mmol/L, respectively; P < 0.01) despite similar basal (group I, 595 +/- 122 pg/mL v group II, 629 +/- 96 pg/mL) and maximal (group I, 1,114 +/- 299 pg/mL v group II, 1,425 +/- 141 pg/mL) PTH levels. Before calcitriol treatment, the rate of serum ionized calcium recovery from induced hypocalcemia was greater (P < 0.05) for similar PTH levels in the older than younger patients. After calcitriol treatment, despite a similar reduction in PTH levels, the rate of calcium recovery increased (P < 0.05) in the younger patients but did not change in the older patients. We also observed that toward the end of the low-calcium hemodialysis, PTH values decreased even though serum ionized calcium level continued to decline when the rate of calcium reduction slowed. In addition, hysteresis, defined as a lower PTH value during the recovery from hypocalcemia than during the induction of hypocalcemia for the same serum calcium concentration, was present during the spontaneous recovery from hypocalcemia. In conclusion, in the hemodialysis patient: (1) age appeared to affect the bone response to PTH and calcitriol treatment, (2) the PTH response to hypocalcemia was affected by a deceleration in the rate of calcium decrease, and (3) hysteresis of the PTH response to hypocalcemia occurred during the spontaneous recovery from hypocalcemia.

Adult↗

PubMed1999

Evaluating recovery from anorexia nervosa and bulimia nervosa: integrating lessons learned from research and clinical practice.

The aims of this article are to critically examine the conceptualization and measurement of recovery, within the eating disorder outcome literature, and suggest possible ways of developing the clinical utility of outcome research. First, definitions and measures of recovery operationalized in outcome studies are critically reviewed, highlighting the variety of definitions and measures used in outcome research. Two important caveats in the outcome literature are identified: absence of clients' views on their recovery from outcome evaluations and dissociation of outcome research from negotiated interpersonal and organizational meanings of recovery. These caveats form the focus of the second section of the article. A need for greater integration between research and clinical perspectives on recovery is identified, and the final section of the article suggests several proposals for enhancing current research on recovery from eating disorders. These proposals particularly advocate development of methods and measures that can accommodate diversity of clients' experiences of recovery, while remaining informative to both researchers and clinicians.

Adolescent↗

PubMed2003

Role of ventrolateral periaqueductal gray neurons in the behavioral and cardiovascular responses to contextual conditioned fear and poststress recovery.

We have previously shown that conditioned fear to context increases Fos expression in the caudal ventrolateral region of the periaqueductal gray in the rat. To understand the reason for this activation and its role in the expression of the contextual fear response, the ventrolateral periaqueductal gray was temporarily blocked with bilateral microinjections (0.4 microl) of the GABA agonist muscimol (0.2 mM) or the glutamate antagonist kynurenic acid (0.1 M). Cardiovascular changes and activity were recorded by radio-telemetry and the microinjections were made immediately before testing the conditioned response in the aversive context. Muscimol and kynurenic acid had the same effects: when compared to saline controls, freezing immobility and ultrasonic vocalizations were reduced and replaced by marked locomotor activity, and the increase in heart rate was enhanced; however, the increase in arterial blood pressure remained the same. Interesting changes were also observed when animals were returned to the safe context of their home box after fear (recovery). Basically, the recovery response was either prevented or delayed: instead of returning to resting immobility, the rats remained agitated in their home box with a moderately elevated activity, heart rate and blood pressure. However, the effect of ventrolateral periaqueductal gray blockade on heart rate, arterial pressure and activity did not appear to be specific to the fear response or its recovery because they were also observed in animals returned to the safe context of their home box immediately after injection. The later response was also a recovery response from the milder stress of handling and the injection procedure.We discuss the results by arguing that the ventrolateral periaqueductal gray is involved in the immobility component of both the fear response and poststress recovery responses. To explain our interpretation we consider the findings in relation to the classic descending defence-arousal system and the hyporeactive-hypotensive immobility pattern that has been attributed to the ventrolateral periaqueductal gray. We propose that there is a dual activation of the defence-arousal system and of the ventrolateral periaqueductal gray during fear, with the ventrolateral periaqueductal gray acting as a brake on the defence-arousal system. The role of this brake is to impose immobility and hold off active defence responses such as fight and flight. The result of this combination of arousal and immobility is a hyperreactive freezing immobility associated with ultrasonic vocalizations, and a pressor response accompanied with a slow rise in heart rate. Basically, the animal is tense and ready for action but temporarily immobilised. The ventrolateral periaqueductal gray also acts to impose immobility during recovery; however, this is without coactivation of the defence-arousal system. The result is a return to resting immobility, associated with a return to baseline blood pressure and heart rate. This is an active process that insures a faster and complete return to rest. We conclude that the ventrolateral periaqueductal gray is an immobility center involved not only in the fear response but also in poststress recovery responses.

Animals↗

PubMed2001

Extent and kinetics of recovery of occult spinal cord injury.

PURPOSE: To obtain clinically useful quantitative data on the extent and kinetics of recovery of occult radiation injury in primate spinal cord, after a commonly administered elective radiation dose of 44 Gy, given in about 2 Gy per fraction. METHODS AND MATERIALS: A group of 56 rhesus monkeys was assigned to receive two radiation courses to the cervical and upper thoracic spinal cord, given in 2.2 Gy per fraction. The dose of the initial course was 44 Gy in all monkeys. Reirradiation dose was 57.2 Gy, given after 1-year (n = 16) or 2-year (n = 20) intervals, or 66 Gy, given after 2-year (n = 4) or 3-year (n = 14) intervals. Two animals developed intramedullary tumors before reirradiation and, therefore, did not receive a second course. The study endpoint was myeloparesis, manifesting predominantly as lower extremity weakness and decrease in balance, occurring within 2.5 years after reirradiation, complemented by histologic examination of the spinal cord. The data obtained were analyzed along with data from a previous study addressing single-course tolerance, and data from a preliminary study of reirradiation tolerance. RESULTS: Only 4 of 45 monkeys completing the required observation period (2-2.5 years after reirradiation, 3-5.5 years total) developed myeloparesis. The data revealed a substantial recovery of occult injury induced by 44 Gy within the first year, and suggested additional recovery between 1 and 3 years. Fitting the data with a model, assuming that all (single course and reirradiation) dose-response curves were parallel, yielded recovery estimates of 33.6 Gy (76%), 37.6 Gy (85%), and 44.6 Gy (101%) of the initial dose, after 1, 2, and 3 years, respectively, at the 5% incidence (D(5)) level. The most conservative estimate, using a model in which it was assumed that there was no recovery between 1 and 3 years following initial irradiation and that the combined reirradiation curve was not necessarily parallel to the single-course curve, still showed an overall recovery equivalent to 26.8 Gy (61%). The spinal cords of symptomatic monkeys consistently revealed a mixture of white matter necrosis and vascular injury, but the majority of spinal cords of asymptomatic animals did not exhibit overt lesions detectable by light microscopy. CONCLUSION: Combined analysis with the data of the previous studies yielded firm evidence that the spinal cord has a large capacity to recover from occult radiation injury induced by a commonly prescribed elective dose. This finding strengthens the rationale for selective use of radiotherapy to treat second primary tumors arising in previously irradiated tissues or late recurrences. However, some caution should be exercised in applying quantitative experimental data, because the length of follow-up in these experiments was limited to 2-2.5 years after reirradiation, whereas human myelopathy cases occasionally occur after longer latency. Because there is a large variation in long-term recovery among tissues, the tolerance of other tissues at risk should also be taken into account in prescribing therapy.

Animals↗

PubMed1983

A clinical study of the order and speed of sensory recovery after digital replantation.

The order of sensory recovery (the first appearance of each sensory modality in the amputated digit) and the speed of sensory recovery in the amputated digit were recorded in 74 replanted digits in which both digital nerves had been severed and repaired primarily. The order of sensory recovery was measured by Frey hairs to determine pressure (30 gm) and touch (2 gm). Pain (5 gm) was measured by an algesiometer and cold (0 degree C) and warmth (50 degrees C) were measured by a thermometer (Yufu Seiki Co., Ltd.). Perspiration was measured by the bromophenol blue printing method. The mean times of the appearance of sensibility in the amputated digits were: pressure, 9.8 weeks; touch, 11.6 weeks; pain, 13.4 weeks; cold, 15.3 weeks; warmth 16.8 weeks; and perspiration, 26.9 weeks. The speed of sensory recovery was a measurement of the first appearance of sensibility in the amputated digit to the restoration of sensibility to the fingertip. The speed of sensory recovery for touch and pain was calculated by dividing the number of months required for sensory recovery by the distance from the replant level to the fingertip. The mean speed of sensory recovery for touch was 14.0 mm per month, and for pain it was 13.2 mm per month.

Adolescent↗

PubMed1998

Exponential onset and recovery of temporary threshold shift after loud sound: evidence for long-term inactivation of mechano-electrical transduction channels.

The onset and recovery of temporary threshold shift (TTS) in one human subject (the author) has been studied during and after pure-tone overstimulation lasting between minutes and days. Under the conditions of these experiments the time courses appeared reproducible, and thresholds always recovered to normal within 3 days. The onset and recovery followed a multiple-exponential time course, with the time constants for the onset being 6.5 and 800 min, and the recovery time constants being 30, 240 and 800 min. The observed time courses were consistent with data previously reported in humans, and with the view that the threshold elevation was due to an inactivation and reactivation of the stretch-activated channels at the apex of the outer hair cells of the cochlea. The time constants of the multi-exponential onset and recovery do not appear to depend on the duration of the overstimulation, but the exponential coefficients do. A simple kinetic model of the onset and recovery is described (for more detail see Patuzzi (1998)). It is suggested that the rapid recovery in the first 5 min after exposure is due to a short-lived disruption of the synapses between the inner hair cells and the primary afferent neurones. Intermittent exposures were found to produce much less TTS than continuous tones, and this reduction was found to be inconsistent with the Equal Energy Hypothesis, in that the TTS produced by intermittent tones was much less than predicted using the Equal Energy model, and the recovery time course was also different from that expected from a shorter exposure to a continuous tone of equal energy.

Acoustic Stimulation↗

PubMed2000

End-diastolic wall thickness as a predictor of recovery of function in myocardial hibernation: relation to rest-redistribution T1-201 tomography and dobutamine stress echocardiography.

OBJECTIVES: The study assessed whether end-diastolic wall thickness (EDWT), measured with echocardiography, is an important marker of myocardial viability in patients with suspected myocardial hibernation, and it compared this index to currently established diagnostic modalities of dobutamine stress echocardiography (DSE) and rest-redistribution thallium-201 (T1-201) scintigraphy. BACKGROUND: Because myocardial necrosis is associated with myocardial thinning, preserved EDWT may provide a simple index of myocardial viability that is readily available from the resting echocardiogram. METHODS: Accordingly, 45 patients with stable coronary artery disease and ventricular dysfunction underwent rest 2D echocardiograms, DSE and rest-redistribution T1-201 tomography before revascularization and a repeat resting echocardiogram > or =2 months later. RESULTS: Global wall motion score index decreased from 2.38 +/- 0.73 to 1.94 +/- 0.82 after revascularization (p < 0.001). Thirty-eight percent of severely dysfunctional segments recovered resting function. Compared to segments without recovery of resting function, those with recovery had greater EDWT (0.94 +/- 0.18 cm vs. 0.67 +/- 0.22 cm, p < or = 0.0001) and a higher T1-201 uptake (78 +/- 13% vs. 59 +/- 21%; p < 0.0001). An EDWT >0.6 cm had a sensitivity of 94% and specificity of 48% for recovery of function. Similarly, a T1-201 maximal uptake of > or =60% had a sensitivity of 91% and specificity of 50%. Receiver operating characteristic curves for prediction of recovery of regional and global function were similar for EDWT and maximum T1-201 uptake. Combination of EDWT and any contractile reserve during DSE for recovery of regional function improved the specificity to 77% without a significant loss in sensitivity (88%). CONCLUSIONS: End-diastolic wall thickness is an important marker of myocardial viability in patients with suspected hibernation, and it can predict recovery of function similar to T1-201 scintigraphy. Importantly, a simple measurement of EDWT < or =0.6 cm virtually excludes the potential for recovery of function and is a valuable adjunct to DSE in the assessment of myocardial viability.

Aged↗

PubMed1985

Comparative echocardiographic study of recovery of diastolic versus systolic function after brief periods of coronary occlusion: differential effects of intravenous nifedipine administered before and during occlusion.

The effect of intravenous nifedipine (5 micrograms/kg) on the recovery of myocardial function after occlusion of the left anterior descending coronary artery was studied in 18 closed chest dogs. Using computer-aided analysis of two-dimensional echocardiograms, systolic and diastolic function of ischemic segments in low papillary left ventricular cross sections were characterized, respectively, as holosystolic fractional area change and early diastolic velocity of luminal area change. The time required for systolic function to return to preocclusion values after a 1 minute untreated control occlusion (n = 12) was 5 to 10 minutes, and after a 2 minute occlusion (n = 6) it was 20 to 30 minutes. When nifedipine was administered during the occlusion, recovery after a 2 minute occlusion was accelerated slightly to 10 to 15 minutes. Recovery times of early diastolic function were substantially longer, and nifedipine effects were more pronounced. After a 1 or 2 minute control coronary occlusion, 60 to 75 minutes or 90 to 105 minutes were needed to return early diastolic function to normal levels. Nifedipine administered during a 1 or 2 minute coronary occlusion improved these recovery times to 10 to 15 minutes. When the dogs were treated with intravenous nifedipine before coronary occlusion, recovery after 1 or 2 minutes of acute ischemia was apparent as early as 2 minutes after reperfusion. Thus, intravenous nifedipine accelerates the recovery of myocardial function after brief periods of ischemia, and when administered before coronary occlusion, it assures very prompt recovery of function.

Animals↗

PubMed1998

Effect of process conditions on recovery of protein activity after freezing and freeze-drying.

The objective of this research was to gain a better understanding of the degree to which recovery of activity of model proteins after freeze-drying can be maximized by manipulation of freeze-dry process conditions in the absence of protective solutes. Catalase, beta-galactosidase and lactate dehydrogenase (LDH) were used as model proteins. All of the three proteins exhibited a concentration-dependent loss of activity after freezing, with significantly higher recovery at higher concentration. The freezing method and the type of buffer were also important, with sodium phosphate buffer and freezing by immersion of vials in liquid nitrogen associated with the lowest recovery of activity. Differential scanning calorimetry was predictive of the onset of collapse during freeze-drying only for beta-galactosidase. For the other proteins, either no Tg' transition was observed, or the apparent glass transition did not correlate with the microscopically-observed collapse temperature. The time course of activity loss for beta-galactosidase and LDH was compared during freeze-drying under conditions which produced collapse of the dried matrix and conditions which produced retention of microstructure in the dried solid. Recovery of activity decreased continuously during primary drying, with no sharp drop in recovery of activity associated with the onset of collapse. The most important drying process variable affecting recovery of activity was residual moisture level, with a dramatic drop in activity recovery associated with residual moisture levels less than about 10%.

Animals↗

PubMedDate not supplied

Assessment of in vitro and in vivo recovery of gallamine using microdialysis.

The application of microdialysis technique for the investigation of pharmacokinetics and pharmacodynamics of drugs requires careful assessment of probe performance to ensure validity of the data obtained using this technique. The aim of this study was to establish and validate the microdialysis technique for investigation of the pharmacokinetics and pharmacodynamics of the neuromuscular blocker, gallamine. In vitro recovery of gallamine from the microdialysis probe when different perfusion flow rates were employed was evaluated leading to selection of a flow rate of 2 microl/min with 15-min sampling intervals for the subsequent studies. In vitro recovery of gallamine from the microdialysis probe was independent of concentration, stable over an 8-h period and reproducible. Comparable in vitro recoveries were obtained by different established approaches including recovery estimation by gain, loss and the zero-net flux (ZNF) method. Recovery by loss was used to study the in vivo recovery of gallamine from rat muscle tissue. The in vivo recovery was stable over a 5.5-h sampling period. In vitro performance of the probe subsequent to the in vivo study remained stable supporting reusage of the probe. These data highlight the importance of a systematic examination of microdialysis probe validation.

Animals↗

PubMed2000

Excitability recovery curve of the sympathetic skin response in healthy volunteers and patients with palmar hyperhidrosis.

OBJECTIVES: Patients with primary palmar hyperhidrosis (PPH) might exhibit hyperexcitability of the reflex circuits involved in sweating. We hypothesized that this hyperexcitability could become evident in the study of the excitability recovery curve of the sympathetic sudomotor skin response (SSR). METHODS: In 10 patients with PPH and 10 healthy volunteers used as control subjects, we recorded the SSR in the palm of the right hand to pairs of median nerve electrical shocks separated by inter-stimuli intervals (ISIs) ranging from 0.5 to 3.5 s. The amplitude of the SSR generated by the second stimulus (SSR2) was expressed as a percentage of that generated by the first (SSR1), and compared between control subjects and patients for each ISI. RESULTS: None of the control subjects showed a recovery of the SSR for ISIs of 1.5 s or less. On the contrary, patients showed a statistically significant enhancement of the SSR excitability recovery curve, with onset of recovery at 1.5 s in 5 patients. Two patients showed a double peak response to single electrical stimulation and were not considered in the calculation of the SSR recovery curve. Mean excitability recovery percentages were larger in patients than in control subjects at ISIs of 2, 2.5 and 3 s. CONCLUSIONS: The enhancement of the SSR recovery curve in patients with PPH suggests hyperexcitability of the somatosympathetic polisynaptic pathway involved in sweating. This could partly underlie the pathophysiology of PPH.

Adult↗

PubMed2002

Detection of changes occurring during recovery from the dauer stage in Heterorhabditis bacteriophora.

Nematodes of the genus Heterorhabditis are insect parasites that are widely used as biological control agents. When conditions are unfavourable for reproduction in H. bacteriophora, a long-lived, non-feeding, survival and dispersal stage, the dauer juvenile (DJ), is formed. This DJ stage is also adapted for host finding and infection. When it infects a suitable host, the DJ recovers and resumes growth and development. We describe a series of methods for improved detection of recovery in H. bacteriophora. We also describe some of the physiological changes that occur immediately after the onset of recovery in these nematodes as revealed using fluorescent nucleic acid binding SYTO dyes. Although recovery could be monitored using morphological changes, we found that observation of the uptake of fluorescent latex microspheres by recovering nematodes was a far more sensitive and efficient means of detecting recovery. SYTO dyes were also found to be useful indicators of recovery, binding to the pharyngeal glands and genital primordia as little as 3 h after the onset of recovery. The use of SYTO dyes also indicated that the pharyngeal glands produce large quantities of RNA following the onset of recovery, implying that these structures may produce proteins important in the infection and/or feeding process of H. bacteriophora.

Animals↗

PubMedDate not supplied

Adsorption-desorption process using wood-based activated carbon for recovery of biosurfactant from fermented distillery wastewater.

Methods used for biosurfactant recovery include solvent extraction, precipitation, crystallization, centrifugation and foam fractionation. These methods cannot be used when distillery wastewater (DW) is used as the nutrient medium for biosurfactant production by Pseudomonas aeruginosa strain BS2, because recovery of biosurfactant by any of these methods imparts color to the biosurfactant. The biosurfactant has a nonaesthetic appearance with lowered surface active properties. These methods cannot be used for continuous recovery of biosurfactant during cultivation. Hence, a new downstream technique for biosurfactant recovery from fermented DW comprised of adsorption-desorption processes using wood-based activated carbon (WAC) was developed. This study involves batch experiments to standardize the factors affecting the rate of biosurfactant adsorption onto WAC. WAC was the most efficient adsorbent among various ones tested (i.e., silica gel, activated alumina and zeolite). The WAC (1% w v(-1)), equilibrium time (90 min), pH range of 5-10 and temperature of 40 degrees C were optimum to achieve 99.5% adsorption efficiency. Adsorption kinetics and intraparticle diffusion studies revealed the involvement of both boundary layer diffusion and intraparticle diffusion. The Langmuir adsorption isotherm of WAC indicated the formation of a monolayer coverage of the biosurfactant over a homogeneous carbon surface, while the Freundlich isotherm showed high adsorption at strong solute concentrations and low adsorption at dilute solute concentrations. WAC concentration of 4% w v(-1) facilitated complete removal of the biosurfactant from collapsed foam (contained 5-fold higher concentration of biosurfactant than was present in fermented DW). Biosurfactant adsorption was of chemisorption type. Acetone (polar solvent) was a specific viable eluant screened among various ones tested because it selectively facilitated maximum recovery, i.e., 89% biosurfactant from WAC. By acetone treatment, complete regeneration of WAC was feasible and WAC can be reused for biosurfactant recovery up to 3 cycles. The recovered biosurfactant showed improved surface-active property (i.e., much lower critical micelle concentration value of 0.013 verses 0.028 mg mL(-1) for biosurfactant recovered by classical methods). The reuse potential of WAC was assessed and results suggest that the carbon can be reused for three consecutive cycles for biosurfactant adsorption from fermented wastewater without any decrease in adsorption efficiency. Thus, this process forms a basis for continuous recovery of biosurfactant from fermented DW and concentrated foam. This process reduces the use of high cost solvent, avoids end product inhibition and minimizes product degradation.

Adsorption↗

PubMed2001

Effect of pedological characteristics on aqueous soil extraction recovery and tert-butyldimethylsilylation yield for gas chromatography-mass spectrometry of nerve gas hydrolysis products from soils.

Detection and identification of alkyl methylphosphonate (RMPA) and methylphosphonate (MPA) are performed to verify the existence of nerve gases by gas chromatography-mass spectrometry (GC-MS) after tert-butyldimethylsilylation (TBDMS). However, it is sometimes difficult to detect RMPA and MPA in soils. This study examines the relationship between the pedological characteristics and the aqueous extraction recoveries and TBDMS derivatization yields of ethyl-, isopropyl- and pinacolyl methylphosphonate and MPA for 21 soil samples. The aqueous extraction recoveries were measured directly by capillary electrophoresis. Andosols showed low extraction recoveries, while Regosols and Fluvisols showed high recoveries. RMPA were extracted with higher recoveries than MPA from all soils. MPA could not be extracted from Andosols. Within the pedological characteristics, phosphate absorption coefficients showed a strong negative correlation with the extraction recoveries of all phosphonates. The levels of RMPA and MPA in aqueous soil extracts were also determined for eight soils by GC-MS after TBDMS. Compared to the aqueous extraction recoveries, the yields of TBDMS derivatives were low. Strong anion exchange led to a significant improvement in derivatization yields. The efficiencies of TBDMS derivatization were inversely correlated with the levels of alkaline earth metals extractable from soils when the three soils that possessed high total carbon were excluded.

Chemical Warfare Agents↗

PubMed2000

Recovery and serious brain disorders: the central role of families in nurturing roots and wings.

Recovery in severe mental illness is a powerful concept for consumers, invoking a journey through understanding and acceptance of illness and disability, along with hope for a quality life, self-empowerment, and responsibility. Although not widely recognized, the journey toward recovery is also important for family members of individuals with severe mental illnesses, who often serve in a care-giving or supportive role for their loved ones. From the family perspective, to make recovery a real possibility, several issues must be confronted. First, progress toward recovery must acknowledge and involve care-giving and supportive family members, recognizing their significant role in the lives of many individuals with severe mental illnesses as well as the journey of family members in understanding and accepting a severe mental illness in a loved one. Second, a real, recovery-oriented system implements treatments and supports shown to be effective. In this day and age, the gap between research findings and ordinary care condemns too many consumers and their families to outcomes far short of what is possible. This includes not only medications, psychotherapy, employment services, dual diagnosis services, housing and other supports for consumers, but also family education, shown to be effective by a large body of research. Third, a recovery-oriented system of care cannot afford to dance around the thorniest and most controversial issues in severe mental illnesses-such as individuals with the most intractable forms of illness or the relatively infrequent but very real situations in which either consumers or family members are assaultive or abusive. All of these elements are essential if recovery is to be more than a slogan, but rather a true goal in a system of care that respects consumers with these disorders and their care-giving family members.

Adult↗

PubMed1996

Double burst monitoring during recovery from atracurium-induced neuromuscular blockade: a comparison with train-of-four.

BACKGROUND: Double burst stimulation (DBS) was originally introduced for improved manual detection of residual neuromuscular blockade. Previous studies demonstrated a high correlation between mechanomyographical responses to DBS and train-of-four (TOF) stimulation during recovery from neuromuscular blockade. However, repeatability and bias analyses that are recommended when new monitoring devices are introduced into clinical practice [11] have not yet been performed. OBJECT: The object of the present study was to evaluate if DBS3,350/50 (3 stimuli at 50 Hz followed 0.750 sec later by 3 stimulations at 50 Hz) and TOF measurements are in so close agreement that they can be used interchangeably during spontaneous recovery from atracurium blockade. METHODS: The study comprised 20 women undergoing gynaecological laparotomy and anaesthetised with fentanyl, thiopentone, halothane, and nitrous oxide. The neuromuscular blockade was induced and maintained with atracurium. The ulnar nerve was stimulated using DBS or TOF stimulation. Neuromuscular transmission was monitored mechanomyographically. Alternating sequences of 4 DBS and 6 TOF stimulations were applied during the phase of spontaneous recovery. Repeatability, bias (accuracy) and limits of agreement were calculated as proposed by Bland and Altman [11]. RESULTS: The repeatability coefficients before any neuromuscular blocking agent was given were 3.4 and 7.7% for T1 and D1, respectively (P < 0.05), and 3.8 and 3.5% for TOF ratio and DBS ratio, respectively (P > 0.05). The mean difference between duplicated DBS and TOF measurements during recovery (repeatability) differed from zero due to the ongoing recovery process. It was therefore not possible to calculate the repeatability coefficients. The DBS ratio bias decreased from 6.69 to 3.51% (P < 0.05) during recovery. The limits of agreement between the DBS and TOF ratios increased from -2.07 to 15.45%, to -11.93 to 18.95% during recovery, while the limits of agreement between the DBS and TOF twitch heights increased from -5.02 to 10.68%, to -21.02 to 25.26%. CONCLUSION: The limits of agreement between DBS and TOF responses were so wide that DBS and TOF can not be used interchangeably.

Adult↗

PubMed2003

Direct observation of the enthalpy relaxation and the recovery processes of maltose-based amorphous formulation by isothermal microcalorimetry.

PURPOSE: The applicability of isothermal microcalorimetry (IMC) for evaluating enthalpy relaxation and recovery processes of amorphous material was assessed. METHODS: A maltose-based formulation was prepared by freeze-dry method. Differential scanning calorimetry (DSC) was used to investigate its glass transition and relaxation behaviors. IMC was applied to quantitatively analyze the relaxation and the recovery processes. The IMC data were analyzed using a derivative of the Kohlrausch-Williams-Watts equation. RESULTS: The glass transition temperature of the formulation and its fictive temperature stored at 15 degrees C for 1 year were 62 and 32 degrees C, respectively. DSC study showed that annealing below the fictive temperature increased the enthalpy recovery, but it was decreased by annealing at higher temperatures. IMC enabled direct observation of the heat flow during both the relaxation and the recovery processes. The decay constant for the recovery process (recovery time) was much smaller and less sensitive to the temperature than that for the relaxation process (relaxation time). CONCLUSIONS: IMC was successfully used to obtain quantitative information on both relaxation and recovery processes of amorphous material. The relaxation parameters obtained by this method could explain the thermodynamic behavior of the formulation.

Calorimetry↗