First result from the Alpha Magnetic Spectrometer on the International Space Station: precision measurement of the positron fraction in primary cosmic rays of 0.5-350 GeV

A precision measurement by the Alpha Magnetic Spectrometer on the International Space Station of the positron fraction in primary cosmic rays in the energy range from 0.5 to 350 GeV based on 6.8 × 10(6) positron and electron events is presented. The very accurate data show that the positron fraction is steadily increasing from 10 to ∼ 250  GeV, but, from 20 to 250 GeV, the slope decreases by an order of magnitude. The positron fraction spectrum shows no fine structure, and the positron to electron ratio shows no observable anisotropy. Together, these features show the existence of new physical phenomena.

A web-based program to empower patients who have schizophrenia to discuss quality of care with mental health providers

OBJECTIVE

This study evaluated a Web-based tool to help patients with schizophrenia communicate with clinicians about evidence-based treatments.

METHODS

Fifty patients used an interactive Web-based intervention featuring actors simulating a patient discussing treatment concerns (intervention group; N=24) or were shown an educational video about schizophrenia treatment before an appointment for routine follow-up care (control group; N=26). The visits were recorded and analyzed by using the Roter Interaction Analysis System.

RESULTS

Visits by patients in the intervention group were longer (24 versus 19 minutes, p<.05) and had a proportionately greater patient contribution to the dialogue (288 versus 229 statements, p<.05) and a smaller ratio of clinician to patient talk (1.1 versus 1.4, p<.05) compared with visits by the control group. Patients in the intervention group asked more questions about treatment (2 versus .9, p<.05), disclosed more lifestyle information (76 versus 53 statements, p<.005), and more often checked that they understood information (3.6 versus 2.1 checks, p<.05). Clinicians asked more questions about treatment (7.5 versus 5.1, p<.05) and the medical condition (7.8 versus 4.7, p<.05) to control group patients but made more statements of empathy (1.3 versus .4, p<.03) and cues of interest (48 versus 22, p<.05) with the intervention group. The patient-centeredness ratio was greater for visits by patients in the intervention group than by the control group (8.5 versus 3.2, p<.05). Patients' tone was more dominant and respectful (p<.05) and clinicians' tone was more sympathetic (p<.05) during visits by patients in the intervention.

CONCLUSIONS

The Web-based tool empowered persons with schizophrenia to engage more fully in a patient-centered dialogue about their treatment.

A web-based program to empower patients who have schizophrenia to discuss quality of care with mental health providers

OBJECTIVE

This study evaluated a Web-based tool to help patients with schizophrenia communicate with clinicians about evidence-based treatments.

METHODS

Fifty patients used an interactive Web-based intervention featuring actors simulating a patient discussing treatment concerns (intervention group; N=24) or were shown an educational video about schizophrenia treatment before an appointment for routine follow-up care (control group; N=26). The visits were recorded and analyzed by using the Roter Interaction Analysis System.

RESULTS

Visits by patients in the intervention group were longer (24 versus 19 minutes, p<.05) and had a proportionately greater patient contribution to the dialogue (288 versus 229 statements, p<.05) and a smaller ratio of clinician to patient talk (1.1 versus 1.4, p<.05) compared with visits by the control group. Patients in the intervention group asked more questions about treatment (2 versus .9, p<.05), disclosed more lifestyle information (76 versus 53 statements, p<.005), and more often checked that they understood information (3.6 versus 2.1 checks, p<.05). Clinicians asked more questions about treatment (7.5 versus 5.1, p<.05) and the medical condition (7.8 versus 4.7, p<.05) to control group patients but made more statements of empathy (1.3 versus .4, p<.03) and cues of interest (48 versus 22, p<.05) with the intervention group. The patient-centeredness ratio was greater for visits by patients in the intervention group than by the control group (8.5 versus 3.2, p<.05). Patients' tone was more dominant and respectful (p<.05) and clinicians' tone was more sympathetic (p<.05) during visits by patients in the intervention.

CONCLUSIONS

The Web-based tool empowered persons with schizophrenia to engage more fully in a patient-centered dialogue about their treatment.

Bath salts: an emerging danger

We report a case of psychosis in an individual who has ingested a new compound known as "bath salts." Bath salts represent an emerging public health threat due to serious neuropsychiatric and behavioral symptoms associated with their use.

New limit on the lepton-flavor-violating decay μ+→e+γ

We present a new result based on an analysis of the data collected by the MEG detector at the Paul Scherrer Institut in 2009 and 2010, in search of the lepton-flavor-violating decay μ(+)e(+)γ. The likelihood analysis of the combined data sample, which corresponds to a total of 1.8×10(14) muon decays, gives a 90% C.L. upper limit of 2.4×10(-12) on the branching ratio of the μ(+)→e(+)γ decay, constituting the most stringent limit on the existence of this decay to date.

Neurosyphilis and organic psychosis

Neurosyphilis is a Central Nervous System infection that can manifest as a psychiatric condition. Although neurosyphilis is not widely considered in the differential when patients present with psychiatric symptoms, routine Rapid Plasma Reagin (RPR) screening is indicated when assessing new-onset psychiatric illness. This case report will illustrate the usefulness of RPR testing for patients admitted to inpatient or outpatient psychiatric treatment.

The clinical impact of a cardiologic follow-up in breast cancer survivors: an observational study

Anthracycline-containing chemotherapy (A-CHT) can induce late cardiotoxicity adding a considerable burden to cardiovascular risk. Irradiation of left breast cancer has also been associated to an increased risk of cardiovascular disease. The aim of this observational study is to prove the usefulness of an accurate cardiovascular evaluation in left breast cancer survivors treated with radiotherapy (RT) and A-CHT. Patients with left breast cancer, on follow-up after treatment with A-CHT plus RT in an adjuvant setting, were eligible for this observational study. Patients underwent cardiovascular assessment with myocardial perfusion imaging. Thirty patients were enrolled in the study: mean age at diagnosis 55.8 years; stage: I/III; Er and/or pgR status: positive in 24/30 pts; 3 patients in pre-menopausal status. Twenty-two patients (73.3 percent) had normal perfusion imaging, 1 patient (3.3 percent) had a fixed myocardial perfusion defect, 7 patients (23.3 percent) had reversible myocardial perfusion defects; 1 patient (3 percent) with normal perfusion scan showed depressed rest and stress LVEF. Only 1 patient had a large defect and underwent coronary angiography and percutaneous coronary intervention. Five patients with small defect showed normal coronary arteries at Multislice Computed Tomography. Cardiovascular followup may reveal signs of A-CHT or RT-induced cardiotoxicity. A stress test combined with MPI- and GATED-derived data of ventricular systolic performance after stress can give information on the coronary reserve and the contractile reserve and allow early appropriate treatment.

SCREENING FOR AND PREVALENCE OF HIV AND HEPATITIS C AMONG AN OUTPATIENT URBAN SAMPLE OF PEOPLE WITH SERIOUS MENTAL ILLNESS AND CO-OCCURRING SUBSTANCE ABUSE

BACKGROUND

To assess rates of screening and testing of HIV and HCV among those with serious mental illness and co-occurring substance use disorders.

METHODS

One hundred fifty-three people with serious mental illness and cooccurring substance use disorders completed measures and were screened for HIV and HCV.

RESULTS

Six percent were HIV positive and 25% were HCV positive. Almost a quarter reported a history of injection drug use and 86% reported a history of unprotected sexual encounters. Compared to those without a diagnosis of Hepatitis C, those diagnosed with Hepatitis C were significantly more likely to have a sexually transmitted infection, (p = 0.01), have a lifetime history of injection drug use, (p < 0.001), and a lifetime history of sniffing drugs, (p = 0.01).

CONCLUSIONS

Given the high levels of infection of HIV and HCV and high levels of transmission risk factors efforts to improve screening and provide risk reduction counseling are warranted.

Assessing the STIRR model of best practices for blood-borne infections of clients with severe mental illness

OBJECTIVES

People with co-occurring severe mental illness and a substance use disorder are at markedly elevated risk of infection from HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), but they generally do not receive basic recommended screening or preventive and treatment services. Barriers to services include lack of programs offered by mental health providers and client refusal of available services. Clients from racial-ethnic minority groups are even less likely to accept recommended services. The intervention tested was designed to facilitate integrated infectious disease programming in mental health settings and to increase acceptance of such services among clients.

METHODS

A randomized controlled trial (N=236) compared enhanced treatment as usual (control) with a brief intervention to deliver best-practice services for blood-borne diseases in an urban sample of clients with co-occurring disorders who were largely from racial-ethnic minority groups. The "STIRR" intervention included Screening for HIV and HCV risk factors, Testing for HIV and hepatitis, Immunization against hepatitis A and B, Risk reduction counseling, and medical treatment Referral and support at the site of mental health care.

RESULTS

Clients randomly assigned to the STIRR intervention had high levels (over 80%) of participation and acceptance of core services. They were more likely to be tested for HBV and HCV, to be immunized against hepatitis A virus and HBV, and to increase their knowledge about hepatitis and reduce their substance abuse. However, they showed no reduction in risk behavior, were no more likely to be referred to care, and showed no increase in HIV knowledge. Intervention costs were $541 per client (including $234 for blood tests).

CONCLUSIONS

STIRR appears to be efficacious in providing a basic, best-practice package of interventions for clients with co-occurring disorders.

Assessing the STIRR model of best practices for blood-borne infections of clients with severe mental illness

OBJECTIVES

People with co-occurring severe mental illness and a substance use disorder are at markedly elevated risk of infection from HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), but they generally do not receive basic recommended screening or preventive and treatment services. Barriers to services include lack of programs offered by mental health providers and client refusal of available services. Clients from racial-ethnic minority groups are even less likely to accept recommended services. The intervention tested was designed to facilitate integrated infectious disease programming in mental health settings and to increase acceptance of such services among clients.

METHODS

A randomized controlled trial (N=236) compared enhanced treatment as usual (control) with a brief intervention to deliver best-practice services for blood-borne diseases in an urban sample of clients with co-occurring disorders who were largely from racial-ethnic minority groups. The "STIRR" intervention included Screening for HIV and HCV risk factors, Testing for HIV and hepatitis, Immunization against hepatitis A and B, Risk reduction counseling, and medical treatment Referral and support at the site of mental health care.

RESULTS

Clients randomly assigned to the STIRR intervention had high levels (over 80%) of participation and acceptance of core services. They were more likely to be tested for HBV and HCV, to be immunized against hepatitis A virus and HBV, and to increase their knowledge about hepatitis and reduce their substance abuse. However, they showed no reduction in risk behavior, were no more likely to be referred to care, and showed no increase in HIV knowledge. Intervention costs were $541 per client (including $234 for blood tests).

CONCLUSIONS

STIRR appears to be efficacious in providing a basic, best-practice package of interventions for clients with co-occurring disorders.

A prospective clinical study of the A1 pulley in trigger thumbs

A prospective study was performed in 19 patients with trigger thumbs to define the anatomy of the A1 pulley of the thumb in this condition and to evaluate biomechanical parameters of the thumb after complete division of the A1 pulley. Pre- and postoperatively, flexion of the interphalangeal and metacarpophalangeal joints, key pinch strength and tip pinch strength were measured and compared with these measurements on the contralateral thumb. We identified three types of A1 pulley. The clinical data showed that there is no deficit with respect to motion and strength of the thumb after completely sectioning any of the three types of A1 pulley.

Avulsión tipo I del tendón flexor profundo: Reinserción con arpón y movilización activa precoz. Presentación preliminar

Objetivo: Evaluar los resultados de la reinserción y anclaje del tendón flexor digitorum profundus con arpón y movilización activa precoz.

Material y Método: En un estudio retrospectivo, se analizaron cuatro pacientes con avulsión de tendón flexor digitorum profundus sin arrancamiento óseo. Para su reinserción se utilizaron arpones roscados en la falange distal. En la rehabilitación postoperatoria se limitó la extensión dorsal con una férula durante 6 semanas, permitiendo la movilización activa precoz a las 48 horas. La evaluación fue semanal durante el primer mes y medio, con un estudio radiológico al finalizar este periodo. En la evaluación clínica se midió la flexión y extensión de la articulación interfalángica distal, comparando el rango de movilidad con la contralateral; se estimó la intensidad del dolor con la escala analógica visual y mediante palpación en la zona de inserción del arpón. El seguimiento promedio fue de 9.5 meses (rango: 8-12 meses).

Resultados: La flexión promedio interfalángica distal obtenida en el dedo lesionado fue de 72° (rango: 65° a 87°); y la extensión 2° (0° a 3°). La flexo-extensión contralateral fue de 85° (80° a 90°) y –7° (0° a –10°), respectivamente. El arco total de movilidad promedio fue de 71° (62° a 87°). Según la escala de Strickland y Glogovac modificada por Moiemen y Elliot los resultados fueron excelentes en todos los pacientes. Ningún paciente presentó dolor en actividades diarias. La palpación en la zona del arpón causó dolor en dos pacientes (valor de 3 según la escala analógica visual), Los dos restantes no presentaron dolor (valor de 0). Radiográficamente, dos arpones no presentaron protrusión, mientras otros dos sobresalían 1mm en la cara palmar de la falange distal. No hubo complicaciones infecciosas.

Conclusión: La utilización de anclaje óseo con arpón roscado en las avulsiones de tipo I del flexor digitorum profundus, constituye una alternativa válida que permite la movilización activa precoz, con mejora en los resultados funcionales.

Infected nonunion of the humerus treated with an antibiotic cement rod. Case report

The authors present a case of an infected nonunion of the humerus treated initially with reaming of the medullar canal followed by the introduction of an antibiotic-impregnated intramedullary rod. Reconstruction of the humerus with bone fixation and bone graft was performed in a second stage. The final result was healing of the fracture and a good functional result with no evidence of recurrence of infection at a 25 months follow up.

Developing a model psychiatric treatment program for patients with intellectual disability in a community mental health center

The Special Needs Clinic of the Johns Hopkins Bayview Medical Center in Baltimore, Maryland provides comprehensive treatment for patients with developmental or intellectual disability and psychiatric illness. This report describes the clinical characteristics and service utilization of patients attending this clinic. Factors that support quality mental health services that are both cost-effective and accessible are identified.

Cost-sharing requirements and access to mental health care among medicare enrollees with schizophrenia

OBJECTIVE

This study explored the association between Medicare cost-sharing requirements and the probability of use of various mental health outpatient services among Medicare enrollees with schizophrenia.

METHODS

Multivariate logistic regression was used to estimate the probability of use of each of seven types of services over six months. Patients were recruited from public and private mental health treatment provider organizations in six states. The analyses included 1,088 Medicare enrollees, of whom approximately 55 percent were also enrolled in Medicaid.

RESULTS

Medicare-only patients (with greater cost-sharing) were 25 to 45 percent less likely to have used rehabilitation services, individual therapy with nonpsychiatrist mental health providers, and case management. No association was found between Medicaid enrollment and probability of service use for medical clinic visits, group therapy, individual contact with a psychiatrist, or receipt of second-generation antipsychotics.

CONCLUSIONS

Among Medicare enrollees with schizophrenia, gaps in Medicare coverage may be more problematic for rehabilitation, case management, and contact with nonpsychiatrist providers. Local public and private subsidies for mental health treatment may compensate for some of the gaps in coverage. However, such subsidies are not universally or uniformly provided.

Impact of the wait for an initial appointment on the rate of kept appointments at a mental health center

Failure to keep initial appointments at a community mental health center results in a burden on the staff and the center's financial resources. The authors studied referrals to an outpatient program and found that delay in scheduling appointments had a significant impact on rate of kept appointments. The impact was significant during the first week of delay and appeared to stabilize after day seven. Age influenced the rate but differed in influence between the adult and child programs. Changes aimed at reducing wait time for initial appointments may favorably affect rate of kept appointments and ultimately preserve staff and financial resources.

The ''central'' quadrantectomy. Introducing a new reconstruction technique after excision of the central sub- and periareolar portion of the breast

A new method is presented for the closure of a central cylindrical breast exeresis, embracing, full thickness, the skin and the gland. For this reconstruction, performed without altering the original shape of the breast, without removing any additional healthy tissue, we used a skin-gland flap rotated from the inferior quadrant to correct the defect.

The effect of a split in WAIS-R VIQ and PIQ scores on patients with cognitive impairment and psychiatric illness

This study examined the clinical effects of cognitive impairment on the course of patients who have a major psychiatric disorder. Surprisingly, a statistical split between Verbal and Performance IQ on the Wechsler Adult Intelligence Scale-Revised is not a marker for greater psychiatric morbidity.

Evaluation of simplified Frykman and AO classifications of fractures of the distal radius. Assessment of interobserver and intraobserver agreement

In order to evaluate interobserver and intraobserver agreement of the Frykman and AO classifications and their variations between assessors with different levels of experience, three hand specialists, a fellow and two senior residents classified radiographs of 200 fractures of the distal radius in anteroposterior and lateral views. Reproducibility was assessed by the use of the proportion of agreement and kappa coefficient between pairs of observers. The Frykman classification showed moderate interobserver reproducibility (kappa = 0.43) and good intraobserver reproducibility (kappa = 0.61). The experience of the reviewers did not significantly affect either of these. The AO system showed regular interobserver reproducibility (kappa = 0.37) and moderate intraobserver reproducibility (kappa = 0.57). The younger group obtained higher intraobserver agreement than the senior. Possible causes for the low reproducibility of both classifications are discussed together with a review of the literature. We do not recommend the Frykman or AO classifications for clinical application because of their questionable reproducibility.