Reducing psychiatric discharges to homelessness

In London, Ontario, discharges from psychiatric wards to shelters or NFA occurred 194 times per year. This discovery led to the creation of a pilot project that provided immediate access to a housing advocate and changed normal policies related to housing and start-up fees for a select group of income support recipients. The intervention was successful; seven participants who received this additional assistance were still housed six months later, whereas 6 of 7 who received usual care were still homeless. The goal of the current study was to determine the strengths and areas for improvement of a method to prevent discharge from hospital to NFA and suggest improvements in preparation for wider implementation.

Phase 2: intervention to all acute psychiatric patients within a general hospital.

Phase 3: intervention to all patients within a specialized tertiary care psychiatric hospital. Intervention included on-ward access to a housing advocate and income support staff which was facilitated through computer linkages to housing and income databases.

Findings revealed the success of the intervention across both acute and tertiary sites. All hypotheses were supported: the rate of discharge to homelessness decreased; those accessing the service were poor; and the cost savings from the program exceeded the cost of implementation. Advantages of the approach included: accessibility and convenience of services on site, positive influence on overall treatment plan and feelings of independence and support. Results reveal the positive influence a cross-sectoral approach has on preventing discharge from psychiatric wards to the streets and shelters.

Nontarget Biomolecules Alter Macromolecular Changes Induced by Bactericidal Low-Temperature Plasma

Low-temperature plasmas (LTPs) have a proven bactericidal activity governed by the generated reactive oxygen and nitrogen species (RONS) that target microbial cell components. However, RONS also interact with biomolecules in the environment. Here we assess the impact of these interactions upon exposure of liquid suspensions with variable organic content to an atmospheric-pressure dielectric barrier discharge plasma jet. Salmonella enterica serovar Typhimurium viability in the suspension was reduced in the absence [e.g., phosphate buffered saline (PBS)], but not in the presence of (high) organic content [Dulbecco's Modified Eagle's Medium (DMEM), DMEM supplemented with foetal calf serum, and Lysogeny Broth]. The reduced viability of LTP-treated bacteria in PBS correlated to a loss of membrane integrity, whereas double-strand DNA breaks could not be detected in treated single cells. The lack of bactericidal activity in solutions with high organic content correlated with a relative decrease of ^•OH and O₃/O₂(a¹\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}${\Delta }\text{g}$ \end{document})/O, and an increase of H₂O₂ and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}$\mathrm{NO}_{2}^{-}$ \end{document} in the plasma-treated solutions. These results indicate that the redox reactions of LTP-generated RONS with nontarget biomolecules resulted in a RONS composition with reduced bactericidal activity. Therefore, the chemical composition of the bacterial environment should be considered in the development of LTP for antimicrobial treatment, and may affect other biomedical applications as well.

Chronic multifocal retinal infiltrates in patients infected with human immunodeficiency virus

PURPOSE

To describe the clinical features of a disorder characterized by chronic multifocal retinal infiltrates and uveitis in individuals with human immunodeficiency virus (HIV) disease.

METHODS

We reviewed the medical records of HIV-infected patients with multifocal retinal infiltrates of unknown cause seen by investigators at four institutions. The following data were collected: demographic characteristics, presenting signs and symptoms, laboratory test results, and course of disease.

RESULTS

We identified 26 HIV-infected patients (50 involved eyes) with this syndrome. Median CD4+ T-lymphocyte count at presentation was 272 per microl (range, 7 to 2,118 per microl). The most common presenting symptom was floaters. Median visual acuity of involved eyes at presentation was 20/20 (range, 20/15 to 20/100) and remained stable (median, 20/20; range, 20/15 to 20/70) after a median follow-up period of 9 months (range, 0 to 110 months). Typical retinal lesions were gray-white or yellow, irregular in shape, and less than 200 microm in greatest dimension. All were located in the midperiphery or anterior retina and enlarged slowly or remained static in size. Mild to moderate anterior chamber or vitreous humor inflammatory cells were present in 47 of 50 eyes (26 of 26 patients). Retinal lesions possibly responded to zidovudine but not to acyclovir or ganciclovir. Anterior chamber and vitreous humor inflammatory reactions responded to topical or periocular injections of corticosteroid.

CONCLUSIONS

Uveitis with chronic multifocal retinal infiltrates is a distinct clinical entity of unknown cause that occurs in HIV-infected patients. Retinal lesions may respond to antiretroviral therapy. Visual prognosis is good.

Decreased thrombogenicity of vascular prostheses following gas denucleation by hydrostatic pressure

The high rate of thrombosis of 1.0-mm polytetrafluoroethylene (PTFE) grafts has limited their use in microvascular surgery. One possible reason for this is the blood-gas interface due to entrapped air in the interstices. The present study examines the effect on patency rates of elimination of this blood-gas interface by high pressurization. Comparing pressurized and nonpressurized grafts in the same animals showed a patency rate of 100 percent at 7 days for treated grafts, while the control (nonpressurized) grafts had all clotted by 1 hour. The implications for microvascular surgery as well as vascular surgery in general are discussed.