Supported education for persons with psychiatric disabilities: Implementation in an urban setting

The onset of mental illness may drastically interrupt individual lives, often occurring during young adulthood when people are pursuing academic or vocational goals. Many individuals with psychiatric disabilities would like to resume these pursuits but need support to be successful. Responding to this need, the Michigan Supported Education Research Project (MSERP) was developed as a three-year federally funded collaborative effort providing support, assistance, and information to individuals with serious mental illness who wish to pursue college or vocational education. This article describes implementation of the project in metropolitan Detroit, the issues encountered, and solutions developed along the way. Significant factors in implementation include an urban-based location on a college campus, the collaboration between the public mental health system and academic institutions, and the many challenges presented by the students and the educational and mental health systems in place to serve them.     

Carbon tetrachloride-induced increase in the antitumor activity of cyclophosphamide in mice: A pharmacokinetic study

Summary Carbon tetrachloride is an hepatotoxin that depresses hepatic microsomal cytochrome P-450 and other enzyme activities. Cyclophosphamide is an anticancer drug that is activated by hepatic microsomal cytochrome P-450, while the products of cyclophosphamide metabolism by cytochrome P-450 can be metabolized by other hepatic enzymes. Carbon tetrachloride pretreatment has been found to increase the in vivo antitumor activity of cyclophosphamide against murine leukemia P-388. Carbon tetrachloride did not, however, affect the direct cytotoxicity of cyclophosphamide or 4-hydroxycyclo-phosphamide to cells in culture. Pharmacokinetic studies in mice revealed a delayed plasma disappearance of cyclophosphamide after carbon-tetrachloride pretreatment with an apparent initial half-time of 20.4 min compared to 9.0 min in non carbon-tetrachloride-pretreated mice. Plasma levels of total alkylating activity and plasma 4-hydroxycyclophosphamide increased more slowly and reached a lower peak, but were maintained for a longer time period in mice pretreated with carbon-tetrachloride than in untreated mice. The half-life for plasma elimination of 4-hydroxycyclophosphamide in untreated mice was 12 min and in carbon-tetrachloride-pretreated mice 27 min. There was, however, no difference in the area under the curve for either plasma total alkylating activity or plasma 4-hydroxycyclophosphamide between the two groups. It is suggested that prolonged exposure of tumor cells to 4-hydroxycyclophosphamide might be responsible for the increased antitumor activity of cyclophosphamide following carbon-tetrachloride pretreatment.     

Regional haemodynamic effects of endothelin-1 and endothelin-3 in conscious Long Evans and Brattleboro rats.

1. The regional haemodynamic effects of bolus doses (4 and 40 pmol) and infusions (12 and 120 pmol h-1) of endothelin-1 and endothelin-3 were assessed in conscious, Long Evans and Brattleboro (i.e. vasopressin-deficient) rats, chronically-instrumented with pulsed Doppler flow probes. 2. In both strains of rat the lower bolus dose of endothelin-1 caused only a slight pressor effect, but there were marked renal and mesenteric vasoconstrictions and hindquarters vasodilatation. 3. The lower bolus dose of endothelin-3 did not affect blood pressure significantly, although the changes in regional haemodynamics were qualitatively similar to those seen following endothelin-1 in Long Evans and Brattleboro rats. 4. The higher dose of endothelin-1 caused an initial hypotension accompanied by substantial hindquarters vasodilatations in Long Evans and Brattleboro rats. Subsequently, in both strains, there was a rise in blood pressure accompanied by renal, mesenteric and hindquarters vasoconstrictions. 5. The higher bolus dose of endothelin-3 caused initial hypotension and hindquarters vasodilatation similar to those seen with endothelin-1. However, the subsequent pressor effect was less with endothelin-3, as was the renal vasoconstriction, and it did not cause any increase in hindquarters vascular resistance. 6. Infusion of endothelin-1 at the lower rate (12 pmol h-1) caused renal and mesenteric vasoconstrictions in both strains of rat, whereas endothelin-3 at this rate caused only mesenteric vasoconstriction. 7. Infusion of endothelin-1 at the higher rate (120 pmol h-1) caused progressive hypertension and vasoconstrictions in all three vascular beds studied; these were similar in both strains of rat.(ABSTRACT TRUNCATED AT 250 WORDS)     

Estimated cost effectiveness of a police automated external defibrillator program in a suburban community: 7 years experience.

OBJECTIVE: To estimate the cost effectiveness of a 7-year police automatic external defibrillator (AED) program in four suburban communities. METHOD: 10-year retrospective study (7/89-7/99) of patients of four suburban communities during two study periods: (1) police first response and advanced life support (ALS) care (No-AED) and; (2) AED equipped police first response (P-AED) with subsequent ALS care. Using the perspective of the communities, we obtained costs of AED program from police agencies. We estimated cost/life saved and cost/year lives saved using decreased time to VF shock by EMS. We performed a sensitivity analysis for estimates of potential benefit using estimated improved survival as a result of decreased EMS response interval and obtained survival data. We used literature-based estimates of life expectancy after cardiac arrest survival to estimate cost/year life saved. We used student's t-test and chi(2) to estimate differences between groups. RESULTS: During the 10-year study period 208 patients met study criteria; (81 No-AED, 128 P-AED). The two groups were not different by patient age, ALS response interval, percent in VF, percent witnessed (WIT), or arrest location. Interval to first defibrillator equipped EMS vehicle arrival was less in the P-AED group (2.0 vs. 5.4 min, P<0.001) as was the interval from the emergency (911) call to first VF shock (6.6 vs. 8.4 min, P=0.02). Survival to DC was not statistically different with P-AED (11.9 vs. 9.9%, P=0.66) but this study was not powered to detect a difference. Estimated cost per life saved with P-AED varied from $23542 to $70342 and cost per year life saved ranged from $1582 to $16060. CONCLUSION: Police AED appears to be a cost-effective intervention in these suburban communities which have relatively rapid EMS response intervals.     

Tissue expression of transforming growth factor-β1 and transforming growth factor-α during wound healing in human skin explants

In the dynamic and complex process of wound healing, locally produced growth factors are important mediators, although their actual roles have not been fully established. In the present study, the presence of transforming growth factor-beta1 and -alpha during the re-epithelialization of full-thickness wounds was investigated in an in vitro model of wound healing in human skin. The amounts of transforming growth factor-beta1 and -alpha secreted from the wound area were measured with enzyme immunoassays, and immunohistochemistry was used to study the localization of these two growth factors in the healing wound. The wounds were followed until they were completely re-epithelialized. The results showed a continuous increase in secreted transforming growth factor-beta1 throughout the re-epithelialization phase of healing followed by a decrease after its completion. The keratinocytes migrating out from the wound edges showed intense staining for transforming growth factor-beta1 which declined to the level of the surrounding epidermis after the wound was covered by a new epidermis. After the skin was wounded, a decrease both in secreted transforming growth factor-alpha and in immunostaining for this growth factor was apparent. Even though a minor increase in the immunoreactivity for transforming growth factor-alpha occurred after the completion of re-epithelialization, no increase in secreted transforming growth factor-alpha could be detected by enzyme immunoassay. These data suggest that keratinocytes modulate their expression of transforming growth factor-beta1 and -alpha during the wound healing process in human skin and that these changes may be controlled in part by autocrine pathways.     

Side-effects of corticosteroid agents

Anti-inflammatory corticosteroid drugs are powerful therapeutic agents for a wide range of disorders. However, they do have recognized side-effects, most of which are related to the dose and the duration of therapy. Thus, short courses of even high doses of corticosteroid drugs have very few adverse effects. A detailed knowledge of the long-term side-effects of corticosteroid agents and their incidence will assist the physician in making informed judgements on the potential benefits of treatment with these drugs.     

Trigeminal neuroma. A report of eleven cases

The clinical features, diagnosis, and management of a series of 11 cases of trigeminal neuroma (four men, seven women; mean age 40 years) are summarized. Symptoms at presentation were generally those of cerebellopontine angle and petrous apex space occupying lesions. Computed tomography scanning and magnetic resonance imaging were found to provide the best preoperative localization of these lesions, allowing better planning of the surgical approach and thereby maximizing tumor exposure, an essential for any attempt at total excision, considering the large size (greater than 3 cm) of these tumors when diagnosed. A retromastoid incision and posterior fossa craniectomy or a combined suprainfratentorial approach was used. Total excision was possible in four cases. In seven cases, a macroscopic clearance was effected (operative mortality nil, excellent outcome occurred in ten of the 11 cases). There has been no clinical evidence of recurrence or ongoing tumor growth despite possibly subtotal excision.