A need-based model for determining staffing needs for the public sector outpatient mental health service system

This article proposes a need-based model for determining staffing needs for regional or national public sector outpatient mental health services. It constitutes a spreadsheet method involving a sequence of calculations relating demographic variables, workers' productivity, anticipated demand, and standards pertaining to annual visits per client distributed among the core mental health professions. The authors demonstrate the application of the model to national planning of adult outpatient mental health services using standards based on both expert consensus and existing staffing patterns while they note the need for more rigorously derived and empirically based standards. It is suggested that by using clearly stated assumptions and quantifiable variables, the model can facilitate constructive negotiations among various agencies and community organizations involved in policymaking and in budget allocations.     

Inhibition of γ-glutamyl transpeptidase activity decreases intracellular cysteine levels in cervical carcinoma

Purpose To determine whether gamma-glutamyl transpeptidase (-GT) is involved in the maintenance of elevated cysteine levels in cervical carcinoma.Methods Four cervical carcinoma cell lines were tested in vitro for cysteine accumulation and -GT levels. The highest and lowest -GT-expressing cell lines were used in in vivo experiments to determine the effect of -GT inhibition on cysteine levels.Results Treatment of a series of cervical carcinoma cell lines with acivicin decreased intracellular cysteine concentrations. Cysteine depletion was evident in Me180 cells which had the greatest levels of -GT activity, and had a more pronounced cysteine decrease in medium with glutathione and cysteine concentrations simulating the in vivo situation. Also investigated were the effects of inhibition of -GT activity on intracellular cysteine levels in xenografts grown in severe combined immunodeficient (SCID) mice. With the use of 35 mg/kg of acivicin, -GT activity decreased to basal levels of detection in both tumour types and significant decreases in cysteine levels were seen in the high -GT-expressing tumours (Me180). Thus, inhibition of -GT activity may have therapeutic potential in high-expressing cancers.Conclusions In tumours and cell lines with elevated levels of -GT activity, inhibition of this enzyme led to decreases of cysteine levels.This work was supported by the National Cancer Institute of Canada through funds raised by the Terry Fox Run (D.W.H).     

Are Callous-Unemotional Traits Associated with Conflict Adaptation in Childhood?

This study examined associations between childhood callous-unemotional (CU) traits and cognitive control using a conflict adaptation paradigm. Participants were (N = 158) children aged 9 to 12 years (M = 10.42, SD = 1.05; 57 % boys), who completed a modified color-word Stroop task. CU traits and conduct problems were indexed via self-reports on the Strengths and Difficulties Questionnaire and the Inventory of Callous-Unemotional Traits. CU traits were found to be uniquely associated with reduced conflict adaptation, however, this significant association was specific to boys. Conversely, conduct problems were associated with increased conflict adaptation, but among girls only. These findings contribute to evidence of atypical goal directed behavior in boys with CU traits by providing preliminary evidence that the specific impairments in cognitive control that characterize these boys include those concerning dynamic adjustments in cognitive control. Findings are discussed in relation to accounts of childhood CU traits based on the Response Modulation hypothesis.     

Efficacy evaluation of iclaprim in a neutropenic rat lung infection model with methicillin-resistant <Emphasis Type="Italic">Staphylococcus aureus</Emphasis> entrapped in alginate microspheres

The objective of this study was to demonstrate the efficacy of iclaprim in a neutropenic rat lung infection model with methicillin-resistant Staphylococcus aureus (MRSA) entrapped in alginate beads. An inoculum of 5.25?×?10⁵ colony-forming units (CFU)/mL of S. aureus strain AH1252 was administered intratracheally to rats with prepared alginate bacteria suspensions. Beginning 2 h post-infection, rats received: (1) iclaprim 80 mg/kg (n?=?16); (2) iclaprim 60 mg/kg (n?=?16), or (3) vancomycin 50 mg/kg (n?=?24), for 3 days via subcutaneous (SC) injection every 12 h. Twelve hours after the last treatment, rats were euthanized and lungs collected for CFU determination. Iclaprim administered at 80 mg/kg or 60 mg/kg or vancomycin 50 mg/kg SC twice a day for 3 days resulted in a 6.05 log₁₀ CFU reduction (iclaprim 80 mg/kg compared with control, p?<?0.0001), 5.11 log₁₀ CFU reduction (iclaprim 60 mg/kg compared with control, p?<?0.0001), and 3.42 log₁₀ CFU reduction, respectively, from the controls (p?<?0.0001). Iclaprim 80 mg/kg and 60 mg/kg resulted in 2.59 and 1.69 log₁₀ CFU reductions, respectively, from vancomycin-treated animals (80 mg/kg iclaprim vs. vancomycin, p?=?0.0005; 60 mg/kg iclaprim vs. vancomycin, p?=?0.07). Animals receiving iclaprim, vancomycin, and controls demonstrated 100%, 91.7%, and 48.3% survival, respectively. In this neutropenic rat S. aureus lung infection model, rats receiving iclaprim demonstrated a greater CFU reduction than the controls or those receiving vancomycin.     

Risk for cytomegalovirus infection following reduced intensity allogeneic stem cell transplantation

Preliminary data suggest a faster immune recovery following non-myeloablative stem cell transplantation because of the persistence of recipient T cells, but the real impact on post-transplant infectious complications remains unknown. We retrospectively analysed the incidence of cytomegalovirus (CMV) infection in twenty patients following reduced intensity conditioning with busulfan/fludarabine±thiotepa and post-transplant immunosuppression with cyclosporine A/mycophenolate mofetil. Results were compared with 20 patients receiving myeloablative transplants during the same time period and who were matched for CMV risk group and for donor origin. The cumulative incidence of CMV infection following reduced intensity vs. myeloablative transplants was 60.4% vs. 40.0%, respectively (p value 0.1, log rank test). The risk for CMV infection in both cohorts was increased after in vivo T cell depletion with antithymocyte globulin (75% and 60%, respectively). Acute GVHD preceded the diagnosis of CMV infection by a median of 25 (range, 9–61) days following reduced intensity transplants and a median of 14 (range, 10–34) days in myeloablative transplants. Recurrent CMV infections were observed only in patients receiving reduced intensity transplants. Using multivariate analysis only reduced intensity transplantation and in vivo T cell depletion had a significant impact on the risk of CMV infection. In our series the incidence for CMV infection following reduced intensity transplants seems to be increased as compared with risk-matched myeloablative transplants. When adding anti-T cell antibodies to the conditioning regimen, the risk for CMV infection increases by up to 75%. Thorough studies of the risk of post-transplant viral infection are necessary to optimize surveillance as well as pre-emptive and/or prophylactic treatment strategies in the non-myeloablative transplantation setting.     

The longer patients are in hospital before Intensive Care admission the higher their mortality

Objective To explore the relationship between hospital mortality and time spent by patients on hospital wards before admission to the intensive care unit (ICU).Design Observational study of prospectively collected data.Setting Participating intensive care units within the North East Thames Regional Database.Patients and participants Patients, 7,190, admitted to ICU from the hospital wards of 24 hospitals.Interventions None.Measurements and results Of ICU admissions from the wards, 40.1% were in hospital for more than 3 days and 11.7% for more than 15 days. ICU patients who died in hospital were in-patients longer (p=0.001) before admission (median 3 days; interquartile range 1–9) than those discharged alive (median 2 days; interquartile range 1–5). Hospital mortality increased significantly (p<0.0001) in relation to time on hospital wards before ICU: 47.1% (standardised mortality ratio 1.09) for patients in hospital 0–3 days before ICU admission up to 67.2% (standardised mortality ratio 1.39) for patients on the wards for more than 15 days before ICU. Length of stay before ICU admission was an independent predictor of hospital mortality (odds ratio per day 1.019; 95% confidence interval 1.014–1.024). There were significant differences (p<0.001) in patient age, APACHE II score and predicted mortality in relation to time on wards before ICU admission.Conclusions Mortality was high among patients admitted from the wards to ICU; many were inpatients for days or weeks before admission. The longer these patients were in hospital before ICU admission, the higher their mortality. Patients with delayed admission differed in some respects compared to those admitted earlier.Electronic Supplementary Material Supplementary material is available in the online version of this article at Preliminary analysis of this data was presented in abstract at the Intensive Care Society (UK) State of the Art Scientific Meeting in London, December 2001.     

Risk of caffeine toxicity associated with the use of ‘legal highs’ (novel psychoactive substances)

Purpose  

Caffeine has desired stimulant effects similar to but weaker than both classical recreational drugs and novel psychoactive substances. This study was undertaken to determine the caffeine content of a sample of novel psychoactive substances, and we discuss the implications for the management of acute recreational drug toxicity.