Handbook of Community Psychiatry

XVI, 632 p. 11 illus.online resource

A Level of Care Instrument for Children\u27s Systems of Care: Construction, Reliability and Validity

The Child and Adolescent Level of Care System/Child and Adolescent Service Intensity Instrument (CALOCUS/ CASH) is designed to help determine the intensity of services needed for a child served in a mental health system of care. The instrument contains eight dimensions that are rated following a comprehensive clinical evaluation. The dimensions are risk of harm, functionality, co-morbidity (psychiatric, substance abuse, development disability and medical), environmental stressors, environmental supports, the child\u27s resiliency, and the child and family\u27s willingness to engage in treatment. An algorithm connects the ratings to a level of care recommendation. The instrument specifies six levels of care defined flexibly enough to consider whatever services are available. The results of psychometric testing using raters with a broad range of clinical experience and training from four different systems of care around the country are presented. The testing demon-strates excellent reliability when rating vignettes. Using children and adolescents in live system of care clinical settings, the CALOCUS/CASH demonstrates reasonable validity when compared with the Child Global Assessment Scale, and the Child and Adolescent Functional Assessment Scale

Two-dimensional zymography differentiates gelatinase isoforms in stimulated microglial cells and in brain tissues of acute brain injuries.

Excessive activation of gelatinases (MMP-2/-9) is a key cause of detrimental outcomes in neurodegenerative diseases. A single-dimension zymography has been widely used to determine gelatinase expression and activity, but this method is inadequate in resolving complex enzyme isoforms, because gelatinase expression and activity could be modified at transcriptional and posttranslational levels. In this study, we investigated gelatinase isoforms under in vitro and in vivo conditions using two-dimensional (2D) gelatin zymography electrophoresis, a protocol allowing separation of proteins based on isoelectric points (pI) and molecular weights. We observed organomercuric chemical 4-aminophenylmercuric acetate-induced activation of MMP-2 isoforms with variant pI values in the conditioned medium of human fibrosarcoma HT1080 cells. Studies with murine BV-2 microglial cells indicated a series of proform MMP-9 spots separated by variant pI values due to stimulation with lipopolysaccharide (LPS). The MMP-9 pI values were shifted after treatment with alkaline phosphatase, suggesting presence of phosphorylated isoforms due to the proinflammatory stimulation. Similar MMP-9 isoforms with variant pI values in the same molecular weight were also found in mouse brains after ischemic and traumatic brain injuries. In contrast, there was no detectable pI differentiation of MMP-9 in the brains of chronic Zucker obese rats. These results demonstrated effective use of 2D zymography to separate modified MMP isoforms with variant pI values and to detect posttranslational modifications under different pathological conditions

Public psychiatry fellowships: a developing network of public-academic collaborations.

In response to the expanding public behavioral health care system, a network of 15 public-community psychiatry fellowships has developed over the past six years. The fellowship directors meet yearly to sustain and develop fellowships to recruit and retain psychiatrists in the public sector. This column describes five types of public-academic collaborations on which the fellowships are based. The collaborations focus on structural and fiscal arrangements; recruitment and retention; program evaluation, program research, and policy; primary care integration; and career development. These collaborations serve to train psychiatrists who will play a key role in the rapidly evolving health care system

2D zymography reveals gelatinase isoforms in mouse brains after focal cerebral ischemia.

<p>Mice were sacrificed 24 h after filament-induced MCAo in mice. (<b>A</b>) 1D zymography revealed increases in proMMP-9 and act.MMP-9 levels in the ischemic cortex compared with the contralateral cortex. Under these experimental conditions, proMMP-2 was not altered. Densitometry analysis of intensity of gelatinolytic bands represented proMMP-9 and act.MMP-9, n = 4, *, <i>p</i><0.001, comparing ischemic to contralateral cortex by one-tailed, unpaired Student’s <i>t</i>-test; data are expressed as mean values ± SEM. (<b>B</b>) Brain lysate was incubated with gelatin 4B and applied on 2D gels. In contralateral hemispheres, proMMP-9 was identified as a 105-kDa single spot with pI value between 3 and 4, and proMMP-2 as a 65-kDa single spot with pI value between 4 and 5. In ischemic hemispheres, two streaks of pI values ranging from 5.5 to 8 with the molecular weights at 105 and 95 kDa were identified as proMMP-9 and act.MMP-9, respectively. Ischemic brain lysate was applied on the left side of the gel for comparison. These zymograms are representative results from 3 independent experiments.</p

Microglial activation and neuronal cell death in ischemic cortex.

<p>Representative photomicrographs of mouse cortical region of brain sections stained with microglia marker Iba-1, NADPH oxidase maker p47phox, and neuron marker MAP-2. Nuclear DNA was counterstained with Hoechst dye. Scale bar, 50 μm.</p