A community-based public-academic liaison program

OBJECTIVE: The authors discuss obstacles and incentives associated with successful community-based public-academic liaison activities and illustrate their conclusions by describing their public-academic liaison program, which received the American College of Psychiatrists' first annual Award for Creativity in Psychiatric Education. METHOD: The first 8 years of a state/university collaboration are described in which the parties involved first developed a variety of innovative services designed to fill specific gaps in the public service delivery system and subsequently integrated academic research and training components. RESULTS: The carefully planned and monitored process resulted in the exponential growth of interest in public sector work, the realization of the university's primary goals of developing high quality training and research sites, a substantial increase in the number of graduates accepting positions in the public sector, several projects funded by the National Institute of Mental Health, and two national awards. CONCLUSIONS: These collaborations illustrate the highly complementary relationship of public-academic liaison activities and their potential capacity to improve access to services, substantially improve the quality of these services, generate extramural support for services research, and increase the number of well-trained professionals in the public sector.     

Diagnosis and therapy of aortic prosthetic fistulas: trends over a 30-year experience

A retrospective study was carried out of patients from a single institution over a 30-year period. Thirty-one patients presented with 33 fistulas, four non-enteric and 27 enteric. In 25 of 27 patients with a prosthesis-related enteric fistula gastrointestinal bleeding was present. Angiography revealed the fistula in five patients endoscopy in three, and barium studies, echography and computed tomography each revealed one fistula. Six patients died before and five died during operation. In 20 patients various techniques were used for treatment. In-hospital mortality decreased from six of eight patients before 1970, to seven of ten between 1971 and 1980, and to four of 13 after 1981. In the long term, patients treated with an extra-anatomic reconstruction had a poorer prognosis than those treated by in situ reconstruction. This experience shows that diagnostic tests often fail to reveal a prosthesis-related fistula and that mortality can be substantially reduced by early exploration in patients with negative diagnostic studies.     

Reaction of bulk protons with a mitochondrial inner membrane preparation: time-resolved measurements and their analysis

The laser-induced proton pulse technique [Gutman, M. (1986) Methods Enzymol. 127, 522-538] was applied on suspensions of submitochondrial vesicles, and the exchange of protons between the bulk and the mitochondrial membranes was measured in the time-resolved domain with a submicrosecond resolution. The protons were discharged by photoexcitation of pyranine (8-hydroxypyrene-1,3,6-trisulfonate) by a short laser pulse, and the reprotonation of the pyranine anion was monitored at 457.8 nm. In parallel, the protonation of the membrane was followed at 496.5 nm, looking at the transient absorbance of fluorescein, covalently attached to the M side of the membrane. The analysis of the relaxation dynamics was carried out by a simulation procedure that reconstructs the observed dynamics of the two chromophores. The analysis revealed the presence of the membrane indigenous buffering moieties. The low-pK buffer (pK 4.1) was present in a quantity of 100 +/- 20 nmol/mg of protein, and its kinetics indicate that it appears in multianionic clusters bearing a negative electric charge. The medium-pK buffer (pK 6.9) was present in a larger quantity (200 +/- 20 nmol/mg), and its kinetic parameter indicated clustering into positively charged domains. Both types of indigenous buffer reacted with the proton and pyranine anion in unhindered diffusion-controlled reactions. On the other hand, the exchange of protons between the indigenous buffer moieties was rather slow. No evidence was found for the presence of sites capable of retaining a proton, secluded from the bulk, for a time frame longer than 100 microseconds as required by the models of localized proton gradient.